{"id":799283,"date":"2026-07-14T07:57:10","date_gmt":"2026-07-14T07:57:10","guid":{"rendered":"https:\/\/www.newsbeep.com\/au\/799283\/"},"modified":"2026-07-14T07:57:10","modified_gmt":"2026-07-14T07:57:10","slug":"why-so-many-cold-and-flu-tablets-dont-work-and-how-else-to-manage-nasal-congestion","status":"publish","type":"post","link":"https:\/\/www.newsbeep.com\/au\/799283\/","title":{"rendered":"Why so many cold and flu tablets don\u2019t work \u2013 and how else to manage nasal congestion"},"content":{"rendered":"

Introduction by Croakey: United States pharma giant Johnson & Johnson is facing class action lawsuits in Australia<\/a> and New Zealand<\/a> over the sale of cold and flu medicines such as Codral and Benadryl.<\/p>\n

The actions allege the firm breached consumer laws by claiming an active ingredient in the products, phenylephrine, was an effective nasal decongestant, when in fact it is no better than a placebo.<\/p>\n

It\u2019s just a part of a story that goes back 20 years when the Australian government sought to tackle a rise in the manufacture of illicit drugs, particularly \u201cice\u201d, and which led to a change in how cold and flu medicines are made.<\/p>\n

But, as Adelaide University\u2019s Dr Jack Janetzki and Dr Lauren Cortis write below, new research has led to new evidence, and the US Food and Drug Administration has now proposed removing<\/a>\u00a0oral phenylephrine from over-the-counter cold and flu tablets.<\/p>\n

They outline the changes that have led to the current situation and \u2013 most importantly for most of us \u2013 give advice on what actually works best when a virus strikes. This article was first published in The Conversation.<\/a><\/p>\n

Jack Janetzki and Lauren Cortis write:<\/p>\n

You\u2019ve got the sniffles and your nose is running like a tap. The tissues feel like sandpaper.<\/p>\n

Many Australians reach for cold and flu tablets, expecting them to \u201cclear the sinuses\u201d and get them through a cold. They often promise fast relief.<\/p>\n

But the evidence is clear: for nasal congestion, these medicines do not work as well as they claim. So why are they still being sold?<\/p>\n

Most\u00a0over-the-counter<\/a>\u00a0cold and flu tablets contain a mix of ingredients. Some packs contain different tablets for day and night.<\/p>\n

\u201cDay\u201d products\u00a0often include<\/a>\u00a0paracetamol or ibuprofen to ease aches and pains, along with a decongestant for a runny or blocked nose. \u201cNight\u201d products typically have an extra ingredient \u2013 an antihistamine to make you drowsy and help with sleep.<\/p>\n

In Australia, the\u00a0most common<\/a>\u00a0oral decongestant used in these products is phenylephrine. It works by narrowing blood vessels in the nose, reducing swelling and making it easier to breathe.<\/p>\n

You can also buy phenylephrine as a nose spray, although it\u2019s less common. If you spray phenylephrine into your nose it works well as a decongestant.<\/p>\n

But a large body of research has established it has almost no effect when swallowed in a tablet.<\/p>\n

So, why is phenylephrine still widely sold?<\/p>\n

Tackling misuse<\/p>\n

In the early 2000s, the main decongestant in cold and flu tablets was pseudoephedrine. Phenylephrine was rare as an oral medicine, though it had been\u00a0available as a nose spray<\/a>\u00a0since the 1990s.<\/p>\n

But between 1996 and 2005 there was a\u00a0significant spike<\/a>\u00a0in illicit drug manufacture in Australia.<\/p>\n

Pseudoephedrine<\/a>\u00a0\u2013 available over the counter \u2013 was one of the chemicals being used to make amphetamines including \u201cice\u201d and \u201cspeed\u201d. So pharmacies were increasingly targeted in\u00a0break-ins, ram raids and armed hold-ups<\/a>.<\/p>\n

This\u00a0led<\/a>\u00a0to tightened\u00a0restrictions<\/a>\u00a0on the sale of pseudoephedrine products, including their\u00a0reclassification<\/a>\u00a0in 2006 as \u201cpharmacist only\u201d. This\u00a0meant<\/a>\u00a0they could be bought without a prescription, but \u201cbehind the counter\u201d \u2013 a pharmacist had to be involved in the sale.<\/p>\n

Pseudoephedrine became much harder to obtain, whether the intention was to use it legitimately, or not.<\/p>\n

