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Comment by arthur2e5 | Hacker News Reader

The issue with phenylephrine is that it does not help the symptom. Pseudoephedrine does not deal with the underlying immune reactions, but it does constrict your nose blood vessels enough to stop the mucosa from stuffing your nose holes.

Having your nose unclogged is very useful on its own, considering otherwise you'd be forced into mouth-breathing, which would lead to more discomfort and potentially worse outcomes like sleep apnea.

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The problem with blood vessel constriction medicines, is the body tends to very quickly adjust to their presence. Things like “decongestant nose sprays” are known for being traps, they work a few days, and then one needs an ever increasing amount to achieve the effect. And if one stops using them, then they’ll be worse off because their blood vessels will over expand again without the chemical present, resulting in congestion even after the original cause is gone. It then takes time to ween off the effect, during which the exact problems you mention occur. Same thing with “redness eye reliever” found in eye drops.

Basically, you shouldn’t use these sorts of things for more than ~2 days, but that is not well communicated with consumers.

having witnessed this escalation in a family member, it's completely the same description I'd have used. I can't imagine how annoying it was to have a constantly stuffy nose, yet the only relief is ever-increasing nasal spray.

Chronic nose problems really do require something else. During bad months I start with a regular antihistamine and then to escalate to ketotifen (somehow OTC in China), and if that doesn't work, saltwater rinse (look, I'm lazy). Pseudoephdrine goes after salt water -- I just don't like to go to a physical pharmacy, so I want my stock to last as long as it can.

For some reason steroid spray never seems to work on me. I spray it, it drips out, nothing happens.

There are now decongestants you can use where you spray it into one nostril one night, then the other nostril on the next night. And you can keep swapping back and forth without running into these "boomerang" problems.

My wife can take them, but I can't because I have high blood pressure.

The thing about decongestants is that they increase your blood pressure, so those of us who are already hypertensive cannot take them.

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