Popular cold medications don’t work, say experts, as US considers ban

Phenylephrine ‘is extensively broken down in the liver, resulting in little to no pharmacological effect’

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A pharmacy drugs expert says many popular cold and flu remedies should be banned because they are a waste of money.

It comes as as the American Food and Drug Administration wants to stop phenylephrine, which is widely used in cough and cold medicines from being sold in the US.

The ingredient is in some of the best-selling remedies such as Sudafed, Benadryl, Lemsip and Beechams.

Hisham Al-Obaidi, a pharmacy lecturer at the University of Reading and an ambulance service advanced pharmacist practitioner, said phenylephrine hydrochloride had minimal activity when taken orally.

“Although it is absorbed into the bloodstream, it is extensively broken down in the liver, resulting in little to no pharmacological effect,” Dr Al-Obaidi said.

He said that by contrast, the nasal spray is effective.

“When phenylephrine is administered nasally, it bypasses the gastrointestinal tract and avoids the first-pass metabolism that occurs with oral administration. This allows higher levels of the drug to act directly on the nasal lining, where it can more effectively constrict blood vessels and relieve congestion.”

The oral version should be dropped because “it has no effect so it shouldn’t really be sold as otherwise it a waste of people’s money”, he said.

In the US, if the FDA’s proposal goes ahead, the tablets and pills would be withdrawn, which would rock the multi-million-dollar industry.

Helen Wall, a GP, agreed that products with phenylephrine in taken by mouth were a waste of money, but said some people find they help relieve symptoms because they contain paracetamol and they are “warm and comforting”.

She added: “It’s what people do when they are ill and it’s part of the process of feeling like they are taking some control of the situation which is beneficial to getting better in most illnesses.

“If it helps, then it’s not a waste of money, I guess.

“Phenylephrine has long since been known as an old drug and I think the evidence for it working orally is scanty.”

Dr Wall said that if consumed regularly, such products may increase blood pressure in some people.

“Personally I use paracetamol, some vitamin C and a nasal decongestant for no more than 7 days when I get a cold and plenty fluids.

“As a medical professional, I think banning them would need to be based on safety concerns as they do seem to help some people.”