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FDA proposes ending use of oral phenylephrine as OTC nasal decongestant
- ClassyJacket 2y agoFinally. I hope this reaches Australia and the rest of the world. Phenylephrine doesn't work, it never worked, it's obvious that it doesn't work, it's a literal scam, and the companies selling it are fraudulent.
- denkmoon 2y agoHalf the products in chemist warehouse are pretty blatant scams. It's insane how effective, important pharmaceuticals are sold side by side with products known to be ineffective and that exist purely to strip uneducated customers of their money.
- master_crab 2y agoBack to Pseudoephedrine! It's behind the counter at your local pharmacist.
- bsder 2y agoUnfortunately there is an absurdly low limit on purchasing amount in the US. In addition, I can't seem to find the 24 hour versions anywhere right now. I could probably buy meth more conveniently. :( Cue: "A Simple and Convenient Synthesis of Pseudoephedrine From N-Methylamphetamine" https://improbable.com/airchives/paperair/volume19/v19i3/Pseudoephedrine.pdf https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
- hadlock 2y agoI've only had to buy it in three states, but generally my experience has been that you can buy a "30 day supply" per month. How often are you sick that you need more than 30 days of the stuff every month? If we run out I'll buy a 30 day supply and that generally lasts the whole family a year or more.
- HideousKojima 2y agoYou definitely don't have anyone in your family who gets severe congestion from allergies then. The "funnest" form it takes for me is when I start going partially blind in one eye due the the sinus pressure
- rootusrootus 2y agoWhen it’s that bad why wouldn’t you just get a prescription for an appropriate amount for your situation?
- JumpCrisscross 2y ago> When it’s that bad why wouldn’t you just get a prescription for an appropriate amount for your situation? Prescriptions take time and money.
- rootusrootus 2y agoI could do it with less effort and cost than OTC. Online message my PCP, prescription sent to pharmacy, mailed to me at my house, cost $0 since it's just a generic. And I have a cheap as shit high deductible plan with a steep out of pocket maximum, not some cadillac plan. OTC would be faster, but if I have a chronic need for large amounts of pseudoephedrine I'm not waiting until it hurts before I run to the store. I'm getting my doc to make sure I have a hell of a good stash (and I checked, just to be sure -- the limits don't exist if it's prescription; at least not in Oregon, which is famously restrictive on pseudoephedrine). Would it be better to relax the restrictions that now seem pointless on the OTC version? Yep. But if someone is bitching on HN about how they can barely get what they desperately need, I'd say it's time to stop being idealistic and go get the damn drugs already.
- Brian_K_White 2y ago"I don't have this problem, therefor this problem doesn't exist, and so you don't have this problem."
- mike_d 2y ago> Unfortunately there is an absurdly low limit on purchasing amount in the US. The maximum safe dose for an adult is 240 mg in a 24 hour period. Current guidelines allow for getting a 10 day supply (the average cold lasts 7-10 days) in a single visit, and basically a limitless supply with a few visits (37 days worth every 30 days). If you are running into purchasing limits, you are either making meth or blowing out your liver. Edit: Math is hard. The 30 day limit is 7.5 grams (a 31 day supply), or 3.6 grams per trip (a 15 day supply).
- terribleperson 2y agoAt least some states track it on a household (address) basis.
- PittleyDunkin 2y ago> If you are running into purchasing limits, you are either making meth This would also be an insanely expensive way to make meth.
- bsder 2y agoI seem to only be able to buy 10 days of Sudafed 24 Hour every 14 days. That doesn't work if you have allergies. Presumably because places like Walgreen's can't adjust compliance per state and places like Alaska have "No person may purchase or possess more than 6 g of PSE, EPH or PPA per 30 days unless dispensed pursuant to a prescription" Note that 6g / .240g = 25. So I can only buy 25 days worth of pills every 30 days. Or 12.5 pills every 15 days which is suspiciously close to that 10 every 14 days number.
- ahazred8ta 2y agoThis is where you need to bring a buddy on every trip...
- mike_d 2y ago> Note that 6g / .240g = 25 Fortunately we are both wrong. I have updated my previous post up thread.
- PittleyDunkin 2y agoI was denied this the last time I tried to buy it and the pharmacist couldn't even tell me why aside from "the system won't let me". I went to a different chain a half mile away and walked out with a month's supply of the stuff. Hilariously incompetently-designed regulation. Meanwhile meth making is more efficient, cheaper, and delivers purer-grade glass than ever.
- adrr 2y agoMost worthless law. Now i have to wait in line for 10 minutes to get it and yet meth is still widely available and usage actually increased. Did nothing except shift manufacturing to outside of the US.
- HideousKojima 2y agoAnd I can't stockpile it for allergy season (which is about 9 months out of the year for me). I have to make regularly scheduled trips to the pharmacy every two weeks which is a huge pain in the ass
- deelowe 2y agoYou take 48 pills in two weeks?!
- ksenzee 2y agoThat’s pretty easy when the dose is two pills every six hours.
- pitaj 2y agoThey make twelve hour extended release versions now. There are twelve per box and you can get three boxes at a time. That's 18 days but only if you take them twice a day, which you probably shouldn't if you like sleeping. If you take one a day, that's a whole month's worth.
- deleted 2y ago[deleted]
- deelowe 2y agoYou're going to have serious issues if you take that much. It's causes major problems after a few days.
- HideousKojima 2y agoI can get 15 of the 24 hour generic Claritins every 2 weeks. Works out to about 1 a day
- yellowapple 2y agoOr just straight ephedrine, which is also behind the counter at your local pharmacist (brand name Bronkaid).
