This Common Decongestant Isn’t Effective After All

A government advisory panel has said what many doctors, pharmacists and patients have realized for years: If your head is congested, the ingredient phenylephrine doesn’t work very well in over-the-counter cold, flu and allergy products.

Based on current scientific data, the Food and Drug Administration’s nonprescription drug advisory committee concluded that phenylephrine is not effective as a decongestant.

“We’ve known this for years and would advise patients to not waste their money,” says UNC Health pharmacist Amy Donnelly, PharmD.

Neither the FDA nor the committee, however, raised concerns about safety issues with the use of oral phenylephrine at the recommended dose.

In some products, phenylephrine is the only active ingredient, and in other products, it’s one of several active ingredients. Medicines with other active ingredients may still be effective for other symptoms, such as headaches.

How did an ineffective ingredient come to be used in so many medicines? And what are we supposed to do about it? UNC Health experts discuss.

One Ingredient Works Better But Is Now Regulated

Pseudoephedrine is more effective than phenylephrine and was a common active ingredient in over-the-counter (OTC) decongestant products. But pseudoephedrine is also used to make methamphetamine, a powerful, highly addictive stimulant.

To control the manufacturing of methamphetamine, the federal government passed the Combat Methamphetamine Epidemic Act of 2005, which affected products containing pseudoephedrine.

After the act went into effect in 2006, pharmacies were required to keep pseudoephedrine medicines behind the counter or in locked cabinets to restrict their purchase. Although you don’t need a prescription to buy them, you must ask for them and show your identification, and you can only buy limited amounts. The pharmacy keeps a record of the date and amount of pseudoephedrine products that each person purchases.

Phenylephrine Was Swapped in for OTC Cough and Cold Medicines

The restriction on pseudoephedrine products prompted manufacturers to think differently about the ingredients in their decongestant medicines.

“Companies rushed to come up with an alternative that could be taken orally and still be sold in the normal counter space,” says Brent Senior, MD, an ear, nose and throat physician at UNC Health. “That is when they started adding phenylephrine to oral cold, flu and allergy products.”

Phenylephrine is an effective medicine, Dr. Senior says, just not in oral form.

“Phenylephrine is the active ingredient in some topical sprays,” he says. “That is a very potent decongestant and works very well.”

Nasal decongestant sprays work by shrinking blood vessels in the nose, which decreases swelling and congestion. Dr. Senior warns that nasal sprays containing phenylephrine or oxymetazoline should not be used for longer than two or three days. After that time, the blood vessels don’t respond anymore, which can make the congestion worse.

There Are Natural Ways to Reduce Nasal Congestion

Now that you know phenylephrine isn’t working for your stuffy nose, there are natural ways to ease your symptoms that don’t require medicines, says UNC Health family medicine physician Sarah Ruff, MD.

  • Drink plenty of fluids. Coughing and sneezing can deplete body fluids, so make sure you replenish them to help loosen mucus and relieve congestion. Water, tea and soup can keep you hydrated.
  • Take a warm bath or shower. They can be comforting if you feel chilled, she says, and the steam can moisturize nasal passages.
  • Use a humidifier, especially when sleeping. It moisturizes your nasal passages, throat and lungs, she says, which will make it easier to breathe.
  • Have some honey. Adding a teaspoon to a cup of tea with lemon, or eating a teaspoon by itself, is one of the most effective treatments for cough, she says, because it coats and soothes the throat. Raw honey is best, she says, but never give raw honey to a child younger than 1, as it can be a source of botulism, which causes muscle weakness, breathing difficulty and other problems.
  • Rinse your nasal passages. Nasal irrigation—using a neti pot, for example—flushes mucus and debris from the nose and sinuses. You can also use a saline (saltwater) nasal spray, especially for children.

Serious conditions such as COVID-19, strep throat, flu, bronchitis and meningitis may have symptoms similar to a cold. If your symptoms are severe or linger, call your doctor. Need a doctor? Find one near you.