30 ms·

The Uselessness of Phenylephrine

799 points by hprotagonist 5y ago

O5vYtytb 5y ago
I can buy "Wal-Phed D" at my Walgreens pharmacy. It's Pseudoephedrine HCl 100 mg and works very well. It's quite easy to get, they just look at my ID.
jfengel 5y ago
I've certainly found it useless, and when I need a decongestant I make certain I'm getting actual pseudoephedrine. The 12 and 24 hour slow-release versions are fantastic. I've never done a proper blind trial on myself, but I feel quite certain that I could tell the difference. I suppose people must be buying it, and given how strong placebo effects are in general I guess it's doing something for them.
- nvahalik 5y ago
  Same here. Actual Sudafed works for me and anything else I think generally only tends to work with whatever NSAID they bundle with it.
- tcherasaro 5y ago
  Same, Sudafed is a silver bullet for me. The 12 hour release absolutely works to clear my sinuses and relieves the sinus pressure headache (almost completely when combined with ibuprofen). My wife insists Phenylephrine works for her and thats all she will take. She has offered it to me a couple times when we didn’t have any Sudafed and Phenylephrine had 0 noticeable effects for me. Edit: I forgot to add that Alavert-D 12 also has Pseudoephedrine and works for me too and is what I take when my congestion is allergy related.
  - mh- 5y ago
    One of many such studies: https://pubmed.ncbi.nlm.nih.gov/19230461/ https://pubmed.ncbi.nlm.nih.gov/19230461/ Keep in mind this doesn't say that it's not effective. It's just not more so than the placebo effect, which is quite real even on physiological matters.
  - thehappypm 5y ago
    The article suggests the uptake is widely variable person to person so perhaps she’s just a lucky one.
PaulHoule 5y ago
It is even easier to make https://en.wikipedia.org/wiki/Methcathinone https://en.wikipedia.org/wiki/Methcathinone from pseudoephedrine. You can just oxidize PE with potassium permanganate and purify the product... No need to risk blowing yourself up the way you would making methamphetamine.
blakesterz 5y ago
The Wikipedia article they link to [0] has a pretty long list of brandnames. Many of them are the "-D" version of whatever the thing is. Claritin-D, Zyrtec-D and so on. I think the version without the "-D" doesn't have Pseudoephedrine? [0] https://en.wikipedia.org/wiki/Pseudoephedrine#Brand_names https://en.wikipedia.org/wiki/Pseudoephedrine#Brand_names
- bvinc 5y ago
  In those cases, Claritin and Zyrtec are allergy medicines. The -D indicates that this allergy medicine comes along with a decongestant. The version without the -D will just be the allergy medicine.
  - hammock 5y ago
    Specifically, drugs with -D indicate that they come with pseudoephedrine. In the US, they (like the non-PE version of Sudafed) are only available behind the pharmacy counter.
The_rationalist 5y ago
Levo-methamphetamine is a legal decongestant BTW
- ncmncm 5y ago
  Where does one obtain that? From the waste stream of the methamphetamine producers?
  - pkaye 5y ago
    Used to get Vicks inhalers with it. I don't know if its still available.
  - somebodynew 5y ago
    It is sold over the counter in most US pharmacies under the Vicks inhaler brand. The active ingredient label conveniently uses a spelling that most people will not recognize which is probably effective in preventing alarm from customers who aren't familiar with the dramatic difference in the effects of the two enantiomers.
    - ncmncm 5y ago
      TIL!
  - The_rationalist 5y ago
    btw racemic meth is legally prescribed for ADHD under the brand desoxyn, although it's probably hard to find doctors prescribing it over regular amph
starwind 5y ago
A1 headline right there. Not clickbait, but right to the point
AaronM 5y ago
If you get the chance, go read all of his (Derek Lowe) blog posts about things he refuses to work with. Highly entertaining read.
- samatman 5y ago
  Thanks for pointing out the author, the headline is not news to me and I would have passed on reading it.
  - oh_sigh 5y ago
    Strange that you were reading all the comments about the article you weren't interested in...
    - samatman 5y ago
      I didn't say I wasn't interested in the [headline] I said it wasn't news to me. It's a topic I find interesting, and as it turns out, by an author I already enjoy. The article was not informative [to me], but it was fun reading. Since it was not informative to me (as I deduced correctly from the headline) I could have easily read the comments and not the article. Hope that helps!
- genewitch 5y ago
  FOOF (or FOOOOOOF)
- astrange 5y ago
  The problem with this advice (which gets posted to all of his articles) is those posts aren't meant to all be read at once. They're basically all the same thing, which is why he hasn't written any new ones recently. I still want to know what isocyanide smells like.
- etskinner 5y ago
  The article, for anyone interested: https://www.science.org/content/blog-post/things-i-won-t-work-small-smelly-isocyanides https://www.science.org/content/blog-post/things-i-won-t-wor...
floren 5y ago
My assumption has always been: people know pseudoephedrine works, so that's what they want to buy, but you can no longer sell pseudoephedrine over the counter. However, you can offer phenylephrine, which still lets you reasonably name the drug "Sudafed PE" or whatever. Customer browses the shelves, sees "PE" in the drug name, this triggers a vague impression that it contains pseudoephedrine and thus will actually work well.
- denimnerd42 5y ago
  or maybe like sudafed pe is an advertisement, a reminder to check behind the counter for the real thing
  - floren 5y ago
    The "PE" stands for "placebo, essentially"
    - dkryptr 5y ago
      That's essentially the selling point behind Zicam and other homeopathic drugs.
egberts1 5y ago
First hand experience. Totally useless as a decongestant for me. Stick with pseudoephedrine.
p_l 5y ago
The lack of availability of proper pseudoephedrine in USA led to situation where there are papers describing how to turn methamphetamine into pseudoephedrine, not the other way around. With explanation in abstract that its easier to buy meth than pseudoephedrine.
- dsp 5y ago
  lol https://improbable.com/airchives/paperair/volume19/v19i3/Pseudoephedrine.pdf https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
  - cjhveal 5y ago
    Authored by O. Hai, and I. B. Hakkenshit
  - BatmansMom 5y ago
    "While N-methylamphetamine itself is a powerful decongestant, it is less desirable in a medical setting because of its severe side effects and addictive properties... Other side effects may include violent urges or, similarly, the urge to be successful in business or finance."
  - deleted 5y ago
    [deleted]
  - solveit 5y ago
    Thank you for making my day.
- techsupporter 5y ago
  > With explanation in abstract that its easier to buy meth than pseudoephedrine. People may laugh at this, as they should since it is an absurd situation, but this isn't entirely wrong. Neither my wife or I drive and during the pandemic she gave up her license after getting an appointment at the DOL was difficult. Both of us carry US passport cards as our ID. This has resulted in several situations where we've been turned down for purchasing restricted items like alcohol or drugs containing pseudoephedrine, particularly the latter, because a passport card can't be scanned by the usual point of sale systems. There are a couple of places in Seattle that are happy to accept a passport card but even at them it's sometimes been dependent on who is working the counter that day.
jjoonathan 5y ago
Phenylepherine has excellent "not being easily convertible into meth" properties, if only it had actual decongestant properties to go along with them... Sigh.
- bee_rider 5y ago
  I bet sugar pills would be even harder to turn into meth.
  - mh- 5y ago
    And more useful, too. They can be turned into things like Pez, or Tic Tacs.
chrischen 5y ago
I just recently got scammed by this. I’m not sure why they even allow selling and marketing this.
baggy_trough 5y ago
Phenylephrine must be totally useless since pseudoephedrine barely does anything in my experience!
- ygjb 5y ago
  It's not super effective on me either, except for triggering crippling anxiety, but remember that we are outliers, and it's a very effective medication for most folks.
  - throwawayboise 5y ago
    Same. The original Sudafed did dry up a runny nose somewhat, but also made me jittery like I'd taken a big hit of caffeine.
- deleted 5y ago
  [deleted]
Zak 5y ago
I wonder how difficult it would be to get the restrictions on pseudoephedrine rolled back now that it appears unlikely they're accomplishing their original goal of limiting the methamphetamine supply. Concern (legitimate and otherwise) over ability to breathe is a popular topic in politics lately.
- jrnichols 5y ago
  Difficult. Dianne Feinstein was the figure behind the changes, as part of her war on drugs. She wanted pseudoephedrine made prescription only too. https://www.drugcaucus.senate.gov/press-releases/feinstein-gao-report-examines-effect-of-state-laws-on-methamphetamine-labs/ https://www.drugcaucus.senate.gov/press-releases/feinstein-g... ironically, OR and MS, the states listed in that report, are so far the only 2 that are starting to roll back the restrictions. Our elected officials seem adverse to admitting something doesn't work well and rolling it back, unfortunately.
  - Zak 5y ago
    Every time she's mentioned, there's something to make me dislike Feinstein more than I already did. It does seem likely her strong opposition would be a high bar to clear, though as the oldest current senator, she may not be a factor for a long time.
    - reincarnate0x14 5y ago
      It really is amazing how someone manages to be on the wrong side of seemingly everything, and yet is locked into office past the point of senility.
      - deleted 5y ago
        [deleted]
      - vkou 5y ago
        This means that either your calibration mechanism for 'wrong side' is flawed, or the system is rigged in a way that it consistently produces bad outcomes. Speaking for myself, am shocked and outraged that red senators and other congresscritters are consistently on the wrong side of seemingly everything, yet they keep getting elected. Of course, my political calibration mechanisms are quite in tune.
patwolf 5y ago
I'm also irked by the fact that OTC cough suppressants like dextromethorphan are equally useless.
- hammock 5y ago
  Citation? Dextromethorphan works very well for me. (Also DXM is a recreational drug which is why it's always sold OTC with either Tylenol in it or as an extended-release formula)
  - cardiffspaceman 5y ago
    Chris Rock has a few brilliant, hyperbolic, minutes on how in some neighborhoods "tussin" is a cure-all.
    - throwaway48375 5y ago
      Back then I'm pretty sure robitussin had codeine not DXM.
  - ConceptJunkie 5y ago
    https://pubmed.ncbi.nlm.nih.gov/11045895/ https://pubmed.ncbi.nlm.nih.gov/11045895/
- djrogers 5y ago
  In the vast majority of cases for my family, Dextromethorphan is a miracle drug. We're in the middle of cold and allergy season here, and my kids (and I) stop coughing within 5-10 minutes of taking an appropriate dose. Once every 3-4 years I'll get a cough so bad that DXM won't fix, and when that happens my doc gives me a prescription for a codeine based cough syrup that fixes it (and renders me useless as a human being).
  - genewitch 5y ago
    I dunno, codeine makes me love my family even more, as an anecdote...
EamonnMR 5y ago
Sometimes I wonder if NSAIDs are the same deal, or if there's just a subset of people they don't work well on.
- throwawayboise 5y ago
  Tylenol (acetaminophen) does nothing for me. Advil (ibuprofen) does usually work. I used to get more headaches when I was younger, but I rarely get them now. Two things that have changed that might be related: I no longer use CRT screens, and I no longer drink diet soda (used to drink 4-6 cans a day, most days). Aside from headaches, Advil does better on other aches and pains than Tylenol, which does almost nothing. And it's better for the liver.
  - genewitch 5y ago
    better for the liver, worse for the stomach. It's a sliding scale, you have to decide how much you care about whatever hurts not hurting anymore versus damage to organs you can't even see. Also i used to get wicked headaches from diet soda when i was younger, too. Is it possible to be "slightly" Phenylketonuric? I had to google the spelling, and it's interesting that "hyperactivity and behavioral issues" is listed as one of the symptoms. I doubt "slightly" is possible, that was tongue-in-cheek. Also as an aside, for pain that the standard dose of ibuprofen doesn't seem to help, emergency medicine studies have found that an additional standard dose of acetaminophen alongside the ibuprofen has greater pain reduction efficacy than vicodin.
- JshWright 5y ago
  There is a significant amount of evidence supporting the efficacy of NSAIDs. Note that they are more effective for some types of pain than others, due to the mechanism by which they work.
- skyechurch 5y ago
  NSAIDs and Tylenol definitely work differently on different people and on different types of pain ime. The stronger ones, like Torodol, can be very effective on even quite serious pain, but you can't even get it _with_ a prescription anymore in the USA.
sp332 5y ago
It might not do much if taken orally, but a phenylephrine nasal spray can be pretty powerful.
- ketchupdog 5y ago
  True, but they have a significant rebound effect.
  - mh- 5y ago
    Only relevant if you ever let it wear off. (/s)
- NoPie 5y ago
  This. Derek has missed that spray is rather effective. Also other agents, such as oxymetazoline is used. They all have a rebound effect, so their use should be limited to 7 days at most. Also, this is mostly for comfort. There is no really reason to go back to pseudo-effedrive and risk side-effect (high-blood pressure etc.). Also people value their comfort a lot, they are not so good with assessing risks. Apparently that is the reasoning to continue selling phenylephrine because people want to get something even if it is not distinguishable from placebo.
  - happyopossum 5y ago
    > Also, this is mostly for comfort. Spoken like someone who has never had severe nasal congestion. A week or two of not being able to sleep, taste, or speak with your normal voice would change your view of the importance of good decongestants.
    - genewitch 5y ago
      When i lived in california, this was a yearly ordeal. I also found out that when a bottle says "do not use for more than 4 days" they mean that. I very nearly choked on my tongue because i couldn't move it in my mouth due to the insane dryness, i didn't think it was even possible to accomplish that level of dry. I discovered "neti pots" because in a bout of panicked rage i snorted nearly an entire can of saline nasal wash, had immediate relief, and went and bought my first plastic neti pot. I never use deionized or whatever water, the chances of toxins in my water is extremely low, and i usually just do it in the shower anyhow, where there's hot water right there. Sodium Bicarb + NaCl just works. More recently for the sort of dry allergy nasal stuff i started putting mentholated petrolatum jelly directly in and around my nose. I'm sure in 10 years i'll find out that i'll get nostril cancer or something, but whatever, i can breathe, thank you very much.
bigbillheck 5y ago
I haven't really been able to take pseudoephedrine for a number of years now due to getting heart palpitations with even a small dose. Luckily fluticasone is available without a prescription and I've had success with that.
14 5y ago
It is sad that society has gone into such a protectionist stance. In our great grandfathers day you could buy opiums and cocaine you name it. Now everything is so locked up heaven forbid someone abuses drugs. The problem with a useless drug like this is people won’t get the desired effect and start compounding more drugs into their system. Like what I had to do with an abscesses tooth. I don’t abuse drugs, I no longer drink and don’t smoke marijuana I don’t even drink coffee anymore. But when my tooth went bad all I was allowed was Acetaminophen and ibuprofen which didn’t even come close to touching the pain. So I took extra acetaminophen and ibuprofen anyways despite the risks out of desperation. Then I started using copious amounts of oral gel tooth numbing medicine which has benzocaine I believe which can also increase heart rate I believe. I was so desperate for any form of relief while I waited to get to the dentist that I was forced to abuse anything I could get for relief that one narcotic medication would have easily treated. I have often wished I could return unused narcotics I have been given to show the doctors “look I’m returning drugs I don’t have an abuse problem I only use them for pain control please continue being generous with them in the future”.
jrnichols 5y ago
phenylephrine is a great drug in hospital for sepsis patients, but as a nasal decongestant, it really is useless. the "war on drugs" push to restrict pseudoephedrine created more problems than it's worth. "the new meth" has been even worse. https://crimeandjusticenews.asu.edu/news/chemically-different-new-meth-causing-severe-mental-illness https://crimeandjusticenews.asu.edu/news/chemically-differen... There's a really good Atlantic article about it as well (google "the new meth" Atlantic) but it's behind a paywall.
deleted 5y ago
[deleted]
tyingq 5y ago
It's interesting how many younger people in the US aren't even aware that the only useful decongestants are behind the counter. I assume they just think there isn't a useful treatment for the symptoms.
- taeric 5y ago
  I remember when the over the counter stuff just seemed to stop working. I just assumed that something about my body changed. Took me a year or so to find that the ones behind the counter still worked very well. I think I'm lucky, in that I don't really need too much help that often. I can only imagine if my sinuses were as bad as they were back in the day, though.
smm11 5y ago
I'd be crippled without Bronkaid. And weed.
- djrogers 5y ago
  I'm not sure mixing uppers and downers like that is a great idea, but Bronkaid has been a life saver for me.
  - smm11 5y ago
    One before work, the other after. I tried just one or the other, and it doesn't work as well as before/after.
munificent 5y ago
My drug of choice for colds is NyQuil. It's always been great for opening up my nasal passages enough to let me breathe easily and then knocking me the fuck out so I could sleep off most of the cold. I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo. Only a couple years later did I make the connection that this was right when they passed the law restricting pseudoephedrine. I got my hands on some NyQuil D and everything was back to normal and I had a functioning cold remedy again. Phenylephrine is completely useless.
- hammock 5y ago
  NyQuil is a combination medicine. The cough, cold and flu formula contains Tylenol (fever/pain reliever), DXM (stops cough) and an antihistamine (dries out your runny nose/postnasal drip). NyQuil can be a great all-in-one product when it's what you need. It's useful to know what it is composed of and why. All of the medicines in it treat symptoms, not the underlying cause, which will be fought off by your immune system. If you have only one or two symptoms, you can always buy each drug separately - doing so allows you to more precisely control dosage and timing as well. FYI, two other common symptoms not covered above are sinus congestion - which can be treated with Sudafed - and chest congestion (e.g. a phlegmy cough) - which can be treated with Mucinex.
  - bcrescimanno 5y ago
    Prior to the regulation of pseudoephedrine, NyQuil also contained pseudoephedrine and since the nasal congestion from a a virus can often be the most disruptive factor for sleep (at least, in my personal experience, that's the case) it's considered by some to the be most important component. NyQuil with pseudoephedrine included is now marketed as "NyQuil D" and is available behind many pharmacy counters with the same restrictions as other pseudoephedrine products. However, it could also rightly be called "NyQuil Classic" (to borrow branding from Coca-Cola).
    - Robotbeat 5y ago
cheald 5y ago
Phenylephrine is utterly useless on me. Maybe it works for some people but it may as well be Pez for all the good it does me. I make it a point buy a pack of actual pseudoephedrine from my pharmacist every 6 months or so, to ensure I have a stock when I need it. Fortunately, I don't need it too often, but there's no good substitute when I do.
epmaybe 5y ago
funnily enough, phenylephrine is used daily in ophthalmology for dilated eye exams. On that note, there's a bunch of esoteric drops that used to be used because of their useful pharmacokinetics, diagnostic/therapeutic abilities (cocaine, hydroxyamphetamine, pilocarpine 0.125%, homatropine), but are no longer being manufactured due to cost.
PragmaticPulp 5y ago
The article comes so close to explaining a way to make it work, likely due to his hesitancy to recommend exceeding the recommended dose: > Why is oral phenylephrine so useless? It is extensively metabolized, starting in the gut wall. You can find a bioavailability figure of 38% in the literature, but that appears to be the most optimistic number possible, and you can also find studies that show 1% or less. Overall, the Cmax is highly variable patient-to-patient, and the lack of cardiovascular effects at low doses argues for very low systemic effects (and expected low efficacy as a decongestant). The bioavailability increases at higher doses as you apparently saturate out some of the metabolic pathways, but at the 10mg dose typically used for decongestants, you can forget it. Phenylephrine has variable Bioavailability. The bioavailability doubles if you take it with Tylenol, which is actually common in the context of colds. (Source: https://pubmed.ncbi.nlm.nih.gov/25475358/ https://pubmed.ncbi.nlm.nih.gov/25475358/ ) The maximum dose was probably chosen based on worst-case scenarios, whereas the average person who complains it doesn't work is probably absorbing much less. Always consult with your doctor, but I've found that taking a second dose of phenylephrine if the first one hasn't worked within about 30 minutes usually does the trick. Or just take it with Tylenol. It's worth checking your blood pressure to make sure you haven't started entering the realm of side significant side effects, though. Also I should point out that pseudoephedrine isn't available behind the counter everywhere. It's prescription-only in some places.
- JumpCrisscross 5y ago
  Do we have a study showing these (second dose within 30 minutes or paracetamol + phenylephrine) performing better than placebo?
  - PragmaticPulp 5y ago
    We actually have a lot of studies where even standard 10mg phenylephrine taken alone outperforms placebo: https://pubmed.ncbi.nlm.nih.gov/17692721/ https://pubmed.ncbi.nlm.nih.gov/17692721/ Note that Figure 3 also mentions the Tylenol combination effect and even shows how 10mg Phenylephrine + Tylenol performs somewhere between 10mg and 45mg of phenylephrine. The article author just cherry-picked the one study where phenylephrine performed the worst. Cherry-picking a single study to support a conclusion and ignoring meta-analyses would normally get someone torn apart in the HN comments but apparently everyone loves pseudoephedrine so it gets a pass.
AtlasBarfed 5y ago
My college buddy stayed with me about 22 years ago while he went to med school, and then when he graduated he moved out. I found after he left a box of phenylephine with "PLACEBO" scribbled over it. That is to say, this has been known for at least 20 years. And yet this big, ok, medium-big, lie persists.
zaroth 5y ago
By the way, if you want something that works, that you can buy without a prescription, I cannot recommend “BronkAid” aka ephedrine sulfate 25mg highly enough. It’s sold “behind the counter” in the US at major pharmacy chains, which means you have to ask for it by name, they won’t even have the cards in the aisles that you then bring up and redeem. You have to show ID — not sure if that’s a Federal or a State thing, and you’re limited in the quantity you can buy at once, but the limits are not overly restrictive. It’s sold mainly as an anti-asthmatic. I personally have borderline asthma, meaning I’ve never had an asthma attack but in a test chamber my total lung volume increases 20% after puffing albuterol. It opens up my breathing tremendously, very useful as a pre-workout, has a nice nootropic effect, and for me personally does not cause any increased heart rate, although for many people that is an undesirable effect. Perhaps best not to stack with caffeine. And when I have a cold, I like it better than suppressants, expectorants, or even pseudoephedrine because I get clearing without turning into a leaky faucet. Just my anecdata…
- gojomo 5y ago
