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Negative long-term effects of decongestant usage?
February 7, 2010 8:27 AM   Subscribe

Should I be worried about long-term decongestant/antihistamine usage?

I suffered for nearly two years with chronic cough. I saw five doctors, got two CAT Scans, and many many drugs. In the end, it was decided by my pulmonologist that what I had was merely post-nasal drip for an unidentified reason (which reason remains unknown to this day). He prescribed me Clarinex, which is a drug similar to Claritin. This I found not to be helpful so then he prescribed Clarinex D, which has 12-hour pseudoephedrine and I find it to be helpful.

I've taken Clarinex D twice daily, per his prescription, for maybe a year now. The drug definitely seems to have worked. I'm wondering if I need to be worried about long-term effects. I had asked the pulmonologist about this and he seemed to be unaware of any harmful effects of long-term use. I've always heard, however, that long-term decongestant use can lower effectiveness and can even exacerbate post-nasal drip after chronic use.

Obviously you are not my doctor, but I'd be interested to know what you all think. My impression is that my pulmonologist probably doesn't know of too many patients or studies tracking people who have been using this drug as long as I have.
posted by prunes to Health & Fitness (15 answers total) 4 users marked this as a favorite
 
Not directly answering your question, but asking a followup/clarification question - was one of the 5 doctors you saw an allergist? It seems that perhaps if the cause of the post-nasal drip was finally identified and treated, you could stop taking the Clarinex D. One likely cause of post-nasal drip would seem to me possibly to be allergies of some kind.
posted by gudrun at 9:33 AM on February 7, 2010


I've been on a similar regimen, Zyrtec or Claritin plus generic pseudoephredrine 12-hour twice a day for about three years. Before Zyrtec went OTC, I was taking prescription Zyrtec-D for about five years. I don't know of any bad consequences to my health, and the symptoms haven't 'exacerbated' nor has the pseudoephedrine lost effectiveness.

I do know that my mother, who has problems with her blood pressure anyway and is on medication for these problems, cannot taken Sudafed/pseudoephedrine at all, because it exacerbates the problems. I haven't experienced anything similar so far -- I have my blood pressure checked about twice a year.

I'd also recommend seeing an allergist if you're concerned. Also, it's a big pain in the neck to buy pseudoephedrine chronically with the new limits in place. I feel somewhat sleazy having to show ID everytime I ask for it at the pharmacy. I've also had pharmacists tell me I couldn't possibly need it longterm. It's insulting.

Of course, allergy testing might not find youa magic solution. I've had allergy testing done and basically, I'm allergic to all kinds of things commonly found in the air: dog and cat dander, tree and grass pollen, dust, dust mite particles, dust mite excrement, cockroaches, cockroach droppings. I can reduce the amount of allergens in my surroundings, but I can't eliminate them so the only way my allergist could recommend dealing with the allergies was to treat the symptoms (I also underwent the desensitization shots for three years. This helped, but did not eliminate my congestion symptoms. Additionally, I eventually ended the treatments because they seemed to cause their own side effects...which will send my answer further off on a tangent...)
posted by Tandem Affinity at 9:53 AM on February 7, 2010


Not directly answering your question, but asking a followup/clarification question - was one of the 5 doctors you saw an allergist? It seems that perhaps if the cause of the post-nasal drip was finally identified and treated, you could stop taking the Clarinex D. One likely cause of post-nasal drip would seem to me possibly to be allergies of some kind.

Yes, I did see an allergist. He ended up stumped because my cough was active in winter, when most allergies are dormant. Allergy shots would always be an option but they take 12 to 24 months to kick in.
posted by prunes at 10:04 AM on February 7, 2010


My mother took pseudoephedrine every day for years. One thing she picked up on after a while was that as each dose began to wear off, she'd get a bit edgy - not able to focus/listen well, a little grouchy. She now attributes this to withdrawal and the similarities between ritalin, speed, and pseudoephedrine. (She has ADHD and believes she was self-medicating though; she sort mixed up the mental clear-headedness for physical sinus-related clearheadedness, I guess.)

So - be aware of any non-physical symptoms you may be experiencing.
posted by needs more cowbell at 10:23 AM on February 7, 2010


Yes, I did see an allergist. He ended up stumped because my cough was active in winter, when most allergies are dormant.

My allergist said that it was common for allergies to be worst in winter, like mine, because my primary allergy is to dust mites, and somehow the use of central heating exacerbates exposure. There are environmental controls that can reduce exposure to dust mites, reducing the need for medication somewhat.

A lot of people suffer significant side effects from decongestants and antihistamines. If they're not bothering you, you're lucky, and maybe you don't need to worry. If you do develop another physical problem, then you should consider whether it might be an unlikely side effect. I had to give up all antihistamines, myself, because Chlortrimeton and Benedryl gave me irritable bowel syndrome, Zyrtec gave me tachycardia, Seldane and Allegra didn't work for me at all, and finally Claritin gave me other GI problems. I switched to a nasal spray steroid, Flonase, which has far fewer side effects.

