In October 2023, I wrote about the Food and Drug Administration (FDA)’s Nonprescription Drugs Advisory Committee and its unanimous vote that the primary ingredient in Sudafed PE and many other OTC cold medicines, oral phenylephrine, was not effective.
Advisory Committees are usually called when there is a “scientific, technical, or policy question” around a product or medication. The meetings are convened to review research, have an open discussion, and offer opinions on what the FDA should do. Advisory Committees are overwhelmingly made up of doctors, researchers, pharmacists, sometimes a patient representative, and always an industry and consumer representative. (Disclosure: I am the appointed Consumer representative on the FDA Drug Safety and Risk Management Committee).
In 2023, the patient representative on the advisory committee analyzing the efficacy of oral phenylephrine noted:
“I feel this drug, in this oral dose, should have been removed from the market a long time ago. Patients require and deserve medications that treat their symptoms safely and effectively, and I don’t believe that this medication does that.”
After the 2023 meeting, the FDA published a statement explaining that they would consider withdrawing approval of oral phenylephrine but that it was safe to use in the meantime. So essentially, what the FDA said was, “this medication won’t do anything for your congestion, but probably won’t harm you, so you can continue using it.”
When this statement was released over a year ago, I asked the question: Why would anyone take—or prescribe—a drug that doesn’t work and can harm? (Because every drug can harm.) But that is precisely what the FDA has been allowing.
The good news? Things are beginning to change.
On November 7th, 2024, the FDA finally proposed to remove oral phenylephrine from the market. The process includes allowing time for public comment on the proposal and then FDA review of those comments. There is no specific timeline for removing oral phenylephrine—an ingredient that the FDA concedes likely does not work—from the shelves.
What’s the Difference Between Sudafed and Sudafed PE?
The similar names of Sudafed (with the active ingredient pseudoephedrine) and Sudafed PE (with the active ingredient phenylephrine) often creates confusion.
Pseudoephedrine, Sudafed’s primary ingredient, is an effective drug for congestion (although it does have its own side effects). However, it also has central nervous system (CNS) stimulant properties and can be misused for non-medical purposes in the same way that amphetamines are often misused. Additionally, pseudoephedrine is a precursor to the production of methamphetamine, which means it can be used to create illicit drugs in home labs. Because of this connection, you have to go up to a pharmacy counter—instead of picking it off a drug store shelf—and ask for Sudafed, and usually show an I.D
When the FDA moved Sudafed behind the pharmacy counter, a new type of OTC decongestant product was introduced: Sudafed PE, with phenylephrine as the prime ingredient. While phenylephrine sounds similar to pseudoephedrine, early studies around its effectiveness do not appear to have been peer-reviewed and may have been plagued with either methodologic problems or even possible fraud. Phenylephrine, of course, is the same ingredient the FDA Advisory Committee reviewed and voted unanimously on its ineffectiveness in 2023.
Do Any Phenylephrine Medications Work for Nasal Congestion?
Phenylephrine doesn’t work in an oral pill form because it breaks down in your body before reaching your nasal system, reducing its bioavailability (the portion of a drug that enters the bloodstream). However, when sprays or drops are used directly in the nose, phenylephrine does appear to help clear congestion.
Side Effects of Phenylephrine
It’s important to note that while the FDA mulls over the decision to pull oral phenylephrine from the market, the ineffective ingredient is still available for purchase and comes with its own side effects.
Three of its most common side effects—nervousness, dizziness and sleeplessness—are not likely to cause long-term harm, but they can certainly intrude on your day and make you feel even sicker than before taking the medicine. Many people can’t stay home in bed just because of congestion, and if you need to drive a car or take care of small children, dizziness, nervousness and exhaustion from sleeplessness can add up to a substantial safety issue.
Why the FDA Should Remove Phenylephrine From the Market
According to the Consumer Healthcare Products Association (CHPA), a trade group representing producers of non-prescription medications, more than half of all American households use phenylephrine either on its own or in a combination cold/flu remedy every year, with many of those households using it multiple times a year.
In my opinion, this is a waste of money and may even prolong recovery.
When you or someone you love takes a drug that doesn’t work, four things can happen:
- You do not receive medicinal care for your illness
- You may suffer from side effects with no possibility of benefit
- Effective care may be delayed
- You have wasted money
In the U.S., nearly every decongestant or cold/flu combination medicine available in the drugstore aisle contains phenylephrine. For your reference, here is a short list of the most common meds that include the ineffective oral ingredient:
- Sudafed PE Sinus Congestion
- Children’s Sudafed PE Nasal Decongestant
- Benadryl Allergy Plus Congestion
- PediaCare Children’s Multi-Symptom Cold
- Vicks DayQuil Cold and Flu
Here is an abbreviated list of products that contain pseudoephedrine (an effective drug for clearing congestion). To get any of these products, you will have to go to the counter at the pharmacy:
FDA, please do your job and protect us all from ineffective and dangerous drugs.