  My understanding, consistent with your impression, is that ephedrine has more of a full-system effect, including lungs & bronchial tubes, along with (in many people) more of a general full-system stimulation. In contrast, pseudoephedrine has a greater nasal/sinus effect with a bit less full-system spillover (but still noticeable in some people, or at higher doses, or in combo with caffeine). So it's worth it for people to be aware of ephedrine options – like ephedrine sulfate or ephedrine hcl ('Primatene') – but many will still find pseudoephedrine better for their symptoms. It's worth trying both, separately, depending on personal chemistry & concerns.
- djrogers 5y ago
  Shh! Don't talk about the secret stuff! My pharmacies run out of it too often as it is...
christkv 5y ago
I remember somebody calculated the cost of making meth from over the counter pseudoephedrine tablets and it would be the single most expensive drug available.
cperciva 5y ago
Pseudoephedrine is wonderfully effective, but beware of its side effects. I used to take it regularly due to congestion related to seasonal allergies, but at a recent medical visit I discovered that my blood pressure had jumped from its usual 120/75 up to 150/105. (My doctor was also alarmed!) I no longer take pseudoephedrine. I'm told that the effect on blood pressure is usually mild, but based on my experience I'd recommend blood pressure monitoring to anyone planning on using it, just in case (like me) they're one of the unlucky people who experiences a dramatic increase in blood pressure.
- asdff 5y ago
  How did you control for the pseudoephedrine in this experiment?
  - VLM 5y ago
    I'm not OP, but its elimination half life is about six hours, so you'd superficially expect OP's BP to drop in a curve with a half life of six hours after the last dose. It would be really easy to chart with one of those wrist BP monitors and an excel spreadsheet.
  - cperciva 5y ago
    I stopped taking pseudoephedrine and the following day my blood pressure was back to normal.
- genewitch 5y ago
  there was a study published february 2022 that showed that acetaminophen also increases blood pressure. I was pretty aware that both pseudoephedrine and ephedrine raised blood pressure slightly - but it's always good to see it mentioned online where other people may not have known.
  - cperciva 5y ago
    In my case, I was taking ibuprofen+pseudoephedrine, so acetaminophen wasn't a confounding factor. And yes, there's plenty of literature showing a slight average increase in bp -- but it seems that there's a wide variance, with some people having dramatically larger side effects.
pstuart 5y ago
This is one of the more benign bits of stupidity that is The War On Drugs™.
annoyingnoob 5y ago
Are there any good decongestants? Seems like all of them have potentially serious side effects. Pseudoephedrine works but drives up my blood pressure. There are any number of sprays like oxymetazoline but they all create addiction issues if you use them too much.
noobermin 5y ago
Man I have congestion so often and I always took phenylephrine and always felt it was hit or miss. Now I know it wasn't just me!
mdoms 5y ago
When I get a cold I simply get plenty of rest and ride it out. Drugs are not necessary for minor ailments.
boringg 5y ago
I used the, I believe, dayquil version one time (active ingredient pseudoephedrine) in the US and my ability to focus that day was on a completely different level even being sick. I almost wanted to keep using it for productivity purposes. Also love that I had to go to a controlled substance area of the pharmacy to get it.
stjohnswarts 5y ago
Nothing works as well for allergies for me as zyrtec-d. I get the 12 hour variety and just use benadryl at night. Luckily I only need it a month or two out of the year. Don't know about taking that stuff year round :) (pseudoephedrine)
dataangel 5y ago
I've recently had to deal with the medical profession a lot more than in the past and I'm finding this sort of thing everywhere. OTC medicines that by current standards would not be made OTC, surgeries that are extremely common but have never had quality randomized trials, official sounding diagnoses that on inspection are actually defined as "we have no idea", lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain), medical device approvals abusing the shortcut of being "substantially similar" to an existing device to evade regulatory scrutiny, the complete lack of enforcement of what goes in supplements... I feel like my entire understanding of the medical system in the US was a lie. We're constantly touting that we have the most advanced technology but if you have a complex condition you are likely to fall prey to multiple kinds of grift.
- petschge 5y ago
  And now I am reminded of https://dx.doi.org/10.1136%2Fbmj.327.7429.1459 https://dx.doi.org/10.1136%2Fbmj.327.7429.1459 and the fact that there is no randomised controlled trials that show the effectiveness of parachutes either.
  - thedailymail 5y ago
    Au contraire! https://www.bmj.com/content/363/bmj.k5094 https://www.bmj.com/content/363/bmj.k5094
    - petschge 5y ago
      Note that this is the study that prompted the study I linked to. But yes, worth a read too.
  - astrange 5y ago
    As of 2020 there wasn't an RCT for surgical masks being helpful in surgery.
- travisathougies 5y ago
  You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. In reality, there are a plethora of conditions, some very common and serious, that medicine simply has no idea how to treat. The set of completely treatable / curable conditions is much much much smaller than the set of all possible diseases, yet people act as if it's the opposite. This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution.
joecool1029 5y ago
Phenylephrine does have one use that the author missed: It's used in ophthalmology to dilate the pupils before eye exams. On the topic of other use case medications, I used to take Sudafed (the real pseudoephedrine kind) during allergy season for a few weeks each year and noticed my productivity skyrocketed during that time, when I normally had issues context switching. Eventually I narrowed it down to taking Sudafed and saw this post: https://accidentalscientist.com/2005/08/the-sudafed-test-for-adhd.html https://accidentalscientist.com/2005/08/the-sudafed-test-for... This lead to an ADHD diagnosis and proper meds and my life and work productivity improved pretty dramatically.
- deleted 5y ago
  [deleted]
- throwra620 5y ago
- astrange 5y ago
  Bit disappointing that everyone starts commenting about amphetamines on a post about Sudafed working the same way as Strattera, which isn't a stimulant. Though him telling people Strattera has no side effects hopefully didn't surprise anyone when they went on it, it feels (literally) like being kicked in the stomach and can make you quite nauseous.
  - joecool1029 5y ago
    I didn't like the safety profile on Strattera nor the inability to take it 'as needed'. Rare, but there were reports of liver injuries on it. My doctor seemed to be unimpressed in it when I asked about options on and said in her experience amphetamines almost always had the best efficacy in adult ADHD patients.
    - astrange 5y ago
      It works well for me. Just Vyvanse wasn't 24/7 (unless you enjoy never sleeping) and the comedown is really bad for me. I did have to suggest it myself because my doctor preferred guanfacine for a secondary medicine, but it has a lot of side effects itself - and whenever anyone else asked my medicines they thought I said "guaifenesin".
avidphantasm 5y ago
First, I find that Phenylephrine works well enough as a decongestant for me, without the jitters and heart palpitations. Of course, others' mileage may vary. Second, how did this sentence: "There are a number of synthetic procedures for doing this, some of them quite alarming, and several of which can indeed be performed in the barn, garage, basement, or trailer park of your choice..." make it through editing. This reeks of insensitivity and classism.
- tptacek 5y ago
  No, not really. Meth manufacturing is famously a scourge of trailer park communities, where the manufacture itself poses risk to residents that probably outstrip the risks of the drug. Trailers and barns just happen to be an efficient place to stand up makeshift meth labs.
sydthrowaway 5y ago
I am suffering with a bad/cold flu right now and this has made me mad as hell! What if someone is so sick they can't fathom to walk into a pharmacy? Fuck senators.
- djrogers 5y ago
  Thank God I have about 100 different people I could call and ask to pick up medicine for me were I in that situation.
  - sydthrowaway 5y ago
    Lucky you.
dr_orpheus 5y ago
There's only a couple drugs I know by name to look for on package labels and pseudoephedrine is one of them. The other one is diphenhydramine (an antihistamine i.e. Benadryl) because its common side effect of drowsiness means that its also one of the most common sleep aids. It has been more than once that myself or someone near me was having an allergic reaction and the 7/11 down the block didn't have any Benadryl but did have some sleep aid.
perardi 5y ago
I’m skeptical the regulations will ever get rolled back, because it’s just so trivially easy to get spooked by the idea of making meth, but as mentioned in this article, I don’t think pseudoephedrine would become a significant source of methamphetamine again if it was made easily available over the counter. Because the cartels have gotten really, really good at making meth. Extremely pure and extremely cheap, and the proper psychoactive isomer. There’s a massive supply of cheap and “good” crank out there, so I doubt deregulation of Sudafed would really make a blip in the total supply.
- quickthrower2 5y ago
  I wonder if there is something they can add to it that is harmless to humans but makes it impractical or too expensive to use as a precursor for making meth.
trepetti 5y ago
The title is misleading as written in the article. It should be "The Uselessness of Phenylephrine as a Decongestant". Phenylephrine is a lifesaving medicine in emergency medicine to increase the blood pressure of people with hypotension.
Reason077 5y ago
At least in the US and UK, you can actually still get pseudoephedrine-containing products from a pharmacist. In some countries (New Zealand!), it is prescription-only. Same with anything containing codeine.
cwkoss 5y ago
I had a friend who would keep pseudoephedrine in his glovebox to be used for alertness in case he became drowsy driving. He was a chem nerd, so was not particularly remarkable to me. I have to wonder if the restrictions on pseudoephedrine have driven anyone to purchase meth. The safety profile of pseudoephedrine is pretty good - I think it could be argued its a good legal stimulant to offer to the public. Could increasing it's availability be a legitimate harm reduction measure that would displace/prevent meth use among some populations?
- scythe 5y ago
  Doubtful. Caffeine is already a legal recreational stimulant. What distinguishes methamphetamine/cocaine is that they are, for want of a better word, prosocial. People don't just do meth, they seek out other people who are also doing meth. Pseudo will not fill that niche. There may be other "safe(r)" substitutes, such as HDMP-28 or amfonelic acid or something, but they have to reproduce the social function of recreational stimulants to culturally substitute.
  - cwkoss 5y ago
    Ah, yeah the social aspect probably can't be replaced by pseudoephedrine. However, meth can be functional enough that I would guess it's used for wakefulness/focus among a significant proportion of users (especially in early stages of addiction): truckers using it to drive longer, students using it to study, graveyard shift workers using it to stay alert while operating dangerous equipment, etc. These use cases seem like they could potentially substitute pseudoephedrine, and in doing so, could function as an "anti-gateway-drug": users who solve their use case without the euphoria are less likely to get addicted or transition into social usage.
hilbert42 5y ago
