You may want to check your over-the-counter (OTC) cold and allergy medicine in your medicine cabinet to see if it contains the following ingredient: oral phenylephrine.

In September 2023, FDA advisers concluded that the current scientific data does not support oral phenylephrine’s effectiveness at the recommended dose. Phenylephrine is available as the main ingredient and in combination with other medications, including popular OTC products such as Vicks DayQuil®/ NyQuil®, Benadryl-D Allergy Plus Sinus®, Sudafed PE®, etc.

Phenylephrine has been marketed to treat nasal congestion, relieving stuffy noses. However, the FDA advisers argue that the evidence does not support this claim.

Research debating phenylephrine’s effectiveness dates back to at least 2009, when a randomized controlled trial in the journal Annals of Allergy, Asthma & Immunology showed that phenylephrine was not effective at reducing nasal congestion.

I’ve Been Taking Phenylephrine For Years. Has It Been Harming Me?

The good news is that phenylephrine is generally recognized as a safe medication at the recommended doses. However, if you take it at high doses, there is a chance that your blood pressure could dangerously elevate. Those with known or suspected cardiac disease or high blood pressure should ask their doctor before taking oral decongestants.

There is no need to throw away all your medicine containing phenylephrine. These medicines may contain a combination of ingredients that help other symptoms you may have, such as cough or fever. Although at least one pharmacy retailer is voluntarily removing products with phenylephrine as the only active ingredient, the FDA has not made any final decisions on the status of oral phenylephrine.

What Can I Take Instead of Medicines Containing Phenylephrine?

The answer to this depends on why you are congested. Is it the common cold versus allergies? Is it a short-term problem versus a chronic issue?

If your nasal passages are congested, you typically need a decongestant. If your nose is running, then you may need an antihistamine (Benadryl®, Claritin®, Zyrtec®, etc.). Instead of medicines that contain oral phenylephrine, you can look for oral medicines containing pseudoephedrine to relieve nasal congestion. These medicines are located behind the pharmacy counter and require a government-issued photo ID.

Pseudoephedrine can significantly relieve nasal congestion. Regular Sudafed® contains pseudoephedrine instead of phenylephrine. Again, those with known or suspected cardiac disease or high blood pressure should ask their doctor before taking oral decongestants.

Another option is to take an over-the-counter nasal spray. One of the reasons that oral phenylephrine may not be effective is because the drug doesn’t make it to the nasal cavity after being absorbed and metabolized. Delivering medication directly to the site of action, nasal sprays are very effective at relieving nasal congestion. OTC nasal spray decongestants that are available include Neo-Synephrine (phenylephrine) and Afrin (Oxymetazoline), but use is only recommended for 3 days or recurrent / worsening nasal congestion can occur. Sodium chloride (Ayr® / Ocean®) nasal sprays can be used without the 3-day limitation and may help with congestion and dryness. Other OTC nasal sprays that you may find at your pharmacy are antihistamines and nasal steroids used to treat allergy symptoms such as runny nose or chronic congestion. If nasal symptoms are chronic you may need to see an allergy specialist.

This is a good opportunity to go through your medicine cabinet (throw away those medications that expired 10 years ago!) and learn what the active ingredients are and what symptoms they treat. If you have any questions about medicines you can take for your cold, allergies or another illness, UofL Health – Pharmacy can help. UofL Health has the following pharmacy locations for your medication needs:

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Chris Zirkelback, Pharm.D., BCPS

Chris Zirkelback, Pharm.D., BCPS, completed his undergraduate studies at Bellarmine University and went on to receive his doctor of pharmacy from University of Kentucky College of Pharmacy. He started at UofL Health – Mary & Elizabeth Hospital as a volunteer, then as an Emergency Department technician, and has been a clinical pharmacist at Mary & Elizabeth Hospital for the last 14 years.

All posts by Chris Zirkelback, Pharm.D., BCPS
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