- tdeck 2y agoNext I hope they do cough medicines, I looked a few years ago when I had a cough and it seems like literally none of the OTC ones are more effective than placebo.
- hammock 2y agoDextromethorphan (DM or DXM) is the OTC cough suppressant. Marketed as Delsym comes in an orange box, or you can find it in various combo formulations, and it works
- deleted 2y ago[deleted]
- realce 2y agoDelsym is dextromethorphan-polistirex, a long-acting formulation of DXM that is supposed to last 12 hours. DXM is available in almost all cough syrups.
- hammock 2y agoThe 12 hour formula is the only way you can get it OTC by itself. That’s because it’s a recreational drug that is commonly abused (“robo tripping”) and extended release prevents that. Otherwise you have to get it in a combo drug like NyQuil, which I don’t prefer because I can’t manage distinct symptoms and dosages independently with a combo
- HideousKojima 2y agoCan also give you incredible diarrhea as a nice side effect
- deleted 2y ago[deleted]
- deelowe 2y agoDextromethorphan is the only otc cough medicine that works and pretty much the only prescription stuff that works is opiate based. Of course both are regulated.
- kbos87 2y ago[flagged]
- OutOfHere 2y agoFor the record, with regard to treatment, ivermectin was understood to benefit anyone who had a co-occurring worm infection (targeted by ivermectin) while also having Covid. This just rules out most people in the US as they typically don't have the corresponding worm infections. I myself tried two brands of ivermectin while having Covid, with no luck.
- cbxyp 2y agoBetter to have taken it when (and if) you knew you were exposed. It was always considered to be a prophylactic more so than a treatment. And in that capacity it did seem to work for me. (Having never tested positive for COVID, despite numerous tests, numerous exposures and no shots)
- OutOfHere 2y agoI will try it next time in this way. I wonder if it could also be relevant for a viral cold if taken early.
- cbxyp 2y agohttps://en.wikipedia.org/wiki/Demodex_folliculorum https://en.wikipedia.org/wiki/Demodex_folliculorum is also highly responsive to oral ivermectin. Which makes it very good for treating rosacea. https://www.jaadcasereports.org/article/S2352-5126%2824%2900276-5/fulltext https://www.jaadcasereports.org/article/S2352-5126%2824%2900... I also suspect that the much maligned "fish tank cleaner" hydroxychloroquine remains effective-as-ever for many issues, which "more targeted" in-patent drugs are on the market for.
- OutOfHere 2y agoIt's very interesting to see such skin issues treated with ivermectin, although they are fundamentally a cleanliness issue of skin, clothes, and carpet. Regarding HCQ, do I have a story to tell. Early in the Covid years, I had its symptoms twice. This was before any vaccine or tests. The first time was from a coworker, and the second time from a stairwell while unmasked. Both times, nothing would fix it, but pure CQ did. This was no fish tank cleaned. It was a proper CQ medicine at 250 mg/day for two days, then repeated again after a week for another two days. The only side effects were very minor visual blurriness which resolved on its own within 3 months, and cardiac arrhythmia which resolved using atenolol. The cardiac arrhythmia could just have been an effect of Covid itself for all I know. Note that I do take quercetin which is one of the few agents that is necessary to get CQ or HCQ to do its magic, failing which it could not work for Covid. Later strains of Covid became weaker and the vaccine also protected, so I didn't need it for future reinfections.
- zeroonetwothree 2y agoGreat. I always have to explain to people not to buy this crap and get the good stuff instead
- peterldowns 2y agoJust as a reminder, you are completely allowed to buy pseudoephedrine without a prescription, you just have to ask your pharmacist. My local pharmacy keeps it behind the counter already pre-compounded, and it's cheap and effective. One of those little things that I never used to purchase because I was somehow not certain if I could actually get it. Yes, you can.
- jey 2y agoWhat country are you in? In the US, pseudoephedrine has to be requested at the pharmacy counter, but it's not a compounded medication. Instead it's sold as pills in the usual "blister pack" format.
- peterldowns 2y agoI live in the US. You're right, it's not compounded by my pharmacy, I was confused because of the branding on the package — it's manufactured somewhere else and just repackaged by my pharmacy: https://files.catbox.moe/9pbj43.jpg https://files.catbox.moe/9pbj43.jpg
- khuey 2y agoOhm Laboratories appears to be a subsidiary of Sun Pharma which is one of the largest generic drug manufacturers in the world. This looks like a pretty standard generic drug with store branding package to me.
- mikeweiss 2y agoIt's not repackaged by your pharmacy, Good Neighbor Pharmacy is a generic drug brand for pharmacies and supermarkets that don't have their own generic brand.
- bluedino 2y agoYou need a drivers license though. And they enter something into the computer.
- toast0 2y ago
- biglyburrito 2y agoSo stupid. It was plainly obvious how ineffective it was, compared to pseudoephedrine, anytime you got sick.
- nimbius 2y agowhats wild is this was a solution to a problem that was directly caused by neoliberal capitalism. in the 90s and 2000s when meth first began to spike, the rural economy was changing. Jobs weren't paying as well or were going away altogether. Meth found a niche as a kind of performance enhancement drug for people working long hours at physically demanding jobs. journalist Nick Reding found this in the pork industry in Iowa, and anthropologist Jason Pine found in general in Missouri. neoliberalisms solution was a ham fisted market based restriction that turned a normal cold drug into a rarity. we didnt start working to treat methamphetamine addiction as a disease until it began to spread into more affluent white-collar neighborhoods. this could have been avoided with competent market reforms and regulation, as well as stronger labor protections and minimum wage law.
