It's the season of stuffy noses and achy heads, a time when many people dash to their local drugstores in search of relief. But some people say the oral decongestant phenylephrine—which has recently replaced pseudoephedrine in many over-the-counter products—doesn't do a good job of unclogging their noses at the current 10-milligram dose. Still, while the Food and Drug Administration hasn't sanctioned a higher dose, there are other options if phenylephrine doesn't work for you.
A 2006 federal law requires that anyone purchasing pseudoephedrine, which can be used to make methamphetamines, show ID. Since then, doctors report hearing increasing complaints from patients, who say that they have trouble finding medications containing pseudoephedrine.
Pramod Kelkar, a Minneapolis allergist in private practice, says that some of his patients contend that phenylephrine is less effective than pseudoephedrine. "Some patients feel like it doesn't work at all," he says. Such claims, submitted to the FDA in February in the form of a citizens' petition, led the agency to consider the complaint that phenylephrine was ineffective at the 10-mg dosage used in most over-the-counter medications. The FDA panel, in an 11-to-1 vote, decided last Friday that available research supports the current 10-mg dose for adults and called for research into the safety and effectiveness of a 25-mg dose.
But Step No. 1, before taking any over-the-counter decongestant, is to evaluate the likely cause of your stuffiness, advises Richard Rosenfeld, professor and chairman of otolaryngology at Long Island College Hospital in Brooklyn, N.Y.
Your nose "doesn't just swell up [inside] for no reason," Rosenfeld says. "It's important to understand why your nose" is stuffy. Sinusitis, for instance, may require an antibiotic, which means getting a prescription. Allergies may respond to an antihistamine. And structural problems, like a deviated septum, may require surgery. For persistent congestion, it's usually best to see your doctor, he says.
Once you've determined the cause of your stuffiness, here are some options—other than oral phenylephrine—for unclogging your nose: