Afrin wins because it’s a nasal decongestant spray, and its active ingredients work fast to shrink swollen blood vessels in your nose so that you can breathe more easily. When used in recommended doses, nasal sprays are usually not absorbed into your bloodstream the way oral medications are, so they generally cause fewer side effects. Afrin contains oxymetazoline; so do Dristan and Vicks Sinex, two other good choices for relieving congestion for up to 12 hours. Sprays containing phenylephrine, such as Neo-Synephrine, also work well but last only up to 4 hours.
One important warning: use nasal sprays for three days at most. If you use them longer than that, you could face rebound congestion as the medication wears off. If you’re stuffy for longer than a few days, you can switch to pseudoephedrine pills (Sudafed and generic).
You don’t need a prescription for Sudafed, but stores are required by law to keep it behind the counter, so you’ll need to ask the pharmacist for it. Don’t bother with decongestants sold on open store shelves, such as Sudafed PE. The evidence shows that the active ingredient in them, phenylephrine, doesn’t work that well, if at all.
If you have glaucoma, heart disease, high blood pressure, an enlarged prostate, or thyroid disease, check with your doctor or pharmacist before using any type of decongestant, even sprays, because they sometimes make those conditions worse.