Derek Lowe makes a good point that we're wasting everyone's time and money with useless phenylephrine and the fact that pseudoephedrine is so much better as a decongestant. The fact is that pseudoephedrine is not only banned in the US but it is also banned in many other counties for the same reason that it's a precursor for meth. The trouble is that banning pseudoephedrine seems to have only made matters considerably worse as I learned from this HN story a few months back: https://news.ycombinator.com/item?id=29027284 https://news.ycombinator.com/item?id=29027284 Banning pseudoephedrine has led drug cartels to ramp up production of the precursor P2P, phenylacetone, which, it seems, is a better precursor anyway. It's worth reading this story in conjunction with this one. As Lowe hints, given the circumstances, we'd be better off going back to a decongestant that actually works. Quote from the earlier HN story: "Meth in the US shifted to P2P synthesis between 2009 and 2012. In the before times, meth was made with ephedrine or pseudoephedrine. However, in 2006, the US banned over-the-counter sales of pseudoephedrine, and in 2008 Mexico banned almost all sales. In response to this, meth makers switched to a synthesis based on P2P, which can be made from many different, widely available, source chemicals."
- deleted 5y ago
  [deleted]
- pwned1 5y ago
  Pseudoephedrine isn't banned, you just have to ask the pharmacist for it.
  - hilbert42 5y ago
    Right, 'banned' is a blut word here, I suppose I should have used 'restricted schedule' as per officialdom but the earlier HN article used 'banned'. Incidentally, many countries have banned it or made it only available on script (i.e.: where I live). Never tried to get it myself since it went on script. Personally, I find it repulsive stuff - makes me feel sicker than the cold or flu alone so I no longer use it (makes me feel queasy on the stomach).
sammalloy 5y ago
Now do cough medicine. The last time I looked at the literature, experts were asking why 95% of cough medicine was allowed to be sold when none of it was known to work. The list of OTC medical products that don’t work is very large.
twofornone 5y ago
I have the impression that many cold drugs are similarly useless. Dextromethorphan comes to mind[0]. I think its the nature of colds, they are not particularly severe and symptoms are easily influenced by placebo effects. Many of them are really just relying on caffeine for daytime meds and antihistamines for nighttime formulations. That whole market feels like a borderline scam. 0. https://pubmed.ncbi.nlm.nih.gov/11045895/ https://pubmed.ncbi.nlm.nih.gov/11045895/
60secz 5y ago
The herb ephedra (Ma Huang/Mormon Tea) contains appreciable amounts of ephedrine and is prepared as a tea in Chinese medicine as a remedy for asthma and cold congestion. It can easily be purchased online and the ephedrine ban does not apply to it. https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant-ephedrine https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant...
- jacobmartin 5y ago
  Any idea how pure or clean these online sources are?
- meepmorp 5y ago
  NB: ephedrine and pseudoephedrine are related (they're stereoisomers), but are different drugs with somewhat different pharmacokinetics.
  - culi 5y ago
    This is true, but the plant actually contains both. The amount of each can vary widely based on which species you're talking about. The species linked here, commonly known as Mormon Tea, is one of the few species that doesn't contain any ephedrine and only contains pseudo
thehappypm 5y ago
I need a tl;dr: what medicine should I take if I’m congested??
- JohnTHaller 5y ago
  pseudoephedrine. The ingredient in Sudafed, Nyquil, etc that actually works. You'll usually need to go to the pharmacy counter to get it and show ID. They track how much each person gets because some folks were using it to make meth a while back. The replacement in the OTC Sudafed, etc out one the shelves, phenylephrine, doesn't work.
  - thehappypm 5y ago
    Thank you!
codr7 5y ago
I recommend simply getting a Yoga nose cleaning thingy, it will also help prevent getting sick in the first place.
jay_kyburz 5y ago
The only silver lining of the pandemic is that I haven't had a cold or flu in years and haven't needed to ask for behind the counter pseudoephedrine.
akdor1154 5y ago
For all phenylephrine oral is useless, FYI phenylephrine nasal spray seems to work well as a gentle decongestant, anecdotally much better than saline spray, and not as strong (or addictive) as oxymetazoline.
emmelaich 5y ago
For some, pseudoephedrine make scuba diving possible. The difficulty of getting some is very annoying.
cmrdporcupine 5y ago
Pseudoephedrine is a stimulant and not a particularly pleasant one at that. Here in Canada there's still cold medicines with it in them, and to be honest, when I see it, I avoid it. It may not be as good of a decongestant but phenylephrine won't keep me up at night. And when I'm sick with a cold what I really need is a good sleep.
- jonhohle 5y ago
  I have the same feeling. I’m very sensitive to pseudoephedrine jitters and do my best to avoid it. It may be placebo, but phenylephrine “works” for me and can “tell” days that I forget to take one in the morning when I have post nasal drip. Knowing it should have no clinical effect, I’d be interested in blinding myself to a placebo to convince myself it really has no effect.
- mypalmike 5y ago
  I've found dosage is critical with pseudoephedrine. I can only take one of the small 30mg red buttons (half the recommended dosage) in a 24 hour period and get the benefits without side effects.
- LorenPechtel 5y ago
  Different people are different. It doesn't mess with sleep at all for me. My wife has to use it with care, continued taking of it gives her overdose symptoms. (Obviously, it's not being eliminated as fast as they expect.)
angry_octet 5y ago
If there were a darknet way to buy medical grade Sudafed that would be fine by me.
HL33tibCe7 5y ago
Reminds me of docusate, a very commonly prescribed “Laxative”. The problem? There’s seemingly barely any evidence that it actually works. And plenty to suggest it has no effect over that of a placebo. Yet there’s a culture of prescribing it, so on prescribed it goes.
- insickness 5y ago
  Wow. I've purchased more than a few bottles of ducosate. But it looks like you're right: Reevaluating the Use of Docusate in the Management of Constipation https://www.drugtopics.com/view/reevaluating-the-use-of-docusate-in-the-management-of-constipation https://www.drugtopics.com/view/reevaluating-the-use-of-docu...
caturopath 5y ago
To quote the alt text from https://xkcd.com/971/ https://xkcd.com/971/ > Telling someone who trusts you that you're giving them medicine, when you know you’re not, because you want their money, isn’t just lying--it’s like an example you’d make up if you had to illustrate for a child why lying is wrong.
jordanmorgan10 5y ago
Then why does something like Sudafed seemingly work for me?
dbbolton 5y ago
I'm a physician- although I don't disagree with the spirit of the article the headline is exceptionally misleading. Phenylephrine is useless as an oral decongestant. It is still quite useful for other indications, including as a vasopressor (given IV to increase blood pressure such as in hypotensive shock). I believe it is actually the only commonly available vasopressor in the US that is a pure alpha-1 agonist which in certain scenarios is desirable. It is also indicated for treatment of priapism. The real kicker is that phenylephrine actually does work as a nasal decongestant when it is used as an intranasal spray, which has the added benefit of fewer systemic side effects compared with oral decongestants.
- bin_bash 5y ago
  It's also the active ingredient in Preparation H as a vasopressor
- dataflow 5y ago
  What about when it does work for people as an oral decongestant though? Are you suggesting that's just randomness? Or perhaps the placebo effect? I guess I'm not entirely convinced it's really useless for that purpose, but I'm just a layman.
  - Kwantuum 5y ago
    The original article doesn't just suggest it, it claims it outright, and links a study to back up that claim: https://www.annallergy.org/article/S1081-1206(10)60240-2/fulltext https://www.annallergy.org/article/S1081-1206(10)60240-2/ful...
  - askvictor 5y ago
    Here's my theory: you know that pseudoephedrine works, so taking this thing that's supposed to be a replacement for it, and sounds pretty similar, will convince your brain that phenylephrine will also work. So yes, placebo, but with foreknowledge of the effectiveness of pseudoephedrine. I'm curious if there have been placebo-controlled studies on phenylephrine where the participants were told they were receiving pseudoephedrine
driggs 5y ago
There's only one reason phenylephrine is used as a substitute in the OTC decongestant products: the general public can't pronounce or spell the word "pseudoephedrine" and they're intentionally being duped. They walk into the grocery store, convenience store, or pharmacy after a sleepless night of breathing through their mouth, see the red package that says SUDAFED and a vaguely familiar-looking active ingredient, grab it, and plop their money on the counter. PsEudoEPHedRINE PhEnylEPHRINE This is OTC medical fraud.
- throwaway684936 5y ago
  Not quite the same thing, but it's odd the way they attached 8-chlorotheophylline to diphenhydramine, renamed it "dimenhydrinate" and marketed as "non-drowsy nausea medication" (Dramamine). The added molecule is totally ineffective at combating the drowsiness. It's all-but-technically an identical product to diphenhydramine.
chmorgan 5y ago
Wait until people find out about the effectiveness of wearing masks on preventing covid infection and spread... I noticed Phenylephrine didn't work at all for me a handful of years ago after the pseudoephedrine swap occurred. Did a web search and turned up the same info here. At the time it was amazing to me that these products were being sold. This is a great article and I applaud the author for trying to get these products pulled or replaced with something effective.
eek2121 5y ago
The DEA, FDA, and state regulators are destroying everything IMO. Many doctors don't want to even deal with drugs labeled as a 'controlled substance'. I ended up going off an extremely effective medication due to none of the doctors (including psychiatrists, etc.) wanting to prescribe it anymore due to restrictions. I now suffer daily. There are a few doctors who will still prescribe it, but predictably, NONE of them take insurance (because they know they can corner the market by not doing so). ALL of them charge $400+ per visit.
ck2 5y ago
It's weird to me you can buy steroid nasal sprays OTC (Nasacort, Rhinocort, Flonase, etc.) but not pseudoephedrine
douglaslps 5y ago
How does Naphazoline (usually administrated as nasal drops) compare to pseudoephedrine?
wrekone 5y ago
I won't rule out a placebo effect, but phenylephrine works just fine for me. Pseudoephedrine just makes me jumpy.
meristohm 5y ago
Sometimes the most helpful thing when I have a problem is being listened to and accepted. It is frustrating to see doctors that only pretend to listen, and I wonder to what degree such doctors are satisfied with their work. We finally have for our child a pediatrician who gives us what I hope will someday be normal care and attention.
TheRealSteel 5y ago
Phenylephrine is 100% fake and it's frustrating it's allowed to be sold
Nitramp 5y ago
Over here in Germany, when you ask for a decongestant, you usually get Xylometazolin as a spray. As I understand, that's both more effective and has fewer side effects (due to being local). You can also get pseudoephedrine, but I don't think it's as commonly used as these nasal sprays. Is that not an option in the US?
- TheSpiceIsLife 5y ago
  Have you ever tried taking twice the recommended daily dose of xylometazolin in one go? Quite stimulating!
- f1refly 5y ago
  > As of 2021, no consumer products containing xylometazoline are marketed in the United States, however imported products containing xylometazoline are available online. From the wikipedia article. Fascinating, it's the most common drug I use and it's not even available in US stores!
wastra 5y ago
Physician, anesthesiologist speaking. Intravenous phenylephrine widely used, effective. No good in stomach. Doctors struggle to harness all the historic use and evidence for treatments, sometimes based on great evidence. Often evidence is the best that can be had given available resources. Drug companies hiding data (derived from volunteers and patients) is wrong, and a problem. Selective publishing of only positive findings in medical journals is common. Careers depend on publications. But despite these pressures, most doctors think hard about these issues, and do their truthful best for the patient in front of them, given the imperfect knowledge available. OTC labeling is deceptive at best. Placebo only works for a few things.
LordKano 5y ago
It's so bad that I'd rather just scan my ID and get a product that contains pseudoephedrine.

