TTUHSC doctor talks alternatives after FDA panel says some nasal decongestants don’t work

Published: Sep. 13, 2023 at 11:33 PM CDT
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LUBBOCK, Texas (KCBD) - An FDA advisory committee has confirmed what some may already believe, some over-the-counter decongestants don’t work. The advisory panel said in a unanimous vote Tuesday, oral versions of phenylephrine work no better to clear congestion than a placebo.

Back in 2006, cold medications with pseudoephedrine were moved behind pharmacy counters because criminals could use the drug to create methamphetamine. Phenylephrine took its place on store shelves, found in common medicines like Sudafed, Dayquil and Mucinex.

“Unfortunately everybody with nasal congestion, allergies, have all suffered because of that problem. And we’ve been left with things that are similar but don’t tend to be as effective head-to-head,” Dr. Rodney Young said.

Dr. Young is the regional chair of Family and Community Medicine for the Texas Tech Health Sciences Center School of Medicine, working on the Amarillo campus. He says he wasn’t surprised by the panel’s vote.

“They’re saying phenylephrine doesn’t work and most people that have been using phenylephrine for a long time are nodding their heads in agreement, you’re right, it doesn’t. So, this just takes us back to all the other things we need to be trying to help those folks,” Dr. Young said.

While some may have already suspected its ineffectiveness, FDA data shows Americans bought about $1.8 billion worth of drugs containing phenylephrine last year.

Dr. Young says there is good news though.

“There’s still quite a few tools you can use that are maybe just different than the easy ones you’re used to with phenylephrine,” he said.

To help with seasonal allergies, Dr. Young says nasal steroid sprays like Flonase can help over the course of a week or two. Oral antihistamine pills can also provide relief.

Inexpensive saline rinses can help keep allergens out. For severe congestion, a nasal saline lavage, like a Neti pot, can help flush out sinuses.

Dr. Young nasal sprays like Afrin can sometimes be useful, but he has a warning - only use it for the time frame on the label. If that use goes longer, he says it can become habitual, and cause problems when it’s not there.

“Those are some of the most miserable people we find in terms of nasal congestion symptoms, because they get habituated to it and they literally have to have Afrin all the time to feel like a normal person. And then eventually, even that doesn’t work anymore and it’s not easy to undo that problem,” Dr. Young said.

While not every type of medicine works on everyone, Dr. Young says it’s critical medicines be tested for efficacy.

“It’s important to know that what we say will work will indeed work, on at least a large percentage of the population,” he said.

This isn’t the first time this recommendation has been made to the FDA. Now it will have to decide whether phenylephrine is safe and effective. If not, it will likely be pulled from the market.