November 2023

Phenylephrine Alternatives: Do Any Natural Medicines Relieve Congestion?

The FDA’s recent declaration that phenylephrine is not an effective nasal decongestant has put the spotlight on potential alternatives. So what else can patients try?

When it comes to supplements, explain that there isn’t strong clinical evidence supporting the use of any natural medicines to relieve nasal congestion. Caution patients to be leery of marketing campaigns claiming otherwise. But if congestion is related to allergies, some therapies might be worth a shot. Turmeric and butterbur are two options with limited safety concerns. Clinical research shows that taking a specific curcumin product (Organika Health Products) 500 mg daily for 2 months reduces nasal symptoms, including congestion, in people with allergic rhinitis. As for butterbur, products that are standardized to contain 8 mg petasin might be worth a try. But make sure patients only use butterbur products that are certified as pyrrolizidine alkaloid (PA)-free.

Nasal irrigation is a good non-pharmacological choice for both allergy and cold/flu-related congestion. It works by flushing out mucus and allergens and often improves airflow. For those who tend to battle sinus infections, research shows that it can reduce symptoms and the need for antibiotics. It can also reduce the need for allergy medications. Assure patients that it’s likely safe for most people – the amoebic brain infections some people might ask about are very rare and avoidable. Advise patients to use only water that is boiled (for 3-5-minutes and then cooled down to lukewarm), distilled, or sterile.

Check out our comparative effectiveness charts for details on other studied therapies. And refer to our Pharmacist’s Letter Clinical Resource on Managing Cough and Cold Symptoms for the latest on drug therapy options.

The information in this brief report is intended for informational purposes only, and is meant to help users better understand health concerns. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions. Copyright © 2024 NatMed. Commercial distribution or reproduction prohibited. NatMed is the leading provider of high-quality, evidence-based, clinically-relevant information on natural medicine, dietary supplements, herbs, vitamins, minerals, functional foods, diets, complementary practices, CAM modalities, exercises and medical conditions. Monograph sections include interactions with herbs, drugs, foods and labs, contraindications, depletions, dosing, toxicology, adverse effects, pregnancy and lactation data, synonyms, safety and effectiveness.