Woman on a couch with tissue and nasal spray.


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Listen to your body when choosing cold, sinus meds this winter, UMMC experts say

Published on Sunday, October 1, 2023

By: Danny Barrett Jr. dlbarrett@umc.edu

Choosing the right decongestant could be more complicated this winter in light of statements last month by a federal advisory panel, but experts say knowing your own body is still the best medicine for cold season.

Phenylephrine, a decongestant found in a variety of popular over-the-counter cold and sinus medications, was deemed largely ineffective in oral form in September by a Food and Drug Administration advisory committee.

FDA must now decide whether to pull the products from store shelves or recommend they be re-labeled to reflect the limited effectiveness of the oral version of the drug. The agency has not said when a decision will be reached.

The list of OTC meds containing phenylephrine includes Mucinex Sinus-Max, Theraflu, Vicks Nyquil, Sinex and Benadryl Allergy Plus Congestion. The drug works to relieve congestion by easing swelling in the blood vessels in nasal passages.

Portrait of Gailen Marshall

Dr. Gailen Marshall, the R. Faser Triplett Sr. MD Chair in Allergy and Immunology at UMMC, said patients have to consider how they might respond to alternatives such as pseudoephedrine if they want to stick to pills. Otherwise, he said, nasal sprays hit the target more effectively if used properly.

“When you take the oral version, it has to march around the body to get to blood vessels in the nose that are necessary to open so you can breathe,” Marshall said. “Only about 1 percent of the dose makes its way to the nose, and that’s an insufficient amount for most individuals.

“The reason the kind of phenylephrine that comes in a pill is lacking effectiveness is its concentration and rate of absorption in the body,” Marshall said. “It’s not that it doesn’t work at all – it works just fine in nasal sprays. The amount drug makers can put in the pill has to regulated so it doesn’t create negative side effects, such as heightened blood pressure, nervousness, sleeplessness and more.”

Ideally, symptoms will generally be relieved within 3-5 days if sprays containing the phenylephrine are used as directed, he said. Those directions typically direct patients to allow for 12 to 18 hours between uses. The results are even better if patients are able to handle taking corticosteroid nasal sprays for occasional congestion without over-using the phenylephrine, which can cause rebound congestion.

“What we’ve found is the steroid nasal sprays can allow people to use decongestant nasal sprays for a longer period of time without any kind of rebound congestion,” he said, adding patients using sprays should spray it up into the nose while keeping the head more or less level. Users should also resist the urge to sniff too deeply while using it, as this doesn’t allow the spray to effectively get to swollen vessels without being swallowed, he said.

A third common decongestant, oxymetazoline, is found in Afrin and Zicam nasal sprays and is generally effective, with the same warnings in place against over-use.

In 2006, phenylephrine became the primary decongestant in most OTC cold and sinus meds when pseudoephedrine, found in regular Sudafed, went behind the counter and its quantities limited due to it being a key ingredient in making crystal methamphetamine. In Mississippi, as in all states, people must show proper identification before purchasing Sudafed and quantities are limited.

The systemic side effects Marshall notes for oral phenylephrine are also associated with pseudoephedrine, which could become more in demand this winter despite current federal limits if the FDA acts swiftly on products containing phenylephrine. He predicted there could be a “run” on both major decongestants even if the agency opts to simply relabel certain medications.

“The people who still like pseudoephedrine can still get it,” he said. “It’s just that they can’t buy a year’s supply at one time.”

For children, options are limited during the first two years of life but grow gradually as a child’s immune system develops. The FDA recommends no children under two should be given decongestants due to a seriously high risk of side effects.

Coughs in children older than 1 can be alleviated safely with small doses of honey and with the use of a bulb syringe to remove mucus manually from a baby’s mouth and nose.

Portrait of Jessica Perkins

“One teaspoon of honey can be effective relieving cough,” said Dr. Jessica Perkins, associate professor of pediatrics and medicine and program director for the Allergy and Immunology Fellowship Program.

When they become toddlers, children can be given carefully measured doses of liquid antihistamines such as cetirizine (Zyrtec) to dry up a runny nose and relieve congestion, Perkins said. “For older children not at risk for choking, parents may start moving on to using throat lozenges and chest rubs such as Vicks to relieve a cough as well,” she said.

Some teens can consider taking adult decongestants such as pseudoephedrine, but experts stress caution and using as directed at all times.

Anza Stanley

“With supporting illness, we recommend plenty of fluids, nasal saline spray, cool mist humidifiers and honey for cough if anywhere above the age of a year old,” said Dr. Anza Stanley, associate professor of pediatrics and medical director at Batson Kids Clinic.

Age is only part of the reason people might find they or their children catch colds or have sinus infections this time of year, Marshall said. But regardless of age, parents and children alike can always find the best relief from cold season by their primary care providers.

"There’s parts of your face that change over time, especially in the nose,” Marshall said. “The size and shape of your nose changes over time. It gets bigger, both outside and inside, plus your ears have gotten a little bit bigger. These are consequences of aging. As we get older, our bodies metabolize differently. And the reasons we get congested change. If the reasons change, the responses in medications change.

“If someone doesn’t get satisfactory relief from over-the-counter remedies, then it’s time to reach out to a health care provider and find out why. A person can find out the causes of perhaps being congested too often during the prime periods of the year for it, plus which medication and delivery method might be best for them.”

To see a specialist on any sinus/allergy concerns, call (888) 815-2005.

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