Rosh Review EM Scholar Monthly Question

A 35-year-old woman presents with 4 days of headache, nasal congestion, ear pain, and mild sore throat. She has been taking an over-the-counter medication for her symptoms, but it doesn’t do anything for her. According to recent FDA news, which medication has she likely been taking?

1. Diphenhydramine
2. Oxymetazoline
3. Phenylephrine
4. Pseudoephedrine

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References

1. De Sutter AI, Eriksson L, van Driel ML. Oral antihistamine-decongestant-analgesic combinations for the common cold. Cochrane Database Syst Rev. 2022;1(1):CD004976. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8780136/
2. Deckx L, De Sutter AI, Guo L, Mir NA, van Driel ML. Nasal decongestants in monotherapy for the common cold. Cochrane Database Syst Rev. 2016;10(10):CD009612. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6461189/
3. DeGeorge KC, Ring DJ, Dalrymple SN. Treatment of the common cold. Am Fam Physician. 2019;100(5):281–289. https://www.aafp.org/pubs/afp/issues/2019/0901/p281.html
4. FDA clarifies results of recent advisory committee meeting on oral phenylephrine. U.S. Food & Drug Administration website. Accessed September 21, 2023. https://www.fda.gov/drugs/drug-safety-and-availability/fda-clarifies-results-recent-advisory-committee-meeting-oral-phenylephrine
5. Gelotte CK, Zimmerman BA. Pharmacokinetics, safety, and cardiovascular tolerability of phenylephrine HCl 10, 20, and 30 mg after a single oral administration in healthy volunteers. Clin Drug Investig. 2015;35(9):547–558.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4559581/
6. Laccourreye O, Werner A, Giroud JP, Couloigner V, Bonfils P, Bondon-Guitton E. Benefits, limits and danger of ephedrine and pseudoephedrine as nasal decongestants. Eur Ann Otorhinolaryngol Head Neck Dis. 2015;132(1):31–34.  https://www.sciencedirect.com/science/article/pii/S1879729614001665 
7. Meltzer EO, Ratner PH, McGraw T. Oral phenylephrine HCl for nasal congestion in seasonal allergic rhinitis: a randomized, open-label, placebo-controlled study. J Allergy Clin Immunol Pract. 2015;3(5):702–708. https://pubmed.ncbi.nlm.nih.gov/26143019/

Post Peer Reviewed By: Salim R. Rezaie, MD (Twitter: @srrezaie)