So at least here in Germany, we pretty much all use nasal spray with xylometazoline, and it's very effective as it also binds to adrenergic receptors. It does not seem to be available in the US, and at least from a cursory search I cannot find out why...?
EDIT: After looking a bit more, the simple answer seems to be that it's not FDA approved for nasal congestion, and since there's not much money to be made, there's simply no incentive to go through the costly approval process..
EDIT: After looking a bit more, the simple answer seems to be that it's not FDA approved for nasal congestion, and since there's not much money to be made, there's simply no incentive to go through the costly approval process..