Stuffed Up? Popular Over-the-Counter Decongestants Don’t Work

When you walk through the cold medicine aisle, nearly all of the nasal decongestant pills, gel tabs, and liquid drugs you see will contain the same ingredient: phenylephrine. However, the truth about the oral version of the drug is that phenylephrine doesn’t work.

On Tuesday, September 13, 2023, the FDA’s Nonprescription Drugs Advisory Committee voted 16-0 that oral medications containing phenylephrine were not effective as a nasal decongestant.

Frequently Asked Questions About Over-the-Counter Nasal Decongestants

We spoke with Lisa Fratesi, Singing River’s Director of Pharmacy, to get clear answers about the recent FDA vote, why oral phenylephrine doesn’t work, and what drugs she recommends for when you’re stuffed up.

What is Next for the FDA and Phenylephrine?

The advisory committee’s vote may remove oral formulations of phenylephrine, and there will be a period of public comment. I commend the advisory committee for doing what is right. Even though it’s safe, if it’s not effective, it shouldn’t be marketed as that.

Why Doesn’t Oral Phenylephrine Work?

The drug is inactivated when you take it orally. By the time the drug reaches your blood stream from the pill form, the drug is anywhere from 40-90% inactive. You can’t give a high enough dose to make it effective orally.

Is the Nasal Spray Still Effective?

Yes, the nasal spray is very effective. It is absorbed right where you need it and decongests your nose immediately. Consumers will still be able to buy it in a nasal spray. Because it is taken topically, there’s no need for it to be metabolized.

You get some rebound congestion with the nasal spray, which is why an oral medication is preferred over the nasal. You don’t want to use nasal phenylephrine all the time because if you quit using it, the congestion will be worse. You don’t want to use it every day, whereas you can take oral Sudafed daily for congestion.

Is Phenylephrine Safe?

Yes. This is not a recall. It’s still available.

Which Nasal Decongestants Actually Work?

Pseudoephedrine (Sudafed) is generally safe and effective, and it is available over the counter. In 2006 it was removed from over-the-counter because of its ability to be made into illegal drugs. You can now buy it in the pharmacy without a prescription at the pharmacy counter. The pharmacist is required to take your name and your driver’s license, but you don’t have to have a prescription to get it. 

If I was congested, and I needed something over the counter, I would take Sudafed.

I would also recommend, and I recommended this to somebody yesterday—cromolyn sodium. It’s an old spray that works to stop histamine release. It gets under-utilized in my opinion. When you have that little tickle, you’re congested, and your nose is running, if you use cromolyn sodium nasal spray, it works phenomenally—it’s awesome. It’s not addictive and doesn’t require a prescription.

Sometimes it’s kind of hard to find it. You may have to ask the pharmacist, but it’s available over the counter. All of the Singing River hospital pharmacies keep it in stock.

What Nasal Decongestant Can a Doctor Prescribe Me?

In my opinion, there’s nothing better than Sudafed for congestion. To me, it’s the best, most effective, safest, oldest thing we have. 

When would you recommend someone see a doctor instead of taking over-the-counter decongestants?

Only if they think they have an infection. A cold really isn’t a reason to go to the doctor.

Which Oral Decongestants Contain Phenylephrine?

Around 250 different OTC products contain phenylephrine. Common products include:

  • Sudafed PE Sinus Congestion
  • Benadryl Allergy Plus Congestion Ultratabs
  • Mucinex Sinus-Max
  • Robitussin Peak Cold Nighttime Nasal Relief
  • Theraflu
  • Vicks DayQuil 
  • NyQuil Severe Cold & Flu

Visit Singing River Pharmacy

Need a nasal decongestant that actually works? Stop by a Singing River Pharmacy location at any of our hospitals: