Two pharmacists figured out that oral phenylephrine doesn't work

https://www.scientificamerican.com/article/how-two-pharmacists-figured-out-that-decongestants-dont-work/

by sohkamyung • 3 years ago

297 326 3 years ago

scientificamerican.com

spicybbq• 3 years ago

https://archive.is/wLY8e

dist-epoch• 3 years ago

What's the consensus on eucalyptus oil sucking pills? Seems to work for me.

vidanay• 3 years ago

That's the strangest name for "cough drop" I've ever heard.

christkv2• 3 years ago

I remember using Vicks® VapoRub as a kid for congestion and it seemed to work.

DHPersonal2• 3 years ago

An Atlantic article recently suggested that this is due to the feeling of coolness on the throat and not actually the opening of nasal passages. https://www.theatlantic.com/health/archive/2023/10/humans-ha...

justinator• 3 years ago

Lucky. It was boiled onions for me.

Cthulhu_• 3 years ago

Eucalyptus oil is an effective decongestant. You can put it in an oil burner or a humidifier as well.

rybosworld2• 3 years ago

I was surprised when I heard they are taking phenylephrine off the market.

In my anecdotal experience, it was extremely effective at drying out my sinuses, which did reduce congestion. So I asked some family and friends and their responses were mixed. Some said it did nothing and others swore it was effective.

I'm not claiming that phenylephrine is in fact generally effective, just wondering out loud if there could be more to the story. I.e., it works for some people and not others.

Anecdotes are not science. But if enough people share an experience, sometimes there is more to the story.

JHonaker2• 3 years ago

Anecdotes are not science. But if enough people share an experience, sometimes there is more to the story.

Solely relying on anecdotes as evidence is not science, but they’re absolutely a critical part of it!

corethree4• 3 years ago

Science is expensive and moves slow. Sometimes anecdotes are all you have.

Just because the science doesn't exist doesn't mean anecdotes are completely invalid.

fredgrott• 3 years ago

Anecdotes are not science. But if enough people share an experience, sometimes there is more to the story.

Read that again in context to the two people who found the science of why it does not work..

You are defeating your argument...

evanjrowley3• 3 years ago

There is a problem with the studies these pharmacists are referencing. They are measuring nasal resistance, however, the measurement is not sufficient to capture the combination of things that make up nasal resistance. It's a combination of how much mucus is being secreted vs the degree of sinus inflammation.

New theory: Allergy sufferers are likely primarily experiencing sinus inflammation. Pseudoephedrine is the better solution for that. For those of us who are dealing with secretion - phenylephrine is effective.

https://www.jacionline.org/article/S0091-6749(06)00633-6/ful...

travisjungroth• 3 years ago

What’s a case study but a fancy anecdote? It’s not very sciencey to form an opinion after a study and shut down conflicting evidence.

rybosworld2• 3 years ago

I don't think you've made the point you intended to.

bmurphy1976• 3 years ago

My anecdote is that for me I've known phenylephrine worthless for decades and seek out pseudoephedrine when I need actual relief. Now we have two data points.

exoverito• 3 years ago

Anecdotes are the material for new hypotheses, so they are very much part of the scientific process.

This reminds me of the debate around monosodium glutamate (MSG) causing headaches. There were early scientific reports which found no real link and that it was probably psychosomatic nonsense. However more recent studies found that some people have a heightened sensitivity to glutamate, and since it is a literal neurotransmitter there is a promising pathway for the mechanism of action.

Biology is stupendously complex, it's difficult to make hard and fast rules about something being categorically effective or ineffective.

evanjrowley3• 3 years ago

Thanks for this comment. I maintain the unpopular position that both 1) phenylephrine is mildly effective for drying out my sinuses, and 2) MSG definitely gives me headaches, unlike salt, so most likely glutamate is the culprit.

Der_Einzige• 3 years ago

Silly fun fact, the chemical code for MSG (e621) just happens to also be the name of the largest furry "booru" site on the internet. I have no idea why this is.

sarchertech• 3 years ago

What form are you talking about? The nasal spray isn’t being removed because it is effective. It’s the oral version that isn’t effective.

Also the placebo effect is real. So even if the boxes had always been packed with sugar pills, you would expect some people to report that it was effective for them.

Additionally, even if it did have some mild effect, oral pseudoephedrine is better in nearly every way.

Qem• 3 years ago

The oral absorption of phenylephrine is erratic. Perhaps that is why it was not used as an oral decongestant until it was the only choice. It had long been known that enzymes in the gut lining metabolized oral phenylephrine to inactive metabolites, reducing the amount of the active compound that could enter the bloodstream. The most cited study found that an oral dose of phenylephrine had an absorption rate of 38 percent of an oral dose of phenylephrine, but this study measured more than just the compound's active form. Later studies with more sensitive tests found that less than 1 percent of oral phenylephrine enters the bloodstream in an active form.

Perhaps you have a less active form of the enzyme that degrades it.

fixedpointsnake• 3 years ago

I've been looking for this comment in all these stories regarding the ineffectiveness of phenylephrine!