If you control your allergies well enough, one way or another, you may no longer need to take a decongestant every day.
posted by Ery at 10:42 AM on February 7, 2010


Hmm, really not trying to derail, but some allergies, including mold allergies, can be active all year long. If I were you, I would be tempted to consult another allergist, and possibly to try allergy shots (allergy immunotherapy). If you can start off getting them twice a week, you can get up to maintenance level pretty quick. (Also, if you work at a big company/organization that has a health unit, some of them will keep your allergy serum for you and give you the shots there, so you don't have to go to the doctor's office.) Allergy immunotherapy does not work for everyone and is only partly effective in some people, but it can give you the chance of eventually stopping medication or reducing the amount you have to take. It was the only thing that cured my chronic bronchitis and sinus infections.
posted by gudrun at 10:47 AM on February 7, 2010


I don't really want this thread to get too off-topic but I want to address the allergist related responses:

The reason, I believe, why my allergist was stumped due to my cough occurring in winter, was due to a few reason. Namely, my cough was persistent both at the office and at home, especially when having my post-lunch coffee and when in bed reading before I went to sleep. Honestly, my allergist (and my internist) thought I probably had acid-reflux/GERD. Further, although I did show a reaction to mold on my allergy tests, I don't believe it was an especially strong reaction; further, I live in a fairly new house, vacuum weekly to biweekly, had bought hypoallergenic pillows, blankets, and linens, etc., to no avail.
posted by prunes at 10:55 AM on February 7, 2010


Yes, I did see an allergist. He ended up stumped because my cough was active in winter, when most allergies are dormant. Allergy shots would always be an option but they take 12 to 24 months to kick in.

Huh? Lots of reasons for a cough are more active in winter (certain molds, dust mites). And allergy shots can't be prescribed without knowing what you're allergic to anyway.

More than 12 years ago, my old doc assumed that my symptoms were seasonal allergies and I was prescribed Allegra, which was quickly modified to a scrip for Allegra-D to help with the congestion. Worked great. But after a nasty bout with a chronic sinus infection last year that had me considering surgery, I went to an allergist.

My chronic sinus issues that are not particularly allergy-related. The Allegra was helping with the inflammation perhaps somewhat, but it was really the D that was giving me relief.

I now use a combination of Nasacort, sudafed, nasal irrigation, and Mucinex to keep the issues at bay. If I am a good girl and take good care of my sinuses, I can ease up on this regimen somewhat. When I'm getting stuffy, I've gotta ramp it back up.

I've been taking sudafed regularly for over 20 years (oh, for the olden days when I could buy 100 in a little bottle!) and have never noticed any long-term effects other than it not feeling as speedy in the morning as it used to. (Still works fine, just doesn't make me feel like I had an extra shot of espresso anymore.)

Consider seeing a different allergist.
posted by desuetude at 11:25 AM on February 7, 2010


Hmm, this idea - acid-reflux/GERD - is interesting. Have you pursued that further? I would.
posted by gudrun at 11:52 AM on February 7, 2010


i used claritin or claritin-d at least 5 times a week. in the last month the 12 hour pills were lasting 6 hours and the 24 hour pills lasted about 13 hours. i switched to zyrtec-d and everything is a-ok again. you might consider switching between the two, take one for a month, and then the other.

watch for GI problems. constipation and painful gas seem to be my problems - i think they're related, but i'm still working on getting to the bottom of that.

undiagnosed issues suck. i'm somewhat of a medical anomaly (it took 3 doctors a few years to figure out that my anaphylaxis and facial swelling and atypical rash that i got a few times a year - that would only be treated by steroid shots - was poison ivy), so i understand that frustration. some of my weirder issues have ended up being 2 or 3 things happening simultaneously, but not related. the suggestions to find an aggressive treatment for allergies might help you remove that bit and see what symptoms are left...
posted by nadawi at 12:32 PM on February 7, 2010


I would also consider pursuing the acid reflux/GERD angle. Have you seen a gastroenterologist to rule it in or out?
posted by scody at 12:38 PM on February 7, 2010


*shrug*

The pulmonologist was fairly convinced it wasn't GERD. Also, I had done a full course of Prilosec OTC and had been using pepto whenever a cough attack was coming on with no improvement from either. And now that I use decongestants religiously to dry up my post nasal drip I'm fine. I believe the mechanism by which GERD makes one cough is unrelated to post nasal drip.
posted by prunes at 1:34 PM on February 7, 2010


I've heard of no long-term effects of pseudoephedrine, but I haven't done serious research. My doctor knows what I'm doing.

FWIW, I'll add sth you may not have considered. Chronic cough surprisingly can be caused by bad posture and breathing. I had what I'd call a "nervous cough" for a long time, and it was dramatically improved when a vocal coach pointed out (in passing - that's not the reason I was seeing him) that my posture and breathing were allowing the hyoid bone to strike the larynx, causing random coughing.

Sorry if this is an irrelevant derail, I haven't observed you, but consider that your drip or whatever may not in fact be the cause of the cough. Good luck.
posted by JimN2TAW at 2:46 PM on February 7, 2010 [1 favorite]


That's very insightful, Jim. It could well be why I have a tendency to cough when I lay in bed reading at night.
posted by prunes at 2:49 PM on February 7, 2010 [1 favorite]


I've been taking sudafed regularly for over 20 years (oh, for the olden days when I could buy 100 in a little bottle!) and have never noticed any long-term effects other than it not feeling as speedy in the morning as it used to.

Ditto, only one has to be aware that as you age it may become necessary to reduce dosages of medications, especially ones with systemic effects. And pseudoephedrine in particular is not a drug that you want to have hanging around in your system if you're male and getting to the age where erectile dysfunction can be a problem.
posted by Creosote at 8:29 PM on February 7, 2010 [1 favorite]


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