799 points by hprotagonist 5y ago

I can buy "Wal-Phed D" at my Walgreens pharmacy. It's Pseudoephedrine HCl 100 mg and works very well. It's quite easy to get, they just look at my ID.

jfengel 5y ago

I've certainly found it useless, and when I need a decongestant I make certain I'm getting actual pseudoephedrine. The 12 and 24 hour slow-release versions are fantastic. I've never done a proper blind trial on myself, but I feel quite certain that I could tell the difference. I suppose people must be buying it, and given how strong placebo effects are in general I guess it's doing something for them.

nvahalik 5y ago
Same here. Actual Sudafed works for me and anything else I think generally only tends to work with whatever NSAID they bundle with it.
tcherasaro 5y ago
Same, Sudafed is a silver bullet for me. The 12 hour release absolutely works to clear my sinuses and relieves the sinus pressure headache (almost completely when combined with ibuprofen). My wife insists Phenylephrine works for her and thats all she will take. She has offered it to me a couple times when we didn’t have any Sudafed and Phenylephrine had 0 noticeable effects for me. Edit: I forgot to add that Alavert-D 12 also has Pseudoephedrine and works for me too and is what I take when my congestion is allergy related.
- mh- 5y ago
  One of many such studies: https://pubmed.ncbi.nlm.nih.gov/19230461/ https://pubmed.ncbi.nlm.nih.gov/19230461/ Keep in mind this doesn't say that it's not effective. It's just not more so than the placebo effect, which is quite real even on physiological matters.
- thehappypm 5y ago
  The article suggests the uptake is widely variable person to person so perhaps she’s just a lucky one.

PaulHoule 5y ago

It is even easier to make https://en.wikipedia.org/wiki/Methcathinone https://en.wikipedia.org/wiki/Methcathinone from pseudoephedrine. You can just oxidize PE with potassium permanganate and purify the product... No need to risk blowing yourself up the way you would making methamphetamine.

blakesterz 5y ago

The Wikipedia article they link to [0] has a pretty long list of brandnames. Many of them are the "-D" version of whatever the thing is. Claritin-D, Zyrtec-D and so on. I think the version without the "-D" doesn't have Pseudoephedrine? [0] https://en.wikipedia.org/wiki/Pseudoephedrine#Brand_names https://en.wikipedia.org/wiki/Pseudoephedrine#Brand_names

bvinc 5y ago
In those cases, Claritin and Zyrtec are allergy medicines. The -D indicates that this allergy medicine comes along with a decongestant. The version without the -D will just be the allergy medicine.
- hammock 5y ago
  Specifically, drugs with -D indicate that they come with pseudoephedrine. In the US, they (like the non-PE version of Sudafed) are only available behind the pharmacy counter.

The_rationalist 5y ago

Levo-methamphetamine is a legal decongestant BTW

ncmncm 5y ago
Where does one obtain that? From the waste stream of the methamphetamine producers?
- pkaye 5y ago
  Used to get Vicks inhalers with it. I don't know if its still available.
- somebodynew 5y ago
  It is sold over the counter in most US pharmacies under the Vicks inhaler brand. The active ingredient label conveniently uses a spelling that most people will not recognize which is probably effective in preventing alarm from customers who aren't familiar with the dramatic difference in the effects of the two enantiomers.
  - ncmncm 5y ago
    TIL!
- The_rationalist 5y ago
  btw racemic meth is legally prescribed for ADHD under the brand desoxyn, although it's probably hard to find doctors prescribing it over regular amph

starwind 5y ago

A1 headline right there. Not clickbait, but right to the point

AaronM 5y ago

If you get the chance, go read all of his (Derek Lowe) blog posts about things he refuses to work with. Highly entertaining read.

samatman 5y ago
Thanks for pointing out the author, the headline is not news to me and I would have passed on reading it.
- oh_sigh 5y ago
  Strange that you were reading all the comments about the article you weren't interested in...
  - samatman 5y ago
    I didn't say I wasn't interested in the [headline] I said it wasn't news to me. It's a topic I find interesting, and as it turns out, by an author I already enjoy. The article was not informative [to me], but it was fun reading. Since it was not informative to me (as I deduced correctly from the headline) I could have easily read the comments and not the article. Hope that helps!
genewitch 5y ago
FOOF (or FOOOOOOF)
astrange 5y ago
The problem with this advice (which gets posted to all of his articles) is those posts aren't meant to all be read at once. They're basically all the same thing, which is why he hasn't written any new ones recently. I still want to know what isocyanide smells like.
etskinner 5y ago
The article, for anyone interested: https://www.science.org/content/blog-post/things-i-won-t-work-small-smelly-isocyanides https://www.science.org/content/blog-post/things-i-won-t-wor...

floren 5y ago

My assumption has always been: people know pseudoephedrine works, so that's what they want to buy, but you can no longer sell pseudoephedrine over the counter. However, you can offer phenylephrine, which still lets you reasonably name the drug "Sudafed PE" or whatever. Customer browses the shelves, sees "PE" in the drug name, this triggers a vague impression that it contains pseudoephedrine and thus will actually work well.

denimnerd42 5y ago
or maybe like sudafed pe is an advertisement, a reminder to check behind the counter for the real thing
- floren 5y ago
  The "PE" stands for "placebo, essentially"
  - dkryptr 5y ago
    That's essentially the selling point behind Zicam and other homeopathic drugs.

egberts1 5y ago

First hand experience. Totally useless as a decongestant for me. Stick with pseudoephedrine.

p_l 5y ago

The lack of availability of proper pseudoephedrine in USA led to situation where there are papers describing how to turn methamphetamine into pseudoephedrine, not the other way around. With explanation in abstract that its easier to buy meth than pseudoephedrine.

dsp 5y ago
lol https://improbable.com/airchives/paperair/volume19/v19i3/Pseudoephedrine.pdf https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
- cjhveal 5y ago
  Authored by O. Hai, and I. B. Hakkenshit
- BatmansMom 5y ago
  "While N-methylamphetamine itself is a powerful decongestant, it is less desirable in a medical setting because of its severe side effects and addictive properties... Other side effects may include violent urges or, similarly, the urge to be successful in business or finance."
- deleted 5y ago
  [deleted]
- solveit 5y ago
  Thank you for making my day.
techsupporter 5y ago
> With explanation in abstract that its easier to buy meth than pseudoephedrine. People may laugh at this, as they should since it is an absurd situation, but this isn't entirely wrong. Neither my wife or I drive and during the pandemic she gave up her license after getting an appointment at the DOL was difficult. Both of us carry US passport cards as our ID. This has resulted in several situations where we've been turned down for purchasing restricted items like alcohol or drugs containing pseudoephedrine, particularly the latter, because a passport card can't be scanned by the usual point of sale systems. There are a couple of places in Seattle that are happy to accept a passport card but even at them it's sometimes been dependent on who is working the counter that day.

jjoonathan 5y ago

Phenylepherine has excellent "not being easily convertible into meth" properties, if only it had actual decongestant properties to go along with them... Sigh.

bee_rider 5y ago
I bet sugar pills would be even harder to turn into meth.
- mh- 5y ago
  And more useful, too. They can be turned into things like Pez, or Tic Tacs.

chrischen 5y ago

I just recently got scammed by this. I’m not sure why they even allow selling and marketing this.

baggy_trough 5y ago

Phenylephrine must be totally useless since pseudoephedrine barely does anything in my experience!

ygjb 5y ago
It's not super effective on me either, except for triggering crippling anxiety, but remember that we are outliers, and it's a very effective medication for most folks.
- throwawayboise 5y ago
  Same. The original Sudafed did dry up a runny nose somewhat, but also made me jittery like I'd taken a big hit of caffeine.
deleted 5y ago
[deleted]

Zak 5y ago

I wonder how difficult it would be to get the restrictions on pseudoephedrine rolled back now that it appears unlikely they're accomplishing their original goal of limiting the methamphetamine supply. Concern (legitimate and otherwise) over ability to breathe is a popular topic in politics lately.

jrnichols 5y ago
Difficult. Dianne Feinstein was the figure behind the changes, as part of her war on drugs. She wanted pseudoephedrine made prescription only too. https://www.drugcaucus.senate.gov/press-releases/feinstein-gao-report-examines-effect-of-state-laws-on-methamphetamine-labs/ https://www.drugcaucus.senate.gov/press-releases/feinstein-g... ironically, OR and MS, the states listed in that report, are so far the only 2 that are starting to roll back the restrictions. Our elected officials seem adverse to admitting something doesn't work well and rolling it back, unfortunately.
- Zak 5y ago
  Every time she's mentioned, there's something to make me dislike Feinstein more than I already did. It does seem likely her strong opposition would be a high bar to clear, though as the oldest current senator, she may not be a factor for a long time.
  - reincarnate0x14 5y ago
    It really is amazing how someone manages to be on the wrong side of seemingly everything, and yet is locked into office past the point of senility.
    - deleted 5y ago
      [deleted]
    - vkou 5y ago
      This means that either your calibration mechanism for 'wrong side' is flawed, or the system is rigged in a way that it consistently produces bad outcomes. Speaking for myself, am shocked and outraged that red senators and other congresscritters are consistently on the wrong side of seemingly everything, yet they keep getting elected. Of course, my political calibration mechanisms are quite in tune.

patwolf 5y ago

I'm also irked by the fact that OTC cough suppressants like dextromethorphan are equally useless.

hammock 5y ago
Citation? Dextromethorphan works very well for me. (Also DXM is a recreational drug which is why it's always sold OTC with either Tylenol in it or as an extended-release formula)
- cardiffspaceman 5y ago
  Chris Rock has a few brilliant, hyperbolic, minutes on how in some neighborhoods "tussin" is a cure-all.
  - throwaway48375 5y ago
    Back then I'm pretty sure robitussin had codeine not DXM.
- ConceptJunkie 5y ago
  https://pubmed.ncbi.nlm.nih.gov/11045895/ https://pubmed.ncbi.nlm.nih.gov/11045895/
djrogers 5y ago
In the vast majority of cases for my family, Dextromethorphan is a miracle drug. We're in the middle of cold and allergy season here, and my kids (and I) stop coughing within 5-10 minutes of taking an appropriate dose. Once every 3-4 years I'll get a cough so bad that DXM won't fix, and when that happens my doc gives me a prescription for a codeine based cough syrup that fixes it (and renders me useless as a human being).
- genewitch 5y ago
  I dunno, codeine makes me love my family even more, as an anecdote...

