Alternative to pseudoephedrine?

[Duke Dive Medicine]

DDM-

What are your thoughts on Flonase? It's a non-prescription steroid spray.

For the OP: Flonase made a huge difference for me. I finally figured out that sinus issues I was having are related to chlorine in pools and I didn't want to give up lap swimming. But I wonder about using any kind of steroid unless absolutely needed.

It can be of benefit to some people provided it's used as directed and you don't have any contraindications to it. Beyond that I would just point you to the package insert re potential side effects and other information.

Best regards,
DDM

 

[Hoag]

Here is my personal issue with the sprays. I am not a doctor, but this is based on a conversation during an annual medical.

I was told by an RCAF Fight Surgeon that with many sprays, (and please forgive me if I am using incorrect or imprecise language) they run the risk of a "bounce-back" effect in which when the active medicine wears off, the sinus tissues rapidly swell up and become restricted again, perhaps even more restricted than they were originally. Repeated cycles of this over several days or so can lead to a form of addiction in that the person using the spray becomes unable to breathe without the use of the spray. I have no idea as to the validity of that claim, but as aircrew, nasal sprays, even OTC ones were forbidden. (Having said that, I know a couple people who wouldn't fly without some in one of the pockets of their flightsuit.)

 

[Marie13]

You’re thinking of Afrin and the like. Flonase is not in that category. I’ve been using it daily for years.

 

[Esprise Me]

I believe that bounce-back effect is something you risk with Sudafed, too.

 

[drrich2]

I believe that bounce-back effect is something you risk with Sudafed, too.

I don't think so, in the way people tend to think.

Science Direct has a page on decongestants; some excerpts from that:

"Decongestants are α-adrenergic agonists which are sympathomimetic in nature and decrease vascular congestion in the nose, allowing less respiratory tract obstruction."

"Topical intranasal decongestants are sometimes used by patients with allergic rhinitis. However, when these agents are used for longer than 3 to 5 days, many patients experience rebound congestion after withdrawal of the drug. If patients continue to use these medications over several months, a form of rhinitis, rhinitis medicamentosa, will develop, which can be difficult to treat effectively."

"Oral decongestants do not cause rebound congestion but are not as effective as topical formulations."

Mechanism of action is important. Flonase has a very different mechanism of action than a sympathomimetic, so while it's a 'spray,' it's not to be lumped in with Afrin. Steroids tend to be slower onset medications because of their mechanism.

A concern with Sudafed in the past has been wearing off, not rebound. If you take a dose of the regular form, then get ready to go diving, drive to the shore site or take the boat trip to get there, gear up, then dive an hour or so...it might have time to wear off. And blockage with reverse squeeze can be very bad news when it's time to come up.

Sudafed is available in 12-hour and 24-hour formulations, which are what I use (preferably the latter). Even then, with morning use I notice a decline in efficacy in the evening on multi-dive days. But I usually don't get abrupt wearing-off effects. Your mileage may vary.

So Sudafed wears off...but Afrin can make you worse off than you started over time, or so I interpret the situation. On multi-day dive trips, something to think about.

 

[Esprise Me]

Interesting! I'd read otherwise and have been cautious with my use of pseudoephedrine as a result. Perhaps I don't need to worry so much.

 

[BRT]

I took pseudoephedrine most days for 35 or more years until it became harder to get. I still do not dive without it. I use a nasal rinse, Flonase and antihistimines every day. I use nasal strips to sleep and if they are not adequate I use nasal decongestant spray (Afrin). All these things help, but only pseudoephedrine is reliable for diving. To me, this is because it unclogs my sinus passages that the nasal sprays don't reach and the antihistimines also don't help enough. I can use Afrin for a lot longer than most people think, by using small doses and only when needed, but eventually the rebound hits and I have to go cold turkey. Pseudoephedrine has never done this to me, nor has Flonase or antihistimines. For me, without pseudoephedrine I couldn't dive, and i started diving in the 70's.