21 ms·
The Uselessness of Phenylephrine (2022)
- dang 3y agoDiscussed at the time: The Uselessness of Phenylephrine - https://news.ycombinator.com/item?id=30858202 https://news.ycombinator.com/item?id=30858202 - March 2022 (592 comments)
- calvinmorrison 3y ago[flagged]
- convolvatron 3y agothat wasn't a decision informed by any kind of research
- lokar 3y agoBut it was, it’s just really old research
- scarface_74 3y agoScience has been saying that Phenylephrine was ineffective for years. The news here is that it took so long for the FDA to officially admit it.
- par 3y agoIt's never worked for me and I didn't understand why people bought these products.
- kstrauser 3y agoThey were marketed as working and have similar side effects as pseudoephedrine-based products. I’d think those would be pretty strong contributors to a placebo effect.
- scarface_74 3y agoThis is no different from “cough syrup”, that doesn’t work
- adamredwoods 3y agoKnowledge. Availability. Marketing. FDA. But honestly, I would direct my anger at the lack of transparency and oversight in the supplement market, rather than this. Glad the FDA has finally corrected course.
- toast0 3y agoIf the pharmacy counter is closed, something that maybe might work is better than nothing.
- greatpostman 3y agoProbably will get downvoted for this, but a bunch of my family members are pharmacists. Their quiet opinion is that most pharmaceuticals don’t work. Even the ones that are thought effective. The data is anecdotal, but is over 15 years of watching people come in for prescriptions. The other aspect, is they say it’s mind boggling to see what kind of drugs people are on.
- kstrauser 3y agoI’d like to think you’ve heard them grousing about specific things like this and misinterpreting that as a general mistrust. Every medicine I’ve ever taken had an objective, quantifiable effect on me. Except for phenylephrine, of course, which only served to teach me how to ask the pharmacist for the good stuff.
- jrockway 3y agoI think that people are hoping for larger effects. I have been a lifelong allergy sufferer. Many years ago, my doctor gave me an intranasal antihistamine. It came with a piece of paper about the studies done on it. Patients rated their symptoms on a 1-5 scale, and the study observed the ratings with and without. The placebo group rated their symptoms, say, 4.0. The people on the drug rated them 3.5. I would say that's exactly the effect I got from the medication, an improvement, but not a complete elimination of symptoms. Certainly some people are going to go to their pharmacist and say "this does nothing", and that might lead them to believe it's all a scam. It's not really a scam, it's just that expectations were not set correctly. People want "this will cure you and you'll get a gold metal in the Olympics!" but all we have is "this will make life slightly less miserable". It's probably the same for many conditions and medications. Antidepressants don't turn you into someone who is always happy. Painkillers don't make recovering from surgery a joy. I think that people even had the same feelings about COVID vaccines; they wanted "one shot and you'll never be sick again", but all we got was being 90% less likely to get COVID or whatever. None of this makes these things a scam. Rather, they are imperfect technologies that we work to improve. Silver bullets are rare, but they do exist. Just not all the time. (Have you died from strep throat or polio recently? People used to all the time!)
- omginternets 3y agoThis strikes me as an example of a larger phenomenon. Take for example the counter-insurgency wars that have become normalized since 9/11. In these conflicts, there is enormous pressure to minimize casualties because these directly undermine the political will to conduct military operations. As such, the strategic objectives eventually degenerate to mere "presence", and commanders are effectively unable to pursue the kinds of operations that might actually translate into military success. Similarly, we've collectively decided that selling an OTC drug that is effectively inert is somehow preferable to selling a useful-but-abusable substance, at which point one might argue that it's even safer to sell nothing at all.
- tptacek 3y ago(1) I think there's pretty wide agreement that selling Sudafed PE is worse than selling nothing at all, and I'd sort of expect it to be off the shelves sometime soon (it should have been much earlier than this). (2) "Selling nothing at all" is actually not the policy. Real Sudafed is simply a behind-the-pharmacy-counter drug. You don't need a script to get it (plenty of non-abusable drugs do require scripts, a much higher bar). Real Sudafed is to a first approximation available to everybody.
- omginternets 3y ago> Real Sudafed is to a first approximation available to everybody. I didn't actually know this, and it's good to know. That said, I'm not certain that most people are aware that it is available without a script. Maybe I'm wrong.
- tptacek 3y agoIf you walk up to the pharmacy counter at any Walgreens or CVS, literally the first thing you're going to see is a shelf of decongestants.
- clipsy 3y agoI can’t speak for your Walgreens or CVS, but at mine you’ll see a shelf full of phenylephrine-based decongestants only, because the pseudoephedrine-based ones are behind the counter and out of sight.
- kstrauser 3y agoThe risk:reward ratio is infinite — it has adverse reactions but essentially no benefit. It’s about as much “medicine” as was drinking radium. Good riddance.
- buildsjets 3y agoThe fact that phenylepherine is ineffective is quite old and has been common knowledge for many years. What is news is that the FDA is finally acknowledging it. I've maintained my own reserve of pseudoephedrine for years. https://gizmodo.com/report-many-over-the-counter-decongestants-are-basical-1739641793 https://gizmodo.com/report-many-over-the-counter-decongestan... https://www.forbes.com/sites/daviddisalvo/2015/10/26/the-popular-over-the-counter-cold-medicine-that-science-says-doesnt-work/?sh=417922b84753 https://www.forbes.com/sites/daviddisalvo/2015/10/26/the-pop... https://www.newscientist.com/article/2089555-breaking-bad-sniffles-crystal-meth-made-cold-medicine-rubbish/ https://www.newscientist.com/article/2089555-breaking-bad-sn...
- jeffbee 3y ago> I've maintained my own reserve of pseudoephedrine for years. Synthesizing it from widely-available and affordable street drugs, I assume. https://improbable.com/airchives/paperair/volume19/v19i3/Pseudoephedrine.pdf https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
- nimish 3y agoEasily the best example of why the stupid federal law limiting access to a useful decongestant backfired.
- tptacek 3y agoIn what way did it backfire? It's a useful decongestant. But it also basically is methamphetamine, with just a couple easily-reversible Rubik's turns to make it a decongestant instead of an ultra-powerful stimulant.
- amanaplanacanal 3y agoDidn’t prevent people from getting meth, but did allow drug companies to make millions selling a useless compound. I doubt that was the intent of the legislation.
- wffurr 3y agoContext: On Sept 12th 2023, an FDA panel (the NDAC) definitively voted to find phenylephrine ineffective: https://www.medscape.com/viewarticle/996369 https://www.medscape.com/viewarticle/996369 Next will be re-assessing its GRASE status and potentially removing it from stores.
- no-dr-onboard 3y agophenylepherine is the otc version of pseudoephedrine, what Sudafed was originally created with. If you need Sudafed that works, go to the phamacist and ask for "real sudafed". You might have to scan your ID if you live in certain states and you actually need a Rx if you're in Oregon (lol), but for most free states you're good to just purchase it at the counter.
- RockRobotRock 3y agoThey changed that last year: https://www.statesmanjournal.com/story/news/politics/2022/01/01/oregon-new-law-sudafed-pseudoephedrine-prescription/9039344002/ https://www.statesmanjournal.com/story/news/politics/2022/01...
- zinclozenge 3y agoOregon no longer requires a prescription since 2022.
- wging 3y ago> phenylepherine is the otc version of pseudoephedrine That’s mostly incorrect, both are “otc” (over-the-counter) wherever you can buy them without a prescription. That’s what that means.
- Kirby64 3y agoPsuedophedrine requires an ID to purchase and must be kept behind the counter in any state in the US. It's a federal requirement. Stores are also required to keep a record of purchases for 2 years. If you were able to purchase Sudafed without having someone get it from the back or out of some locked cabinet, and also hand over your ID, it wasn't psuedophedrine.
- scarface_74 3y agoHe said “at the counter”.
- Kirby64 3y ago
- m463 3y agoyesterday: Phenylephrine for colds and allergies don’t work, FDA panel says https://news.ycombinator.com/item?id=37485940 https://news.ycombinator.com/item?id=37485940
- mullingitover 3y agoI always thought it was pretty brazen of them to openly label their cold medicine as 'placebo effect' (pretty sure that's what the 'PE' stands for).
- samtheprogram 3y agoI always thought it was for Phenyl-Ephrine, but this is so funny/perfect I will use this when explaining to people to not buy Sudafed unless it's behind the counter.
- meatmanek 3y agoI always assumed it was there to subtly confuse people into thinking they were getting Pseudo-Ephedrine.
- samtheprogram 3y agoI thought the E is silent in the latter, but I'm a much better speller than pronunciator. Maybe!
- deleted 3y ago[deleted]
- jawns 3y agoI laughed out loud when I read about the lobbyists who are trying to keep phenylephrine from being taken off store shelves. In one article about the FDA panel vote, a lobbyist said that most consumers hate the alternatives -- nasal sprays because of the discomfort and pseudoephedrine because it's stored behind the pharmacy counter -- and so depriving them of a hassle-free option is anti-consumer. The fact that the hassle-free option has been shown to be ineffective was, as you might guess, never mentioned.
- selimthegrim 3y agoMy understanding is the nasal spray version works, but the oral just gets metabolized ineffectively?
- uf00lme 3y agoThank you for sharing, if this is true it will win me a really good arguement. I know someone who hates Phenylephrine, so I will buy some nasal spray just to surprise them.
- lokar 3y agoCorrect
- nonethewiser 3y agoOh wow, didn’t realize this
- ctoth 3y agoUnfortunately, this is the actual logic which will be used to justify it staying on shelves. > The decongestant is in at least 250 products that were worth nearly $1.8 billion in sales last year, according to an agency presentation. Look those yachts aren't gonna buy themselves.
- pixl97 3y ago"Ok fine, you can still sell it over the counter... except a X by Y sign stating 'This product is completely ineffective if taken in pill form' needs displayed on the shelf where the product is sold"
- tech_ken 3y ago"Phenethylamines I Have Known and Felt Kind of Meh About"
- sitzkrieg 3y agocant wait for TIKFKMA
- jkingsman 3y agoI laughed out loud. For those unaware, "Phenethylamines I Have Known and Loved" (aka PiHKAL) is Sasha and Ann Shulgin's book that is half semi-fictional autobiography and half detailed synthesis and in-vivo effects observed in the enormous family of psychoactive phenethylamines. The autobiography part is only available in print, but the chemistry section is freely available[0]. There is a sequel, a similar book for tryptamines called TiHKAL[1]. They are stunningly bold in their chemistry, administration and discovery of novel drugs, and in making good science available under dubiously legal circumstances. [0] https://erowid.org/library/books_online/pihkal/pihkal.shtml https://erowid.org/library/books_online/pihkal/pihkal.shtml [1] https://erowid.org/library/books_online/tihkal/tihkal.shtml https://erowid.org/library/books_online/tihkal/tihkal.shtml
- tech_ken 3y agoPsychoactive phenethylamines??? I've never heard of that, I'm just really into nasal decongestants.
- hn8305823 3y agoIf you like the author Derek Lowe's writing like I do you might like his "Things I won't Work with". Here's one of my favorites: https://www.science.org/content/blog-post/things-i-won-t-work-dioxygen-difluoride https://www.science.org/content/blog-post/things-i-won-t-wor...
- kstrauser 3y ago> If the paper weren't laid out in complete grammatical sentences and published in JACS, you'd swear it was the work of a violent lunatic. I ran out of vulgar expletives after the second page. I love his work.
- blobbers 3y agohttps://www.nbcnews.com/health/health-news/fda-panel-says-common-counter-decongestant-phneylephrine-doesnt-work-rcna104424 https://www.nbcnews.com/health/health-news/fda-panel-says-co... -- "Phenylephrine — found in drugs including Sudafed PE, Vicks Nyquil Sinex Nighttime Sinus Relief and Benadryl Allergy Plus Congestion — is the most popular oral decongestant in the United States, generating almost $1.8 billion in sales last year, according to data presented Monday by FDA officials." * Wasting peoples time and money while consuming their $. * key part is consuming their $.
