Phenylephrine Is No More Effective Than Placebo for Nasal Congestion

Summary and Comment |
September 17, 2015

Phenylephrine Is No More Effective Than Placebo for Nasal Congestion

  1. David J. Amrol, MD

Results were the same for four different drug doses of phenylephrine.

  1. David J. Amrol, MD

For most patients with allergic rhinitis, nasal congestion is the most bothersome symptom. Oral pseudoephedrine is effective for nasal congestion, but federal laws have limited its availability because of its use in methamphetamine production. Phenylephrine, another over-the-counter oral decongestant, is more readily available, but data on its efficacy are limited. In this open-label trial, U.S. investigators randomized 539 adults with allergic rhinitis to phenylephrine (10, 20, 30, or 40 mg) or placebo for 7 days.

Daily nasal congestion scores did not change significantly from baseline in the active-treatment groups or in the placebo group. A total of 14% of phenylephrine patients experienced adverse nervous system or gastrointestinal events such as nausea or headache, whereas 5% of placebo patients experienced such events; one participant in the 40-mg phenylephrine group reported serious adverse events of chest and lower jaw pain, which resolved after the drug was stopped.

Comment

Patients frequently ask me which medicine is best for nasal congestion. Nasal steroids are the most effective medications for all allergic rhinitis symptoms, including nasal congestion, but their peak efficacy might take 2 weeks to achieve. For patients who need short-term congestion relief, the best options are over-the-counter nasal oxymetazoline (e.g., Afrin) and oral pseudoephedrine (e.g., Sudafed). Insomnia, urinary retention, and possible adverse cardiovascular effects should be discussed before using pseudoephedrine, and oxymetazoline should be used for only 3 to 4 days because of potential rebound congestion (rebound is mitigated by concomitant daily use of a nasal steroid). Oral phenylephrine should not be recommended for allergic rhinitis. In addition, little evidence supports its use in alleviating common cold symptoms, so, until we have data supporting its effectiveness, I would not recommend it for any nasal congestion.

Editor Disclosures at Time of Publication

  • Disclosures for David J. Amrol, MD at time of publication Equity Abbott; AbbieVie; Express Scripts; Johnson and Johnson; Novartis; Pfizer; United Health Leadership positions in professional societies Allergy Society of South Carolina (Past President)

Citation(s):

Reader Comments (2)

Young Kim Physician, Emergency Medicine

Study states Sudafed help with nasal congestion in allergic rhinitis.
You comment that Sudafed is useful for short term relief for nasal congestion. However you do not recommend it's use for allergic rhinitis or cold symptoms. In which diagnosis with nasal congestion would you use Sudafed?

Yazdan Asadi Physician, Family Medicine/General Practice

It was a very useful and amazing article, thank you.

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