The cold and flu season is upon us, and many of us turn to over-the-counter (OTC) tablets for relief. But a recent legal battle in Australia involving Johnson & Johnson and their cold and flu medicines has brought to light a troubling issue: many of these tablets don't actually work as promised. The case revolves around the active ingredient phenylephrine, which is claimed to be an effective nasal decongestant. However, research has shown that it is no better than a placebo when taken orally. This is a significant problem, as it means consumers are paying for a medicine that provides little relief. The issue is not new; it dates back to the early 2000s when the Australian government sought to tackle the rise in illicit drug manufacture, particularly of amphetamines like 'ice'. This led to tighter restrictions on the sale of pseudoephedrine, which was being used to make these drugs. As a result, phenylephrine became the main decongestant in oral products. But recent studies have shown that oral phenylephrine performs no better than a placebo for relieving nasal congestion. This is because, when taken orally, only a very small amount of phenylephrine can get into the bloodstream and reach the nose. In contrast, a nasal spray delivers the drug directly to the nasal passages, where it can act on the blood vessels. The US Food and Drug Administration (FDA) has proposed removing oral phenylephrine from over-the-counter cold and flu tablets, citing efficacy concerns. The Australian Therapeutic Goods Administration (TGA) is also aware of the FDA's proposal and is monitoring the outcomes. While the evidence supporting oral phenylephrine as an effective decongestant has changed, the main concern is not that it causes harm. It's that consumers will pay more for a medicine that provides little relief for nasal congestion. So, what helps? Short-term use of a decongestant nasal spray containing phenylephrine, oxymetazoline, or xylometazoline can provide relief. However, using them for longer can cause your symptoms to worsen or come back worse when you stop using it – this is called rebound congestion. Saline nasal sprays or rinses are a safer and more effective option, as they physically dislodge phlegm without the risk of rebound congestion. For other options, speak to your pharmacist. In some cases, a GP or pharmacist may recommend products that contain pseudoephedrine. You may need to show identification to the pharmacist, depending on the state or territory. Paracetamol and ibuprofen can also help ease symptoms such as headache, body aches, and fevers. Steam inhalation or warm showers may provide some temporary relief. But ultimately, 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’s time to see your doctor.
