The same 8 nonanalgesic active ingredients were found in hundreds of brand name over-the-counter (OTC) sinonasal products, according to the findings of a recently published cross-sectional study. 

The study, which aimed to assess the prevalence of specific ingredients present in OTC sinonasal products, included brand and generic OTC drugs that were marketed as sinus, cold, allergy, and nasal remedies. An inventory was completed in 5 pharmacies in New Orleans, Louisiana, representing 5 of the 6 largest US chain pharmacy retailers. 

“The list of common brand names from pharmacy visits was then used as a framework to query the proprietary websites of each individual product,” explained study author Edward D. McCoul, MD, MPH. Multiple sources were used as references during the analysis to determine names, the number of available formulations, and the prevalence of multiple ingredient formulations. Topical formulations (ie, nasal sprays) were excluded in the study.  

A total of 18 brands were identified during the data collection period (July 1 to 31, 2018). A search of commercial websites determined that the 14 most common sinonasal brand names represented a total of 211 unique products. Results showed that “only 8 unique nonanalgesic ingredients were identified among these products, with many products sold under the same brand name and with the same active ingredient.” 

The common active ingredients (with their frequency of occurrence) were reported to be: phenylephrine hydrochloride (261), dextromethorphan hydrobromide (218), pseudoephedrine hydrochloride (130), guaifenesin (127), chlorpheniramine maleate (86), brompheniramine maleate (42), diphenhydramine hydrochloride (34), and doxylamine succinate (10).  It was noted that all available OTC sinonasal remedies included at least 1 of these ingredients and that combinations of 2, 3, or 4 active ingredients were very common.

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“Ambiguous and redundant brand-name labeling of individual and multiple-drug formulations is a potential source of confusion among patients seeking self-directed relief for sinonasal symptoms,” concluded Dr McCoul. He added, “Clinicians should be cognizant of the wide array of OTC formulations and the need for specificity when discussing sinonasal remedies with their patients.”


McCoul ED. Assessment of Pharmacologic Ingredients in Common Over-the-Counter Sinonasal Medications [published online July 16, 2020]. JAMA Otolaryngology–Head & Neck Surgery. doi: 10.1001/jamaoto.2020.1836.