I have a similar story. Congestion is not a symptom I typically get. Covid, however, decided to shake things up and introduce me to a new set of symptoms... One of those was congestion such that my head felt like a balloon. Without experience treating this symptom, I went out and ended up with Sudafed PE, oral phenylephrine. It worked _immediately_, it was like a balloon deflating. It worked so well that these headlines regarding phenylephrine's ineffectiveness still cause bemusement...

anddd that's my story.

evanjrowley3• 3 years ago

I had the same experience with phenylephrine. It dried out my sinuses, which helped me slightly with decongestion but moreso with post-nasal drip.

The effect was not dramatic, and as I understand it, people with allergies need that dramatic effect to be able to breath well.

It seems to me phenylephrine was effective for something different than what the FDA had in mind, but due to their folly, now both phenylephrine and pseudoephedrine are unavailable to the average person.

standardUser• 3 years ago

I think the fact that different drugs work differently on different people is criminally underrated.

diebeforei485• 3 years ago

Are you referring to tablets or nasal spray?

christkv2• 3 years ago

I've only ever had Xylometazoline spray for the nose and pseudoephedrine tablets work and both can only be really taken for a short period of time. Overuse of Xylometazoline will have the opposite effect.

mattmaroon5• 3 years ago

I feel like anyone who has tried a PE drug knew they didn’t work. I’ve wondered for a solid decade why they existed. I’ll happily wait in the tweaker line for my pseudo.

prmph• 3 years ago

They hitched a profitable ride on the placebo effect bandwagon

Scubabear68• 3 years ago

It literally did nothing at all.

Before I started using Flonase for my congestion, real Sudafed was the only thing that would work when I had to fly. If I forgot, take off and landing would be miserable because my ears wouldn’t pop.

hunter2_• 3 years ago

You probably know given your username, but Sudafed is also great for diving to avoid barotrauma (MEBT). Just need to ensure it's not less than the 12 hour formulation, lest it wear off at depth.

HumblyTossed4• 3 years ago

I’ll happily wait in the tweaker line for my pseudo.

HA! Indeed! I got a three pack from Costco. Should last a while.

dylan6042• 3 years ago

How much paperwork and what forms of ID were required to buy that much at one time? It sounds like a sarcastic question, but it is a serious one. The last time I was prescribed a codeine based cough syrup, my signature was required enough times to make me compare to financing a car/house.

toast05• 3 years ago

I seem to recall reading something that said there is an effective does of phenylephrine, if you take it by itself, 2x the dose works, but if you take it with other meds, it might be ok by itself. Something about the stomach acid neutralizing it. Might help to take it with food too.

kstrauser3• 3 years ago

What you’re probably thinking of is topical (is that the right word here?) phenylephrine. If you snort it, like as a nasal spray, and it soaks directly into the inflamed nasal tissue, then it has an effect. Swallowing it does not.

Analogy: you wouldn’t eat hemorrhoid cream.

zbrozek• 3 years ago

It's long past time to remove that regulatory friction. Instead, it's spread to other drugs. My wife got a cold last week and sent me off to get some other non-pseudo drug. Despite being on the shelf, unlocked, it triggered a driver's license scan at checkout. Very dystopian.

tptacek6• 3 years ago

It doesn't seem dystopian to me at all. I get carded when I buy alcohol; in fact, I got declined recently buying alcohol, because my license had expired, but would not have been for Sudafed, where the ID is just there to rate limit purchases.

This is a very old, recurrent HN debate.

datasink• 3 years ago

I briefly worked as a retail pharmacy technician 12 years ago. There were a few pharmacists that I worked with during this time and all of them were aware that phenylephrine essentially did nothing.

I hadn't really thought about it until now, but these pharmacists did not directly work with each other, so it must have been obvious that phenylephrine was ineffective.

naijaboiler• 3 years ago

All professionals knew it did nothing. But the problem is by law FDA only needs to certify that OTC medications are safe not that they are effective. So drug companies go to town making billions off those old safe but useless medications

The real change is to add the mandate of efficacy to FDA for OTC medications.

kridsdale14• 3 years ago

Indeed. My Walgreens has a whole section of clearly and not-clearly labeled homeopathics for these symptoms.

People want to buy them and they won’t get hurt, let em, I guess.

abfan1127• 3 years ago

you don't want to go down the road of the "FDA mandating efficacy". However, requiring "truth in medicating" i.e. demonstrable efficacy rates would be nice.

fnordpiglet• 3 years ago

Every human with a nose knew it didn’t work, because when you took it, it didn’t work. The fact it was marketed was purely a regulatory exploit by pharmaceutical companies. The truth is, they could have continued to let pseudoephedrine be behind the counter and it would have been fine. But someone realized phenylephrine was approved OTC and sounded sort of like pseudoephedrine, so they could claim the shelf space and edge pseudoephedrine products.