- realce 2y agoAnd it's much more profitable to scrape every ounce of working life out of the poor, then use them as slave labor in a prison once their addictions get them into a critical situation or farm them out to a rehabilitation facility that pays councilors 20 bucks an hour and gets a large chunk of it's funding from taxpayer subsidies. If there's any issue, blame the overworked poor for turning to drugs, then sell them energy drinks.
- userbinator 2y agoYou mean caused by the war on drugs.
- refurb 2y ago> whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism. Did you pull a muscle stretching that argument into place? People like meth. People in capitalist countries and non-capitalist countries alike. It was in fact a hamfisted government regulation that drove this.
- treflop 2y agoNeoliberals believe in free market and deregulation, not market restrictions. Nixon was the one that started the war on drugs and also enacted price controls. I would not call him a neoliberal. He also primarily interested in foreign policy and not the economy. Also, Sudafed was only banned from being purchased easily in 2006. The bill was introduced by a random congressman from Indiana, a congressman was also easily offended by an offensive joke written on someone’s else cake.
- MBCook 2y agoAnd yet homeopathy stuff is legal and often mixed in on the shelf with actual drugs. Sigh. Still an improvement.
- deleted 2y ago[deleted]
- sodality2 2y agoI remember complaining to my friends about how frustrating it was to hear that a medicine I frequently used turned out to be placebo, exactly one year ago today. Opened this article up, I'm currently taking the _exact same_ one in the article photo - it's what I had lying around and I had forgotten the name of the "bad" sudafed (it's sudafed PE). They need to take it off the shelves quicker. Every day is tens of thousands of more people who are scammed. Putting my money where my mouth is and leaving a comment on the FDA proposal...
- deleted 2y ago[deleted]
- jart 2y agoHow can you believe you've been taking a placebo for years? Phenylephrine is used for the illicit synthesis of methamphetamine, so there's an inherent bias towards anything that gets it off the shelves. Cherry picking studies that say it's ineffective is more velvet glove than using only the iron fist to ban the stuff. But make no mistake that the iron fist is taking your meds away either way.
- culi 2y agoI think you're confusing Pseudoephedrine (which works and is used to produce meth) with Phenylephrine (which doesn't work and cannot be used to produce meth). This article is about removing phenylephrine (sudafed PE) from shelves. Studies have pretty thoroughly showed it is completely ineffective for what it is marketed for
- sodality2 2y agoI believe that it doesn’t work wholeheartedly, because every time I try it, it is ineffective - but my sinus problems are rarely bad enough to warrant medication (it’s been one year) and by then I’ve forgotten what works and what doesn’t. Also, I suspect you’re mixing up your drugs. Phenylephrine (the drug in this article) lacks the methyl structure to be used for the synthesis of methamphetamines. In fact, that’s why it was popularized - pseudoephedrine, the truly effective sibling, was becoming too good for meth production, so they created a less potent alternative, phenylephrine, that lacks the ingredients necessary. They then locked pseudoephedrine behind the counter. Turns out the oral form of phenylephrine is less than “weaker” - it’s largely useless - so they pumped out enough of this crap to the tune of $1.7B that the American public spent every year for 18 years after they knew.
- crb3 2y agoMy anecdata is that, though it's not as effective as pseudoephedrine, phenylephrine actually is effective in an inhaler, and a helluva lot better at clearing up a stuffy nose than "scents and essential oils". Of course, a cylindrical inhaler with a wick inside it doesn't go near my digestive tract... Now I'll have to look around for a replacement inhaler, something quick enough to avert choking-panic. Thanks, CVS.
- ksenzee 2y agoNo you won’t! It’s just the oral formulations that are being taken off the shelves. The inhaled version does indeed work and will still be available.
- crb3 2y agoIt's off the shelf at my local CVS (e: and has been for weeks). I looked.
- lucubratory 2y agoThat's their company policy or a supply issue, not the FDA's decision.
- crb3 2y agoThanks, CVS.
- lucubratory 2y agoIt's only the oral version which has no effect and is thus being pulled. The inhaled version has more evidence that it works and will remain available.
- currymj 2y agophenylephrine is still pretty effective as a topical nasal spray. so don't write it off if you see it in that form.
- ramenmeal 2y agoDoes anyone else feel like dayquil is an effective decongestant? I do. I can literally feel the gunk running down from my sinuses to the back of my throat when I take it. Confusing to me cause it's phenylephrine, which is what the article states is ineffective. I've had this experience after reading these reports about a year ago.
- solveit 2y agoMight be the other ingredients reducing inflammation, widening your clogged pipes and letting stuff drain.
- pitaj 2y agoIt's probably the guaifenesin (Mucinex) that you're feeling.
- shagie 2y agoAs mentioned in a sibling, try looking at Mucinex a try. There is a 12h version that has Guaifenesin https://en.wikipedia.org/wiki/Guaifenesin https://en.wikipedia.org/wiki/Guaifenesin and Dextromethorphan https://en.wikipedia.org/wiki/Dextromethorphan https://en.wikipedia.org/wiki/Dextromethorphan as the only two active ingredients. Compare with Dayquil - Acetaminophen 650 mg (pain reliever/fever reducer), Dextromethorphan HBr 20 mg (cough suppressant) and Phenylephrine HCI 10 mg (nasal decongestant). > Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication taken by mouth and marketed as an aid to eliminate sputum from the respiratory tract. > ... > Guaifenesin is used to try to help with coughing up thick mucus, and is sometimes combined with the antitussive (cough suppressant) dextromethorphan, such as in Mucinex DM or Robitussin DM. --- > Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines. > ... > The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), or from inhaled particle irritants, as well as chronic cough at a higher dosage. --- The combination of the two is designed to reduce coughing and when you do cough, it is much more productive with the expectorant and cough suppression. It isn't a decongestant, but it has (personal anecdotal take) a good effect on getting rid of the secondary effects of congestion.