EamonnMR 5y ago

Sometimes I wonder if NSAIDs are the same deal, or if there's just a subset of people they don't work well on.

throwawayboise 5y ago
Tylenol (acetaminophen) does nothing for me. Advil (ibuprofen) does usually work. I used to get more headaches when I was younger, but I rarely get them now. Two things that have changed that might be related: I no longer use CRT screens, and I no longer drink diet soda (used to drink 4-6 cans a day, most days). Aside from headaches, Advil does better on other aches and pains than Tylenol, which does almost nothing. And it's better for the liver.
- genewitch 5y ago
  better for the liver, worse for the stomach. It's a sliding scale, you have to decide how much you care about whatever hurts not hurting anymore versus damage to organs you can't even see. Also i used to get wicked headaches from diet soda when i was younger, too. Is it possible to be "slightly" Phenylketonuric? I had to google the spelling, and it's interesting that "hyperactivity and behavioral issues" is listed as one of the symptoms. I doubt "slightly" is possible, that was tongue-in-cheek. Also as an aside, for pain that the standard dose of ibuprofen doesn't seem to help, emergency medicine studies have found that an additional standard dose of acetaminophen alongside the ibuprofen has greater pain reduction efficacy than vicodin.
JshWright 5y ago
There is a significant amount of evidence supporting the efficacy of NSAIDs. Note that they are more effective for some types of pain than others, due to the mechanism by which they work.
skyechurch 5y ago
NSAIDs and Tylenol definitely work differently on different people and on different types of pain ime. The stronger ones, like Torodol, can be very effective on even quite serious pain, but you can't even get it _with_ a prescription anymore in the USA.

sp332 5y ago

It might not do much if taken orally, but a phenylephrine nasal spray can be pretty powerful.

ketchupdog 5y ago
True, but they have a significant rebound effect.
- mh- 5y ago
  Only relevant if you ever let it wear off. (/s)
NoPie 5y ago
This. Derek has missed that spray is rather effective. Also other agents, such as oxymetazoline is used. They all have a rebound effect, so their use should be limited to 7 days at most. Also, this is mostly for comfort. There is no really reason to go back to pseudo-effedrive and risk side-effect (high-blood pressure etc.). Also people value their comfort a lot, they are not so good with assessing risks. Apparently that is the reasoning to continue selling phenylephrine because people want to get something even if it is not distinguishable from placebo.
- happyopossum 5y ago
  > Also, this is mostly for comfort. Spoken like someone who has never had severe nasal congestion. A week or two of not being able to sleep, taste, or speak with your normal voice would change your view of the importance of good decongestants.
  - genewitch 5y ago
    When i lived in california, this was a yearly ordeal. I also found out that when a bottle says "do not use for more than 4 days" they mean that. I very nearly choked on my tongue because i couldn't move it in my mouth due to the insane dryness, i didn't think it was even possible to accomplish that level of dry. I discovered "neti pots" because in a bout of panicked rage i snorted nearly an entire can of saline nasal wash, had immediate relief, and went and bought my first plastic neti pot. I never use deionized or whatever water, the chances of toxins in my water is extremely low, and i usually just do it in the shower anyhow, where there's hot water right there. Sodium Bicarb + NaCl just works. More recently for the sort of dry allergy nasal stuff i started putting mentholated petrolatum jelly directly in and around my nose. I'm sure in 10 years i'll find out that i'll get nostril cancer or something, but whatever, i can breathe, thank you very much.

bigbillheck 5y ago

I haven't really been able to take pseudoephedrine for a number of years now due to getting heart palpitations with even a small dose. Luckily fluticasone is available without a prescription and I've had success with that.

14 5y ago

It is sad that society has gone into such a protectionist stance. In our great grandfathers day you could buy opiums and cocaine you name it. Now everything is so locked up heaven forbid someone abuses drugs. The problem with a useless drug like this is people won’t get the desired effect and start compounding more drugs into their system. Like what I had to do with an abscesses tooth. I don’t abuse drugs, I no longer drink and don’t smoke marijuana I don’t even drink coffee anymore. But when my tooth went bad all I was allowed was Acetaminophen and ibuprofen which didn’t even come close to touching the pain. So I took extra acetaminophen and ibuprofen anyways despite the risks out of desperation. Then I started using copious amounts of oral gel tooth numbing medicine which has benzocaine I believe which can also increase heart rate I believe. I was so desperate for any form of relief while I waited to get to the dentist that I was forced to abuse anything I could get for relief that one narcotic medication would have easily treated. I have often wished I could return unused narcotics I have been given to show the doctors “look I’m returning drugs I don’t have an abuse problem I only use them for pain control please continue being generous with them in the future”.

jrnichols 5y ago

phenylephrine is a great drug in hospital for sepsis patients, but as a nasal decongestant, it really is useless. the "war on drugs" push to restrict pseudoephedrine created more problems than it's worth. "the new meth" has been even worse. https://crimeandjusticenews.asu.edu/news/chemically-different-new-meth-causing-severe-mental-illness https://crimeandjusticenews.asu.edu/news/chemically-differen... There's a really good Atlantic article about it as well (google "the new meth" Atlantic) but it's behind a paywall.

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tyingq 5y ago

It's interesting how many younger people in the US aren't even aware that the only useful decongestants are behind the counter. I assume they just think there isn't a useful treatment for the symptoms.

taeric 5y ago
I remember when the over the counter stuff just seemed to stop working. I just assumed that something about my body changed. Took me a year or so to find that the ones behind the counter still worked very well. I think I'm lucky, in that I don't really need too much help that often. I can only imagine if my sinuses were as bad as they were back in the day, though.

smm11 5y ago

I'd be crippled without Bronkaid. And weed.

djrogers 5y ago
I'm not sure mixing uppers and downers like that is a great idea, but Bronkaid has been a life saver for me.
- smm11 5y ago
  One before work, the other after. I tried just one or the other, and it doesn't work as well as before/after.

munificent 5y ago

My drug of choice for colds is NyQuil. It's always been great for opening up my nasal passages enough to let me breathe easily and then knocking me the fuck out so I could sleep off most of the cold. I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo. Only a couple years later did I make the connection that this was right when they passed the law restricting pseudoephedrine. I got my hands on some NyQuil D and everything was back to normal and I had a functioning cold remedy again. Phenylephrine is completely useless.

hammock 5y ago
NyQuil is a combination medicine. The cough, cold and flu formula contains Tylenol (fever/pain reliever), DXM (stops cough) and an antihistamine (dries out your runny nose/postnasal drip). NyQuil can be a great all-in-one product when it's what you need. It's useful to know what it is composed of and why. All of the medicines in it treat symptoms, not the underlying cause, which will be fought off by your immune system. If you have only one or two symptoms, you can always buy each drug separately - doing so allows you to more precisely control dosage and timing as well. FYI, two other common symptoms not covered above are sinus congestion - which can be treated with Sudafed - and chest congestion (e.g. a phlegmy cough) - which can be treated with Mucinex.
- bcrescimanno 5y ago
  Prior to the regulation of pseudoephedrine, NyQuil also contained pseudoephedrine and since the nasal congestion from a a virus can often be the most disruptive factor for sleep (at least, in my personal experience, that's the case) it's considered by some to the be most important component. NyQuil with pseudoephedrine included is now marketed as "NyQuil D" and is available behind many pharmacy counters with the same restrictions as other pseudoephedrine products. However, it could also rightly be called "NyQuil Classic" (to borrow branding from Coca-Cola).
  - Robotbeat 5y ago

cheald 5y ago

Phenylephrine is utterly useless on me. Maybe it works for some people but it may as well be Pez for all the good it does me. I make it a point buy a pack of actual pseudoephedrine from my pharmacist every 6 months or so, to ensure I have a stock when I need it. Fortunately, I don't need it too often, but there's no good substitute when I do.

epmaybe 5y ago

funnily enough, phenylephrine is used daily in ophthalmology for dilated eye exams. On that note, there's a bunch of esoteric drops that used to be used because of their useful pharmacokinetics, diagnostic/therapeutic abilities (cocaine, hydroxyamphetamine, pilocarpine 0.125%, homatropine), but are no longer being manufactured due to cost.

PragmaticPulp 5y ago

The article comes so close to explaining a way to make it work, likely due to his hesitancy to recommend exceeding the recommended dose: > Why is oral phenylephrine so useless? It is extensively metabolized, starting in the gut wall. You can find a bioavailability figure of 38% in the literature, but that appears to be the most optimistic number possible, and you can also find studies that show 1% or less. Overall, the Cmax is highly variable patient-to-patient, and the lack of cardiovascular effects at low doses argues for very low systemic effects (and expected low efficacy as a decongestant). The bioavailability increases at higher doses as you apparently saturate out some of the metabolic pathways, but at the 10mg dose typically used for decongestants, you can forget it. Phenylephrine has variable Bioavailability. The bioavailability doubles if you take it with Tylenol, which is actually common in the context of colds. (Source: https://pubmed.ncbi.nlm.nih.gov/25475358/ https://pubmed.ncbi.nlm.nih.gov/25475358/ ) The maximum dose was probably chosen based on worst-case scenarios, whereas the average person who complains it doesn't work is probably absorbing much less. Always consult with your doctor, but I've found that taking a second dose of phenylephrine if the first one hasn't worked within about 30 minutes usually does the trick. Or just take it with Tylenol. It's worth checking your blood pressure to make sure you haven't started entering the realm of side significant side effects, though. Also I should point out that pseudoephedrine isn't available behind the counter everywhere. It's prescription-only in some places.

JumpCrisscross 5y ago
Do we have a study showing these (second dose within 30 minutes or paracetamol + phenylephrine) performing better than placebo?
- PragmaticPulp 5y ago
  We actually have a lot of studies where even standard 10mg phenylephrine taken alone outperforms placebo: https://pubmed.ncbi.nlm.nih.gov/17692721/ https://pubmed.ncbi.nlm.nih.gov/17692721/ Note that Figure 3 also mentions the Tylenol combination effect and even shows how 10mg Phenylephrine + Tylenol performs somewhere between 10mg and 45mg of phenylephrine. The article author just cherry-picked the one study where phenylephrine performed the worst. Cherry-picking a single study to support a conclusion and ignoring meta-analyses would normally get someone torn apart in the HN comments but apparently everyone loves pseudoephedrine so it gets a pass.

