Why useless decongestants are still for sale

Phenylephrine doesn’t work better than a placebo. So why is it still on shelves?

If you’ve taken an over-the-counter decongestant in the past 20 years, you’ve probably taken something with phenylephrine as the main active ingredient. A Food and Drug Administration panel recently recommended that it be taken off shelves because it doesn’t work any better than a placebo. What happened?

In the above video, Vox’s Phil Edwards chronicles the history of the FDA’s regulation of over-the-counter medicines. That process is the reason that, despite decades of evidence that phenylephrine doesn’t work (especially in typical OTC doses), it’s remained an option for consumers.

Watch the above video to learn more.

Further reading:

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[Dalroth]

As somebody who's suffered from allergies my whole life, I've been able to tell you for decades that phenylephrine was worthless.

[YoungGandalf]

The "PE" stands for Placebo Effect.

[eagz]

If it's proven to be ineffective, and has been, wouldn't this be a clear case of false advertising or even fraud and open itself up to legal action from consumers?

[MIshthra]

It felt like an open secret most people just didn't bother to hear. Since 2005 I've advised anyone I knew was sick to go "get the real medicine" behind the counter.

[cathrinewhite]

They demonized pseudoephedrine 20 years ago because of meth. But it really is the only thing that works on colds and flu. So when I get sick, I trudge in to the only pharmacy in my town that sells generic Sudafed. I give them my drivers license and am on a law enforcement reporting list every time I need it. It's a pain, but it's the only med that works!🤷‍♀️x

[arothmanmusic]

My doctors have been telling me for years not to bother with phenylephrine, and I could tell from personal experience that it did eff all, but I had always assumed it simply worked for some people but not me. Learning that it was actually never good for anyone, period, is astonishing.

[dphunk]

I've been an Urgent Care PA for several years now and was so glad when I saw this news break recently. Providers who are up to date with the literature have known for a long time that PE was useless. And then patients come in thinking they have something really bad going on because it doesn't help. These companies have always known PE didn't work and should be held accountable

[theprecipiceofreason]

It is a weird thing that only people who were alive during that particular meth epidemic are aware that you have to go behind the counter for the effective medicine.

[cravinsomeraven]

I’m sick and have been taking an off-brand of Sudafed PE the last day or two…and noticed my congestion wasn’t changing so switched to a different med. I thought it was just me. It all makes sense now!
Medications that don’t work shouldn’t be on the market. The American public puts their trust into these agencies…how disappointing.

[jimbrentar]

i remember when i suffered from chronic congestion. i remember driving to three stores who didn't have anyone on duty at the time to unlock the sudafed case. because of the moronic nature of the war on drugs, it was much easier to get a hold of meth than sudafed

[randyhatton]

Although ORAL phenylephrine does not work, phenylephrine nasal spray is an effective decongestant when used short-term for a cold. A better alternative, however, is oxymetazoline (e.g., Afrin) decongestant nasal spray, which works longer than phenylephrine nasal spray for a cold. Remember, only use these for a few days to avoid rebound congestion associated with chronic use. OTC topical nasal corticosteroid sprays (e.g., Flonase) are remarkably effective for congestion due to allergies. Oral pseudoephedrine is the only oral option for a cold, but OTC antihistamines both oral and nasal sprays might help some patients. Talk to your pharmacist.

[azn]

i'm not even a little surprised a useless medication was allowed to stay on shelves in the US

[leekichang]

It would be weird if we didn’t have problems with the way our healthcare system is structured

[fourcatsandagarden]

....when I was younger, I'd be given these meds when I had a cold or allergy issue, and every time I was like 'it isn't helping' but no one listened to me. so, turns out, I was right all along. that also explains why the meds I picked out for myself when I was older DID help, because I poked around til I found ones that did work, instead of being told 'its working stop complaining.' I think I know if a medicine is making my face hurt less or not!

[ldeming]

I remember when I was younger how effective Sudafed was. As an adult with some worsening allergies, of course I went for Sudafed (PE) because of my memories of it, only to have it be completely useless. Thank goodness I can still get Pseudoephedrine behind the counter, because it actually works.

[Ramboost]

The thing is pseudoephedrine is so much harder to come by that one joke scientific journal article proposed a way to synthesize it from meth instead because "it would be of great interest to have a simple synthesis of pseudoephedrine from reagents which can be more readily procured"

[PacesIII]

Phenylephrine is a TOPICAL vasodilator. It generally only works on mucous membranes by direct contact and this was noted when pseudoephedrine was pulled from shelves. I read articles about this ages ago about how PE simply wouldn't work. It's neutralized in stomach acid.

[rachelschneider]

This is why I only buy the behind the counter decongestant. When they moved what I used to by over the counter to behind, I found the over the counter stuff didn’t work. The decongestants keep me from getting sinus infections so I need them to work! Thank you for validating me so many years later!!

[akaLaBrujaRoja]

A big problem for families with children under 18 is that when one person gets sick, usually others are also sick, whether it’s a respiratory virus or inherited seasonal allergies. But the monthly limit isn’t enough to treat 3 or more people when only 1 or 2 of them is old enough to buy it.

[jspihlman]

I have no problem going up to the counter to ask for Sudafed, but if you're like me and realize you need medication at 10pm and the pharmacy counter is closed, you're SOL in the US until the next day.