- colechristensen 2y agoHere's a solid completely factual reason why people don't trust the FDA or the government to give health advice. Pointless drug allowed for decades. If you want to be trusted you have to be consistently trustworthy. What else is the FDA wrong about and will continue to be wrong about for decades?
- OutOfHere 2y agoIt makes me wonder if it has anything to do with Trump winning the election. > What else is the FDA wrong about Too much. For one, numerous harmful additives are freely allowed. These additives may not cause immediate damage, but over the long term they really inflame the gut. They serve no good purpose in the medicines. Examples include: propylene glycol, sodium lauryl sulfate, titanium dioxide, talc, ammonium hydroxide, monoethanolamine, n-butyl alcohol.
- rileymat2 2y agoThis conversation is confusing without the FDA isn’t everything allowed by default and you get far worse like the current supplement industry?
- initplus 2y agoRegulatory challenge is that the FDA have to combine 3 related but seperate concepts: 1. Manufacturing quality/ingredients accuracy (is the product what is says on the tin) 2. Safety 3. Efficacy Medicines must pass all three, supplements don't have to meet any.
- rustcleaner 2y agoFDA and DEA should be concerned mainly with the contents matching the box, and not on medical claims of effectiveness.
- rileymat2 2y agoIn your opinion, should any government agency monitor truth of claims, or is this all outsourced to private things like consumer reports? Is it class action lawsuits? And in the case of drug effectiveness, isn't this a very expensive endeavor, where the primary source of funding would be the companies themselves biasing results? In this case we had companies happily selling us ineffective drugs, not because the FDA wanted it, but because they did not reject it. In a world without the FDA, what entity rejects?
- kens 2y agoOne of my favorite papers is "A simple and convenient synthesis of pseudoephedrine from N-methylamphetamine" [1]. This is a satirical paper. Because pseudoephedrine (i.e. the good decongestant) is very difficult to obtain due to restrictions, but "N-methylamphetamine can be procured at almost any time on short notice", the paper describes how to synthesize pseudoephedrine from meth with a procedure that looks valid. [1] https://improbable.com/airchives/paperair/volume19/v19i3/Pseudoephedrine.pdf https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
- hansvm 2y agoI found out recently that you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from, because apparently each state administers its own database. If you run out and have a persistent cough (weakened immune system from not licking doorknobs the last few years of covid, or so do the doctor says) from a common cold while on vacation, you're shit out of luck unless you go back home or you and an accomplice are willing to procure your cough medicine with their license.
- randrus 2y agoSeems like it varies by state - I’ve purchased Sudafed in at least two states other than my own.
- numbsafari 2y agoSame here.
- schmidtleonard 2y agoMe too.
- Gibbon1 2y agoMy WAT. Refused sale of Sudafed because my license was expired. Apparently I accidentally tossed my new license and kept the old one. Doh! However they happily refilled my schedule III meds with the expired license. As I said WAT.
- Spivak 2y agoAm I taking crazy pills, because I've been taking PE for years and it works just fine? Like yes the behind the counter stuff is stronger but it also comes with more annoying side effects. I use it to sleep during allergy season and I can tell when I don't take it when I mouth breathe the whole night. I might try some experiments to see if I can tell but I didn't think you could placebo while sleeping.
- ClassyJacket 2y agoYou're almost certainly experiencing the placebo effect. There's mountains of evidence phenylephrine does exactly nothing.
- readthenotes1 2y ago[flagged]
- wombatpm 2y agoI’ve hearing great things about this new drug called placebo. You can apparently prescribe it for anything and in many cases it’s just as good as existing medications.
- jabits 2y agoWell, I guess I’m here because of one of these miracle drugs. My kidneys would have crapped out year ago without it. I guess call me a fan…
- dudeinjapan 2y agoIt's also a great band!
- spoonsies 2y agoNext up, eliminating the work of the Fiendish Fluoridators
- evanjrowley 2y agoPhenylephrine worked great for clearing my mucus overproduction. Unfortunately, this has little to do with allergy relief, so I can see why many here hold that it's ineffective. I can imagine how frustrating it must be to have actual allergy issues and be prescribed something that doesn't solve the problem.
- Nursie 2y agoIt’s not just allergies - taken orally there is no evidence it works for anything, and there’s pretty good evidence it is basically metabolised away. The frustration largely comes from pharmacists and pharmaceutical companies selling decongestant remedies that do nothing and are known to do nothing.
- tobinfricke 2y agoWell, it doesn't work.
- gnabgib 2y agoDiscussion (136 points, 76 comments) https://news.ycombinator.com/item?id=42083559 https://news.ycombinator.com/item?id=42083559
- dang 2y agoMerged hither. Thanks!