Their defense to the FDA in being allowed to continue to market despite being proven even before they began their cynical ploy was consumers want convenience, which sadly is clearly true, that despite knowing if you walked five feet further and got the pseudoephedrine they would get relief they grabbed the drug conveniently placed. Fortunately lobbying money only went so far this time.

rincebrain2• 3 years ago

A lot of pharmacies have limited hours and long lines for people to say "give me the thing" compared to just grabbing it off the shelf at any time of day with no line.

Some people I know are essentially nocturnal, and have to significantly disrupt their lives whenever they have to do an irregular medication pickup rather than having it shipped ahead of time.

So it can be beyond just "slightly more work" for many people to get it.

Personally, I try to remember to get some whenever I refill meds at the pharmacy, not because I go through it that often, but because if I'm feeling poorly enough that I'm taking it, I probably am not in a state where I want to wait an hour in line just to ask for it.

gehwartzen• 3 years ago

This is sadly so true for many many categories of consumer products; by the time sufficiently enough people discover the product is bullshit to turn general public opinion the original sales already made the "innovator" enough money to make the whole endeavor worthwhile.

jwineinger• 3 years ago

My dad is a physician and as far back as I can remember, he said it was worthless.

xyzzy_plugh2• 3 years ago

The US is so weird. Elsewhere, like Canada, pseudoephedrine is readily available without needing to present any ID. I always bring some with me when I travel just in case.

Everyone knows phenylephrine is useless.

paulcole• 3 years ago

Everyone knows phenylephrine is useless.

Easy to say now once it’s proved.

CamperBob2• 3 years ago

If it took that long for regulators and the drug industry to figure out that phenylephrine is worthless, I certainly don't hold out much hope for more advanced cures.

The same is true if corruption rather than incompetence is the explanation.

jtbayly• 3 years ago

Except anyone could have known it did nothing for them. My sister and I confirmed this many years ago.

DHPersonal2• 3 years ago

I recall it being the year it came out when I heard it was useless.

technothrasher• 3 years ago

It's been pretty common knowledge for years that it doesn't work. That doesn't mean that common knowledge was right, but it certainly isn't a case of everybody only now claiming they knew it.

Runways• 3 years ago

Actually, it's funny. My parents aren't Libertarian, but they kinda lean that way in terms of not trusting the government - etc. When they restricted pseudoephedrine, they immediately were suspicious about phenylephrine and eventually came to the conclusion that it doesn't do anything. They'd demand pseudoephedrine and claim that phenylephrine was just a way to restrict pseudoephedrine while allowing pharma to rip us off, yada yada. That's where my strong disdain for phenylephrine came from. Once I was in college buying my own medicine, I came to the same conclusion that one worked and one didn't. Pseudoephedrine was just a miracle drug to me, I remember stopping taking it too early and feeling blegh within hours.

maccard2• 3 years ago

We've known for ages - https://www.forbes.com/sites/daviddisalvo/2015/10/26/the-pop...

HumblyTossed4• 3 years ago

Everyone who is easily congested already knew it.

stephen_g3• 3 years ago

Nope, I remember the first time I tried to use a phenylephrine based cold tablet it after the big uproar about putting pseudoephedrine behind the counter - this is more than a decade ago. I’ve always had relief from pseudoephedrine but I felt absolutely no effect from the phenylephrine tablets (apart from the paracetamol they also contain, but zero decongestant effect). I looked it up and other people were reporting the same, I was so annoyed I never bought it again and from then always ask for the real thing.

Weird thing was the pharmacists always want to know why you’re asking (even beyond doing the drivers license check) and I had to say every time that the off the shelf tablets do literally do nothing for me.

michaelcampbell• 3 years ago

It never worked for me, but I thought that was a "because me" thing.

It makes me both exhausted and unable to sleep, and although I'm not very good at very many things, I'm generally an exceptional sleeper so this was something I wasn't willing to experiment on dosage experiments to make it work.

karaterobot• 3 years ago

Ha. I think everyone who tried it said this. I think every conversation I've had with a sick person has included the phrase "this over the counter stuff doesn't do anything". The most cursory search of the internet finds an article from 2006 with the literal phrase "There's just one problem. Phenylephrine doesn't work, and most in the pharmaceutical industry know it."

https://reason.com/2006/12/21/step-away-from-the-cold-medici...

And 2005 is the year Phenylephrine replaced Pseudoephedrine, so it's not like it took anyone any time at all to figure this out.

mdorazio• 3 years ago

In case you're not aware, it's because pseudoephedrine is used to make meth. As for why it's restricted in the US and not Canada, the DOJ believes that meth production in Canada is relatively low compared to the US [1].

[1] https://www.justice.gov/archive/ndic/pubs13/13853/product.ht...

singleshot_2• 3 years ago

I think the implication is that the rest of the world isn’t overrun by tweakers?

SV_BubbleTime2• 3 years ago

As a pedantic correction was used to make meth. Once the supply ran out it became just one more step to make whatever it needed other ways.

Practically speaking, lots of things are used to make meth. I had to give ID last time I bought acetone. Which is crazy for all sorts of big brother reasons.

