What’s in Your Medicine Cabinet - Common Decongestant Proven Ineffective

Common over the counter decongestant Phenylephrine proven ineffective, but there are still other decongestants available though they require a trip to the actual pharmacy

By: Deborah Palmer

When you’re feeling congested and unable to breathe with ease, one of the first things you may reach for is a decongestant. Decongestants are drugs that are specifically designed to provide relief from nasal congestion by reducing inflammation and promoting the opening up of air passages. However, not all decongestants are created equal, with some being proven to be ineffective. Let us discuss decongestants, their effectiveness, and what your options are this cold & flu season.

Decongestants are drugs that help to alleviate nasal congestion by constricting blood vessels in the nasal passages, reducing inflammation, and allowing more air to flow through the passages. These drugs can be taken orally or applied topically (via nasal sprays or drops).

There are two types of decongestants: adrenergic and anticholinergic. Adrenergic decongestants, such as phenylephrine (found in Sudafed PE and many over the counter Sinus formulated cold medications) and pseudoephedrine (found in Sudafed available from the pharmacy), work by stimulating the sympathetic nervous system to constrict blood vessels in the nasal passages. Anticholinergic decongestants, such as ipratropium bromide (available by Rx), work by blocking the action of acetylcholine, a neurotransmitter that is involved in the constriction of blood vessels.

Phenylephrine and pseudoephedrine are the only oral nasal decongestants available without a prescription. However, Phenylephrine is the only oral decongestant available “over-the-counter” (aka outside the pharmacy) after products containing Pseudoephedrine moved "behind-the-counter" in the early 2000s due to federal regulation aimed to combat illicit manufacturing of methamphetamine.

Have you ever said to yourself the “real” Sudafed just works better, well you were right. Phenylephrine has been found in a study done by the Cochrane group found to be no more effective than a placebo in treating congestion. As such, phenylephrine is being pulled from some retail pharmacy shelves.

While Phenylephrine may not be effective, Pseudoephedrine is still effective in treating nasal congestion, this drug, however, due to its regulation is only available only behind the pharmacy counter. In addition, anticholinergic decongestants such as ipratropium bromide have also been shown to be effective in treating nasal congestion.

It is important to note that decongestants should be used judiciously as they can have side effects. Adrenergic decongestants can cause rebound congestion if used too frequently, while anticholinergic decongestants can cause dry mouth and throat, dizziness, and blurred vision. In addition, decongestants can interact with certain other medications, especially those used to treat high blood pressure and depression.

Decongestants are designed to provide significant relief from nasal congestion, but not all of them are created equal. While phenylephrine may be commonly used as you can get it over the counter, it has been found to be ineffective than other decongestants such as pseudoephedrine and anticholinergic decongestants. Patients should discuss the use of decongestants with their healthcare provider, especially if they have underlying medical conditions or are taking other medications. Decongestants should be used only as directed and with caution to avoid adverse effects.

Looking to learn more, reach out to Freedom Doctors or schedule a Meet & Greet Zoom visit to see how you can benefit from Direct Primary Care.

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