Historically, doctors were concerned that oral decongestants may have an adverse effect on the user’s blood pressure and heart rate. Because decongestants are adrenergic drugs, meaning they are like epinephrine, they constrict blood vessels in the nose and sinuses. Blood vessel constriction usually raises the systolic and diastolic blood pressure. So, do oral decongestants have long term adrenergic effects? Do they raise BP and increase heart rate?
Cochrane for Clinicians reviewed five studies designed to see if long-term decongestants had adverse effects on BP and heart rate. The drugs studied were ephedrine, pseudoephedrine, and phenylpropanolamine taken every day for 7 days at varying doses. Compared to placebo, oral decongestants have little or no effect on systolic and diastolic BP and have little or no effect on heart rate nor do they have withdrawal effects. Patients took these drugs for at least one week and many for up to seven weeks. Still, no harmful effects were seen.
So, the answers to the two questions posed are “no,” and “no.”
NO: they don’t have long term adrenergic effects.
NO: they don’t raise BP or increase heart rate.
Despite the outcomes of these studies, “the long term effects of oral decongestants on blood pressure “remain unclear.” Current guidelines recommend avoiding [epinephhrjne-like drugs] …. in patients with uncontrolled, resistant hypertension.” It is even less clear in patients with mildly elevated BP.
Phenylpropanolamine has been removed from all OTC products in the U.S. for safety and efficacy concerns and high risk patients should still be restricted, or warned, about the risks of taking OTC decongestant combinations.
Reference: Johns T, Jenkins J. Effect of Adrenergic Agonist Oral Decongestants on Blood Pressure. Am Fam Phys 2026 June;113(6):534.
