Sudafed

[lowwall]

Those of us that made the mistake (once!) of buying the over the counter crap didn't need them to tell us it doesn't work!

Real Sudafed with pseudoephedrine is still OTC in the USA, but you have to ask the pharmacist for it and show a driver's license so they can log the purchase. The issue is pseudoephedrine can be relatively easily converted to methamphetamine, so ...
FDA.gov - Legal Requirements for the Sale and Purchase of Drug Products Containing Pseudoephedrine, Ephedrine, and Phenylpropanolamine

The OTC drugmakers knew this would vastly cut into their sales, so quickly came up with versions of their products that replaced pseudoephedrine with the similar looking phenylephrine. They all knew that phenylephrine is useless when taken orally (it does seem to help when used as a nasal spray), but sales are obviously far more important than efficacy in the OTC market.

 

[Kendall Raine]

Afrin, don't over do it, and nasal steroid for longer term use. Afrin is the best but I do not like using it for more than 2-3 days. I've used it up to a week but the rebound is awful. Steroids work good, not as good as Afrin, but you can use that for a week straight.

I've done Afrin and steroids for 2 days and then steroids after, works well.

I find daily nasal rinses make a huge difference. (2 packets, Dr Neil)

Steroids and decongestants do different things. Steroids are anti inflammatories and decongestants are vaso constrictors. Afrin is a decongestant for which you raspidly build a tolerance (rebound effect). Flonase and Budesonide are steroids. They're fine for long term use. Saline nasal rinse (NeilMed) is neither, but, as you say, works well to keep the sinuses clean and is a good in combination with steroids. I've had good success using nasal rinse to administer Budesonide with Afrin as a kicker in the event of a cold. The steroids will help prevent/significantly reduce the rebound from Afrin so you can stay on it longer. That's not to say long term Afrin use is a good thing. It definitely isn't, but in combination with steroids it can keep you going in the short run.

 

[boulderjohn]

If you are talking about Sudafed PE, you should note that the latest news on it is that research indicates it does not do diddly squat for decongestion, and because of that it will likely lose its FDA approval and be removed from the shelves. It may no longer be an option for you soon.

I think your best choice is something like Afrin, and as others have noted, you shouldn't take it for more than a few days. The fact that you will only betaking it once a day rather than the normal dosage for a cold may help with that. If you are talking about a typical week or so of diving, the first few days should be all you need anyway. After that, your eustachian tubes should get the idea and work well without any help.

 

[ROUS]

I pop a Fisherman's Friend lozenge before most dives. It seems to open up my sinuses wide open. YMMV.

 

[lowwall]

I pop a Fisherman's Friend lozenge before most dives. It seems to open up my sinuses wide open. YMMV.

You want wide open sinuses? Wasabi for the win.

 

[boulderjohn]

In my first years of diving, I had a lot of trouble equalizing. One instructor even said diving might not be for me. Years of diving got my interior plumbing in shape, but until I reached that point, I struggled and did many things. I got one of the very best in a flea market in Australia--eucalyptus oil. Before each dive, I would simply take off the lid and take a whiff. Eventually it wore out, but it was great until then.

I would think wasabi would indeed do the job.

 

[lowwall]

What's the cause of the congestion?

I have pretty bad seasonal-type allergies. Grasses and pollen are the main culprits. I take loratadine (Claritin) daily most of the year except mid-winter. If it gets bad in the spring or fall or if I'm travelling to somewhere with high allergen loads, I'll add a nasal steroid (Flonase). You do have to start a few days in advance.

The Neil-Med saline rinse does help, but it's kind of annoying so I tend to only use it when my symptoms are bad. I take the rinse bottle and packets on trips because I sometimes react badly to the local flora and it's a quick way to get at least minor relief.

I don't worry too much about mild congestion caused by allergies when diving. As long as I can breathe through my nose on the surface, any minor congestion clears up very quickly when I'm on filtered tank air/nitrox.

If the congestion is caused by a minor cold, then I use the saline rinse. If that doesn't solve it, then psuedophedrine is the last resort for diving. I'll use it, but only after thinking hard about whether I should be doing the dive at all. I take it an hour or so in advance and if I'm still congested close to the dive, I won't go out. I don't mess with Afrin because I've found the congestion relief to be pretty short-lived. It might be enough for one dive, but it's not going to make it through a 2-tank boat ride and I do not want to deal with a reverse squeeze.

 

[atiumb]

I had a similar issue and went to an ENT and also spoke with DAN. Both recommended trying a clartin(not Claritin-D) and Flonase spray(starting 3-4 days before). I tried it and it worked great, I stopped using the Claritin and just use the Flonase, no issues equalizing and greatly improved breathing as well.

 

[BoundForElsewhere]

so NOT use cocaine. it will have the opposite effect.

 

[lowwall]

I stopped using the Claritin and just use the Flonase, no issues equalizing and greatly improved breathing as well.

This prompted me to do a quick literature search and, indeed, nasal corticosteroids like Flonase are somewhat more effective than loratadine in alleviating allergic rhinitis symptoms. I need to think about switching my strategy to Flonase daily and save the loratadine for those few times a year when symptoms warrant.

FWIW, I imagine most allergy sufferers have tried all the antihistamines. But here's what works for me. I prefer loratadine because it has no discernible side effects and it's good enough for most days here in Chicago. If that's insufficient for hay fever type symptoms, I'll take Zyrtek (cetirizine) but it makes me a little drowsy.

Both Allegra (fexofenadine) and Benadryl (diphenhydramine) are even most effective, but make me feel really sleepy and for Benadryl a little loopy so I only take them if I have to go to the house of someone who has a cat. My cat allergy is pretty bad. Even after taking these strong antihistamines, I can only last a couple of hours before the rhinitis symptoms break through with a vengeance. It's about 10 minutes if I haven't taken anything.