- robg 3y agoMy kids seem to derive benefit from chewable tablets which I tell them to suck on. Curious if anyone has found different research on metabolization in the mouth versus gut?
- rscho 3y agoOral and rectal blood goes directly to the greater circulation without going through the liver (that metabolizes most toxins) first.
- deleted 3y ago[deleted]
- mattmcknight 3y agoHoping this adds to the pressure to get pseudoephedrine back on the shelf.
- AlbertCory 3y agoPublic service announcement: sinus rinse (e.g. NeilMed) works. Available in every drug store with no prescription or pharmacist involvement necessary. It's gross, though. Do it in private.
- doug_durham 3y agoIt doesn't reduce the sinus inflammation. At least for me all I end up with is a still congested, but now watery nose.
- AlbertCory 3y agoNoted. At least you've tried it. The water dripping out of your nose: that's a feature, not a bug /s
- quercusa 3y agoIt's useful to rinse out the sinuses so that nasties don't grow there.
- lazide 3y agoIf you already are pretty bad off, yeah it usually doesn’t help. It really helps prevent it from getting that bad though, by washing out pollen, gunk, etc. and hydrating things.
- the_sleaze9 3y agoI have swollen nasal polyps (or something) which causes every single cold I get to eventually transform into a 2 week sinus infection + cough ordeal. Netty pot with salty water and a pinch of baking soda, and an even saltier water gargle clears things up nicely. And is very budget friendly.
- AlbertCory 3y agoIt was when I had the mother of all sinus infections that someone told me about this. Never had the problem again. YMMV. People imagine it must burn, because getting water up your nose when swimming burns. But the salt & baking soda neutralizes that.
- ksaj 3y agoI wish they would give similar treatment to homeopathic "remedies." It's appalling to find them sold at drug stores when they've never even been proven effective in any way. You can literally give the opposite "medicine" to someone and they wouldn't be able to tell the difference.
- rscho 3y agoPhenylephrine is ineffective when taken orally. It is super effective topically or iv. I can definitely tell, because it's the most commonly used vasopressor used under anaesthesia (iv). Also used topically to avoid nosebleeds during nasal intubation.
- tech_ken 3y agoCurious about how this aligns with the bioavailability point discussed in the article. Presumably if the gut lining is where the bulk of metabolism occurs then IV sidesteps this and increase the bioavail drug, leading to improved efficacy.
- wrs 3y agoThe gut metabolism makes it less available, which is why if you put it in your stomach not much shows up in your nasal lining. If you spray it or inject it directly where it needs to go, no problem.
- Tao3300 3y agoI was indeed surprised to see it go by in the mix during one of my wife's c-sections. I'd always thought it was a completely useless thing, but there it was keeping her blood pressure stable under the anesthetics.
- nicole_express 3y agoPhenylephrine did its job of convincing people to accept restricting access to pseudoephedrine, since there was a substitute that could still be freely available. Now it'll be taken off the market, but pseudoephedrine that actually works will still be restricted. At least the homeopathics consumers will buy instead have fewer side effects
- xylophonermore 3y agoI, like many others I suspect, bought phenylephrine when Sudafed first disappeared from store shelves. It was 100% ineffective for me from the first dose. In the meantime, Sudafed has become one of the most difficult to acquire substances for my daily life (I need it every day as directed by my doc). So many times when I go to a pharmacy to get it, they're out of 96-count or 48-count or any count, meaning my one allowed purchase/month nets me less than a month's worth. Or the state's tracking system is down (this happens frequently) and they won't sell me anything. IOW, buying Sudafed is difficult and often infuriating. Meanwhile, meth problems haven't gone away—-in fact meth use is WAY up since these restrictions were put in place in the aughts. Sure, hiding and tracking it got some of the meth production moved south, but it didn't negatively affect meth availability. Supply is plentiful, prices are down, purity is up. Even Oregon, who restricted Sudafed to prescription only, has seen a 3x increase in meth deaths. [1] Sadly, the restrictions on Sudafed are unlikely to ever change as lawmakers rarely care that their laws hurt a ton of law-abiding people as long as they can claim something about being tough on crime. [1] https://www.nytimes.com/2018/02/13/us/meth-crystal-drug.html https://www.nytimes.com/2018/02/13/us/meth-crystal-drug.html
- freedomben 3y agoI've been in this boat too, and it's infuriating. I once had a doctor that wrote me a script for it though and the pharmacy let me get a whole 90 day supply with no problems. I ended up moving and couldn't see this doc anymore, sadly. This was in the late 00s though, I don't doubt that they closed this "loophole" and don't allow docs to write for that anymore.
