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What pharmacy staff need to know about managing congestion


The symptoms of cold and flu are similar, but flu symptoms are often more severe. Cold symptoms usually appear gradually, and mainly affect the nose and throat. In contrast, flu symptoms come on very quickly. Those affected by flu may feel exhausted and unable to carry on as normal.(1,2)

Cold symptoms:(2)

  • Blocked or runny nose
  • Sore throat
  • Headaches
  • Muscle aches
  • Coughs
  • Sneezing
  • Raised temperature
  • Pressure in the ears and face
  • Loss of taste and smell

Flu symptoms:(1)

  • Sudden fever – a temperature of 38°C or above
  • Aching body
  • Feeling tired or exhausted
  • Dry cough
  • Sore throat
  • Headache
  • Difficulty sleeping
  • Loss of appetite
  • Diarrhoea or stomach pain
  • Feeling sick and being sick


Sinusitis, swelling of the sinuses usually caused by infection, is common after a cold or flu.(3)

Symptoms of congestion associated with sinusitis after a cold or flu:

  • Pain, swelling and tenderness around cheeks, eyes or forehead
  • Blocked nose
  • Reduced sense of smell
  • Green or yellow mucus from the nose
  • Sinus headache
  • High temperature of 38°C or above
  • Toothache
  • Bad breath





Patients may treat sinusitis at home with the following:(6)




Congestion relief(7-10)

Nasal congestion is the congested feeling in the nose due to the membranes lining the nasal passages becoming inflamed and irritated.(11) Over-the-counter products are available as single ingredient products or as combination ‘all-in-one’ remedies. They are available as tablets, capsules, nasal sprays and liquids. Patients should be reminded to take only one medicine with the same type of active ingredient at a time.



During the consultation you can advise on appropriate management options for the patient’s symptoms.

  • Who is the medication for?
  • What symptoms do they have?
  • How long have they had the symptoms?
  • Are they taking any other medication?
  • Have they already taken anything for the symptoms?


  • Develop a high temperature (above 39°C or 102.2°F), which can be a sign of a more serious type of infection
  • Feeling confused or disorientated
  • Notice a sharp pain in their chest
  • Coughing up blood-stained phlegm (thick mucus)
  • Finding it difficult to breathe
  • Notice a marked swelling of the glands in their neck and/or armpits
  • Symptoms lasting longer than three weeks(16)

*Please note symptoms are not limited to the above list.


Sudafed Decongestant Tablets (Pseudoephedrine HCl 60mg) Product Information

Presentation: Reddish-brown, round, biconvex film-coated tablets, with ‘Sudafed’ on one side. Tablets contain pseudoephedrine HCl 60mg. Uses: Symptomatic relief of allergic rhinitis, vasomotor rhinitis, common cold and influenza. Dosage: Adults and children over 12 years: 1 tablet every 4-6 hours up to 4 times a day. Contraindications: Hypersensitivity to ingredients, severe hypertension or coronary artery disease, with or within 2 weeks of receiving MAOIs. Precautions: Mild to moderate hypertension, renal impairment, severe hepatic impairment, heart disease, diabetes, hyperthyroidism, elevated intraocular pressure, prostatic enlargement. Patients with rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption should not take this medicine. Concomitant use of tricyclic antidepressants, bretylium, betanidine, guanethidine, debrisoquine, methyldopa, alpha and beta blockers, other sympathomimetic agents. Pregnancy and lactation: Not recommended Side effects: Sleep disturbance, skin rash, urinary retention, rarely hallucinations. RRP (ex VAT): 12s, £3.47 Legal category: P PL Holder: McNeil Products Ltd, Foundation Park, Roxborough Way, Maidenhead, SL6 3UG. PL Number: PL 15513/0024 Date of prep: January 2013.



  1. NHS. Overview Common cold. (accessed 30/09/2019).
  2. NHS. Flu. (accessed 30/09/2019).
  3. NHS. Sinusitis (Sinus infection). (accessed 30/09/2019).
  4. Graf P. et al. Expert Opin Pharmacother 2009; 10:889-891.
  5. Eccles Curr Med Res Opin 2010; 26:4, 890.
  6. Britannica Mucus Secretion. (accessed 30/09/2019).
  7. Graf P. et al. Expert Opin Pharmacother 2009; 10:889-908 pg. 1, 2 and 3.
  8. Eccles and Webber (ed). Common Cold. Birkhauser Advances in Infectious Diseases. 2009. Burkhausser Verlag Basel/ Switzerland pg. 251.
  9. Fokkens WJ. et al. Rhinology 2012;50 (suppl 23):1-298 pg. 37.
  10. Consultation skills for pharmacy practice: taking a patient-centred approach. (accessed 06.10.2019).
  11. Self-Care Guide for the Common Cold, PennState Behrend. (Accessed 07.10.2019).
  12. Martindale. The Complete Drug Reference. Accessed via microdermex 2017 pg. 3 and 6.
  13. Graf P. et al. Expert Opin Pharmacother 2009; 10:889-908 pg. 1, 2 and 3.
  14. Eccles and Webber (ed). Common Cold. Birkhauser Advances in Infectious Diseases. 2009. Burkhausser Verlag Basel/ Switzerland pg. 251.
  15. NHS. Decongestants. (accessed 07.10.2019).
  16. When to see a GP, Sinusitis (sinus infection). (accessed 07.10.2019).
  17. SUDAFED® ACTIVE INGREDIENTS. (accessed 07.10.2019).


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