I’m not a chemist, but as I understand it, meth isn’t too often made with PE anymore, yet, it sits behind the counter forever now.

tptacek6• 3 years ago

It's not so much "used to make meth" as that it is some very simple chemistry away from being meth, and that chemistry, when employed by the amateurs who use Sudafed to make meth, is particularly rough on the neighbors.

kazinator3• 3 years ago

Who needs meth when you have poutine and maple syrup to get you through Christmas?

soylentcola• 3 years ago

But not in (at least much of) the UK apparently. I was on vacation in England and Scotland a year ago and many in our group came down with an annoying cold.

Every chemist had piles of phenylephrine tablets but no pseudoephedrine (or even phenylephrine nasal spray, which works quite well). I did not have a fun time explaining to my sniffly girlfriend why these were all trash and there was no point in buying them - she just wanted some relief and couldn't understand how I would somehow know better than all the different drugs on the shelves. It made me feel like some nutty conspiracy theorist, insisting that the medicine was all phony.

Thankfully it didn't derail the trip, and in the end I found some other nasal spray that sort-of worked.

maccard2• 3 years ago

Pharmacies in the UK absolutely do stock pseudoephedrine. It's usually behind the counter and you have to ask for it.

"Sinutab, or own brand, without pain relief" is what you're looking for, for anyone reading.

stephen_g3• 3 years ago

I’ve bought pseudoephedrine tablets at Boots on a trip but I think I did have to ask at the counter.

jcadam• 3 years ago

I've found plain 'ol saline nasal spray works well enough... and, a hot toddy helps clear the sinuses.

dfawcus• 3 years ago

It is generally available behind the counter in chemists all over the UK. One simply has to ask, and there are no ID requirements.

There is a limit to how many they will supply, but I'm not sure what it is. Generally available now in two forms, with and without paracetamol.

It used to be available off the shelf, but that changed about 15-20 years ago, for the same illicit drug production issues.

petercooper• 3 years ago

The UK's pharmaceutical culture is poor. If "NICE" doesn't think something is the right way to treat a condition, forget it. Even people with diagnosed conditions can struggle to acquire medication. Also, beware of daring to mention the name of a medication, because that's a sign of "drug seeking"! (Luckily I've not been on the receiving end of this, but know folks who have.)

pajko• 3 years ago

That's strange and I was surprised reading in the article that phenylephrine is ineffective. Basically this is the only combo that works for me all the time: https://www.drugs.com/mtm/pheniramine-and-phenylephrine.html

It's available as Neo Citran in the EU. Tried a couple of other meds, neither worked, nor the parts of the combo separately (combined with other stuff). Only side effect is that it knocks me out a bit, making me feel tired. At least falling asleep is easier. It's the side effect of pheniramine.

542458• 3 years ago

Everyone knows phenylephrine is useless.

It’s pretty easy to find phenylephrine on the shelves in Canada (I’d say about half the drugs use it vs pseudoephrine) so obviously somebody is buying it. Anecdotally, I always tell people to read the labels and only buy pseudoephrine based medication, and it’s consistently a surprise to people - I don’t think the difference was anywhere near universally known.

dreamcompiler6• 3 years ago

People buy homeopathic remedies by the truckload too. They are even less effective than phenylephrine.

The average person has no clue how to evaluate medicines. Stupid laws should not impede those of us who do have said clue.

dang3• 3 years ago

Please keep nationalistic flamebait out of your comments here. It leads to nationalistic flamewar (in the general case—not in this thread, but that was by luck).

https://news.ycombinator.com/newsguidelines.html

xyzzy_plugh2• 3 years ago

I'm puzzled by this comment.

The first thing that sprung to mind when reading the article was how terrible it was to be treated like a drug abusing criminal whenever we tried to purchase anything containing pseudoephedrine in the United States.

Pharmacist can't figure out how to scan an out of country license, makes you get your passport. Can't figure out how to scan your passport, makes you get additional ID. Can't figure out what to do with additional ID, shrugs and says sorry you can't have this medicine. I'm sorry, what??? Is this a joke? I was turned away at the pharmacy buying cold medication?

Don't even get me started about prescriptions that family members literally depend on for their livelihoods and the continuous monthly battle to keep those prescriptions filled. And I'm not just referring to stimulants.

Insofar as I can tell the prevalence of phenylephrine is due solely to this dumb policy under the umbrella of The dumb War on Drugs.

If this is somehow nationalistic flamebait, or somehow leads to nationalist flamewar, I fail to see how that is my fault. I pay plenty of US taxes, I buy my medicines elsewhere.

danielbln5• 3 years ago

Not technically a decongestant, but I swear by Ectoine nasal spray, personally. As far as I understand, Ectoine is extracted from bacteria that live in harsh conditions like in the extremely salty dead sea. It does so by building a water barrier around itself, or something like that.

It's sold as an anti allergic nasal spray (it definitely helps with my light dust allergy at night) but it also works very well when suffering from Rhinitis.

