OTC Decongestants are Useless

Or so the headlines have read lately…

Last week, the FDA released results of a long-running (16 years!) review of the evidence on oral phenylephrine, an over the counter nasal decongestant in medications like Sudafed and Sudafed PE (you can also find it in “cold combo” meds like Tylenol Cold and Flu). When pseudoephedrine moved “behind the counter” about 20 years ago under the Combat Methamphetamine Epidemic Act of 2005, it left phenylephrine as the only readily available option for oral decongestants. In response, most drug companies switched to phenylephrine as the “decongestant” active ingredient.

But here’s the thing.

It doesn’t work.

Specifically the FDA review stated, “PE [phenylephrine] is not as effective as a nasal decongestant at the monographed dosage (10mg PE hydrochloride every 4 hours) as well as at doses up to 40mg (dosed every 4 hours).” In fact, “<1% of an oral PE dose is systemically available in an active form” and clinical studies suggest it may be no more effective than placebo.

So next time you feel a cold coming on, consider alternative therapies ranging from saline nasal rinses, to herbal steam inhalation, to nasal decongestant sprays* (like brand name Afrin). Don’t forget to increase your rest and hydration and treat your body with care and compassion along the way.

*Nasal decongestant sprays can be habit forming and should not be taken more than directed (generally up to 3 days)