5.1.3. Decongestants
Short-course treatment with nasal or oral decongestant can be beneficial in treating a common cold but should be limited to a maximum of 7 days. WADA allows some decongestants (caffeine, phenylephrine, phenylpropanolamine, adrenaline, xylometazoline and synephrine) and restricts others to a certain dose ((methyl)ephedrine < 10 µg /ml and Pseudoephedrine < 150 µg /ml in urine). Most other decongestants, especially those containing sympathomimetic amines or stimulants are currently prohibited by the WADA 61; The list of prohibited drugs changes annually, so physicians should verify when prescribing these products to athletes. Moreover, the use of oral decongestants can lead to a series of side effects such as tachycardia, tremor, insomnia, elevated heart rate and blood pressure, which can be problematic for athletes. Unfortunately, in many countries these drugs are available on an over-the-counter base and therefore athletes need to be counseled about the actual prohibited substances.
Decongestants do not have a part in the treatment of AR, NAR or CRS because of the risk of inducing rhinitis medicamentosa, a decongestant-induced paradoxical swelling of the nasal mucosa.