4 ms·

So at least here in Germany, we pretty much all use nasal spray with xylometazoline, and it's very effective as it also binds to adrenergic receptors. It does n

by deng 2y ago

So at least here in Germany, we pretty much all use nasal spray with xylometazoline, and it's very effective as it also binds to adrenergic receptors. It does not seem to be available in the US, and at least from a cursory search I cannot find out why...? EDIT: After looking a bit more, the simple answer seems to be that it's not FDA approved for nasal congestion, and since there's not much money to be made, there's simply no incentive to go through the costly approval process..

relistan 2y ago
I’ve wondered this also. As an American who lived in Germany and found this while living there, I can attest that it’s quite effective for me. There are other quite useful and safe drugs that are not available in the US.
- Aurornis 2y ago
  The US equivalent is oxymetazoline https://en.wikipedia.org/wiki/Oxymetazoline https://en.wikipedia.org/wiki/Oxymetazoline It's actually slightly more selective for a1 receptors than the German alternative. They both have the same dependence potential and rebound liability.
robinduckett 2y ago
They have oxymetazoline but I think the problem with this class of decongestants is that it is ineffective and dependency is basically guaranteed if used for more than a couple of days
- deng 2y ago
  Oxymetazoline is different from Xylometazoline, although it was derived from it. Xylometazoline is pretty harmless for adults when not used over extended periods (it is advised to not use it longer than 6 days, but that will cover your typical cold). It is true that if you take it regularly over extended periods, you will have a rebound effect and your nose will get congested when not taking it, so in that way, you develop a "physical dependency", but that's obviously much more harmless than other medication dependencies. Getting off a Xylometazoline dependence means that you'll have to deal with a congested nose for a few weeks...
  - sph 2y ago
    I don't see from your comment how the risk from congested nose for a few weeks deems it "harmless" for you. Two fully congested nostrils is hell for one night alone, imagine a few weeks of that. A few weeks of terrible sleep, if any. It's torture. It can also cause permanently enlarged turbinates with chronic use.
    - deng 2y ago
      I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos. Even here in tightly regulated Germany, Xylometazoline can be bought without a prescription. It is very effective and, compared to other drugs, pretty harmless. Look, there are always extreme cases. Just look up how many people need a liver transplant or even die each year from misusing paracetamol. So should we make it a prescription drug? Maybe, I don't know, it's always a trade-off.
      - gojomo 2y ago
        Is there any basis to think xylo- is better than the similar oxymetazoline available in the US? Both the efficacy and downsides seem similar from discussion so far.
      - sph 2y ago
        > I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos. I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin. I mean, I quit smoking, hardest thing I've ever done, and the physical withdrawal effects were insignificant compared to that. It's funny; looking back, I quit smoking exactly BECAUSE I was suffering from crazy congestion, and after a week of Afrin and poor sleep I thought quitting smoking altogether would help me regain my sanity.
        deng 2y ago