Also doesn't build dependence, which is a big plus.

denton-scratch3• 3 years ago

Ha! As far as I'm aware, every drug promoted as "doesn't build dependence" turns out to build dependence. Even cocaine and diazepam used to be pitched as not dependence-forming.

danielbln5• 3 years ago

True, though at least I can say from myself that after prolonged use not using it for a few weeks has no adverse effects (unlike classical decongestant sprays).

kridsdale14• 3 years ago

And heroin. And Percocet. And OxyContin.

britzkopf• 3 years ago

I've bad hay fever, for which an allergist prescribed corticosteroid nasal spray. When I told him I didn't want to take it until allergy season because of dependence, he told me that's not a problem and the drug will work better if I take it ALL the time. He is the medical professional I guess but I still couldn't bring myself to take that advice.

badwolf• 3 years ago

Not medical advice, but you'd probably get a similar response just by using regular ol' saline nasal spray for those lighter allergy or dust symptoms.

danielbln5• 3 years ago

I've tried, but regular water sprays don't last as long, somehow.

bethekind• 3 years ago

So how does it actually work? Sounds like a gimmick to me. Bacteria produced anti-allergy nasal spray?

danielbln5• 3 years ago

https://en.m.wikipedia.org/wiki/Ectoine

corethree4• 3 years ago

Seems like the entire food regulatory body the USDA and the FDA are just in the pocket of the industry. Lack of funding is the least of it. Paid off and corrupt is likely the better characterisation.

Seems like Literally nothing you eat is regulated at all.

Unless it kills you. Then if it kills people the FDA acts only after they see a good amount of people dying.

Almost all of this is universal knowledge now. I wonder why there's no outrage or pressure to change.

corethree4• 3 years ago

I hope a lawyer jumps on this and sues on behalf of the American public.

Refund all instances of the sold chemical, put the company out of business. Is it possible?

If it can't be refunded funnel the money into actually creating an effective regulatory body. One can dream.

VikingCoder• 3 years ago

I need more caffeine. My brain read,

"Two Hot Pharmacists Figured Out That Decongestants Don't Work"

kridsdale14• 3 years ago

Maybe you’ve been browsing too many alternative websites.

magicmicah85• 3 years ago

I’ve known this for a long time. Put me on a watchlist and give me my meth, my sinuses are clogged.

burkaman3• 3 years ago

I feel like I'm living under a rock, how is everyone in these comments so intimately familiar with this subject? I've never heard the word "phenylephrine" in my life.

booleandilemma• 3 years ago

It's the internet. I have a feeling a lot of people are not. One tab for HN, another tab for wikipedia.

HumblyTossed4• 3 years ago

That might define you, but not the rest of us. Think about it, most people likely to reply on this subject probably know something about it.

jannyfer• 3 years ago

I strongly agree that non-experts in HN comments write as if they are experts. Without some sort of upvote counter, it becomes hard to distinguish confident bullshit from expertise.

Certain individuals are prolific bullshitters too. I’d read a questionable comment and notice it’s the same person.

(My observation is general, not specific to this topic)

singleshot_2• 3 years ago

It’s pretty handy to know the names of all these drugs because frequently there is a nineteen dollar package of Advil and a nine dollar package of Walgreens Ibuprofen. It’s pretty easy to figure out all the names of these drugs because all the generics say things like “compare with Claratin.” And it’s smart to use the generic because the active ingredients are molecule for molecule the same.

I guess the generics could be using cheap corn starch…

kridsdale14• 3 years ago

Many of us have severe allergies.

I came to the conclusion about these drugs on my own years ago.

alteriority• 3 years ago

https://xkcd.com/2501/

willcipriano• 3 years ago

When I'm sick I "do my own research". If you are similar you are familiar with over the counter remedies and their purported effects. Not that many 'effective' medicines are available over the counter in the US and this was a very popular one.

orev• 3 years ago

If you take any kind of OTC medicine, it’s assumed that you’ll read the directions (which includes the list of ingredients). Clearly most people don’t, and they just rely on the marketing material printed on the box/bottle to understand what the medicine does.

If they did read the ingredient list, people would realize that all those products in the pharmacy are mostly remixes of the same handful of chemicals sold at different prices.

burkaman3• 3 years ago

I do know to always buy the generic version of a medicine when it's available, but I also generally rely on the FDA to not let companies lie about what a drug does. Apparently that has failed in this case.

I guess I only buy decongestants like once a year at most though, I would probably pay more attention if I needed them more often.

dessimus• 3 years ago

Sure, but one hopes that a national brand takes care to avoid any type of contamination that might cause a scare on the level of the Tylenol scandal in the 80s. A generic making 20-some store brands might be more lax.

AnthonyMouse• 3 years ago

If they did read the ingredient list, people would realize that all those products in the pharmacy are mostly remixes of the same handful of chemicals sold at different prices.

This is one of the major problems with putting pseudoephedrine behind the counter. It had been an ingredient in many of these combination products -- after all, if you have a cold, you have the combination of symptoms that come with a cold and want to take the corresponding combination of drugs.

But the combination products are convenience products. You could just as well buy the ingredients individually and take them together. People buy the combination product to be saved the trouble, which isn't compatible with the trouble of getting something from behind the counter.

