Alternative Decongestants: FDA trashes phenylephrine oral products
Let's look at what else is effective
Phenylephrine is a mild sympathomimetic - a selective alpha1-adrenergic receptor agonist with minimal to no beta-adrenergic activity. It constricts both arteries and veins.
University of Florida researchers petitioned the FDA to remove most oral phenylephrine products based on their studies showing the products failed to outperform placebo pills to reduce congestion. Using a higher dose of phenylephrine is not an option because that could elevate blood pressure too high.
Phenylephrine, became the main drug in over-the-counter decongestants when medicines with pseudoephedrine were moved behind pharmacy counters. [A 2006 law forced restricted purchasing of pseudoephedrine to small amounts, preventing its use to synthesize methamphetamine.] Phenylephrine OTC versions are labeled "PE" on product packaging.
If the FDA follows the panel's recommendations, drugmakers could be required to pull their marketed oral medications containing phenylephrine. That would likely force consumers to switch back to the now behind-the-counter pseudoephedrine products. Or instead use phenylephrine-based nasal sprays and drops.
Decongestants: What to Use Instead?
Phenylephrine-based nasal sprays, drops, ointments
Nasal Spray formulations are old standbys, used for decades. However, the nasal products have problems, such as rebound congestion. Rebound congestion is tough to treat and can take up to 1 year to go away. You can avoid rebound congestion by stopping decongestant nasal sprays after 3 to 5 days.
Swollen hemorrhoidal veins can still be treated with phenylephrine ointments. Preparation H, a well known brand for generations, was often used by women to shrink their under eye ‘bags’ - now most eye creams instead use caffeine.
Natural Products
Horseradish and Wasabi: The oil responsible for the pungent taste of horseradish, wasabi and mustard is called allyl isothiocyanate, or mustard oil. It has been used for many years in traditional medicine to treat bronchitis, sinusitis, cough and the common cold. The pungent smell of this cruciferous vegetable also helps expel mucus from the upper respiratory system. When taking this root vegetable for sinus problems, it may produce excess mucus, but this is beneficial. Commonly consumed as a condiment, you can also eat it raw, pickled or cooked.
Eucalyptus: Native to Australia, there are more than 680 species of eucalyptus, ranging in size from shrubs to trees. The bark and leaves are sources for the pungent fragrance. Eucalyptus leaves are well known to relieve cold and cough. It is used in Ayurvedic medicines as a cold remedy and today it is used in many marketed OTC cold and cough products. It decreases mucus production and acts as an anti-inflammatory agent.
Eucalyptus oil is used as a fragrance in perfumes and cosmetics, and is found in mouthwashes, liniments and ointments, toothpastes, cough drops, and lozenges. As an aromatherapy remedy for respiratory symptoms, you can buy eucalyptus prepared as a tea, chest rub, or vaporizer. Cineole constitutes 60% to 80% of the eucalyptus oil. This chemical component gives eucalyptus oil most of its important therapeutic properties. Limonene constitutes about 10% of the oil. Pinene constitutes less than 10% of the oil - it is an aromatic compound also found in pine trees. Other components are phellandrene, camphor, and sabinene.
Camphor: is a chemical that used to be made by distilling the bark and wood of the camphor tree. Today, camphor is usually synthesized from turpentine oil.
Menthol: Menthol, a compound naturally found in peppermint, opens your airways to help you breathe more easily. It treats coughs too. You can find menthol in chest rubs, cough drops, and peppermint tea.
Steam
Last but not least, breathing in steam vapor is a tried and true go-to for colds, congestion, headache and cough. You can breathe it in from simmering chicken soup, a bedside vaporizer or just a bowl filled with boiled water and aromatics.
Whatever your choice, stock up and prep for the cold season ahead. And, as we head into winter, here is a reminder to keep up your indoor humidity:
REFERENCES
A popular nasal decongestant doesn't actually relieve congestion, FDA advisers say. https://www.npr.org/2023/09/12/1199159009/a-popular-nasal-decongestant-doesnt-actually-relieve-congestion-fda-advisers-say
R Link. Horseradish Root Helps Prevent Respiratory Illness, UTIs & Cancer https://draxe.com/nutrition/horseradish-root/
https://www.webmd.com/vitamins/ai/ingredientmono-709/camphor
https://www.webmd.com/cold-and-flu/ss/slideshow-natural-cough-remedies
https://sedonaaromatics.com/aromatherapy-steam-inhalation-for-coughs-colds-flu-and-sinus-problems/
Hi Laura,
Only skimmed this because it is above my paygrade, but seeing the name and photo of "Sudafed" brought back some memories and possibly a connection. Back in the mid 70's when I was a marine biology student, sudafed was commony used by scubadivers to clear conjestion before dives. On my check-out dive for my license, I had taken Sudafed (hay fever), but when I dropped to about 4 meters, I could not equalize the pressure in my sinuses. I drifted over to the anchor rop and pulled myself one painful centimeter at a time, until the pain was gone. I had equalized the pressure, or so I had thought. On coming back up from what was maybe a 30 meter dive, when I hit that same 4 meter level, I suddenly got vertigo (air expanding in the middle ear, offsetting a sense of balance), and my mask started filling with blood. I had 'balanced' the pressure going down by rupturing the blood vessels in my sinuses.
On the positive side, with what I thought was death closing in, I had one of those "near-death" experiences and literally saw my life flash before my eyes like a high speed movie trailer. That helped set me on another course of philosophy of science and then education. No regrets.
Just guessing that Sudafed's restriction of blood vessels had something to do with the rupture.
Ah ... memories. 😂