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image of Cardiovascular and Cerebrovascular Events Linked to Abuse and Misuse of Sympathomimetic Nasal Decongestants: A Narrative Review of Clinical Evidence

Abstract

Background

Sympathomimetic nasal decongestants such as pseudoephedrine, phenylephrine, oxymetazoline, and xylometazoline are commonly used to relieve nasal blockage caused by allergic rhinitis, infections, or sinus inflammation. They work by activating α-adrenergic receptors, which promote vasoconstriction. However, overuse or inappropriate use of these medications has been linked to serious cardiovascular and cerebrovascular side effects.

Objective

The purpose of this review is to compile the available clinical evidence on the misuse and overuse of sympathomimetic nasal decongestants and their association with detrimental cardiovascular and cerebrovascular outcomes. It examines potential mechanisms, identifies risk factors, highlights diagnostic concerns, and outlines preventive measures.

Methods

A thorough literature search was conducted using databases such as Medline, PubMed, Scopus, Web of Science, and Google Scholar. The selection included case reports, observational studies, pharmacovigilance data, and clinical investigations published in English that evaluated the negative cardiovascular or cerebrovascular effects of sympathomimetic decongestants. Duplicate records were removed.

Results and Discussion

Although rare, significant events such as myocardial infarction, stroke, hypertensive crises, and vasospasm have been documented with both oral and intranasal sympathomimetics, particularly when used excessively or in combination with other medications. Strong vasoconstriction, endothelial dysfunction, and elevated sympathetic activity are the primary mechanisms underlying these adverse effects. Nonspecific symptoms and underreporting of OTC drug use can delay diagnosis. Numerous reports suggest potentially serious or fatal outcomes, and most clinical evidence comes from case reports rather than high-level studies.

Conclusion

Sympathomimetic nasal decongestants are generally safe when used as directed. However, excessive or inappropriate use may lead to potentially fatal cerebrovascular and cardiovascular events. Healthcare professionals should thoroughly review patients’ medication histories and provide clear instructions on proper use. Educating patients on the correct administration of sympathomimetic nasal decongestants and encouraging safer alternatives such as intranasal corticosteroids or saline sprays, when appropriate, is essential. Preventive measures, regulatory oversight, and interprofessional collaboration are crucial to ensuring safe use and reducing adverse outcomes.

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2026-01-21
2026-02-04

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Cardiovascular and Cerebrovascular Events Linked to Abuse and Misuse of Sympathomimetic Nasal Decongestants: A Narrative Review of Clinical Evidence
Bentham Science Publishers ; https://doi.org/10.2174/0118715257418908251126101911
/content/journals/chamc/10.2174/0118715257418908251126101911
/content/journals/chamc/10.2174/0118715257418908251126101911
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  • Article Type:     Review Article
Keywords: abuse ; cerebrovascular events ; stroke ; overuse ; myocardial infarction ; naphazoline ; phenylephrine ; misuse ; oxymetazoline ; xylometazoline ; pseudoephedrine ; sympathomimetics ; cardiovascular events ; propylhexedrine ; Nasal decongestants

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