FDA says decongestant in many cold medicines doesn't work. So what does?

Summary

The FDA has proposed phasing out oral phenylephrine, a common decongestant in cold medicines like Sudafed PE and DayQuil, after studies showed it is no more effective than a placebo.

The drug, ineffective when swallowed due to breakdown in the stomach, remains usable in nasal sprays.

Alternatives include pseudoephedrine, nasal sprays, and steroid treatments like Flonase.

The regulatory process to remove phenylephrine could take over a year, but experts argue removing ineffective options will help consumers choose better remedies for congestion. Drugmakers are expected to challenge the proposal.

59 comments

Pseudoephedrine. In the US, you have to go to the pharmacy counter and ask for it, but it works.
- And it works great! I woke up with a ton of sinus pain yesterday. My whole face ached. Two pseudoephedrine and it was gone in an hour.
- The problem is that it is legally an evil drug because you can make meth from it, so it remains heavily restricted. There are more effective ways to make meth at commercial scale than by buying and crushing up cold and flu tablets, but it’s a question of moral principle, i.e. not condoning evil.
  
  This is some dumb pearl clutching bullshit.
  With this asinine logic, buying apples are condoning evil because their seeds contain cyanide and though there are more effective ways to create cyanide at commercial scale than buying apples and extracting the small amount of cyanide from the seeds it's still a question of moral principle i.e not condoning evil.
  
  They spend more money and chemistry making pseudoephedrine hard to make into meth then they do on the everything else in the medicine. It's also why meth labs tend to blow up when they didn't with with standard pseudoephedrine.
  
  It's not that hard. The only real issue is when the pharmacy is closed and you're trying to buy one a holiday or after-hours. I just keep some spare pseudoephedrine in the medicine cabinet to hold me over until the pharmacy opens.
phenylephrine is effective as a nasal spray, not in tablet or liquid (i.e. taken orally).
drug makers were all in a panic over lost sales due to pseudoephedrine getting put behind the counter. they basically lied to everyone about phenylephrine's effectiveness when they put it in all the stuff sold on retail shelves just to protect their fucking profits.
- F these soulless business associations:
  For now, the Consumer Healthcare Products Association — which represents medicine makers — wants the products to stay available, saying Americans deserve “the option to choose the products they prefer for self-care.”
  Hatton says he and his colleagues disagree: “Our position is that choosing from something that doesn’t work isn’t really a choice.”
Edit: OP is a cool guy
Hi, I'm a pharmacist
Can you please edit your post to say a common decongestant in cold medicines such as Sudafed PE? It's inaccurate to say it's in Sudafed.
Sudafed is the brand name for pseudoephedrine and it very much is effective. Phenylephrine is in the Sudafed PE which only exists because you need to use a driver's license to get Sudafed from the pharmacy in the US.
Goddamn pseudoephedrine is the best, hands down. I have allergies that routinely stuff me up and I vehemently hate fucking tweakers for trying to ruin one of the most effective over the counter drugs out there.
- PPA was better, but they banned it around 2000.
  PE pills have never worked for me, but PE nasal spray works great.
  
  PE pills have never worked for anyone
experts argue removing ineffective options will help consumers choose better remedies for congestion
Homeopathic medicine says what?
- I love this video that explains the potency of homeopathic medicine: https://youtu.be/8HslUzw35mc
Drugmakers are expected to challenge the proposal.
But has anyone thought about the corporations?
- Yeah, that one guy did.
The stuff that they restricted.
This stuff is a miracle here in the UK:
First time I tried the Micromist nasal spray I was 100% blocked up and had no expectations of it working. After a couple of minutes my nose was completely unblocked.
I still use it now and then as my nostrils alternate being blocked and some days I just can't put up with it or struggle to sleep. But you have to take long breaks from using it as you get "blowback" where symptoms come back hard if you use it for too long and then stop.
- This is sold as Afrin in the US. Can confirm it works amazingly well. Can also confirm that long term use (more than a few days) will mess you up pretty badly due to rebound congestion.
  
  Yeah I know people essentially addicted to affrin because of that rebound congestion. Its best used only when absolutely necessary
- Oxymetazoline reduces congestion in seconds, but causes terrible rebound congestion.
  Phenylephrine doesn't work when taken orally, but it is extremely effective nasally, with far less rebound congestion than oxymetazoline nasal sprays.
Just stay home when you are sick. being miserable in bed stops the spread.
- My work won't allow it. I'm just getting over a horrible sickness after I spread it to everyone at work. Boss didn't come in for a week, but we had to be there. There needs to be laws.
- You know that you can stay home and take a decongestant.
- This, but if you can't sleep then its a good idea to take something. Your body can't heal if you can't sleep.
Phenylephrine sucks via the oral route, but it works pretty damn good via the nasal route. In my experience, phenylephrine nasal sprays (4-Way and generics) work as well as oxymetazoline sprays, with much less rebound congestion.
Phenylpropanolamine worked better than pseudoephedrine, but slightly increased the risk of stroke, so it had to be banned entirely.
- But that nasal decongestant fucks up your nasal mucosa, leading to worse swelling and congestion over time.
  
  Just for clarity, because I am not 100% certain I am grokking your comment properly:
  In my experience, your comment is true of oxymetazoline nasal sprays.
  In my experience, your comment is not true of phenylephrine nasal sprays.
  By that, I mean I, personally, have never experienced difficulty weaning myself off of generic PE nasal sprays; I have experienced such difficulties with oxymetazoline.
  That being said, I can't rule out the possibility or severity of rebound congestion from any decongestant, including both nasal sprays and pills.
How about you do something about all of the fucking scams then
There's another ingredient in Sudafed that does a pretty damn good job of unblocking your nose, let me tell you
- Yeah, the Pseudoephedrine does what it says it does, I was using Tylenol cold/Flu (daytime meds have that on it) years ago when I came down with something nasty, made me not feel like death. It's an amphetamine so those on stim meds (like myself since then) should talk to your pharmacist first, mixing stims isn't a great idea.
Meth
Drixoral!
~~Try DXM~~
- DXM is a cough suppressant
  
  Damn, my bad
  
  It is also an SNRI and a dissociative hallucinogen. It might not make it easier to breath through your nose, but it can put a bit of a fog over the part of your brain that cares about such things.
Stop being such a wet cat

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