        > I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin. Let me assure you that there's (yet?) no Xylometazoline epidemic ravaging though Europe, with tens of thousands of people dying each year, destroying families and communities, in effect causing endless grief for people and huge profits for pharma companies. There's also no black market for Xylometazoline, with people overdosing because there's nasal spray on the street that is contaminated with a much more potent derivative than can kill pretty much instantly. I've also never heard of babies born with congested noses that spend their first weeks of life going through a Xylometazoline withdrawal. So to summarize, I think my initial statement that a physical dependence on Xylometazoline is less harmful than a dependence on opioids is probably correct.
- sph 2y ago
  Worse, the symptoms gets worse after you stop using it, see rhinitis medicamentosa. Many people have used decongestants so much they cannot quit them or will have to suffer weeks of nasal congestion. I risked going through that; later I swore I will never touch one ever again.
  - Terr_ 2y ago
    > Worse, the symptoms gets worse after you stop using it, Very tangentially, "iatrogenic" is a nice niche vocabulary word: Something unintentionally caused by a medical activity, usually undesirable.
  - wruza 2y ago
    Same. I’d rather start and quit smoking again than this.
  - morsch 2y ago
    Kind of funny to see a medication that's super common in Germany, widely recommended by doctors, given to children, etc. to be discussed in those terms.
    - Moto7451 2y ago
      This isn’t that strange in the context that all medicines, while generally safe in OTC form, can have negative side effects if used for too long or at the wrong dose or in the wrong circumstance. My wife has one kidney and as such is told to avoid NSAIDs as a class of medicine. She’s realistically fine taking it every so often but her doctors are asking her to avoid using kidney capacity that could hypothetically be needed to filter and excrete something else. Acetaminophen/Paracetamol is great alternative for her since it’s processed in the liver. However if you’re a frequent drinker, have a liver deficiency, or have to take some other drug straining your liver, it’s contraindicated. For most of us most of the time you’re completely correct though. In the case of these nasal spray decongestants I had a case of rebound congestion due to over-reliance on them while surviving some family bringing really bad colds into the house and my son starting daycare. It was really bad. I then managed by switching to an alternating schedule of pseudoephedrine and the nasal spray so I could reduce the physical dependency on the latter and get a good night’s sleep. My doctor eventually cleared me to take an allergy spray medication (Fluticasone propionate) that is safer for long term use but generally not used for colds because it inhibits immune response and mask the symptoms which can cause new infections and hurt your ability to heal. Yet another case of the mundane medicine that is contraindicated. While seemingly being the wrong thing to be put on while fighting off infections it worked out great. After four months I had seen enough child germs and no adult has brought their own plague or food poisoning (it was a very bad summer for me) and I finally became healthy again.
- dreamcompiler 2y ago
  Oxymetazoline is an extremely effective nasal decongestant. It works almost instantly and it lasts 24 hours. It also creates dependency. A drug that is ineffective cannot cause dependency.
  - admash 2y ago
    Of course it can. You take drug A for 5 days to get rid of symptom X. The symptom X does not go away. It is ineffective! You stop taking drug A and immediately experience brutal migraines that go away when you start taking drug A again. Ergo, you have become dependent on drug A for normal functioning, even though it is ineffective at ridding you of symptom X.
AdamN 2y ago
There are nasal sprays in the US - and yes they are more targeted and better in general than pills. But Americans love their pills ... almost as much as Germans love their homeopathic remedies :-)

