6 Alternatives to Phenylephrine (Sudafed PE) You Can Try for Congestion

When nasal congestion hits, you likely want fast, effective relief. For years, many people would turn to phenylephrine (Sudafed PE) to help clear their stuffy noses. But in September 2023, the FDA ruled that oral phenylephrine is ineffective for nasal congestion. Given the wide availability of the decongestant, this announcement has had a far-reaching impact.

In response to this ruling, many retailers have been removing phenylephrine-containing products from their shelves. Manufacturers will also be reformulating dozens of cough and cold medications. But most importantly, the FDA’s ruling has left millions of people scrambling to find alternatives to phenylephrine for nasal congestion.

Why did the FDA deem phenylephrine ineffective?

Put simply, the FDA deemed phenylephrine ineffective because multiple studies showed that the medication doesn’t work.

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For healthcare providers and pharmacists, this ruling wasn’t surprising. In fact, it was common practice to recommend phenylephrine alternatives long before the FDA made their decision. Sheila McAdoo, PharmD, a community pharmacist and creator of the Over the Counter podcast, told GoodRx Health she is transparent with patients about phenylephrine’s limited effects.

“Before the ruling, I was aware phenylephrine tablets were on the weaker side of decongestants and even ineffective. I would tell my patients that phenylephrine might be less effective than the alternative over-the-counter (OTC) options,” said McAdoo. “The only situation that I would consider phenylephrine is if a patient had a history of uncontrolled high blood pressure and I couldn’t recommend alternatives.”

The FDA reviewed a total of 14 studies evaluating phenylephrine. They found that when you take the medication by mouth, very little is absorbed from the digestive tract. The amount of phenylephrine that reaches the bloodstream isn’t enough to provide the intended effect. And when oral phenylephrine was compared to placebo (a pill that has no medication in it), there was no significant difference in congestion relief.

Good to know: The FDA’s ruling doesn’t affect nasal sprays that contain phenylephrine. These products are still considered effective. But phenylephrine nasal sprays should only be used for up to 3 days in a row.

Which medications contain phenylephrine?

There are hundreds of medications that contain phenylephrine. It’s best to read the OTC medicine label when selecting a product. It lists all of the active ingredients in the medication. Some examples of medications that contain oral phenylephrine include:

• Sudafed PE

• Some DayQuil products

• Some NyQuil products

• Some Robitussin products

• Some Mucinex products

• Many Theraflu products

• Most Dimetapp products

6 alternatives to phenylephrine

When your go-to OTC medication isn’t available, it can be frustrating. Thankfully, there are several alternatives to phenylephrine. Below, we review six medications that work for nasal congestion.

Be sure to ask your healthcare provider or pharmacist before trying these. They can review your health history and medication list to make sure these are safe for you to try.

1. Sudafed

Pseudoephedrine (Sudafed) is an oral nasal decongestant. It’s often confused with phenylephrine because their brand and generic names sound very similar. But rest assured, pseudoephedrine is effective. Even before the FDA’s ruling, healthcare professionals would often recommend it over phenylephrine.

“If someone was choosing between pseudoephedrine and phenylephrine, I would always recommend pseudoephedrine,” said McAdoo. “In my own experience, patients that chose phenylephrine before speaking to a pharmacist or healthcare provider would return to get something ‘stronger.’”

Keep in mind that products containing pseudoephedrine aren’t out on the shelf with the rest of the cough and cold medications. Instead, they’re kept behind the pharmacy counter, and you’ll need a photo ID to purchase them.

Good to know: Pseudoephedrine isn’t recommended for people with high blood pressure or other heart problems. You also shouldn't take it for more than 7 days in a row without your provider’s OK. Long-term use of pseudoephedrine can cause side effects, such as fast heart rate or raised blood pressure.

2. Afrin

Oxymetazoline (Afrin) is a decongestant nasal spray. The medication works in a similar way to phenylephrine. But it’s applied directly to the nasal passages. This allows it to work fast (within 5 to 10 minutes) and have limited body-wide side effects.

You shouldn’t use oxymetazoline for more than 3 days in a row. Overusing this nasal spray can lead to rebound (worsening) congestion. Rebound congestion is tricky to treat and often takes months to go away.

3. Neo-Synephrine

Phenylephrine nasal spray (Neo-Synephrine) is another alternative to oral phenylephrine. This can seem confusing. How is phenylephrine an alternative to phenylephrine?

As mentioned earlier, the FDA’s ruling only affects oral phenylephrine products. Nasal sprays containing the medication are still considered effective. That’s because the issue with the oral product has to do with how the medication is absorbed from the gut. Phenylephrine nasal sprays don’t have to be absorbed from the digestive tract, so this isn’t an issue.

Similar to oxymetazoline, phenylephrine nasal sprays shouldn’t be used for more than 3 days in a row. This medication can also cause rebound congestion if you use it too long.

4. Nasal sprays like Flonase

Fluticasone propionate (Flonase) and other corticosteroid nasal sprays are popular options for congestion relief. They’re effective for a variety of symptoms. They’re considered first-choice medications for both allergies and sinus infections.

Keep in mind that it takes nasal steroid sprays a few days to start working. Many people take a faster-acting decongestant, such as pseudoephedrine, until the steroid spray takes effect. But you should ask your provider or pharmacist if this combination is OK for you before starting it.

5. Saline rinses and nasal sprays

What if the options above aren’t right for you? Well, there’s a medication-free option you can try. Saline rinses (neti pots) and saline nasal sprays can be effective phenylephrine alternatives. Some studies suggest that saline rinses may provide more relief than saline sprays. But both are more effective for congestion than no treatment at all.

Good to know: Properly using saline rinses is important to prevent complications. For instance, you should only use sterile water when preparing the rinse. Using plain tap water can cause serious infections. Your pharmacist is a great resource if you have questions on how to safely use a saline rinse.

6. Antihistamines like Claritin

Loratadine (Claritin) is one of several OTC antihistamines. These medications are commonly taken for seasonal allergy symptoms. They’re not a go-to choice for nasal stuffiness. But there are certain cases where they might provide relief.

If your congestion is due to allergies, antihistamines can be a potential option. But if something else is causing your stuffy nose, such as the common cold, these medications may not be as helpful. And in the case of sinus infections, they could worsen symptoms.

Because antihistamines aren’t always the best choice for congestion, it’s a good idea to ask your provider or pharmacist before taking one.

Is it still safe to take phenylephrine?

Yes, it’s still safe to take oral phenylephrine. The FDA’s review didn’t find any safety concerns with the medication. It’s just not effective.

Keep in mind that phenylephrine can still cause side effects. Common phenylephrine side effects include anxiety, headache, and dizziness. So if you take the decongestant, you may experience bothersome side effects with little or no congestion relief.

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Written by:

Christina Aungst, PharmD

Christina Aungst, PharmD, is a pharmacy editor for GoodRx. She began writing for GoodRx Health in 2019, transitioning from freelance writer to editor in 2021.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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