Who Moved My Sudafed?

By Christine Gorman

The fall allergy season brings a new headache this year. Starting this week, allergy sufferers who want to treat their stuffy noses with pseudoephedrine (an active ingredient in Sudafed and similar over-the-counter remedies) will have to go to a pharmacist or salesclerk, show photo identification and sign a logbook recording their name and street address. The national rule, which echoes restrictions found in several states, is supposed to make it tougher for criminals to manufacture the illegal drug methamphetamine using packets of pseudoephedrine as its raw material. Allergy sufferers who don't want to go through the extra trouble had better have a lot of tissues on hand. The most common alternative, the nasal decongestant phenylephrine, may not be as effective.

Both compounds work by constricting the blood vessels in the nose. But, says Leslie Hendeles, a professor of pharmacy practice and pediatrics at the University of Florida, "phenylephrine doesn't get into the bloodstream very effectively" because it is so quickly metabolized by the digestive system. That made Hendeles and a colleague curious about why the Food and Drug Administration considered the drug effective in the first place. They tracked down the studies on which an advisory panel had based its recommendations back in 1976 and were surprised to learn that seven of the 11 studies showed the drug was no better than a placebo at relieving nasal congestion. Part of the problem may be that there's a lot more variation in people's response to this particular pill, making it difficult to tell if it really works--and for whom.

Fortunately, phenylephrine does a pretty good job for most people when it's sprayed directly into the nose. So a decongestant spray like Neo-Synephrine is a good bet, but only if you use it for three days or less. Using the spray any longer sets you up for something called rebound congestion, in which you become even more stuffed up than you were when you began. That warning also holds true for oxymetazoline, the nasal decongestant found in such nasal sprays as Afrin.

On the other hand, phenylephrine sprays are usually safe for folks with high blood pressure, since the medication stays pretty much in the nose and doesn't affect the rest of the body. Pseudoephedrine, by contrast, should not be used, except under a doctor's order, if you have hypertension. Also, in extremely rare cases, the drug may trigger a heart attack.

So if you have a short-lasting cold, you're covered. But allergy sufferers generally need more than three days' relief. Antihistamines will take care of the runny nose and watery eyes. For your stuffy nose, you're going to want to think about signing that logbook. And if you use a big drugstore, be sure you visit before the pharmacy section closes for the night. There's also a limit to how many boxes you can buy each month, so families may need to plan accordingly. As an alternative, you may want to see a doctor about getting a prescription for a nasal corticosteroid spray.

As with any medication, read the label to make sure you know what you're getting--even if you have used a particular product before. Manufacturers of many familiar nonprescription brands have quietly switched to phenylephrine so that their packages can stay on drugstore shelves. Allergies may be hard to avoid, but if you do your homework and follow the rules, you can still get the relief you need.