Phenylephrine replaced pseudoephedrine as the main decongestant in oral products, not because it was a better medicine but because there was less risk of it being misused.<\/p>\n

Early studies and reviews\u00a0suggested<\/a>\u00a0phenylephrine was an effective alternative.<\/p>\n

Over time, better research has begun to tell a different story, particularly about phenylephrine taken orally.<\/p>\n

Recent\u00a0studies<\/a>\u00a0have shown oral phenylephrine performs no better than a placebo for relieving nasal congestion.<\/p>\n

Overall\u00a0evidence<\/a>\u00a0on oral phenylephrine is now\u00a0consistent<\/a>: it does not meaningfully relieve nasal congestion when taken by mouth.<\/p>\n

This is because, when taken orally, only a very small amount of phenylephrine can get into the bloodstream and\u00a0reach the nose<\/a>.<\/p>\n

In contrast, a nasal spray delivers the drug directly to the nasal passages, where it can act on the blood vessels.<\/p>\n

Regulator views<\/p>\n

In 2023, an independent advisory committee to the US Food and Drug Administration (FDA) reviewed the evidence and\u00a0concluded<\/a>\u00a0oral phenylephrine is not effective for nasal congestion when given at standard doses.<\/p>\n

In November 2024, the FDA proposed\u00a0removing<\/a>\u00a0oral phenylephrine from over-the-counter\u00a0cold and flu tablets<\/a>.<\/p>\n

In Australia, the\u00a0Therapeutic Goods Administration<\/a>\u00a0(TGA) is responsible for regulating these medicines.<\/p>\n

A spokesperson for the TGA told The Conversation the regulator is aware of the FDA\u2019s proposal to remove oral phenylephrine from over-the-counter sale, \u201cbased on efficacy concerns not safety concerns\u201d.<\/p>\n

The spokesperson said: \u201cAt this time, while the TGA does not have current plans to conduct a review of the effectiveness of oral phenylephrine, we will continue to monitor the outcomes of the FDA review and consultation.\u201d<\/p>\n

The FDA has not yet announced the outcome of the proposal.<\/p>\n

While the evidence supporting oral phenylephrine as an effective decongestant has changed, the main concern is not that it causes harm. It\u2019s that consumers will pay more for a medicine that provides little relief for nasal congestion.<\/p>\n

If people do feel better after taking cold and flu tablets, it\u2019s likely because of other ingredients, such as ibuprofen or paracetamol.<\/p>\n

In Australia, products containing phenylephrine must be clearly labelled, allowing consumers to make\u00a0an informed choice<\/a>.<\/p>\n

What helps?<\/p>\n

For nasal congestion, short-term use of a decongestant nasal spray containing phenylephrine, oxymetazoline or xylometazoline\u00a0can provide relief<\/a>. This means using them for a maximum of three days.<\/p>\n

Using them for longer\u00a0can cause<\/a>\u00a0your symptoms to worsen or come back worse when you stop using it \u2013 this is called rebound congestion.<\/p>\n

Saline nasal sprays or rinses also help to clear nasal congestion\u00a0safely and effectively<\/a>, by physically dislodging phlegm, without the risk of rebound congestion.<\/p>\n

For other options, speak to your pharmacist. In some cases, a GP or pharmacist may recommend products that contain pseudoephedrine. You may need to\u00a0show identification<\/a>\u00a0to the pharmacist, depending on the state or territory.<\/p>\n

Paracetamol and ibuprofen can also help\u00a0ease symptoms<\/a>\u00a0such as headache, body aches and fevers. Steam inhalation or warm showers may provide some temporary relief.<\/p>\n

But there is no way to treat the cause, which is typically a virus.<\/p>\n

The best thing you can do is rest, stay hydrated, and keep your germs to yourself. You should start feeling better in around seven to ten days and, if not, it\u2019s time to see your doctor.<\/p>\n

Author details<\/p>\n

Dr Jack Janetzki is Lecturer in Pharmacy and Pharmacology, Adelaide University. He works for Pharmaceutical Defence Limited and The Barossa Pharmacist in the Mall (Nuriootpa, South Australia). He is an ethics committee member for Bellberry, a member of Pharmaceutical Defence Limited, the Australasian Pharmaceutical Science Association, the Pharmaceutical Society of Australia and the Observational Health Data Science and Informatics (OHDSI) network.<\/p>\n

Dr Lauren Cortis is Senior lecturer in Pharmacy Practice, Adelaide University<\/p>\n

See Croakey\u2019s archive of articles on safety and quality of healthcare<\/a><\/p>\n

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