Choosing an Over-the-Counter Sinus Infection Medication

Sinusitis affects around 1 in 8 adults in the United States. Infection is a frequent cause of sinusitis, affecting about 29 million Americans yearly.

Antibiotics may not be necessary unless the sinus infection is severe and leads to a bacterial infection. Instead, guidelines recommend management strategies aiming to ease symptoms.

Over-the-counter (OTC) medications often help ease sinus-related symptoms, such as pain relievers for sinus headaches and antihistamines for runny nose or postnasal drip.

These and other OTC medications may be used alone or in varying combinations for maximal symptom relief.

You can consult a pharmacist or healthcare provider for help finding the proper medications to ease your symptoms. 

Read on for a more in-depth look at sinusitis, its causes, treatments, and how to manage sinus-related symptoms.

Understanding Sinus Infections

The sinuses are small air pockets behind your nose, cheeks, eyes, and forehead. When the lining of the sinuses becomes swollen, it’s called sinusitis.

With a sinus infection, germs (bacterial, viral, or fungal microorganisms) enter and spread within your sinus cavity.

Your immune system launches an attack against the infection, releasing immune cells and triggering inflammation.

This leads to symptoms that can range from pesky to downright miserable.

Symptoms

Common symptoms of sinus infections include facial pain, congestion, headache, and postnasal drip.

Other symptoms are fever, runny nose, itchy throat, sore throat, cough, and excess mucus.

You might only need antibiotics if your sinus infection persists for longer than a week or becomes more severe. As such, watchful waiting is often the best approach for mild cases in adults.

Most people improve naturally, with antibiotics only slightly increasing symptom relief.

Commonly Used OTC Medications

Because of this, advice from experts is to focus on making yourself feel better by using OTC medicines to relieve your sinus symptoms.

OTC medicines include:

• Sinus headache, facial pain, or fever: Try analgesics, such as Tylenol (acetaminophen), or nonsteroidal anti-inflammatory medications (NSAIDs), such as Motrin or Advil (ibuprofen) or Aleve (naproxen).
• Sneezing, runny nose, cough, postnasal drip: Try an antihistamine, such as Benadryl (diphenhydramine), Claritin (loratadine), or Zyrtec (cetirizine).
• Nasal congestion or stuffiness: Nasal corticosteroid sprays, such as Flonase Allergy Relief (fluticasone) can be helpful. You may also consider orally administered decongestants like Sudafed (pseudoephedrine) or nasal spray forms like Afrin (oxymetazoline), but consult a healthcare professional first since these products carry risks for certain people.
• Chest congestion: Guaifenesin, a mucolytic found in Mucinex and Robitussin (dextromethorphan), among other products, can help thin mucus and make it easier to clear. 
• Dry cough: Try a cough suppressant containing dextromethorphan, such as Delsym.

These medicines, aimed at treating symptoms, and self-care methods like rest may allow you to cope with a sinus infection without a healthcare provider visit or prescription.

Healthcare providers may prescribe antibiotics, such as Augmentin (amoxicillin/clavulanic acid), or other antimicrobials in more severe sinus infections that persist for more than one or two weeks.

This article will discuss some of the best OTC medicines for sinus infections.

Decongestants

Decongestants help manage symptoms of sinus pressure and related headaches. They work to relieve congestion by constricting blood vessels in the nasal passages to reduce swelling in the sinuses.

There are two main decongestants: topical (nasal sprays or drops) and oral (tablets or capsules you swallow).

Topical decongestants, such as Afrin (oxymetazoline nasal spray), offer quick relief from sinus discomfort, and make it easier to breathe through your nose.

You should use decongestants for no longer than three to five days. Exceeding this limit can lead to rebound congestion and make congestion worse instead of better.

Due to dosage differences among various brands, follow the dosing instructions and age limits on the label for your specific product. A common side effect is temporary stinging or burning sensations in the nose.

What Is Sudafed?

Sudafed (pseudoephedrine, or PSE) is the most commonly recommended oral decongestant. PSE helps unblock your nasal passages and sinuses, making breathing easier.

It can also reduce the amount of mucus in your nose and help the Eustachian tube (a part of your ear) stay open.

In terms of side effects, PSE stimulates the body’s fight-or-flight response, leading to:

Due to these effects, decongestants should only be used in the short term, and some people should refrain from using them.

Consult a healthcare professional before using a decongestant if you have:

In addition, PSE is not recommended for children younger than 2 years old, and the extended-release (ER) formulation is not recommended for those younger than 12 years old. 

In fall 2023, a panel of experts at the Food and Drug Administration (FDA) issued a report that the oral decongestant ingredient phenylephrine isn’t effective.

Phenylephrine is the active ingredient in Sudafed PE and many other OTC cold medicines, such as DayQuil. However, generations of pharmacists have recommended pseudoephedrine over phenylephrine for those who were cleared to take it.

When you select an oral decongestant, please look for products containing pseudoephedrine (sold at your pharmacy counter and unavailable on store shelves) instead of phenylephrine. 

Phenylephrine is also an ingredient in topical decongestant nasal sprays, but the FDA’s discussion and recommendations pertain only to oral forms of phenylephrine—not the nasal spray.