AtlasBarfed 5y ago

My college buddy stayed with me about 22 years ago while he went to med school, and then when he graduated he moved out. I found after he left a box of phenylephine with "PLACEBO" scribbled over it. That is to say, this has been known for at least 20 years. And yet this big, ok, medium-big, lie persists.

zaroth 5y ago

By the way, if you want something that works, that you can buy without a prescription, I cannot recommend “BronkAid” aka ephedrine sulfate 25mg highly enough. It’s sold “behind the counter” in the US at major pharmacy chains, which means you have to ask for it by name, they won’t even have the cards in the aisles that you then bring up and redeem. You have to show ID — not sure if that’s a Federal or a State thing, and you’re limited in the quantity you can buy at once, but the limits are not overly restrictive. It’s sold mainly as an anti-asthmatic. I personally have borderline asthma, meaning I’ve never had an asthma attack but in a test chamber my total lung volume increases 20% after puffing albuterol. It opens up my breathing tremendously, very useful as a pre-workout, has a nice nootropic effect, and for me personally does not cause any increased heart rate, although for many people that is an undesirable effect. Perhaps best not to stack with caffeine. And when I have a cold, I like it better than suppressants, expectorants, or even pseudoephedrine because I get clearing without turning into a leaky faucet. Just my anecdata…

gojomo 5y ago
My understanding, consistent with your impression, is that ephedrine has more of a full-system effect, including lungs & bronchial tubes, along with (in many people) more of a general full-system stimulation. In contrast, pseudoephedrine has a greater nasal/sinus effect with a bit less full-system spillover (but still noticeable in some people, or at higher doses, or in combo with caffeine). So it's worth it for people to be aware of ephedrine options – like ephedrine sulfate or ephedrine hcl ('Primatene') – but many will still find pseudoephedrine better for their symptoms. It's worth trying both, separately, depending on personal chemistry & concerns.
djrogers 5y ago
Shh! Don't talk about the secret stuff! My pharmacies run out of it too often as it is...

christkv 5y ago

I remember somebody calculated the cost of making meth from over the counter pseudoephedrine tablets and it would be the single most expensive drug available.

cperciva 5y ago

Pseudoephedrine is wonderfully effective, but beware of its side effects. I used to take it regularly due to congestion related to seasonal allergies, but at a recent medical visit I discovered that my blood pressure had jumped from its usual 120/75 up to 150/105. (My doctor was also alarmed!) I no longer take pseudoephedrine. I'm told that the effect on blood pressure is usually mild, but based on my experience I'd recommend blood pressure monitoring to anyone planning on using it, just in case (like me) they're one of the unlucky people who experiences a dramatic increase in blood pressure.

asdff 5y ago
How did you control for the pseudoephedrine in this experiment?
- VLM 5y ago
  I'm not OP, but its elimination half life is about six hours, so you'd superficially expect OP's BP to drop in a curve with a half life of six hours after the last dose. It would be really easy to chart with one of those wrist BP monitors and an excel spreadsheet.
- cperciva 5y ago
  I stopped taking pseudoephedrine and the following day my blood pressure was back to normal.
genewitch 5y ago
there was a study published february 2022 that showed that acetaminophen also increases blood pressure. I was pretty aware that both pseudoephedrine and ephedrine raised blood pressure slightly - but it's always good to see it mentioned online where other people may not have known.
- cperciva 5y ago
  In my case, I was taking ibuprofen+pseudoephedrine, so acetaminophen wasn't a confounding factor. And yes, there's plenty of literature showing a slight average increase in bp -- but it seems that there's a wide variance, with some people having dramatically larger side effects.

pstuart 5y ago

This is one of the more benign bits of stupidity that is The War On Drugs™.

annoyingnoob 5y ago

Are there any good decongestants? Seems like all of them have potentially serious side effects. Pseudoephedrine works but drives up my blood pressure. There are any number of sprays like oxymetazoline but they all create addiction issues if you use them too much.

noobermin 5y ago

Man I have congestion so often and I always took phenylephrine and always felt it was hit or miss. Now I know it wasn't just me!

mdoms 5y ago

When I get a cold I simply get plenty of rest and ride it out. Drugs are not necessary for minor ailments.

boringg 5y ago

I used the, I believe, dayquil version one time (active ingredient pseudoephedrine) in the US and my ability to focus that day was on a completely different level even being sick. I almost wanted to keep using it for productivity purposes. Also love that I had to go to a controlled substance area of the pharmacy to get it.

stjohnswarts 5y ago

Nothing works as well for allergies for me as zyrtec-d. I get the 12 hour variety and just use benadryl at night. Luckily I only need it a month or two out of the year. Don't know about taking that stuff year round :) (pseudoephedrine)

dataangel 5y ago

I've recently had to deal with the medical profession a lot more than in the past and I'm finding this sort of thing everywhere. OTC medicines that by current standards would not be made OTC, surgeries that are extremely common but have never had quality randomized trials, official sounding diagnoses that on inspection are actually defined as "we have no idea", lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain), medical device approvals abusing the shortcut of being "substantially similar" to an existing device to evade regulatory scrutiny, the complete lack of enforcement of what goes in supplements... I feel like my entire understanding of the medical system in the US was a lie. We're constantly touting that we have the most advanced technology but if you have a complex condition you are likely to fall prey to multiple kinds of grift.

petschge 5y ago
And now I am reminded of https://dx.doi.org/10.1136%2Fbmj.327.7429.1459 https://dx.doi.org/10.1136%2Fbmj.327.7429.1459 and the fact that there is no randomised controlled trials that show the effectiveness of parachutes either.
- thedailymail 5y ago
  Au contraire! https://www.bmj.com/content/363/bmj.k5094 https://www.bmj.com/content/363/bmj.k5094
  - petschge 5y ago
    Note that this is the study that prompted the study I linked to. But yes, worth a read too.
- astrange 5y ago
  As of 2020 there wasn't an RCT for surgical masks being helpful in surgery.
travisathougies 5y ago
You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. In reality, there are a plethora of conditions, some very common and serious, that medicine simply has no idea how to treat. The set of completely treatable / curable conditions is much much much smaller than the set of all possible diseases, yet people act as if it's the opposite. This is why things like 'evidence based' medicine is so dangerous -- we don't have evidence for the vast majority of impactful conditions, simply ignoring patients with these conditions is not a workable solution.

joecool1029 5y ago

Phenylephrine does have one use that the author missed: It's used in ophthalmology to dilate the pupils before eye exams. On the topic of other use case medications, I used to take Sudafed (the real pseudoephedrine kind) during allergy season for a few weeks each year and noticed my productivity skyrocketed during that time, when I normally had issues context switching. Eventually I narrowed it down to taking Sudafed and saw this post: https://accidentalscientist.com/2005/08/the-sudafed-test-for-adhd.html https://accidentalscientist.com/2005/08/the-sudafed-test-for... This lead to an ADHD diagnosis and proper meds and my life and work productivity improved pretty dramatically.

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throwra620 5y ago
astrange 5y ago
Bit disappointing that everyone starts commenting about amphetamines on a post about Sudafed working the same way as Strattera, which isn't a stimulant. Though him telling people Strattera has no side effects hopefully didn't surprise anyone when they went on it, it feels (literally) like being kicked in the stomach and can make you quite nauseous.
- joecool1029 5y ago
  I didn't like the safety profile on Strattera nor the inability to take it 'as needed'. Rare, but there were reports of liver injuries on it. My doctor seemed to be unimpressed in it when I asked about options on and said in her experience amphetamines almost always had the best efficacy in adult ADHD patients.
  - astrange 5y ago
    It works well for me. Just Vyvanse wasn't 24/7 (unless you enjoy never sleeping) and the comedown is really bad for me. I did have to suggest it myself because my doctor preferred guanfacine for a secondary medicine, but it has a lot of side effects itself - and whenever anyone else asked my medicines they thought I said "guaifenesin".

avidphantasm 5y ago

First, I find that Phenylephrine works well enough as a decongestant for me, without the jitters and heart palpitations. Of course, others' mileage may vary. Second, how did this sentence: "There are a number of synthetic procedures for doing this, some of them quite alarming, and several of which can indeed be performed in the barn, garage, basement, or trailer park of your choice..." make it through editing. This reeks of insensitivity and classism.

tptacek 5y ago
No, not really. Meth manufacturing is famously a scourge of trailer park communities, where the manufacture itself poses risk to residents that probably outstrip the risks of the drug. Trailers and barns just happen to be an efficient place to stand up makeshift meth labs.

sydthrowaway 5y ago

I am suffering with a bad/cold flu right now and this has made me mad as hell! What if someone is so sick they can't fathom to walk into a pharmacy? Fuck senators.

djrogers 5y ago
Thank God I have about 100 different people I could call and ask to pick up medicine for me were I in that situation.
- sydthrowaway 5y ago
  Lucky you.

dr_orpheus 5y ago

There's only a couple drugs I know by name to look for on package labels and pseudoephedrine is one of them. The other one is diphenhydramine (an antihistamine i.e. Benadryl) because its common side effect of drowsiness means that its also one of the most common sleep aids. It has been more than once that myself or someone near me was having an allergic reaction and the 7/11 down the block didn't have any Benadryl but did have some sleep aid.

perardi 5y ago

I’m skeptical the regulations will ever get rolled back, because it’s just so trivially easy to get spooked by the idea of making meth, but as mentioned in this article, I don’t think pseudoephedrine would become a significant source of methamphetamine again if it was made easily available over the counter. Because the cartels have gotten really, really good at making meth. Extremely pure and extremely cheap, and the proper psychoactive isomer. There’s a massive supply of cheap and “good” crank out there, so I doubt deregulation of Sudafed would really make a blip in the total supply.

quickthrower2 5y ago
I wonder if there is something they can add to it that is harmless to humans but makes it impractical or too expensive to use as a precursor for making meth.

trepetti 5y ago

The title is misleading as written in the article. It should be "The Uselessness of Phenylephrine as a Decongestant". Phenylephrine is a lifesaving medicine in emergency medicine to increase the blood pressure of people with hypotension.

Reason077 5y ago

At least in the US and UK, you can actually still get pseudoephedrine-containing products from a pharmacist. In some countries (New Zealand!), it is prescription-only. Same with anything containing codeine.

cwkoss 5y ago

I had a friend who would keep pseudoephedrine in his glovebox to be used for alertness in case he became drowsy driving. He was a chem nerd, so was not particularly remarkable to me. I have to wonder if the restrictions on pseudoephedrine have driven anyone to purchase meth. The safety profile of pseudoephedrine is pretty good - I think it could be argued its a good legal stimulant to offer to the public. Could increasing it's availability be a legitimate harm reduction measure that would displace/prevent meth use among some populations?

scythe 5y ago
Doubtful. Caffeine is already a legal recreational stimulant. What distinguishes methamphetamine/cocaine is that they are, for want of a better word, prosocial. People don't just do meth, they seek out other people who are also doing meth. Pseudo will not fill that niche. There may be other "safe(r)" substitutes, such as HDMP-28 or amfonelic acid or something, but they have to reproduce the social function of recreational stimulants to culturally substitute.
- cwkoss 5y ago
  Ah, yeah the social aspect probably can't be replaced by pseudoephedrine. However, meth can be functional enough that I would guess it's used for wakefulness/focus among a significant proportion of users (especially in early stages of addiction): truckers using it to drive longer, students using it to study, graveyard shift workers using it to stay alert while operating dangerous equipment, etc. These use cases seem like they could potentially substitute pseudoephedrine, and in doing so, could function as an "anti-gateway-drug": users who solve their use case without the euphoria are less likely to get addicted or transition into social usage.

hilbert42 5y ago

Derek Lowe makes a good point that we're wasting everyone's time and money with useless phenylephrine and the fact that pseudoephedrine is so much better as a decongestant. The fact is that pseudoephedrine is not only banned in the US but it is also banned in many other counties for the same reason that it's a precursor for meth. The trouble is that banning pseudoephedrine seems to have only made matters considerably worse as I learned from this HN story a few months back: https://news.ycombinator.com/item?id=29027284 https://news.ycombinator.com/item?id=29027284 Banning pseudoephedrine has led drug cartels to ramp up production of the precursor P2P, phenylacetone, which, it seems, is a better precursor anyway. It's worth reading this story in conjunction with this one. As Lowe hints, given the circumstances, we'd be better off going back to a decongestant that actually works. Quote from the earlier HN story: "Meth in the US shifted to P2P synthesis between 2009 and 2012. In the before times, meth was made with ephedrine or pseudoephedrine. However, in 2006, the US banned over-the-counter sales of pseudoephedrine, and in 2008 Mexico banned almost all sales. In response to this, meth makers switched to a synthesis based on P2P, which can be made from many different, widely available, source chemicals."

