Are OTC decongestants effective?

John Pulcini, MD

Allergy and Immunology

Whether it’s from a cold or allergies, stuffy nose sufferers have often turned to over-the-counter decongestants for relief. But you may be wondering … are OTC decongestants effective? Allergist John Pulcini, MD, explained what to look for when it comes to OTC decongestants.

What to know about products with phenylephrine

The Food and Drug Administration recently reported that phenylephrine used in oral decongestants is ineffective at reducing nasal congestion. Phenylephrine can be found in OTC medicines such as Sudafed, Mucinex, Dayquil, Tylenol Sinus and Advil Sinus Congestion.

“Many studies have shown that these oral products are just not helpful,” Dr. Pulcini said. “They do not have enough bioavailability, meaning, if you take an oral form of phenylephrine, only about 1% ends up in the blood, which isn’t enough to cause any noticeable benefit.”

Although some patients have said oral decongestants with phenylephrine have helped, the studies have showed they are no better than a placebo.

What OTC decongestants are effective?

The nasal form of phenylephrine has been found to be effective.

“It just has some limited side effects because you can only use it for about five to seven days a month or it can cause rebound congestion,” Dr. Pulcini explained. “The nasal form can also sometimes affect blood pressure.”

Another option is oral pseudoephedrine, which can be found in many cold and allergy medicines, but it’s more difficult to access because it’s kept behind the pharmacy counter and requires a signature. Pseudoephedrine is the main ingredient used to make methamphetamines (meth), so there are limits on how much a customer may purchase.

If you have medications with phenylephrine, should you stop taking them?

Dr. Pulcini said phenylephrine has not shown to be harmful, it’s just not any more helpful than a placebo.

“Since it’s not helpful, it’s a waste of time and money,” he said. “But if a patient is taking it and they feel like it’s helpful and they want to keep on taking it, I would not say they have to stop.”

If you have seasonal allergies, what can you do to relieve congestion?

First, it’s best to start taking allergy medicines early, just before allergy season starts. If you usually suffer with congestion or drainage, a nasal steroid, such as Flonase, Nasonex or Nasacort, would be helpful. Taking an oral antihistamine like Zyrtec, Claritin or Allegra will help with sneezing and itchy eyes.

“If you’re using those medicines and you’re still not having improvement, or if you’re just tired of taking these medicines, then it might be time to talk to your primary care provider and decide if you need to be referred to an allergist for allergy testing.”

Immunotherapy, or allergy shots, can be used to make you less allergic.

“For a lot of patients, allergy shots really do make a big difference so they can enjoy their quality of life,” Dr. Pulcini said.