A committee that advises the US Food and Drug Administration found in September that a popular decongesting ingredient — phenylephrine — doesn’t actually work at decongesting or “unstuffing” your nose when it’s taken orally.
There are no safety issues with phenylephrine, and the FDA itself still hasn’t yet issued new rules on the ingredient or how it’s sold. It’s included in many popular medications like some NyQuil, Mucinex and more name- and store-brand kinds of oral medications, though of them contain other ingredients besides phenylephrine that may ease symptoms.
Ahead of official agency action, CVS last month pulled a “small number” of medications that contain phenylephrine as the only active ingredient (think Sudafed PE). The company said it “will continue offering many other oral cough and cold products to meet consumer needs.”
Many people use over-the-counter decongestants for milder symptoms of a virus or to treat their seasonal allergies. This makes them an easy first-line treatment. And according to Dr. Geoffrey Rutledge, chief medical officer and co-founder of the telemedicine site HealthTap, having choices when you’re feeling miserable can be one of the most important parts of treatment.
But you don’t have to settle for one option.
“As a physician in practice, I have never recommended patients use phenylephrine products,” he said. Instead, he directs them behind the counter for a more effective decongestant, pseudoephedrine, or to other medications if the source of congestion is allergies.
Medications that contain phenylephrine often contain other active ingredients, don’t throw away your meds just yet. Here’s what you should know about finding a decongestant heading into cold, flu and virus season.
What is phenylephrine?
Phenylephrine is a decongestant that works by restricting the blood vessels in your nose. It’s found in common medications like Sudafed PE (not regular Sudafed), Theraflu, Tylenol Sinus, Advil Congestion, NyQuil Severe Cold and Flu products and more. These are medications that don’t require a prescription, are easily available on store shelves and are typically meant to treat other symptoms of cold or flu in addition to congestion.
Phenylephrine’s more effective cousin: pseudoephedrine
There’s another oral decongestant that works similarly, pseudoephedrine, and research has shown for a while that it’s more effective than phenylephrine, according to Dr. Stacia Woodcock, a pharmacist and pharmacy editor at GoodRx.
“The idea that phenylephrine doesn’t work isn’t a new one for most health care professionals,” Woodcock said in an email. “Pseudoephedrine (Sudafed) has clearly been the superior decongestant for quite some time.”
Pseudoephedrine, however, faces more restrictions because it’s also a main ingredient used to make methamphetamine. This means that while phenylephrine-containing Sudafed PE is available on store shelves, you probably have to ask a pharmacist and show ID to purchase regular Sudafed, which contains pseudoephedrine. There are also limits on how much you can buy at once. (Other names for pseudoephedrine medication include 12 Hour Cold Maximum Strength.)
As a result of the restrictions on pseudoephedrine, “most cough and cold medication manufacturers turned to phenylephrine to replace pseudoephedrine in their OTC products,” Woodcock said. “This allowed people to purchase them when the pharmacy is closed, if they’d reached their monthly limit on pseudoephedrine products, or if they didn’t have the necessary ID to purchase it.”
While pseudoephedrine is considered safe for most adults when taken as directed, it also works by constricting blood vessels and acts more like a stimulant. This means it’s a good idea to talk to your doctor before taking a decongestant (especially pseudoephedrine) if you have certain health conditions like high blood pressure, a heart problem, glaucoma, diabetes or if you’re pregnant or breastfeeding. A certain type of antidepressant, monoamine oxidase inhibitors (MAOIs), may also interact with pseudoephedrine and phenylephrine.
Read more: What to Know About the New COVID Vaccines This Fall