- schoen 2y agoContext for readers from countries where this isn't an issue, or anyone who hasn't followed decongestant news: one of the most effective decongestants is called pseudoephedrine. https://en.wikipedia.org/wiki/Pseudoephedrine https://en.wikipedia.org/wiki/Pseudoephedrine In the past this was easily available, with the most popular brand being Sudafed. My parents always told me that one should take Sudafed when flying after having had a cold, in order to avoid severe ear pain from the pressure changes, but people would also obviously take it when not flying, just in order to reduce the discomfort of the congestion itself. Pseudoephedrine is very effective. It is also used to synthesize the somewhat related illegal drug methamphetamine ("meth"). Historically, meth manufacturers would hire people to buy large amounts of pseudoephedrine pills at pharmacies and supermarkets, then grind them up and synthesize meth from them. In order to deter this, authorities in the U.S. restricted the availability of pseudoephedrine, while not making it prescription-only, by limiting the amount that people could buy, and requiring buyers to show ID and be put on a registry (which law enforcement could use in investigations). I think this is the only drug that is treated this way. Some people stopped buying pseudoephedrine entirely, either because they were offended by these rules or because they were afraid that they could wrongly be implicated in meth investigations if they appeared to buy it too often. The pharmaceutical industry produced an alternative called phenylephrine, the substance that this proceeding relates to. Most manufacturers of pseudoephedrine-based drugs, including Sudafed, formulated alternative decongestants using phenylephrine. There are no legal restrictions on phenylephrine drugs; one can buy them anonymously and in any quantity. Customers have complained for years that these are much less effective than the original formulations. A couple of years ago this regulatory authority started looking into the question of whether phenylephrine is actually completely useless as a decongestant (rather than just much worse than pseudoephedrine). Their preliminary review of studies suggested that it is probably, in fact, useless. This proceeding is now proposing to ban it on the grounds that it's ineffective and so people should not be encouraged to buy and use it as a medicine for purposes for which it doesn't actually work. (There doesn't seem to be much corresponding initiative to remove or reduce the restrictions on pseudoephedrine.)
- gniv 2y agoI read this and was puzzled, until I realized that you are talking about the pills. The nasal spray is effective, although probably not more effective than a saline solution.
- snvzz 2y agoJust take N-A-C instead. Actually works and your liver will be happy as well.
- adrianmonk 2y agoAs long as we're giving decongestant advice, in my experience a neti pot (sinus rinse) really helps. I also take pseudoephedrine when things get bad. I'm not trying to push a natural stuff only approach. The neti pot really seems to reduce the odds that sinus congestion will spiral into a terrible sinus headache. Do be aware of the need to use sterilized water to avoid a possible dangerous infection, though. Distilled water is the easiest way.
- iscrewyou 2y agoIt works wonders on me and family members. Except we just always go for the Neil Med bottles from Costco or Target. They are also easy to disinfect in the microwave. Always distilled water, though. It’s not worth waiting to boil the water, let it cool down, and then manage the dish used after. It’s also easy to get just the right temperature using distilled water in the microwave.
- deleted 2y ago[deleted]
- radicality 2y agoI tried this once when I was a teenager. As far as I remember, I took the precautions of sterilized water, getting the right salt, etc. Guess I didn’t know how to properly use it, since I gave myself an awful sinus infection and was bedridden for next two weeks. To this day it’s the worst I’ve ever felt. Never touching a neti pot since then :/
- whamlastxmas 2y agoThe infection may have happened despite the neti pot, not because of it
- Etheryte 2y agoI would strongly advise against broadly recommending this across the board, because while rinsing your sinuses can help with some infections, it can make the situation considerably worse if you're working with e.g. inflammation instead. For a lot of people the difference isn't easy to tell and they end up making their own situation worse. As always, ask a medical professional, even your pharmacist can tell you what to do or not to do once you describe the symptoms.
- DidYaWipe 2y agoWay overdue. I wonder if the purveyors of this fraud have ever been sued. One refrain I got tired of hearing was that it "wasn't a safety issue." WRONG. Anyone who has ever had a ruptured eardrum can tell you that it is 100% a safety issue. If you're about to take a flight with any congestion, you're relying on decongestant to save your ears. I've had ruptured eardrums; it's probably the worst pain I've experienced. I had to take a flight a couple years ago with only this crap, and must have come extremely close to rupturing them again. It was EXCRUCIATING.
- JumpCrisscross 2y agoDo we know the story around the people who pushed this? (EDIT: By "this" I mean phenylephrine.) Had they never had a stuffy nose?
- gambiting 2y agoPhenylephrine doesn't work though. It never did. It was "pushed" as an alternative to pseudoephedrine which can be used to synthesize meth, but afaik every single study done on this shows that phenylephrine does absolutely nothing, it's a placebo drug. The faster it's phased out the better.
- raverbashing 2y agoHow it was approved in the first place should have been reviewed
- Suppafly 2y agoIt was approved back in the 70s after there being some studies that showed it was somewhat effective against congestion. I suspect it was no better than a placebo, but once it gets over the hurdle of being shown to be safe to use it probably didn't take much to get it approved. I don't think it was ever a popular product until the government starting making pseudoephedrine, which is highly effective, hard to buy.
- riahi 2y agoStrictly speaking, phenylphrine works when it’s injected. It is approved and used every day for this indication in the service of general anesthesia. However, the oral bioavailability is zero. This is an example of using something off label that’s approved for something else. Sometimes it’s fine. And sometimes, it’s dumb.
- gambiting 2y agoThat's cool to know - I had no idea! I assumed that it literally did nothing in every scenario.
- User23 2y agoIt's rather annoying that the only actually effective nasal decongestants are amphetamines or otherwise closely related compounds. Sudafed is great for daytime relief, but there really is no good sleep time decongestant. Sure Nyquil is a thing, but it just relies on the antihistamine to produce drowsiness without any actual decongestant effect. And Dextromethorphan is arguably even more useless than Phenylephrine since at least the latter could conceivably be effective if you shot it up.
- rustcleaner 2y agoTime to hand rifles to everyone (including felons) and ban the State.