- deleted 3y ago[deleted]
- wrs 3y agoFrom the referenced paper: “Other examples of scientifically proven ineffective OTC medications include guaifenesin as an expectorant, dextromethorphan as a cough suppressant, and chlorpheniramine for cold symptoms.”
- jmprspret 3y ago> dextromethorphan Wow, seriously? I abused plenty of this to get high back in my day. And I can say that smoking while on it was definitely way easier, I barely coughed at all.
- smrtinsert 3y agoI will go to my grave swearing nyquil used to be some sedative mixed with psuedoephedrine, but modern pharmacy people seem to have no memory of it.
- lazide 3y agoHere you go - don’t say I never gave you nothing! https://www.drugs.com/mtm/nyquil-d.html https://www.drugs.com/mtm/nyquil-d.html
- derefr 3y agoQuestion: why does anyone want to use stimulant decongestants anyway, when corticosteroid nasal sprays (the -metazolines) are equally effective at treating a runny nose, and much more effective at unplugging a stuffy nose?
- pnpnp 3y agoHow long do they last, and how easily is a tolerance developed for steroids? I’m asking this as a chronically congested person who doesn’t like the side effects of extended release pseudoephedrine, but it works.
- dreamcompiler 3y agoMetazolines are not steroids. They are vasoconstrictors and immediate decongestants. You may be thinking of fluticasone, which is used to desensitize the nose to allergens over time but which has very little immediate decongestant effect.
- hn_throwaway_99 3y agoNasal sprays like Afrin (oxymetazoline) give me major rebound congestion, even if I only use it for a couple days. I.e. even if I just use it for one night to make it easier to sleep, I always feel like I'm more stuffed up the next day. The only thing I'll use these days is a neti pot/sinus rinse. It obviously doesn't open up my sinuses as much as something like Afrin but there are no negative side effects for me.
- notadoc 3y agoAnyone who has ever taken phenylepherine knows that it is completely ineffective. But, like most moral panics, the fantasy of kids stealing pseudoephedrine pills and becoming Meth Lab Moguls, was too much.
- zeagle 3y agoMy read of the headline was "bullshit! It's a great alpha-1-adrenergic vasopressor in anesthesiology and critical care(1). Funny how ones training and past experiences affect this. Similarly I read unionized as the chemistry un-ionized every time. (1) https://www.ncbi.nlm.nih.gov/books/NBK534801/#:~:text=In%20the%20setting%20of%20IV,or%20non-cardiac%20shock%20states https://www.ncbi.nlm.nih.gov/books/NBK534801/#:~:text=In%20t...
- aunwick 3y agoIn my sample size of 1 I concluded this substitute didn't work years ago. And why can't I find an actual good antihistamine Doxylamine succinate sold separately anymore. New crap that doesn't work replaced old working products....
- deleted 3y ago[deleted]
- hamilyon2 3y agoI recommend oxymetazoline.
- 7thaccount 3y agoI find it interesting to see this. I use it as a nasal decongestant (pill form), and it works like magic. Completely dried up in like an hour or so. Granted, my nose leaks 24/7 like a leaky faucet, so it doesn't last, but that's just bad genetics.
- thedrbrian 3y agoI assume the original documents/testing that got it approved stated how effective and safe it was.