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Stuffy Nose? This OTC Decongestant Doesn't Work

Find out what OTC medicine to skip when you have a cold—and what to do instead.

When it’s bad enough, a stuffy nose can send you scrambling to the drugstore, scouring the shelves for a decongestant. And while many over-the-counter (OTC) decongestants market themselves as offering temporary relief, researchers say that one OTC decongestant in particular—oral phenylephrine—doesn't work at all. 

For one 2015 study in The Journal of Allergy and Clinical Immunology: In Practice, scientists enlisted 539 adults to try the medicine. Some participants received a 10 mg immediate-release tablet of oral phenylephrine in fixed dosages ranging from 10 mg to 40 mg, taken every four hours. Other study participants took a placebo. The researchers concluded that none of the Federal Drug Administration (FDA)-approved dosages were better than a placebo for clearing clogged nasal passages. 

This wasn’t the first time the drug had come up short in studies. “Two trials in 2009 had the same result,” says Keith Roach, MD, an Associate Professor in Clinical Medicine in the division of general medicine at Weill Cornell Medical College and New York Presbyterian Hospital. “It’s not a good drug.” 

What is oral phenylephrine? 
Phenylephrine was intended to be a replacement for pseudoephedrine, an OTC decongestant often used in the illegal production of methamphetamine. But due to these findings, some groups have asked the FDA to remove oral phenylephrine from the market. 

“The drug companies say taking this medicine will make you feel better,” says Dr. Roach. “But you can feel better taking a placebo without the risk of serious side effects. I can give you a sugar pill with nothing in it and for some people, it works.” 

Possible side effects of phenylephrine include "acute urinary retention, meaning you can’t pee even though your bladder is full,” says Roach. This can especially be a problem for older men with enlarged prostates. “You could end up in the ER needing a tube in your bladder,” he adds. 

It can also raise your heart rate and blood pressure as well as make you jittery, says Roach, “and in some people this can be quite pronounced.” 

How to help prevent and treat a stuffy nose 
Prevention is key to avoiding congestion and other cold and flu symptoms. Your first line of defense? Get your flu shot, says Roach. You can also: 

  • Practice good hygiene. Wash your hands frequently. 
  • Avoid touching your mouth, nose and eyes. These are a prime germ entry points. 
  • Get enough sleep. Skimping on your ZZZ's can weaken your immune system. 
  • Manage stress. When you’re stressed-out, your body releases more of the hormone cortisol, which suppresses the immune system and makes it harder for your body to fend off infection. 
  • Eat healthy foods and exercise. 
  • If possible, avoid being around people who are sick. 

If you do pick up a bug, read labels carefully before choosing an OTC medicine for your stuffy nose. Roach recommends choosing products that contain the decongestant pseudoephedrine—you’ll need to buy it at the pharmacy counter and provide your contact information—and loratadine, an antihistamine. Guaifenesin may also work to thin the mucus and help you breathe easier; some allergists put patients on it year-round as it has few drug interactions or side effects. Nasal steroids can be temporarily helpful, too. 

Another medication Roach recommends is montelukast. But you won’t find it on drugstore shelves. “You’ll need a prescription,” he says. Prescription nasal antihistamines can help, as well, if you're suffering and looking for a non-systemic (whole-body) solution. 

Whichever you choose, each medication can be effective in helping you breathe easier.  

Medically reviewed in August 2019. Updated in March 2021. 

Sources: 

Meltzer EO, Ratner PH, McGraw T. “Oral Phenylephrine HCl for Nasal Congestion in Seasonal Allergic Rhinitis: A Randomized, Open-label, Placebo-controlled Study.” The Journal of Allergy and Clinical Immunology: In Practice. Volume 3, Issue 5, September–October 2015, Pages 702-708.  
Hatton RC, et al. “Over-the-Counter Oral Phenylephrine: A Placebo for Nasal Congestion.” The Journal of Allergy and Clinical Immunology: In Practice, Volume 3, Issue 5, 709 – 710. 
Day JH, et al. “Efficacy of loratadine-montelukast on nasal congestion in patients with seasonal allergic rhinitis in an environmental exposure unit.” Annals of Allergy, Asthma & Immunology, Volume 102, Issue 4, 328 – 338. 
National Institute of Diabetes and Digestive and Kidney Diseases. “Urinary Retention.” 
Drugs.com. "Guaifenesin." 

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