- User23 2y agoI do find it amusing reading hundred year old stories where characters walk into a pharmacy to buy a pint of whiskey, a sandwich, and a vial of cocaine and it’s just an everyday normal thing.
- mrbonner 2y agoI can't pronounce either one of the Sudafed substances. One time, an old lady asked me which Sudafed work for her as she pointed to a shelf full of Sudafed plus other decongestant drugs. I told her just buy the one that you need to take the flyer and bring it to the pharmacist to get it. Others are just scam. The real one is used to make meth so they put it behind the counter. She was surprised that the US gov would allow fake decongestant to be sold.
- modeless 2y agoReally hard to trust the FDA when they let this obvious scam go on for so long.
- CodeWriter23 2y agoJunk Science invalidates effective medication. I’m calling this right now, in 5-10 years we’ll be discussing how it counteracts the spike protein.
- phtrivier 2y agoCue: - the entry of trolls everywhere demanding that they can keep the médecine they've been using for ages - the new administration's agreeing with "popular demand" and disagreeing with the FDA, because that's their thing - and the companies selling the drug be like "uh, ok, fine". At least it will be an interesting distraction from trying to fix the opioids epidemic ?
- tigen 2y agoThe brands who have continued to sell this ingredient should be considered untrustworthy. It's basically fraud.
- whamlastxmas 2y agoAlso the stores that stock it, honestly
- tonymet 2y agoSo a useless drug has made billions and took 30 years to be taken off the market . And who knows what damage it’s done ? Can we go back to being suspicious of pharmaceutical companies and the fda ?
- relistan 2y agoIt was on the market more like fifty years.
- tonymet 2y agoWow that’s even more alarming
- Suppafly 2y agoI don't think it's done any damage, it's just not effective.
- mrob 2y agoWasting people's money is damage.
- whamlastxmas 2y agoPreventing people from getting real medical care due to fraud is absolutely damage.
- rustcleaner 2y agoThis is why sovereign immunity needs to be rescinded: bad law should get politicians incarcerated for long periods of time and their assets stripped to help pay back the treasury for the piles of money it should be printing and handing its victims. It should also be legal to lie to police while they're barred from lying to you (again, at threat of incarceration). We are supposed to be sovereign, not them!
- 2y ago
- thegrizzlyking 2y agoMeanwhile generic decongestants like Ambroxol that actually work are too expensive to go through FDA approval. https://marginalrevolution.com/marginalrevolution/2024/05/the-left-on-fda-peer-approval.html https://marginalrevolution.com/marginalrevolution/2024/05/th... Maybe a shorter duration(<5yrs) patent(for lack of better word) for unapproved generics might do the trick.
- refurb 2y ago> Maybe a shorter duration(<5yrs) patent(for lack of better word) for unapproved generics might do the trick. There already is something similar - the NDA exclusivity period. You get 3-5 years where the FDA won't approve any other versions of the product. https://www.tandfonline.com/doi/pdf/10.4155/ppa.14.30 https://www.tandfonline.com/doi/pdf/10.4155/ppa.14.30 But ambroxol isn't a decongestant - it supposed to help with phlegm.
- Aurornis 2y agoAmbroxol is not a decongestant, it's an expectorant. If you take Ambroxol expecting to clear your sinus pressure like pseudoephedrine, you're going to be disappointed. I've used it. I thought it was going to be better than guaifenesin (equivalent available in the US). In my experience, it was not. That entire blog post appears to be based on a second-hand report from someone who went on vacation in France and was told something by the person at the pharmacist selling them Ambroxol. I don't understand why rationalist bloggers are so keen to rely on anecdotes and hearsay when it supports a point they're trying to make.
- deleted 2y ago[deleted]
- noneeeed 2y agoI've noticed that in the UK all phenylephrine based OTC medications also contain paracetamol (acetaminophen) and often caffine. They are just an expensive way to buy two very cheap compounds with an added bit of placebo effect from the flashy packaging. I can't take pseudoephedrine due to high blood pressure and I've found that the most effective thing for me, especially at night, is paracetamol, a blast from a nasal spray, and one of those nasal strips that help keep your nostrels open a bit more. It's not quite up there with the real Sudafed, but it's generally enough to get me a good night's sleep.
- Suppafly 2y ago>I can't take pseudoephedrine due to high blood pressure I really miss being able to take pseudoephedrine. I mentioned to my doctor that it seemed to affect my blood pressure and he looked scandalized and told me I should never take it again. Apparently someone should have told me when I was diagnosed with high blood pressure. The only real information I got was a handout for a DASH diet.
- noneeeed 2y agoYeah, I don't think it was mentioned when I was diagnosed, but the pharmacist asked about it when I next went to buy some more. That was a very sad day. I miss being able to take Night Nurse and then sleep like a baby.
- astura 2y agoI just checked the package for a random pseudoephedrine product https://www.cvs.com/shop/sudafed-sinus-congestion-maximum-strength-decongestant-tablets-48-ct-prodid-587763 https://www.cvs.com/shop/sudafed-sinus-congestion-maximum-st... It says consult your doctor before use if you have high blood pressure or heart disease.
- Suppafly 2y agoHow often do you consult your doctor about over the counter medicines that you've taken for years?
- thecupisblue 2y agoNot sure if it's still possible, but in eastern europe back in 2010s you could buy bottles of liquid ephedrine nose drops without a prescription. The pharmacists would get raw ephedrine and mix it in the back, filling the generic nose drop bottles. Tho they'd only give you 1 a month or so, looking at you suspiciously if you came multiple times in a row. Back when I was obsessed with sports and being the peak athlete I can be, I'd go to the different pharmacies around town and buy a bunch of nose drops. These would get mixed in with coffee to get a dumb version of EC stack. Not sure if it was worth it, but it definitely had me wired to the gills.
