Holy Name doctor breaks down why decongestants don’t work well — and what to do instead

FDA announces this week that phenylephrine, leading drug in over-the-counter-medication, is largely ineffective

It’s nice to know after all these years that, when it comes to nasal congestion, it’s not me … it’s the drug.

Like so many others, I’m prone to debilitating sinus congestion/headaches a handful of times a year. Earlier this week, the Food and Drug Administration acknowledged what so many of us have thought for years: Phenylephrine, the active ingredient in so many over-the-counter cold and allergy medications (think Sudafed), doesn’t actually work.

In a unanimous vote, an FDA advisory panel said specifically declared oral formulations of phenylephrine are ineffective.

The announcement certainly will disrupt a nearly $2 billion-a-year industry.

Dr. David Shaker, an internal medicine physician with Holy Name, explained the conclusion.

“This class of medication is now found to be only mildly effective,” he said.

One of the biggest reasons? Overuse.

“Patients frequently overused them, which caused them to lose their effect over time,” he said.

The key, Shaker said, is not to run to the medicine chest every time you feel sinus pressure. There are alternatives.

“It is not appropriate to treat every small bout of congestion with such a strong medication,” he said. “Saline rinses have proven to be far more effective when patients can tolerate them. Patients who have repeat congestion and sinus infections should be evaluated for a source as well as an underlying diagnosis, rather than self-treating with this class of medication.”

Phenylephrine was thought to relieve congestion by reducing the swelling of blood vessels in the nasal passages.

The panel’s vote came after the FDA found that, when phenylephrine is taken orally, only a small amount of the drug actually reaches the nose to relieve congestion.

Shaker said “stronger” medicine may not be the answer, either.

“Turning to antibiotics is also a common approach, but often does not lead to therapeutic outcomes when compared to supportive measures,” he said. “And steroids are a common and effective medication for treating sinus congestion, allergies, bronchial, airway issues and sinus headaches, but they also have their fair share of side effects.”

What to do?

For me, it will be the tried-and-true method of using the steam from a boiling pot of apple cider vinegar. Sometimes, the home remedies work best. It’s nice to know the FDA agrees.