On September 11 and 12, the FDA Drug Advisory Committee reviewed the effectiveness of oral phenylephrine, a commonly used over-the-counter medication to treat nasal congestion associated with colds and infections. Products may contain this ingredient alone or in combination with other medications, such as pain relievers, antihistamines and/or cough suppressants. Common drug products containing phenylephrine include Vicks® Nyquil™, Sudafed PE® and Benadryl® Allergy Plus Congestion. Before this review, oral phenylephrine was thought to be a safe and effective decongestant. Newly available data has shown that approved doses of oral phenylephrine are still considered safe, but they are not effective in the treatment of congestion from infection or cold. Going into the fall and winter, it becomes more common to experience colds, infections and illnesses. Due to the latest finding, patients may need to consider alternative ways to manage nasal congestion during cough and cold season.
Although oral phenylephrine is not recommended, other over-the-counter treatment options will remain accessible to patients. Phenylephrine nasal spray is still widely available and supported by the FDA as an effective form of treatment. Nasal sprays containing phenylephrine or oxymetazoline are very effective medications that decrease congestion for up to 3 days of use. Patients are advised to use these medications as directed to avoid the risk of rebound congestion, which is inflammation of the mucosal layer of the nose caused by overuse of decongestant nasal sprays. Steroid nasal sprays, like Flonase® (fluticasone) or Nasonex™ (mometasone), can decrease congestion, itching and sneezing and can be used for a longer time than decongestant nasal sprays.
There are also still many oral, over-the-counter, options available for patients to take as well. Antihistamines, such as Claritin® (loratadine), Zyrtec® (cetirizine), Allegra® (fexofenadine) and Benadryl® (diphenhydramine), may help relieve congestion by reducing the amount of histamine that your body produces and can cause nasal inflammation and allergy symptoms. Among these options, diphenhydramine may cause more drowsiness than the others. Pseudoephedrine is an additional non-prescription medication with very efficacious decongestant effects. While patients do not need a prescription to acquire pseudoephedrine, they must purchase it from a pharmacy and only in a limited quantity. Like phenylephrine, pseudoephedrine is available on its own or in combination with pain relievers and/or other ingredients to manage cough and cold symptoms. Patients with high blood pressure should discuss with their pharmacist if pseudoephedrine is an appropriate treatment option for them.
In addition, there are drug-free options for relieving nasal congestion. Saline rinses, sprays and drops and neti pots can be used by patients to clear out congestion caused by pollen, mucus or debris within the nasal cavity. Humidifiers can also be used to loosen congestion and are appropriate for patients of any age. With a variety of treatments available, patients should consult with their physician or pharmacist to discuss which options are best for their needs.