Will Your Cold Medicine Actually Work?

The cold and flu meds in your medicine cabinet may not be effective at clearing congestion.

Medically reviewed by Vivek Cherian, MDFact checked by Haley Mades

Decongestants are a part of pretty much everyone's medicine cabinet, to help clear away congestion when the inevitable cold, flu, or other respiratory illness hits. But odds are, the decongestant in your medicine cabinet right now may not help at all in clearing your nose.

That's the finding by an FDA panel, which published a briefing in September 2023 that incorporated several new clinical trials. Based on the research, the panel determined that products containing phenylephrine (which include many over-the-counter decongestant products) are ineffective at clearing congestion when taken orally in pill or liquid form.

"The question was does it work for this one symptom," says Nazlie Latefi, Ph.D, co-founder and chief scientific officer of Applied Biological Laboratories. "The advisory committee for the FDA voted 16-0 that it is not effective."

So what does that mean as respiratory illness season starts? Here's what you need to know (and what you can use instead when your next respiratory illness strikes).

Related: Every Medicine Cabinet Essential to Have at Home in Case of Illness or Injury

What Is Phenylephrine?

Phenylephrine is an active ingredient in many sinus and cold medicines that constricts the blood vessels to help reduce congestion.

But studies studies of the product have found that while phenylephrine can be effective when applied in nasal spray form, if given by pill, your body metabolizes most of the chemical, leaving nothing to help you relieve your congestion.

What Products Contain Phenylephrine?

You'll find phenylephrine in many common over-the-counter sinus or cold and flu medicines by major companies (and in the corresponding store brands). Some of the products include:

• Advil Sinus Congestion

• Alka-Seltzer Plus Cold and Cough Formula

• Benadryl

• Dayquil

• Children's Dimetapp Cold and Cough

• Lusonal

• Mucinex

• PediaCare Children's Decongestant

• Sinex

• Sudafed PE

• Suphedrin PE

• Theraflu Cold and Flu

• Tylenol Sinus

(You can check out the full list of dozens of different medications at Medline Plus.)

How Will This Affect Cold Medicine Availability?

Currently, these products are still available on store shelves, as this FDA panel can only recommend, not require changes. But the FDA will be considering this panel's findings, and can decide to take them off the market to help keep people avoid spending the “unnecessary costs of taking a drug with no benefit," according to the briefing. "According to the FDA, stores sold roughly 242 million of OTC cold and allergy oral medications containing phenylephrine," Latefi says. The products containing phenylephrine make up nearly $2 billion of a $13 billion cold, cough, and sore throat medication market, according to Latefi.

If the FDA decides to take them off the market, the manufacturers will have to reformulate their products to create something that works effectively—which could mean empty cold medicine shelves, at least temporarily.

"Sinus congestion and colds are very common and both patients and pharmaceutical companies are motivated to have a range of accessible treatment options," says Nicholas Rowan, MD, clinic director of otolaryngology at Johns Hopkins. "So while there might be a bit of a shake-up currently with these medications that contain phenylephrine, I have little concern that effective cold and sinus medications will be made readily available to the consumer."

Should I Throw Out My Cold Medicine?

Over-the-counter medications containing phenylephrine aren't unsafe—they just aren't effective at stopping congestion. Cold medicines that have multiple active ingredients (such as products that contain guaifenesin or dextromethorphan in addition to phenylephrine) may still help you quiet a cough or clear mucus. But keep in mind that these products won't shorten the length of your symptoms, because they don't address the inflammation that is causing them, Latefi says.

You can check the list of active ingredients in the cold and sinus medications in your medicine cabinet. If phenylephrine is the only active ingredient, it may be something you can declutter from your medicine cabinet.

How to Treat Congestion Effectively

You don't have to suffer with a stuffy nose if your cold medicine isn't working as well as you'd hoped. There are other options for helping clear away your congestion.

Buy decongestants that contain pseudoephedrine instead

Pseudoephedrine is a similar chemical that definitely provides congestion relief. But in 2005, it was required to be held at the pharmacy for supervised purchase, due to people buying Sudafed and similar pseudoephedrine products to make meth.

You'll need to head to the pharmacy counter and produce a photo ID in order to purchase these cold medicine products.

Use nasal sprays or neti pots

Nasal sprays are an underutilized way to fight congestion right at the source. And while phenylephrine may not work well in pill form, it still works as a nasal spray to help fight congestion. You'll find it in products like Sinex Nasal, Neo-Synephrine, and Little Remedies for Noses. Other nasal sprays like Afrin contain oxymetazoline hydrochloride, which is also an effective decongestant.

And don't discount the power of the neti pot. "Beyond the tried-and-true methods of mom’s chicken noodle soup, medications such as over-the-counter nasal steroid sprays, nasal saline sprays, and nasal saline washes like neti pots work well for sinus congestion," Dr. Rowan says.

Related: Yes, Neti Pots Really Work—Here's How to Use One Safely

Try home remedies

Break out the tea with honey and lemon! There is research that shows that many home remedies for congestion—including drinking lots of fluids, taking hot showers, and using a humidifier—can help remove mucus and soothe congestion.

"The best thing to do is to go with home remedies if the congestion is really bothering you," Latefi says. "You can use a neti pot—just make sure to follow directions carefully and use clean water—use hot steam to loosen up congestion, or take a hot shower, and drink a lot of water or teas."

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