JACKSON, Miss. (WJTV) – UMMC officials acknowledge that choosing the best decongestant may be difficult this year, especially after the FDA said many oral medicines containing phenylephrine aren’t very effective.
The list of over-the-counter medications containing phenylephrine includes Mucinex Sinus-Max, Theraflu, Vicks Nyquil, Sinex and Benadryl Allergy Plus Congestion. The drug works to relieve congestion by easing swelling in the blood vessels in nasal passages.
Dr. Gailen Marshall is the R. Faser Triplett Sr. MD Chair in Allergy and Immunology at UMMC. According to Marshall, nasal sprays with phenylephrine are effective. But the decongestant’s effectiveness drastically reduces in drugs consumed orally.
“When you take the oral version, it has to march around the body to get to blood vessels in the nose that are necessary to open so you can breathe,” Marshall said in a UMMC press release. “Only about 1 percent of the dose makes its way to the nose, and that’s an insufficient amount for most individuals.”
Marshall said in a press release that patients have to consider how they might respond to alternatives such as pseudoephedrine if they want to stick to pills.
A third common decongestant, oxymetazoline, is found in Afrin and Zicam nasal sprays and is generally effective, with the same warnings in place against over-use.
In 2006, phenylephrine became the primary decongestant in most OTC cold and sinus meds when pseudoephedrine, found in regular Sudafed, went behind the counter and its quantities restricted due to it being a key ingredient in making crystal methamphetamine. In Mississippi, as in all states, people must show proper identification before purchasing Sudafed and quantities are limited.
The systemic side effects Marshall noted for oral phenylephrine are also associated with pseudoephedrine, which could become more in demand this winter despite current federal limits if the FDA acts swiftly on products containing phenylephrine. He predicted there could be a “run” on both major decongestants even if the agency opts to simply relabel certain medications.
“The people who still like pseudoephedrine can still get it,” Marshall said. “It’s just that they can’t buy a year’s supply at one time.”
For children, options are limited during the first two years of life but grow gradually as a child’s immune system develops. The FDA recommends no children under two should be given decongestants due to a seriously high risk of side effects.
Coughs in children older than one years old can be alleviated safely with small doses of honey and with the use of a bulb syringe, mucus can be removed manually from a baby’s mouth and nose.
Some teens can consider taking adult decongestants such as pseudoephedrine, but experts stress caution and using as directed at all times.
Regardless of age, Marshall recommends that adults and children alike find the best relief from the cold season from their primary care provider.
“There’s parts of your face that change over time, especially in the nose,” Marshall said. “The size and shape of your nose changes over time. It gets bigger, both outside and inside, plus your ears have gotten a little bit bigger. These are consequences of aging. As we get older, our bodies metabolize differently. And the reasons we get congested change. If the reasons change, the responses in medications change.”