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:
- Consider nasal washings. A November study published in Archives of Otolaryngology—Head & Neck Surgery found that saline irrigation was more effective than saline spray for a group of patients with chronic nasal and sinus symptoms. "But many people who have colds [also] find it soothing," Rosenfeld says. "The basic principle is you need to irrigate, not just moisturize." Several nasal rinse kits are available on store shelves, or you can create a homemade kit: Squeeze about 4 to 8 ounces of saltwater into your nose "until there is no more mucous or cloudy material coming out," Rosenfeld suggests.
- Seek out pseudoephedrine. Don't assume that because one store doesn't carry your favorite product that it's totally unavailable. Try other stores to see if they carry the medication you want... And don't let having to show ID scare you away.
- Try a nasal spray, but don't use an over-the-counter decongestant spray for longer than 3 days. Overuse can create a rebound effect of narrowing and constricting the blood vessels of your nose, according to the Mayo Clinic. Prescription nasal sprays are also an option, if your doctor thinks they'll ease your congestion. Steroid sprays, such as Flonase and Nasonex, work by reducing swelling in the nose.
- Ask your doctor for a prescription oral decongestant. If your congestion is due to more than a simple cold—perhaps you're experiencing a nasty bout of sinusitis—it's reasonable to ask for a prescription oral decongestant, particularly if phenylephrine doesn't work for you and you're having trouble finding over-the-counter pseudoephedrine. "If a patient's condition warrants it...I would be happy to prescribe it," says Kelkar.
- Inhale steam. Sitting in front of a cool mist humidifier or using personal steam inhalation devices may loosen up congestion, Rosenfeld says.