So there generally isn't a combination product available with the decongestant that actually works in them. And phenylephrine, in addition to not working, has more dangerous side effects (e.g. larger increase in blood pressure) than pseudoephedrine. But now it's the thing in the bottle grandma gets when she has a cold.

scottyah• 3 years ago

Just because two medications contain the same active ingredient doesn't mean they'll have the same results. A lot of work gets put into speed and location of of release.

stephen_g3• 3 years ago

Well for me I remember the big news about gangs buying up cold tablets for the pseudoephedrine that they had in them to make meth, so the pharmacies making it harder to buy them. Then the new ones on the shelves (which are marketed as ‘PE’ here) just plain don’t work at all, unlike the real ones (which you can still get but you have to ask the pharmacist for). So I read the ingredient list and googled it, and was annoyed to find my experience confirmed and that they’d replaced a really useful medication with one that basically everyone reported didn’t work.

Scoundreller• 3 years ago

Well for me I remember the big news about gangs buying up cold tablets for the pseudoephedrine that they had in them to make meth, so the pharmacies making it harder to buy them.

You missed the step where cartel super-producers (that didn’t depend on small qtys of feedstock from pharmacies) just started producing 5% more to make up for it.

The organized producers appreciated the government shutting down their nibbling competitors.

Sucks for the public though, paying the price for an ineffective measure.

jfengel• 3 years ago

You may not know the word "phenylephrine", but you almost certainly know Sudafed (and perhaps its generic name, pseudoephedrine).

If you live in the US or several other places, you probably know that the "good" Sudafed is kept behind the counter, and you have to sign for it. You may have also noticed that there is another version, called "Sudafed PE", that you can just pick up off the shelf.

A lot of people have done that and concluded for themselves that the PE version didn't work. That's why there are so many people commenting that they already knew the thing the article is about.

So... a lot of people were familiar with "PE", and apparently a lot of them knew that it stood for "phenylephrine". And it all touches on a bunch of existing controversy about why the effective medication is locked up.

It wasn't always. People knew that Sudafed was an pretty effective drug. (It was even used, under a different brand, on Apollo missions -- there was a TV ad with an astronaut endorsing it.) A lot of people are grumpy that a well-known effective medicine was made hard to get, and something else sneakily substituted.

The point being, it's not entirely a surprise that people are aware of the phenylephrine -- especially if they're older than, say, 40, and live in the United States. They remember, sniffily, when cold medicine started to suck.

burkaman3• 3 years ago

Thanks this is helpful, I'm aware of the Sudafed/meth issue but I didn't realize the alternatives were all clearly labeled PE. That explains why it's so obvious to a lot of people.

6stringmerc• 3 years ago

This is a fantastic write up and as for anecdotal confirmation, an award winning career journalist cited his “on deadline” setup was a box of Sudafed and a pot of Coffee, then a bottle of Jack Daniels once it was all in. Very effective compound and I also didn’t know the PE longhand…only went to the counter…

JohnFen6• 3 years ago

you probably know that the "good" Sudafed is kept behind the counter, and you have to sign for it.

In my state, that's not how it works. You have to have a doctor's prescription to get it, which means you have to have a doctor -- and getting a doctor is incredibly difficult.

redandblack• 3 years ago

In early 2000s, I switched to using codeine for cough after seeing commentary that is the best treatment for cough/lungs without any bad side effects. That person, a physician noted that all others will have some effect.

I usually pick these cough syrups with codeine when traveling overseas, and has worked extraordinary well, including for my then young children. They are recovering by the 2nd or 3rd day after sleeping though the night without coughing. Obviously children dosage. I think sleep was the medicine.

mdasen• 3 years ago

I think it'll depend on who you are. If you have allergies or often suffer from nasal congestion, you'll likely know it. If you're someone whose nose just kinda works, there's no reason you'd be aware of it.

pfranz• 3 years ago

Hard-won experience? I vaguely remember when Sudafed got put behind counters because it was used to make meth. I don't frequently get sick. Often, the last medication I bought is expired by the time I need it again. One year, I found something that worked for me. Another year, I thought I bought the same thing, but it just didn't work. The one I had originally bought (same brand) had a behind-the-counter version that worked. It's annoying to catch the pharmacy when it's open, but now I just ask the pharmacist for generic Sudafed with the smallest-lasting dose (so I can decide if I want to take more).

I've found with most medications looking for an active ingredient and an amount is helpful. You can search for effectiveness or side-effects. The brand I got last time isn't always available and they'll have 3-hour or 12-hour versions with warnings about exceeding recommended dosages (or mixing medications). Or company annoyingly package similarly-branded things that just aren't the same.

samtho• 3 years ago

I've found with most medications looking for an active ingredient and an amount is helpful. You can search for effectiveness or side-effects.

Is this not common practice? I would be uncomfortable taking an ambiguously labeled “cold medicine” pill, personally. I know which medicines are effective for me and which are a waste of time and money.

josefresco2• 3 years ago

You must not have allergies. Congratulations. Joking aside, I wouldn't know a single thing about these drugs if I didn't have crushing seasonal allergies.

rvbissell• 3 years ago

My reply is a bit off-topic, but: I'm beginning to personally notice a correlation with sugar intake and degree of my allergy symptoms. I can't say if I was just oblivious before, or the personally correlation is recent. I started noticing it when I began avoiding foods containing sugars or breads. My allergies aren't completely gone, but they very much spike up when I relapse on my voluntary diet restriction.

