Decongestants dry you out, so you really need to drink more water - not fluids that are diuretics like coffee, tea, sodas, etc. Plus, they bump up your heart. I can really tell a diffrence in a workout. I get up to higher heart rates (using a monitor) much easier, which concerns me from a heart-health standpoint.
I personally only take any drugs when there is no reasonable alternative because every drug has some sort of side effect. They are a last resort to me, not that I don't see them as an effective tool. Kind of like sun screen...you only use it when you need it!
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