The best way to unclog a stuffy nose

Now that common decongestants have been found to be ineffective, where can we turn when our noses and lungs fill?

Last fall, an FDA advisory committee announced that the ingredient phenylephrine, a common decongestant found in popular medications, like Sudafed PE, Tylenol Cold & Flu Severe, Nyquil Severe Cold & Flu, Dayquil and some 250 other medications, doesn’t actually work to relieve congestion. Even though the medications are not considered unsafe, the group concluded that the oral versions of the medications are broken down in the gut and the active ingredient never actually reaches the nose.

Pharmacist Maria Michaud, RPh, who works at the Specialty/Retail Pharmacy at Cape Cod Hospital, agrees with that analysis. She has never recommended products like Sudafed PE with phenylephrine. 

“We’ve known for years that phenylephrine doesn’t really work as a decongestant,” she said.

Part of the reason for the popularity of medications that contain phenylephrine is that they are available on the shelf, so they were more accessible to people than medications that contain pseudoephedrine, the active ingredient in Sudafed, Michaud said. Products with that ingredient were pulled off the retail shelves in 2005 and can only be sold behind the pharmacy counter, because they were being used in the manufacture of methamphetamines.

Alternatives for Relief

With cold and flu season almost here, Michaud offered several suggestions for people looking for relief from congestion. “There are many other products available,” she said. Here are a few she recommends:

• Mucinex – is an expectorant that loosens phlegm and can help break up congestion.
• Afrin - is a decongestant nasal spray used every 12 hours for a maximum of 3 days. Longer use may cause rebound congestion. It works locally to relieve congestion in the nose and can be used in patients with high blood pressure.
• Flonase or Nasacort – are steroidal nasal sprays that are now over the counter.
• Sudafed - is an effective decongestant available behind the pharmacy counter. It is not recommended for patients with certain conditions such as high blood pressure, thyroid disease or 3rd trimester in pregnancy. Sudafed does have some side effects such as restlessness, dry mouth, and difficulty sleeping.

A few non-pharmaceutical remedies Michaud suggests are:

• Humidifiers as the moisture helps clear nasal passages, Michaud said.
• Saline nasal sprays also help with moisture.
• Neti pots are very helpful for those who can use them. One caution with neti pots is that you have to use distilled water, since tap water is not considered safe.

Michaud usually advises people to avoid combination products. They may have ingredients that are not necessary or may be duplicated with other medications the patient may be taking. “You really should just treat the symptoms you have,” she said.

Most people do not need to see their doctor for a cold, but if symptoms linger for longer than seven to 10 days, Michaud recommends making an appointment. It may be something other than a cold such as a sinus infection.