- teekert 2y agoI had a student once from Sofia (capital and largest city of Bulgaria), she told me her mother mailed her all sort of antibiotics because they were not available here (western Europe) and "what if she'd catch a cold or the flu?" (Both are viruses so antibiotics don't even do anything other than kill the useful bacteria in your body!)
- genocidicbunny 2y agoMany of the eastern-european markets around here have a little mini pharmacy where you can buy stuff that's either stronger than what you can find in the US, or can't be found at all. Especially various topicals, they tend to have versions with 2-5% of the active ingredient whereas most of the equivalents I can find in the US are 1%; Obviously nothing that's controlled/scheduled.
- EVa5I7bHFq9mnYK 2y agoI have tried many nasal sprays, but what is really effective is a salt in water solution (slightly salty to taste) and a 10 ml syringe. Simply inject it into each nostril so that the water comes out through the mouth, a couple of times a day. Cleans out all the garbage really well. Among the medications, Flonase spray is effective, but saltwater is enough most of the time.
- ceejayoz 2y agoMake sure you’re using sterile water for this. https://en.wikipedia.org/wiki/Naegleria_fowleri?wprov=sfti1 https://en.wikipedia.org/wiki/Naegleria_fowleri?wprov=sfti1 The saline wash is also known as a Neti pot here.
- marcosdumay 2y agoIt's 0.9% by mass. You can buy it easily in large bottles so you don't need to learn to disinfect and filter your water correctly.
- EVa5I7bHFq9mnYK 2y agoBoiling is enough, saltwater sold in pharmacies is $5 a bottle where I am, a rip off. Not that I can't afford $5, but I don't like to be a sucker.
- marcosdumay 2y agoAt least filter it. And I'm not sure boiling is enough, that will depend on what is in it.
- deleted 2y ago[deleted]
- wink 2y agoWonder how many people "fell" for it though. I remember, many years ago, that I got some Antihistamine tables with Pseudoephedrine to take in 'light' emergencies for my allergies, cat hair in my case. I wasn't going to fall over like other people but have trouble breathing and a runny nose, so every time I visited people with cats, I could take one and everything was fine. When they banned it and my supply was used up, I got something with Phenylephrine and it just did... nothing. Then 5min of online research told me just as much.
- TomMasz 2y agoIt doesn't relieve nasal congestion and it never did. While it's certainly safe, it's not even slightly effective.
- Molitor5901 2y agoThanks to the Administrative Procedures Act, and per the release from the FDA, the proposal will take some time. Comments are accepted until May 7, 2025. If the government moved with all legal alacrity, the order might get finalized by this time next year, that's if there are no lawsuits, petitions, etc. I mention this because I can't help but feel the APA takes too long when an agency is doing something proactive for the public good. This should take sixty days, not years, because it's not a removal of a product for safety reasons, that's often done via the FTC. There is a hole between FDA's authority to create and amend regulations, order the removal of products due to safety, and what should be a more routine streamlining of the FDA cleaning up.. APA - 5 U.S.C. §§ 551–559
- stronglikedan 2y agoGood. I get food poisoning symptoms from it, but it's so popular that my other options are limited.
- viggity 2y agoFor most of my adult life, I was "addicted" to sudafed (pseudoephedrine, not phenylephrine). I had absolutely horrific sinus problems. Could never breathe, tons of sinus infections, etc etc. Things like sinus rinses (not a netipot which is gravity driven, but a positive pressure squeeze bottle) helped, but it was still a major inhibitor in life. I got a new ENT, and I started getting a quarterly "chemical nasal cautery". It has ABSOLUTELY changed my life. I can breathe sooo much easier, and I couldn't recommend it enough to anyone with persistent sinus issues. It is super easy. It doesn't even kind of hurt, the most mild of stings if anything at all. Doc will spray a lot of afrin up your nose, then lidocaine, then carbolic acid which kills a bunch of your immune cells (so they can't overreact to tree pollen and make you miserable). You get it done once a month for three months, then once every 3 months thereafter.
- daft_pink 2y agoThe outrageous thing about this is that people are getting accused of a crime for trying to buy the effective drug.
- pbhjpbhj 2y agoYou can still get pseudoephedrine containing Sudafed in UK sometimes, I've had difficulties finding it, but they package it almost identically to the phenylephrine containing placebo. To me this has always seemed like obvious fraud. We don't have class actions in the UK, but perhaps in USA there's a chance of punishing this sort of behaviour going forward? Basically they took the active ingredient out, added a similarly sounding chemical, continued to sell the new known-ineffective chemical in the virtually the same packet, under the same trade dress and branding... Pseudo was really effective for me. When I first bought Sudafed after they took the active ingredient out (of the easy to find product) I thought I'd misremembered, took a couple of illnesses before I twigged, then some very careful analysis of packaging to make sure to get the actual medicine.
- jfengel 2y agoInteresting. I was just in the UK (Scotland), and picked up a cold on the plane. I was unable to locate any pseudoephedrine. My search was far from comprehensive, so it might merely have required looking harder. But I gave up early, on the assumption that the UK was similarly restrictive to the US.
- pbhjpbhj 2y agoMaybe it has, but last time we bought it was within the last year - branded Sinutab (actually clearly marked, unlike Sudafed), from Tesco Pharmacy I think. It's always with paracetamol; which I assumed made it difficult/useless for meth makers.
