Cold Meds Deception: Popular Decongestant Doesn't Work

Many Australians use over-the-counter cold and flu medications expecting relief from nasal congestion, but a key ingredient is proving ineffective. Oral phenylephrine, widely used in these tablets to narrow nasal blood vessels, has been found by recent studies to perform no better than a placebo. This finding contradicts earlier beliefs and has led to significant scrutiny.

The widespread use of oral phenylephrine is largely a consequence of past regulatory actions. In the early 2000s, pseudoephedrine, a previously common decongestant, was frequently used in the illicit manufacture of amphetamines. To curb this, pseudoephedrine products were reclassified in Australia in 2006, making them 'pharmacist only' and much harder to obtain.

Phenylephrine was adopted as a replacement, not for superior efficacy, but due to lower misuse potential. However, accumulating research, including a 2023 review by a US FDA advisory committee, indicates oral phenylephrine is ineffective at standard doses. Consequently, the FDA proposed removing it from over-the-counter products in November 2024. Australia's Therapeutic Goods Administration (TGA) is aware and monitoring international reviews, though it has no immediate plans to review phenylephrine's effectiveness.

The primary concern is not safety, but consumer spending on products that offer minimal relief for nasal congestion. Any perceived benefit is likely from other ingredients like paracetamol or ibuprofen. For genuine relief, short-term use of phenylephrine nasal sprays or saline rinses are recommended, along with rest and hydration for viral infections.