Walk down the cold and flu aisle in any drug store and you’ll spot dozens of over-the-counter drugs that contain the decongestant phenylephrine, the ingredient that a Food and Drug Administration advisory committee on Tuesday said does not work.
Phenylephrine is found in a wide range of cold and flu medications, including Sudafed PE, Benadryl Allergy D Plus Sinus and Vicks DayQuil Cold and Flu Relief.
Here’s what experts say are effective alternatives to relieve nasal congestion.
Pseudoephedrine
Pseudoephedrine, the decongestant found in Sudafed, is highly effective in helping people with stuffy noses breathe more easily, said Dr. Maryann Amirshahi, a medical toxicologist and a professor of emergency medicine at Georgetown University School of Medicine.
The downside, Amirshahi said, is that the medication is not over the counter but “behind the counter” — meaning that it doesn’t require a prescription but people must request it from a pharmacist to buy it.
In 2006, pseudoephedrine was moved behind the counter and limits were placed on how many a person could buy as a means to determine people from using it to make methamphetamine.
Phenylephrine — the ingredient deemed ineffective — took off in popularity as a replacement for pseudoephedrine.
Mike Koelzer, a pharmacist in Grand Rapids, Michigan, said he doesn’t expect any issues with more people requesting pseudoephedrine. Pharmacists have long known that phenylephrine was potentially ineffective and have been recommending alternatives like pseudoephedrine.
Amirshahi noted that pseudoephedrine comes with side effects, including dizziness, nervousness and trouble sleeping. It may also increase blood pressure, a potential drawback for people with heart problems.
“But that being said, if you’re using it for a short-term course of therapy, and not chronically, that’s really not as much of an issue because you’re only going to be using it for a few days,” she he said.
Nasal spray
While people tend to prefer taking a pill to using a nasal spray, the sprays are effective at relieving congestion, said Dr. Vin Gupta, a pulmonologist and an affiliate faculty member at the University of Washington in Seattle.
For people who can’t take pseudoephedrine, Gupta, who is an MSNBC medical contributor, said he recommends using a corticosteroid nasal spray like Flonase, a common over-the-counter allergy medication that can also relieve congestion.
Phenylephrine is also still thought to be effective when used as a nasal spray, said Dr. Wynne Armand, a primary care physician at Massachusetts General Hospital.
The FDA panel on Tuesday specifically considered the effectiveness of oral phenylephrine. Studies have shown that when taken as a pill, too much of the drug is broken down in the body before it gets into the nose to relieve congestion. With a nasal spray, it’s delivered directly to the nose.
Armand said that people using decongestant nasal sprays should not use them for more than three days. Prolonged use can lead to so-called rebound congestion, she added.
Oxymetazoline, a common ingredient in over-the-counter nasal sprays including Afrin and Zicam, is also an effective alternative, Koelzer said. Like phenylephrine nasal spray, prolonged use of oxymetazoline nasal spray can also cause rebound congestion.
Antihistamines
Dr. Purvi Parikh, the national spokesperson for the Allergy & Asthma Network, an advocacy group, said that she usually does not recommend pseudoephedrine to her patients because of its effects on blood pressure.
Instead, she recommends oral antihistamines like Zyrtec, Allegra and Claritin.
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