5 ms·

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 mo

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
        Not very harmful on an absolute scale != harmless. There is a whole spectrum between harmless and bloody heroin.
        2y ago
  - qwerty456127 2y ago
    Many medicines pose some risk to some people who would abuse it for too long. Xylometazoline just is crazy effective (instantly eliminates congestion and running nose completely in most cases) and completely harmless in what looks like 99% cases of usage - nearly-everyone here in the EU uses it happily and has no problems. I would really dread a cold without it and never travel without having it with me. Just try to not over-use habitually. The sense of measure is always a key to healthy and happy living.
  - jorvi 2y ago
    That’s why if you developed a dependence you don’t quit cold turkey. The strategy I’ve heard is purchasing a normal bottle, and refilling it with boiled cool water when it’s ½ empty. Then refilling it again when it’s ¾ empty. Xylometazoline is an absolute godsend, and has even more efficacy in a dual-action spray with saline water. It feels nothing short of magical to do one spray per nostril, and be completely uncontested in less than 10 minutes.
    - gojomo 2y ago
      In my experience oxymetazoline has similar fast-action - even "10 minutes" seems a bit on the long side.
- deleted 2y ago
  [deleted]
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.

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
        Not very harmful on an absolute scale != harmless. There is a whole spectrum between harmless and bloody heroin.
        2y ago
- qwerty456127 2y ago
  Many medicines pose some risk to some people who would abuse it for too long. Xylometazoline just is crazy effective (instantly eliminates congestion and running nose completely in most cases) and completely harmless in what looks like 99% cases of usage - nearly-everyone here in the EU uses it happily and has no problems. I would really dread a cold without it and never travel without having it with me. Just try to not over-use habitually. The sense of measure is always a key to healthy and happy living.
- jorvi 2y ago
  That’s why if you developed a dependence you don’t quit cold turkey. The strategy I’ve heard is purchasing a normal bottle, and refilling it with boiled cool water when it’s ½ empty. Then refilling it again when it’s ¾ empty. Xylometazoline is an absolute godsend, and has even more efficacy in a dual-action spray with saline water. It feels nothing short of magical to do one spray per nostril, and be completely uncontested in less than 10 minutes.
  - gojomo 2y ago
    In my experience oxymetazoline has similar fast-action - even "10 minutes" seems a bit on the long side.
deleted 2y ago
[deleted]

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.