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Nov 14, 2023

Everyday Health

FDA Finds Popular Oral Decongestants Do Not Work

Decongestants and the Popularity of Phenylephrine

Phenylephrine has been a top choice for those seeking relief from nasal congestion. This decongestant is a key ingredient in many familiar products like Sudafed PE and DayQuil. But a new finding suggests phenylephrine oral decongestants do not work.

The FDA's Deliberations

In September 2023, the FDA brought together experts to assess phenylephrine's effectiveness in oral form. What did they find? The committee unanimously agreed that, at recommended doses, phenylephrine is no more effective than a placebo for cold and allergy symptoms.

Understanding the Science Behind the Decision

The body rapidly metabolizes phenylephrine when taken orally. This means only a small amount actually reaches the nasal passages, limiting its effectiveness in clearing up congestion.

The committee was hesitant to explore higher doses due to concerns about potential side effects, like increased blood pressure. However, it's notable that the discussion and the safety concerns were solely about the oral form of phenylephrine. The nasal spray form, which applies the medication directly to the nasal passages, is still seen as effective.

OTC Oral Medications Containing Phenylephrine

If you're curious about which products contain phenylephrine, here's a list:

  • Sudafed PE
  • Vicks Sinex
  • Benadryl Allergy Plus Congestion
  • Nasop
  • Sudafed PE Congestion
  • Sudafed PE Children's Nasal Decongestant
  • Neo-Synephrine

Why Do So Many Products Contain Phenylephrine?

The widespread use of phenylephrine in many over-the-counter (OTC) cold and allergy medications can be attributed to several reasons:

  • Regulatory Restrictions on Pseudoephedrine: Phenylephrine gained popularity as an alternative to pseudoephedrine, another common decongestant. Pseudoephedrine's sale is restricted because it can be used to illegally manufacture methamphetamine. As a result, it's kept behind the pharmacy counter, and purchasing it requires identification. To avoid these restrictions and make their products more accessible to consumers, many manufacturers switched to using phenylephrine.
  • Versatility in Combination Products: Phenylephrine is often included in combination with other active ingredients to treat multiple symptoms of colds, flu, and allergies. For instance, it's commonly found in products that also contain pain relievers, cough suppressants, or antihistamines. This versatility makes it a useful component in multi-symptom relief medications.
  • Market Demand for Oral Decongestants: There's a significant demand for oral decongestants, as many consumers prefer pills or liquid medications over nasal sprays. Phenylephrine, being one of the few available oral decongestants, fills this market need.

Navigating Alternatives: What Are Your Options?

As for alternatives, pseudoephedrine and oxymetazoline nasal spray have been suggested as effective substitutes. Pseudoephedrine, while subject to purchasing restrictions, can typically be purchased from the pharmacist with a valid driver's license. Oxymetazoline is the main ingredient in Afrin nasal spray.

In the context of nasal decongestants, phenylephrine remains effective as a topical decongestant in nasal sprays. Other alternatives for nasal congestion include antihistamines (available both topically and systemically) and nasal steroid sprays, which are safe and effective. Topical decongestants should be used only for short-term relief as long-term use can lead to addiction and worsening problems. For chronic disorders like nasal allergies, decongestants are generally not recommended.

Pseudoephedrine-based Products

These are typically available behind the counter; you'll need to ask your pharmacist. An ID, like a driver's license, is often required for purchase.

  • Contac Cold
  • Sudafed Congestion, Sudafed 12-Hour, Sudafed 24-Hour
  • 12 Hour Decongestant, 12 Hour Nasal Decongestant
  • Afrinol
  • Allermed
  • Cenafed
  • Children's Dimetapp Decongestant Infant
  • Chlor-Trimeton Nasal Decongestant
  • Decofed, Decofed Liquid
  • Drixoral Decongestant Non-Drowsy
  • Efidac
  • Elixsure Decongestant
  • Entex
  • Genaphed
  • Nasofed
  • Nexafed Nasal Decongestant
  • Novafed
  • Silfedrine
  • SudoGest, SudoGest 12 Hour
  • Suphedrine
  • Zephrex-D

Other Decongestants
  • Options include AH-Chew D, Contac-D, Nasop, Neo-Synephrine, and more
  • These might be more readily available than pseudoephedrine products

Please note that the availability of these products might vary based on location, and it's always recommended to consult with a healthcare professional before using any medication. Additionally, due to the potential misuse of some decongestants like pseudoephedrine, purchasing restrictions may apply.

The Bottom Line

The FDA advisory on phenylephrine is a reminder of the evolving nature of medical knowledge and drug efficacy. As consumers, staying informed and consulting healthcare professionals is key. Alternatives exist, but finding the right one for you might require a bit more effort and understanding. Remember, effective treatment is not just about relieving symptoms but understanding and addressing the root cause of your discomfort.

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