- EasyMark 2y agoIn the US everywhere has it, but it’s behind the counter and you have to show ID so they can track how much buy. It’s ridiculous, but it’s not hard to get, and has never stopped an illegal drug chemist from making crystal meth, but regular folks pay the price in inconvenience
- pbhjpbhj 2y agoPerhaps if you pay cash in UK they have to get ID, if you don't (or you use a discount card) then they're already tracking you so extra checks probably aren't needed.
- dang 2y agoThere's also https://arstechnica.com/health/2024/11/fda-proposes-ditching-common-decongestant-for-being-completely-useless/ https://arstechnica.com/health/2024/11/fda-proposes-ditching... (via https://news.ycombinator.com/item?id=42083559 https://news.ycombinator.com/item?id=42083559, but we merged the comments hither)
- Aurornis 2y agoI'm sure this will be unpopular, but I think the real problem with Phenylephrine is that it isn't dosed appropriately in standard formulations. The standard 10mg dose is too low. Decongestants work by constricting blood vessels, which inherently increases blood pressure as a side effect. Pseudoephedrine at standard doses is known to raise blood pressure slightly. Phenylephrine at standard doses (10mg) shows no such effect (Source https://journals.lww.com/ebp/abstract/2018/03000/how_much_do_oral_decongestants_increase_blood.11.aspx https://journals.lww.com/ebp/abstract/2018/03000/how_much_do... ) Phenylephrine does increase blood pressure when delivered by IV at doses that work. The oral 10mg dose just isn't enough to get absorbed and do anything. It's not that phenylephrine is ineffective, it's that it's underdosed in the oral formulation.
- abbefaria27 2y agoThere was some article about it on HN a while ago. If I remember right the problem was that its bioavailability is super low. You can take all you want, but only a tiny percent makes it through to get absorbed. In theory you could increase the the dose a lot but I imagine that might have other issues.
- genocidicbunny 2y agoI believe the problem is that the oral route causes most of it to be broken down in the digestive system. Nasal spray seems to be more effective because it has a chance to directly enter the blood stream rather than go through the gut.
- steveBK123 2y agoIt was obvious to consumers very quickly that it didn't actually do anything. Astonishing this charade went on so long.
- chankstein38 2y agoClearly placebo for me, I guess? It's wild how many people are saying phenylephrine is completely ineffective. It saved my ass during a really long COVID stint. It was impossible to find by itself but when we finally found it we bought 2 boxes because we use it and, for us, it works wonders... Hope they release something else better I guess.
- ziml77 2y agoThe better thing is the original: psuedoephedrine. It was never impossible to buy, it just required going to the pharmacy counter and showing ID. I knew about this when it happened in the 2000's because my dad needed Sudafed often, but the changeover was almost certainly invisible to most people given that the packaging is essentially identical between the two versions of the product.
- mullingitover 2y agoEveryone in the pharma and regulatory world has known this stuff is worthless for years. I feel like the pharma industry should be severely fined for knowingly perpetrating a fraud on the public. Sadly, they would likely be able to defend themselves on the grounds that the FDA allowed it.
- ahi 2y agoA faculty member clued me in when I worked for a college of pharmacy 20 years ago! FDA should be embarrassed. This shouldn't even have been hard. How many drugs have been p-hacked into efficacy and would need expensive trials to disprove? Oral PE is metabolized too quickly make it to the bloodstream and can't be more than a placebo.
- sanex 2y agoI find the Sudafed PE is useless but the Alka Seltzer with phenylephrine works and works really fast.
- horsawlarway 2y agoWhich is actually supported and documented here: https://pubmed.ncbi.nlm.nih.gov/26097788/ https://pubmed.ncbi.nlm.nih.gov/26097788/ Lots of versions of Alka Seltzer use aspirin instead of acetaminophen, and aspirin in combination with phenylephrine is documented to reduce congestion more than either alone. Note - avoid the cold & flu versions (the ones with orange bottoms) and the day & night versions (orange and green bottoms), because they're not aspirin, they're acetaminophen. The traditional blue bottom "Alka Seltzer Severe Cold" is the one with aspirin and phenylephrine.
- sanex 2y agoGood to know thanks. Considering it does work it would be weird to pull ALL phenylephrine in that case. I remember the last time PE came up they were just pulling medicines that were only PE like the fake Sudafed.
- jonahbenton 2y agoLooking forward to the FDA recommending ivermectin to take its place in late January 2025.
- SeanLuke 2y agoIt's been definitiely shown since at least 2010 that phenylephrine is useless for this purpose. How in the world did the FDA let the decongestant industry push this drug for 15 years before coming down on it?
- cryptonector 2y agoMake pseudoephedrine great again.
- avsteele 2y agoI knew this stuff didn't work the first time I bought it by accident because I thought it was normal Sudafed. Amazing its lasted this long
- apatheticonion 2y agoSide question; is phenylephrine applied topically under the eyes good for reducing the appearance of dark circles? I've seen some anecdotes suggesting this due to its vasoconstrictive effects
- redareda9 2y agoDidn't see any one talk about it but French health agency recommended all pharmacists and doctors to stop issuing Pseudoephedrine for colds as there is supposedly increased risk of heart attacks and strokes. It was only for people with high BP but seems like it's now for general population too. Source: https://www.rfi.fr/en/france/20231024-french-health-agency-warns-against-risks-caused-by-cold-tablets https://www.rfi.fr/en/france/20231024-french-health-agency-w...
- intelligentuser 2y ago[dead]
- intelligentuser 2y ago[dead]
- cudgy 2y ago“While the panel upheld the drug's approval, it concluded that more studies were needed for a full assessment.” That’s comforting. They approved a drug before it’s full assessment.