EIGHTWGT:
I had allways been under the impression you should never use either of these medications before a dive.
Can anyone give me an EDUCATED MEDICAL opinion on this topic ? I am correct that this should not be done am I not ? Correct me please if I am wrong....
You've hit on a pet peeve of mine, Tom...an inappropriate simple "rule" that is put in place to protect people from themselves when they're thought to be incapable of understanding the
real reasons for the "rule".
Oral decongestants (like Sudafed/pseudoephedrine) and topical spray decongestants (like Afrin/oxymetazoine) reduce swelling of the mucosal lining of the upper airways. Reducing the swelling can assist with equalization when diving.
Topical sprays have the advantage of only affecting where they're applied- they have minimal if any generalized systemic side effects for most people. Topical sprays have the
disadvantage of only affecting where they're applied. If you spray them in your nose, you're likely to affect the openings of your sinuses and assist in sinus clearing, but unless you happen to get some on the openings to your eustacian tubes to your ears, you're less likely to help with ear equalization. There are different kinds of topical spray nasal decongestants, and people need to know what they're using. The "12 hour" types (like oxymetazoline) are probably better for divers than the 2-6 hour types (like phenylephrine)- more on that later. Debersole has already mentioned the "rebound effect" after using decongestant nasal sprays for more than a few days.
Oral decongestants have the advantage of working systemically and going "everywhere". They not only reduce swelling of the nose, sinus openings, and openings of the eustacian tubes, but also of the mucosa lining the eustacian tubes to help with ear equalization. Oral decongestants have the
disadvantage of working systemically and going "everywhere". Not only do people get systemic effects, they can also sometimes get systemic
side effects. People should consult with their doctor before taking pseudoephedrine
if they have high blood pressure, thyroid disease, heart disease, diabetes, trouble urinating due to an enlarged prostate gland, or other significant medical or psychiatric condition. Pseudoephedrine
can cause nervousness, dizziness, sleeplessness, or palpitations in some people. Every diver should try any medication
before diving and be aware of potential side-effects. In divers, there is some
theoretical concern about using pseudoephedrine with high partial pressures of oxygen (which might be seen with some nitrox or technical diving), but even that isn't an absolute reason not to use pesudoephedrine. (See a DAN article at:
http://www.diversalertnetwork.org/medical/articles/article.asp?articleid=51 )
debersole:
As far as oral decongestants go, the preferred one is Sudafed. A lot of my diving ENT friends recommend 30mg twice daily beginning the day before diving for those people who have equalization problems. Please note, however, that there is a theoretical risk of a reverse block if the drugs wear off at depth and then you have difficulty equalizing on the way up.
I'm gonna depart form debersole here. (He's hit on another of my pet peeves. You should see my peeve farm sometime- I've got a whole menagerie!) He's warning you that decongestants can "wear off" during a dive and you can be caught with a reverse squeeze on the ascent. I'm going to go a step further and say that if someone is too stupid to read directions and tell time so they'll know when their medication will "wear off" then they're too stupid to dive
at all. After all, their air might run out during the dive and they'll drown. The drug "wearing off" is unlikely to be a concern unless the diver doesn't use even the most basic level of common sense. Now the medication being
insufficient to complete the dive safely is a real concern. The "rule" that you're repeating here is that you should "never ever take decongestants and dive". Stupid rule. A
better rule would be that you should exercise extreme caution if you take decongestants to dive if you could not otherwise dive without the decongestants- and you should seriously consider not diving at all until the problem resolves. If you couldn't dive without the decongestant, then there's the distinct possibility that the decongestant you use could turn out to be inadequate and you could have a problem equalizing at some point during the dive (like on ascent when it's too late to abort). But I have no problem with people using a decongestant to
facilitate equalization. That's very different from taking it to
enable equalization.
Debersole says his ENT friends recommend 30 mg of Sudafed/pseudoephedrine twice a day when diving. Well, that is a
very conservative dose that is less likely to cause side-effects. But sorry, I gotta say that IMHO if someone follows that recommendation then they are just setting themselves up for that old (and avoidable) "drug wearing off during the dive" scenario. The 30mg Sudafed is a 4 hour drug, and the generally recommended dose for adults is
60mg per dose (2 pills at a time, every 4-6 hours, no more than 4 doses per day). Drugs don't start working immediately when you take them, and they don't wear off completely at the end of the dose interval- they continue to have some effect- so 30mg of Sudafed twice a day might be enough for some people in some situations. But if you take half a dose of a 4 hour decongestant (oral or topical spray), then IMHO you're more
likely to have it "wear off" at some point during a day of diving. That's why my personal preference is to use a 12 hour medication like a time-release 12 hour pseudoephedrine and/or a 12 hour nasal spray like Afrin/oxymetazoline. Of course higher doses do bring on a higher likelihood of side-effects, you might not
need the higher dose, and those drugs could still be inadequate for someone to complete a dive if they couldn't dive without the medicine, but if you can tell time you can time the dose so it won't "wear off" during a dive. But hey, that's just my opinion.
Bottom line is your doctor was right. There is (or should be) no absolute rule prohibiting decongestant use when diving. There are
individuals who should not use decongestants and dive due to their individual situation, but barring personal untoward reactions or side-effects many divers use decongestants successfully to facilitate clearing when they dive. Like in all aspects of diving (and life in general) you need to weigh the
risks of what you want to do verses the
benefits. If for
you the potential benefits outweight the potential risks, then go for it.
Just my 2¢,
Bill
The above information is provided for discussion purposes only and is not meant as specific mecial advice for any individual.