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pwned1 5y ago
Pseudoephedrine isn't banned, you just have to ask the pharmacist for it.
- hilbert42 5y ago
  Right, 'banned' is a blut word here, I suppose I should have used 'restricted schedule' as per officialdom but the earlier HN article used 'banned'. Incidentally, many countries have banned it or made it only available on script (i.e.: where I live). Never tried to get it myself since it went on script. Personally, I find it repulsive stuff - makes me feel sicker than the cold or flu alone so I no longer use it (makes me feel queasy on the stomach).

sammalloy 5y ago

Now do cough medicine. The last time I looked at the literature, experts were asking why 95% of cough medicine was allowed to be sold when none of it was known to work. The list of OTC medical products that don’t work is very large.

twofornone 5y ago

I have the impression that many cold drugs are similarly useless. Dextromethorphan comes to mind[0]. I think its the nature of colds, they are not particularly severe and symptoms are easily influenced by placebo effects. Many of them are really just relying on caffeine for daytime meds and antihistamines for nighttime formulations. That whole market feels like a borderline scam. 0. https://pubmed.ncbi.nlm.nih.gov/11045895/ https://pubmed.ncbi.nlm.nih.gov/11045895/

60secz 5y ago

The herb ephedra (Ma Huang/Mormon Tea) contains appreciable amounts of ephedrine and is prepared as a tea in Chinese medicine as a remedy for asthma and cold congestion. It can easily be purchased online and the ephedrine ban does not apply to it. https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant-ephedrine https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant...

jacobmartin 5y ago
Any idea how pure or clean these online sources are?
meepmorp 5y ago
NB: ephedrine and pseudoephedrine are related (they're stereoisomers), but are different drugs with somewhat different pharmacokinetics.
- culi 5y ago
  This is true, but the plant actually contains both. The amount of each can vary widely based on which species you're talking about. The species linked here, commonly known as Mormon Tea, is one of the few species that doesn't contain any ephedrine and only contains pseudo

thehappypm 5y ago

I need a tl;dr: what medicine should I take if I’m congested??

JohnTHaller 5y ago
pseudoephedrine. The ingredient in Sudafed, Nyquil, etc that actually works. You'll usually need to go to the pharmacy counter to get it and show ID. They track how much each person gets because some folks were using it to make meth a while back. The replacement in the OTC Sudafed, etc out one the shelves, phenylephrine, doesn't work.
- thehappypm 5y ago
  Thank you!

codr7 5y ago

I recommend simply getting a Yoga nose cleaning thingy, it will also help prevent getting sick in the first place.

jay_kyburz 5y ago

The only silver lining of the pandemic is that I haven't had a cold or flu in years and haven't needed to ask for behind the counter pseudoephedrine.

akdor1154 5y ago

For all phenylephrine oral is useless, FYI phenylephrine nasal spray seems to work well as a gentle decongestant, anecdotally much better than saline spray, and not as strong (or addictive) as oxymetazoline.

emmelaich 5y ago

For some, pseudoephedrine make scuba diving possible. The difficulty of getting some is very annoying.

cmrdporcupine 5y ago

Pseudoephedrine is a stimulant and not a particularly pleasant one at that. Here in Canada there's still cold medicines with it in them, and to be honest, when I see it, I avoid it. It may not be as good of a decongestant but phenylephrine won't keep me up at night. And when I'm sick with a cold what I really need is a good sleep.

jonhohle 5y ago
I have the same feeling. I’m very sensitive to pseudoephedrine jitters and do my best to avoid it. It may be placebo, but phenylephrine “works” for me and can “tell” days that I forget to take one in the morning when I have post nasal drip. Knowing it should have no clinical effect, I’d be interested in blinding myself to a placebo to convince myself it really has no effect.
mypalmike 5y ago
I've found dosage is critical with pseudoephedrine. I can only take one of the small 30mg red buttons (half the recommended dosage) in a 24 hour period and get the benefits without side effects.
LorenPechtel 5y ago
Different people are different. It doesn't mess with sleep at all for me. My wife has to use it with care, continued taking of it gives her overdose symptoms. (Obviously, it's not being eliminated as fast as they expect.)

angry_octet 5y ago

If there were a darknet way to buy medical grade Sudafed that would be fine by me.

HL33tibCe7 5y ago

Reminds me of docusate, a very commonly prescribed “Laxative”. The problem? There’s seemingly barely any evidence that it actually works. And plenty to suggest it has no effect over that of a placebo. Yet there’s a culture of prescribing it, so on prescribed it goes.

insickness 5y ago
Wow. I've purchased more than a few bottles of ducosate. But it looks like you're right: Reevaluating the Use of Docusate in the Management of Constipation https://www.drugtopics.com/view/reevaluating-the-use-of-docusate-in-the-management-of-constipation https://www.drugtopics.com/view/reevaluating-the-use-of-docu...

caturopath 5y ago

To quote the alt text from https://xkcd.com/971/ https://xkcd.com/971/ > Telling someone who trusts you that you're giving them medicine, when you know you’re not, because you want their money, isn’t just lying--it’s like an example you’d make up if you had to illustrate for a child why lying is wrong.

jordanmorgan10 5y ago

Then why does something like Sudafed seemingly work for me?

dbbolton 5y ago

I'm a physician- although I don't disagree with the spirit of the article the headline is exceptionally misleading. Phenylephrine is useless as an oral decongestant. It is still quite useful for other indications, including as a vasopressor (given IV to increase blood pressure such as in hypotensive shock). I believe it is actually the only commonly available vasopressor in the US that is a pure alpha-1 agonist which in certain scenarios is desirable. It is also indicated for treatment of priapism. The real kicker is that phenylephrine actually does work as a nasal decongestant when it is used as an intranasal spray, which has the added benefit of fewer systemic side effects compared with oral decongestants.

bin_bash 5y ago
It's also the active ingredient in Preparation H as a vasopressor
dataflow 5y ago
What about when it does work for people as an oral decongestant though? Are you suggesting that's just randomness? Or perhaps the placebo effect? I guess I'm not entirely convinced it's really useless for that purpose, but I'm just a layman.
- Kwantuum 5y ago
  The original article doesn't just suggest it, it claims it outright, and links a study to back up that claim: https://www.annallergy.org/article/S1081-1206(10)60240-2/fulltext https://www.annallergy.org/article/S1081-1206(10)60240-2/ful...
- askvictor 5y ago
  Here's my theory: you know that pseudoephedrine works, so taking this thing that's supposed to be a replacement for it, and sounds pretty similar, will convince your brain that phenylephrine will also work. So yes, placebo, but with foreknowledge of the effectiveness of pseudoephedrine. I'm curious if there have been placebo-controlled studies on phenylephrine where the participants were told they were receiving pseudoephedrine

driggs 5y ago

There's only one reason phenylephrine is used as a substitute in the OTC decongestant products: the general public can't pronounce or spell the word "pseudoephedrine" and they're intentionally being duped. They walk into the grocery store, convenience store, or pharmacy after a sleepless night of breathing through their mouth, see the red package that says SUDAFED and a vaguely familiar-looking active ingredient, grab it, and plop their money on the counter. PsEudoEPHedRINE PhEnylEPHRINE This is OTC medical fraud.

throwaway684936 5y ago
Not quite the same thing, but it's odd the way they attached 8-chlorotheophylline to diphenhydramine, renamed it "dimenhydrinate" and marketed as "non-drowsy nausea medication" (Dramamine). The added molecule is totally ineffective at combating the drowsiness. It's all-but-technically an identical product to diphenhydramine.

chmorgan 5y ago

Wait until people find out about the effectiveness of wearing masks on preventing covid infection and spread... I noticed Phenylephrine didn't work at all for me a handful of years ago after the pseudoephedrine swap occurred. Did a web search and turned up the same info here. At the time it was amazing to me that these products were being sold. This is a great article and I applaud the author for trying to get these products pulled or replaced with something effective.

eek2121 5y ago

The DEA, FDA, and state regulators are destroying everything IMO. Many doctors don't want to even deal with drugs labeled as a 'controlled substance'. I ended up going off an extremely effective medication due to none of the doctors (including psychiatrists, etc.) wanting to prescribe it anymore due to restrictions. I now suffer daily. There are a few doctors who will still prescribe it, but predictably, NONE of them take insurance (because they know they can corner the market by not doing so). ALL of them charge $400+ per visit.

ck2 5y ago

It's weird to me you can buy steroid nasal sprays OTC (Nasacort, Rhinocort, Flonase, etc.) but not pseudoephedrine

douglaslps 5y ago

How does Naphazoline (usually administrated as nasal drops) compare to pseudoephedrine?

wrekone 5y ago

I won't rule out a placebo effect, but phenylephrine works just fine for me. Pseudoephedrine just makes me jumpy.

meristohm 5y ago

Sometimes the most helpful thing when I have a problem is being listened to and accepted. It is frustrating to see doctors that only pretend to listen, and I wonder to what degree such doctors are satisfied with their work. We finally have for our child a pediatrician who gives us what I hope will someday be normal care and attention.

TheRealSteel 5y ago

Phenylephrine is 100% fake and it's frustrating it's allowed to be sold

Nitramp 5y ago

Over here in Germany, when you ask for a decongestant, you usually get Xylometazolin as a spray. As I understand, that's both more effective and has fewer side effects (due to being local). You can also get pseudoephedrine, but I don't think it's as commonly used as these nasal sprays. Is that not an option in the US?

TheSpiceIsLife 5y ago
Have you ever tried taking twice the recommended daily dose of xylometazolin in one go? Quite stimulating!
f1refly 5y ago
> As of 2021, no consumer products containing xylometazoline are marketed in the United States, however imported products containing xylometazoline are available online. From the wikipedia article. Fascinating, it's the most common drug I use and it's not even available in US stores!

wastra 5y ago

Physician, anesthesiologist speaking. Intravenous phenylephrine widely used, effective. No good in stomach. Doctors struggle to harness all the historic use and evidence for treatments, sometimes based on great evidence. Often evidence is the best that can be had given available resources. Drug companies hiding data (derived from volunteers and patients) is wrong, and a problem. Selective publishing of only positive findings in medical journals is common. Careers depend on publications. But despite these pressures, most doctors think hard about these issues, and do their truthful best for the patient in front of them, given the imperfect knowledge available. OTC labeling is deceptive at best. Placebo only works for a few things.

LordKano 5y ago

It's so bad that I'd rather just scan my ID and get a product that contains pseudoephedrine.