Phenylephrine for colds and allergies don’t work, FDA panel says | Hacker News Reader

Phenylephrine for colds and allergies don’t work, FDA panel says

cnn.com

58 pointsjohnkpaul38 comments

The ever-excellent Derek Lowe has a deep dive on this from a year ago:

"The Uselessness of Phenylephrine"

https://www.science.org/content/blog-post/uselessness-phenyl...

To anyone in Australia, apparently you can still get pseudoephedrine over the counter. You just need to explicitly ask for it (brand name is Codral Original) and provide ID so that the chemist can register the sale.

Expect a visit from the AFP if you start hoarding boxes. :)

pseudoephedrine is still available over the counter in Canada, too.

Despite pressure from the USA, that fact hasn't changed. I literally just bought cold meds with it as an ingredient just yesterday. Not just limited to "store brand" or "generic" versions, either. Name brand Tylenol or Advil "cold".

It's available over the counter in the USA, too. You do have to show ID.

This is something literally anyone who was forced into the penylephrine based allergy could tell you. Meanwhile banning an effective drug did nothing to lower meth production.

Where is pseudoephedrine actually banned? It's available everywhere I know of in the US, you just have to show ID to get it.

Not anywhere in the US as far as I know, but even the requirement of showing ID is ridiculous. What has it accomplished? And how many people got tricked into buying the useless stuff that's 10x easier to purchase?

Sorry.

"can no longer be bought without advance planning so that you can get to a pharmacy during open hours and have time to stand in line"

e.g. no real hope if you realize allergy nonsense is happening on the way to or from work

La la la-la la la,

Sing a happy song

Dude just buy in bulk and keep it on you. Thats what I do. 96 25mg quick release tablets costs like 6 dollars at walmart.

I know it is no longer available in Colombia, prescription or not.

Is "Sudafed PE" different than normal Sudafed? I typically take the latter when I have a cold. If it's a placebo, it's a darn effective one!

Edit: Oh I see, my box of Sudafed has a different active ingredient, "pseudoephedrine".

Sudafed / pseudoephedrine is the real stuff, the stuff that works. It's also the stuff that you use to make meth.

I find it funny that “things you need to cook meth” are such common knowledge among normal people.

Breaking Bad sure had a deep influence!

It's more due to the fact that you can only buy it in tiny amounts "because some people use it to make meth." As far as I know, that restriction predated the show by several years at least.

In the UK ‘Sudafed’ (the brand of decongestants) is available off the shelf, but doesn’t contain pseudoephedrine. There is a different ‘Sudafed’ branded coloured box that you can get from behind the counter by asking someone, that does contain pseudoephedrine.

Did big phenylephrine's check not clear this year? Why did the FDA approve it previously if it didn't work?

> These products generated nearly $1.8 billion in sales last year alone

A real mystery.

A new, prescription-only, medication is likely coming out.

Just heard about this on the radio. It works as a nasal spray, and was approved back in the 1970s when medical trials were different than they are now (in some way that the radio show guest, a professor of pharmacy, didn't explain). It doesn't work when taken orally because less than 1% of it survives the trip to your nose, and wouldn't pass trials today for the oral route.

that said, my doctor has told me the pseudoephedrine hcl it replaced doesn't really help your cold or allergy, maybe just your symptoms. I don't know the truth/reality of the matter.

It is expected to just work on the nose/sinus congestion, so yes, it's for managing symptoms. That's very useful though if it lets you sleep.

The issue with phenylephrine is that it does not help the symptom. Pseudoephedrine does not deal with the underlying immune reactions, but it does constrict your nose blood vessels enough to stop the mucosa from stuffing your nose holes.

Having your nose unclogged is very useful on its own, considering otherwise you'd be forced into mouth-breathing, which would lead to more discomfort and potentially worse outcomes like sleep apnea.

The problem with blood vessel constriction medicines, is the body tends to very quickly adjust to their presence. Things like “decongestant nose sprays” are known for being traps, they work a few days, and then one needs an ever increasing amount to achieve the effect. And if one stops using them, then they’ll be worse off because their blood vessels will over expand again without the chemical present, resulting in congestion even after the original cause is gone. It then takes time to ween off the effect, during which the exact problems you mention occur. Same thing with “redness eye reliever” found in eye drops.

Basically, you shouldn’t use these sorts of things for more than ~2 days, but that is not well communicated with consumers.

having witnessed this escalation in a family member, it's completely the same description I'd have used. I can't imagine how annoying it was to have a constantly stuffy nose, yet the only relief is ever-increasing nasal spray.

Chronic nose problems really do require something else. During bad months I start with a regular antihistamine and then to escalate to ketotifen (somehow OTC in China), and if that doesn't work, saltwater rinse (look, I'm lazy). Pseudoephdrine goes after salt water -- I just don't like to go to a physical pharmacy, so I want my stock to last as long as it can.

For some reason steroid spray never seems to work on me. I spray it, it drips out, nothing happens.

There are now decongestants you can use where you spray it into one nostril one night, then the other nostril on the next night. And you can keep swapping back and forth without running into these "boomerang" problems.

My wife can take them, but I can't because I have high blood pressure.

The thing about decongestants is that they increase your blood pressure, so those of us who are already hypertensive cannot take them.

I have a friend who won't take medication (cold meds and otherwise) because they don't treat the illness "only the symptoms". While I understand the distinction I don't understand the lack of desire to treat the symptoms (assuming the meds aren't themselves damaging)

In at least some cases, the symptoms are part of the body's attempts to fight the sickness - fever for example, which raises body temperature, making it more hostile to the pathogen.

True, but I have yet to hear any good reason to have a stuffed nose so bad you can't even function or sleep well. Pretty sure that's just the illness helping itself spread.

I don't take meds for fevers, but first thing I do when I'm getting a cold is make sure I still have a box of pseudoephedrene to use. It turns 90% of colds or flus into just a boring few days instead of abject misery.

The other two essentials IMO are an expectorant and a cough suppressant. All separate meds so you can pick and choose (it's also cheaper typically, the boxes of random mixed crap tend to be stupidly expensive).

cold medication has, as far as I've personally seen, never claimed to treat the problem, just relieve the symptoms. The marketing definitely deviates from this, though.

Since most colds are caused by viral infections, and we don't have a lot of anti-viral meds... there isn't much to do but wait for your immune system to figure out how to beat the invaders. But no one ever got rich on "return to the mean".

The symptoms are what I want fixed, thank you very much.

It would be one thing if we were discussing chronic pain or some such, but colds are generally temporary. A drug that can make the cold more pleasant is exactly what I want.

The better you feel, the more likely you are to get better sleep.

Good, restive, sleep helps your body heal from most anything while the reverse, a lack of sleep, will always wreck your health.

There is zero nobility, or reason, for people to suffer through a cold.

Psuedoephedrine is super disruptive to sleep. Its a pretty strong cns stimulant. In fact if you have low tolerance you can get pretty zooted off it.

Yes, but if people treat the symptoms then carry on with their normal life, they risk spreading the virus to everyone else. Those "Soldier on with Codral" ads were really messed up.

Grammar.

you sure bro

Phenylephrine for colds and allergies DOESN’T work.

Yes, I’m sure.

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