It has always been a challenge to pick the right cold care product for your individual needs.  Now that 34 states have recently restricted the sale of the most popular decongestant, pseudoephedrine, relieving congestion has become more complicated.

The states were moved to limit the sales of the products containing pseudoepepherine because it can be used to cook–up crystal meth in home labs.  Where it is restricted, it is still available from behind the pharmacists counter.  It also means that these decongestants are not available in grocery, convenience or discount stores. Some  manufacturers have completely removed pseudoephedrine from their cold care products, especially in combination formulations.  Other companies like Pfizer have substituted another FDA decongestant, phenylephrine, in their products such as Sudafed PE. 

Consumers and vendors are confused and concerned about these changes in cold care products. Are they safe?  Do they cause more side effects?  Do they work?  The good news is that the substitute ingredient phenylephrine is safe and does not cause increase in  unwanted symptoms  (e.g., insomnia or palpitations).  The bad news?  A letter published in the Journal of Allergy and Clinical Immunology reviewed a number of studies that showed that phenyephrine is less effective than the now restricted pseudoephdrine. 

One study showed that, when taken by mouth, only 40% of phenylephrine reaches the blood stream.   By comparison  90% of  pseudoephdrine gets into the blood stream.  Two other studies by two different investigators found that phenylephrine was no more effective than a placebo in relieving congestion.

So what do these findings mean to you and  your stuffy nose?  If your doctor believes that you have sinusitis or an ear infection and feels that a decongestant would both be needed and safe, select a decongestant with the now restricted pseudoephedrine from your pharmacist.  If the congestion is part of a common cold, start with a saline nasal spray to relieve symptoms.  If you still feel congested, use a nasal decongestant spray like Afrin which contains another type of decongestant.  But remember use the spray  for no more than 3 days to avoid rebound congestion. You can also ask your physician for a prescription for nasal decongestion  such as Atrovent that contains  ipatropium.  This is a different form of decongestant called an anti-cholinergic and usually has fewer side effects. Antihistamines such as Benedryl and Claritin  may also relieve some of these symptoms.  

When the congestion is due to allergies, nasal corticosteroid spray such as Flonase or Nasocort will  provide needed relief.