Nick87633• 3 years ago

I have seasonal allergies and I found an effective method for myself: When I realize the allergies are kicking in (usually after 6 hours of watery eyes and sneezing) I take a claritin and a zyrtec together, as well as spraying my nose with Flonase. Usually this knocks it off and I will keep taking one of the once-a-day meds for a bit to prevent reoccurrence.

Zyrtec and Flonase together is probably the best normal combo and is generally accepted to be ok.

Disclaimers: I'm not a doctor. Combining a nose spray and a pill is generally accepted practice and studied in several peer review studies I've seen. Stacking claritin and zyrtec pills together is not generally accepted practice, so don't do it.

tpm• 3 years ago

I have a permanent non-allergic rhinitis, but even for allergic rhinitis you would be prescribed local steroids (momethasone mostly), or systemic antihistamines (desloratadine etc), or both, is this not common in the US?

simonebrunozzi• 3 years ago

Please make room for me under there. Same feeling. :(

milofeynman• 3 years ago

I think a lot of people watched this Vox video about sudafed 2 months ago and became armchair experts tbh: https://youtu.be/ZlFF7A8nk0w

inemesitaffia2• 3 years ago

Some of us have first hand knowledge and found alternatives too

schwartzworld• 3 years ago

It's the "active" ingredient in most cold medicine. There's real Sudafed behind the counter, and everything else is just varying amounts of phenylephrine, acetaminophen, guaifenesin, and dextromethorphan. If you read labels for otc medication, you see these same names over and over again.

quickthrower23• 3 years ago

Lol… I am more familiar with it via watching Breaking Bad than anything else.

But in general for any HN topic the people who have something to say get attracted to the article.

annoyingnoob• 3 years ago

I have bad allergies and have at times relied on Sudafed so that I could breath through my nose. It was apparent to me the very first time I tried a product where phenylephrine had replaced Sudafed that phenylephrine does not work at all. I never purchased another product with phenylephrine.

I've found that conservative and non-continuous use of Afrin is a better option for me.

JohnFen6• 3 years ago

I'm extremely familiar because I suffer from severe hayfever. When they made pseudoephedrine unavailable, it was immediately obvious that the replacement, phenylephrine, didn't work at all.

So I have a sore spot about this whole issue. I get made to suffer in order for lawmakers to have an empty gesture toward addressing the meth problem.

flybrand• 3 years ago

How dare they do their own research.

seattle_spring• 3 years ago

Sadly "do your own research" usually means saving a few Facebook political memes and panning through Infowars headlines.

user3939382• 3 years ago

Snorting salt water works for me though it's very unpleasant. Very spicy food/capsaicin as well.

msluyter• 3 years ago

Takeaway: when faking data, make sure your numbers are randomly distributed. ;)

Seriously, this was fascinating and disturbing that it took so long.

hn_throwaway_99• 3 years ago

So many folks saying "phenylephrine is useless". The oral formulation, yes, precisely because not enough of the drug actually makes it to your nasal passages.

So just take a nasal spray. I get it, all the pills that include it should have it removed, but I don't understand why people just wouldn't use the nasal spray. Personally I don't like decongestant drugs at all because I always feel like I get a stronger "rebound", and a netty pot makes me feel considerably better in any case.

sp332• 3 years ago

The effect from the nasal spray is fast and quite strong. Sometimes it even hurts, but there are days when having a very dry nose is the better option.

mrkeen• 3 years ago

but I don't understand why people just wouldn't use the nasal spray.

I heard it didn't work! But I haven't exactly gone looking for studies.

Also I know I'm doing it wrong. I read instructions somewhere that say if you spray it in your nose and it dribbles back out again, you didn't get it into your sinuses, where it needs to be. Every. Damn. Time.

smeagull• 3 years ago

Because if you're using a spray then you may as well use Xylometazoline.

beej71• 3 years ago

The trade-off was worth it, though, since there's no longer a meth problem.

Rebelgecko• 3 years ago

We just need someone to figure out how to make fentanyl out of phenylephrine

Hitton• 3 years ago

The most cited study found that an oral dose of phenylephrine had an absorption rate of 38 percent of an oral dose of phenylephrine, ...

That's not very much.

dreamcompiler6• 3 years ago

Misleading title (par for the course for what Scientific American has become).

Decongestants work.

Oral phenylephrine does not.

Pseudoephedrine works just fine but it was moved behind the counter long ago and now you have to ask the pharmacist for it, because besides the fact that it's a great decongestant it can also be used for making meth. TIWWCHNT (this is why we cannot have nice things).