Antihistamines

Antihistamines are the go-to medications for the “runny or itchy” symptoms: sneezing, runny nose, postnasal drip, itchy throat, and watery eyes. Some or all of these symptoms can accompany sinus infections.

Antihistamines are a class of medications designed to block the effects of histamine, a natural substance released by the body’s immune system when it encounters allergens.

Histamine is responsible for allergy symptoms, such as sneezing, itching, and a runny or stuffy nose. Antihistamines work by blocking histamine receptors.

This prevents histamine from binding to cells throughout the body, including those in the eyes and nasal passages. By blocking histamine, antihistamines reduce the severity and frequency of symptoms like sneezing and runny nose.

Types of Antihistamines

Oral formulations of antihistamines include tablets, capsules, chewable tablets, and liquids.

Remember that the FDA doesn’t specifically approve antihistamines for sinus infections. However, healthcare professionals often recommend them to relieve symptoms of colds and sinusitis.

The following main groups of antihistamines are available without a prescription:

• First-generation (older) antihistamines, such as Benadryl (diphenhydramine), effectively reduce sneezing and runny nose. They also have significant downsides, including drowsiness or dizziness as side effects and requiring multiple daily doses.
• Second-generation (newer) antihistamines, such as Claritin (loratadine), Zyrtec (cetirizine), and Allegra Allergy (fexofenadine), are considered just as adequate as the first-generation but are considered non-drowsy. They provide long-lasting relief, usually once-daily dosing, without causing excessive sleepiness. Some people may experience mild drowsiness, headache, or dry mouth. 

For context, Benadryl is FDA-approved for use in children 6 years and older.

Claritin and Zyrtec are approved for use in children 2 years and older.

Claritin and Zyrtec are similarly effective. However, it’s important to note that individual responses to these medications can differ, and what works better for one person might not for another.

Studies suggest that second-generation antihistamines are safer for children than first-generation, with cetirizine being more likely to cause drowsiness than the other newer-generation antihistamines.

To ensure proper use of antihistamines, follow the recommended dosage and age guidelines on the medication label or personalized instructions from a healthcare provider.

Tips for Sinus Infection Relief

Try to follow preventive measures to help reduce the risk of sinus infections and promote sinus health, such as:

• Maintaining good hygiene: Wash hands frequently and avoid close contact with sick individuals.
• Keeping nasal passages moist: Use nonmedicated saline rinses, saline sprays, humidifiers, and steam inhalation.
• Stay hydrated and nourished: Drink plenty of fluids and eat a nutrient-rich diet, like fruits and vegetables, to support immune health.
• Manage seasonal or year-round allergies according to a healthcare provider’s advice, including reducing your exposure to allergens and irritants.
• Avoid being around smoke or quit smoking, manage stress, and get adequate rest to prevent running down your immune system.

Potential for Interaction

OTC sinus relief medications can interact with various prescription medications, potentially leading to harmful effects.

While not an all-inclusive list, here are five key examples of prescription medications that can interact with OTC sinus medications:

Blood Pressure and Heart Medications

Nasal decongestants, like pseudoephedrine, can raise blood pressure.

Combining blood pressure medications for high blood pressure or other heart conditions with cold or allergy medications can raise your blood pressure and lower the effectiveness of antihypertensive medications.

Examples include beta-blocker medications, such as Toprol XL (metoprolol), or calcium channel blockers, such as Norvasc (amlodipine).

Antidepressants

Cold and sinus medications, especially those containing the decongestant pseudoephedrine, can increase blood pressure and heart rate.

When taken with antidepressants commonly used to treat depression and anxiety, there is an increased risk of worsening these cardiovascular effects.

Examples include: selective serotonin reuptake inhibitors (SSRIs), such as Prozac (fluoxetine) and Lexapro (escitalopram).

Anticoagulants

Some cold and allergy medications contain ingredients like aspirin or NSAIDs like ibuprofen.

These ingredients can increase the risk of bleeding when taken with anticoagulant medications (blood thinners), such as Jantoven (warfarin) or Xarelto (rivaroxaban).

Monoamine Oxidase Inhibitors (MAOIs)

When MAOIs are combined with decongestants, there is a risk of a hypertensive crisis, which can be life-threatening.

This interaction risk exists even if you took an MAOI in the past two weeks.

Examples of MAOIs include the antidepressant Marplan (isocarboxazid) and the antibiotic Zyvox (linezolid).

Opioids

Combining sedating antihistamines like Benadryl with prescription pain medications can lead to severe sedation and respiratory depression.

Examples of opioid analgesics include: Tylenol 3 (acetaminophen-codeine), morphine, and oxycodone.

Many other prescription medications may interact with cold or allergy medications.

To be safe, always read the product’s labeled warnings and consult a healthcare professional or pharmacist before taking OTC cold or sinus medications, especially if you’re taking prescription medications.

Summary

Sinusitis commonly affects 1 in 8 people in the United States each year. It often results from infections that trigger uncomfortable symptoms like congestion, facial pain, and headaches.

The good news is that antibiotics are not always necessary, and current guidelines recommend a symptom-focused approach to managing mild sinus infections.

If your symptoms worsen or do not improve while taking OTC medications for relief, or if you experience persistent fever, contact a healthcare provider.

They can help identify the cause of your symptoms and determine if antibiotics, such as Augmentin, or other prescription medications would be beneficial.