11/09/2024
In recent years, phenylephrine has largely replaced pseudoephedrine (Pseudophed or Sudafed) as the primary oral decongestant in most sinus and allergy combination medications, largely since it is less stimulating. In the last year, the FDA has decided that phenylephrine is ineffective (though still safe), and will be removing products containing it from the market. These include many of the combination sinus medications I often recommend, such as Mucinex Fast Max, Dayquil, and Advil Multi-Symptom Cold & Flu.
In light of this, I think it is important to discuss pseudoephedrine as the next option for oral decongestants, which is found in Advil Cold and Sinus, as well as Allegra -D and Zyrtec-D. Pseudoephedrine is by far the most potent oral decongestant, but also poses some risks, due to its stimulatory effects (raising blood pressure and raising heart rate). It is especially risky in patients with certain heart conditions, such as atrial fibrillation and coronary artery disease.
This is also a good time to review what symptoms the individual ingredients in cough and cold medicines actually treat.
Decongestants (oral like pseudoephedrine and nasal sprays like Oxymetazoline (Afrin, etc) and phenylephrine (Neo- synephrine)- these reduce the symptoms of nasal stuffiness, or blockage, due to sinus and nasal congestion.
Antihistamines (oral like Cetirizine (Zyrtec), fexofenadine (Allegra) or Diphenhydramine(Benadryl) as well as nasal sprays like azelastine (astelin) and olopatadine (Pantanase)- these reduce the symptoms of nasal itching, runny nose, post nasal drip and sneezing by blocking the effects of histamine.
Expectorants- Guaifenesin is the main expectorant, and is found in nearly all Robitussin and Mucinex products. Guaifenesin thins and loosens mucus and allows for expectoration of sputum. It also relieves chest congestion.
Cough suppressant- Dextromethorphan- reduces cough by suppressing the cough reflex. Also present in many of the Robitussin and Mucinex products.
Medications for cough, cold , and allergy symptoms often contain these medications in combination. By understanding how they act, you have a better chance at successful control of your symptoms.