by deng 2y ago

relistan 2y ago

I’ve wondered this also. As an American who lived in Germany and found this while living there, I can attest that it’s quite effective for me. There are other quite useful and safe drugs that are not available in the US.

Aurornis 2y ago
The US equivalent is oxymetazoline https://en.wikipedia.org/wiki/Oxymetazoline https://en.wikipedia.org/wiki/Oxymetazoline It's actually slightly more selective for a1 receptors than the German alternative. They both have the same dependence potential and rebound liability.

robinduckett 2y ago

They have oxymetazoline but I think the problem with this class of decongestants is that it is ineffective and dependency is basically guaranteed if used for more than a couple of days

deng 2y ago
Oxymetazoline is different from Xylometazoline, although it was derived from it. Xylometazoline is pretty harmless for adults when not used over extended periods (it is advised to not use it longer than 6 days, but that will cover your typical cold). It is true that if you take it regularly over extended periods, you will have a rebound effect and your nose will get congested when not taking it, so in that way, you develop a "physical dependency", but that's obviously much more harmless than other medication dependencies. Getting off a Xylometazoline dependence means that you'll have to deal with a congested nose for a few weeks...
- sph 2y ago
  I don't see from your comment how the risk from congested nose for a few weeks deems it "harmless" for you. Two fully congested nostrils is hell for one night alone, imagine a few weeks of that. A few weeks of terrible sleep, if any. It's torture. It can also cause permanently enlarged turbinates with chronic use.
  - deng 2y ago
    I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos. Even here in tightly regulated Germany, Xylometazoline can be bought without a prescription. It is very effective and, compared to other drugs, pretty harmless. Look, there are always extreme cases. Just look up how many people need a liver transplant or even die each year from misusing paracetamol. So should we make it a prescription drug? Maybe, I don't know, it's always a trade-off.
    - gojomo 2y ago
      Is there any basis to think xylo- is better than the similar oxymetazoline available in the US? Both the efficacy and downsides seem similar from discussion so far.
    - sph 2y ago
      > I said it's more harmless than other medication dependencies, like getting hooked on pain medication or benzos. I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin. I mean, I quit smoking, hardest thing I've ever done, and the physical withdrawal effects were insignificant compared to that. It's funny; looking back, I quit smoking exactly BECAUSE I was suffering from crazy congestion, and after a week of Afrin and poor sleep I thought quitting smoking altogether would help me regain my sanity.
      - deng 2y ago
        > I've never taken any opiod, but two weeks of being unable to breathe properly or sleep sounds as hellish as my idea of quitting heroin. Let me assure you that there's (yet?) no Xylometazoline epidemic ravaging though Europe, with tens of thousands of people dying each year, destroying families and communities, in effect causing endless grief for people and huge profits for pharma companies. There's also no black market for Xylometazoline, with people overdosing because there's nasal spray on the street that is contaminated with a much more potent derivative than can kill pretty much instantly. I've also never heard of babies born with congested noses that spend their first weeks of life going through a Xylometazoline withdrawal. So to summarize, I think my initial statement that a physical dependence on Xylometazoline is less harmful than a dependence on opioids is probably correct.
sph 2y ago
Worse, the symptoms gets worse after you stop using it, see rhinitis medicamentosa. Many people have used decongestants so much they cannot quit them or will have to suffer weeks of nasal congestion. I risked going through that; later I swore I will never touch one ever again.
- Terr_ 2y ago
  > Worse, the symptoms gets worse after you stop using it, Very tangentially, "iatrogenic" is a nice niche vocabulary word: Something unintentionally caused by a medical activity, usually undesirable.
- wruza 2y ago
  Same. I’d rather start and quit smoking again than this.
- morsch 2y ago
  Kind of funny to see a medication that's super common in Germany, widely recommended by doctors, given to children, etc. to be discussed in those terms.
  - Moto7451 2y ago
    This isn’t that strange in the context that all medicines, while generally safe in OTC form, can have negative side effects if used for too long or at the wrong dose or in the wrong circumstance. My wife has one kidney and as such is told to avoid NSAIDs as a class of medicine. She’s realistically fine taking it every so often but her doctors are asking her to avoid using kidney capacity that could hypothetically be needed to filter and excrete something else. Acetaminophen/Paracetamol is great alternative for her since it’s processed in the liver. However if you’re a frequent drinker, have a liver deficiency, or have to take some other drug straining your liver, it’s contraindicated. For most of us most of the time you’re completely correct though. In the case of these nasal spray decongestants I had a case of rebound congestion due to over-reliance on them while surviving some family bringing really bad colds into the house and my son starting daycare. It was really bad. I then managed by switching to an alternating schedule of pseudoephedrine and the nasal spray so I could reduce the physical dependency on the latter and get a good night’s sleep. My doctor eventually cleared me to take an allergy spray medication (Fluticasone propionate) that is safer for long term use but generally not used for colds because it inhibits immune response and mask the symptoms which can cause new infections and hurt your ability to heal. Yet another case of the mundane medicine that is contraindicated. While seemingly being the wrong thing to be put on while fighting off infections it worked out great. After four months I had seen enough child germs and no adult has brought their own plague or food poisoning (it was a very bad summer for me) and I finally became healthy again.
dreamcompiler 2y ago
Oxymetazoline is an extremely effective nasal decongestant. It works almost instantly and it lasts 24 hours. It also creates dependency. A drug that is ineffective cannot cause dependency.
- admash 2y ago
  Of course it can. You take drug A for 5 days to get rid of symptom X. The symptom X does not go away. It is ineffective! You stop taking drug A and immediately experience brutal migraines that go away when you start taking drug A again. Ergo, you have become dependent on drug A for normal functioning, even though it is ineffective at ridding you of symptom X.

AdamN 2y ago

There are nasal sprays in the US - and yes they are more targeted and better in general than pills. But Americans love their pills ... almost as much as Germans love their homeopathic remedies :-)