How Two Pharmacists Figured Out That Decongestants Don't Work
How Two Pharmacists Figured Out That Decongestants Don't Work
A loophole in FDA processes means older drugs like the ones in oral decongestants weren’t properly tested. Here’s how we learned the most popular one doesn’t work
Good for them, I guess, but those of us with frequent respiratory infections knew that phenylephrine is useless for at least a decade by now.
5Is this in addition to rebound congestion or aside from it?
2Not to doubt Scientific American, but phenylephrine works. It's the only thing that clears my sinuses when they get blocked. They're talking about it not being a nasal decongestent, but I don't think it's suppossed to be?
-8There's no good evidence phenylephrine works for clearing up your nasal passages, at least at the doses sold over the counter. Nasal decongestant is what it's labeled to be sold as, you're referring to the same idea just with different words. Study after study has failed to show any difference between phenylephrine and placebo. In most studies both groups report getting somewhat better, there's just no difference to placebo. Suggesting improvements are just due to some combination of time and placebo effect.
https://pubmed.ncbi.nlm.nih.gov/26143019/
That's just one but there's many others.
Pseudophedrine on the other hand has been shown to be superior to placebo many times (again just one source below, but there are others):
https://pubmed.ncbi.nlm.nih.gov/15794071/
That one is still available. It's just kept behind the counter because of concerns it could be used in the manufacture of meth.
27I've not personally seen it sold as a nasal decongestant. It's in my sinus meds. But saying it doesn't work is false, it doesn't work for a very specific use. It actually has quite a few uses beyond congestion.
The study you quote is into it's use in "Nasal Congestion in Seasonal Allergic Rhinitis" which is even more specific than the article is.
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The oral absorption of phenylephrine is erratic. Perhaps that is why it was not used as an oral decongestant until it was the only choice. It had long been known that enzymes in the gut lining metabolized oral phenylephrine to inactive metabolites, reducing the amount of the active compound that could enter the bloodstream.
The most cited study found that an oral dose of phenylephrine had an absorption rate of 38 percent of an oral dose of phenylephrine, but this study measured more than just the compound's active form. Later studies with more sensitive tests found that less than 1 percent of oral phenylephrine enters the bloodstream in an active form.
You stand alone against many pharmacist who study the medicine, research scientists who test the medicine, and pharmaceutical labs that make the medicine. The only people who want to continue making phenylephrine are those who make hundreds of millions in the misconception it will help you. That's stealing, even if no one gets hurt.
You are probably very sensitive to phenylephrine so it works with those very small amounts. Everyone else is not you. You are lucky to find a solution on the shelf right now. Overwhelmingly we others cannot. It is this very limited helpfulness that has caused phenylephrine to lose its GRASE status (Generally Recognized as Safe & Effective) since it is safe but not broadly effective.
12I think you're confused. The people quoted here say it does not work in one very specific use which as far as I can see it isn't marketed for in most countries. Doesn't appear to be in mine.
This publication has written a pop science headline claiming it doesn't work at all.
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