The over-the-counter replacement for pseudoephedrine is phenylephrine and it's basically a placebo when ingested orally. (It works well in nose drops and nasal spray.)

kazinator3• 3 years ago

TIWWCHNT

Because of asshole governments that wage beyond-insane wars on drugs?

wenebego• 3 years ago

Yes

vintermann• 3 years ago

There's much insanity and cruelty that's done in the name of fighting drug use.

I don't think restricting sale of medicine that is often used to make methamphetamine is one of them. Back when it was over the counter, how much of the profit from selling pseudoephedrine decongestants was really profit from selling a meth precursor?

Private profits from legal meth seems like a problem any society has to deal with.

bsder• 3 years ago

"A Simple and Convenient Synthesis of Pseudoephedrine From N-Methylamphetamine" https://improbable.com/airchives/paperair/volume19/v19i3/Pse...

sib• 3 years ago

Or because of asshole manufacturers of illegal and dangerous drugs?

Porque no los dos?

samstave• 3 years ago

"Pseudoephedrine works just fine but it was moved behind the counter long ago and now you have to ask the pharmacist for it... ..The over-the-counter replacement for pseudoephedrine is phenylephrine and it's basically a placebo"

But this is the entire issue, they knew this from the get-go and made billions based on fraud.

How many Nyquil/Dayquil and other decongestant commercials have you seen in your life time... Ive seen thousands. to the point their jingle and tagline are still easy to recall.

The issue here is fraud, most of the marketed products were oral.

So, here is a conspiracy: If they knew that it was useless, but sounded good on the label - then maybe they could get away with putting even less of the substance, if any, in the products to save costs?

I would assume the FDA would require batch testing at some interval?

hwillis2• 3 years ago

You can see the FDA tests here:

https://www.fda.gov/drugs/science-and-research-drugs/drug-qu...

It's not something they do for very many drugs or very often.

dang3• 3 years ago

Ok, we've put that in the title above. Thanks!

pwarner• 3 years ago

I always buy as much Pseudoephedrine as I can since I get regular head colds. It's always funny to ask for "as much as I can get".

bonniemuffin• 3 years ago

Same. Any time I visit a pharmacy counter for any reason, I add "and the largest box of sudafed you can legally sell me", to make sure I always have a stockpile on hand.

ike2792• 3 years ago

I remember DayQuil being a lifesaver when I was in college in the early 00's and I needed to power through a day of classes with a bad cold. Then I remember at some point in the later 00's it just didn't work anymore (turns out they switched normal decongestant meds to phenylephrine in 2006). Once I found that out I started buying the behind-the-counter stuff with pseudoephedrine and it suddenly worked again. Not sure you need to be a pharmacist to figure this stuff out.

HackeNewsFan234• 3 years ago

Something with Dayquil - it has other medicines that do work for pain and cough suppression. Depending on your symptoms, those two can work and make you feel better even though you're not getting any real decongestion benefits. That makes it harder to detect that the decongestion part isn't working. That is, of course, until you're introduced to the stuff that really does work and then wonder how you went so long without it.

stronglikedan• 3 years ago

Phenylephrine gives me food poisoning like symptoms, so I have to avoid it. Apparently common cold stuff used something different than Phenylephrine when I was a kid, because they did used to work before they started making me ill. Thank goodness for Dextromethorphan!

kayson• 3 years ago

The article suggests that dextromethorphan (which is a cough suppressant, not a decongestant) might be ineffective as well.

victor106• 3 years ago

So, we took the political route, contacting then-congressman Henry Waxman, whose committee at the time had FDA oversight. Waxman’s office wrote four letters imploring the agency to reconsider oral phenylephrine’s effectiveness.

For all the hate that politicians get on public forums like hn, this is one of the few cases where they actually made a difference.

BobaFloutist2• 3 years ago

The only thing that can stop a bad guy with a politician is a good guy with a politician.

skywhopper• 3 years ago

I mean, anyone with sinus allergies who has tried all the medications knows that phenylephrine doesn't work. While it's been nice to have "official" confirmation, it was incredibly obvious to those of us who really benefited from the old pseudoephedrine version of Sudafed.

Rather than put my name on a state government watchlist that tracked whether or not I bought "too much" Sudafed, I figured out that Zyrtec (cetirizine) worked well enough for me, and could be had cheaply at discount warehouse stores.

StopHammoTime• 3 years ago

I actually have HN to thank for knowing this. About a year ago someone pointed out how useless the non-pseudo alternatives are. Colds are nowhere near as bad anymore.

rain_iwakura• 3 years ago

same here, I remember reading a random reply on here about it and then getting Claritin-D or whatever at a CVS near me when I had a cold and then covid. Both times I experienced huge relief.

duffpkg• 3 years ago

As someone who has worked in healthcare for 20+ years now, at least in those circles it was widely known that phenylephrine was a placebo at best, when it was mandated as the on the shelf replacement for psuedoephedrine (Sudafed) nasal decongestant. Again in healthcare circles there was a clear understanding of this being a DEA driven policy to replace an effective medicine that could be abused to create methamphetamine with a different medicine that was ineffective but could not be turned into street drugs. As best as I can tell the policy resulted in harm to millions of people while not reducing the spread and availability of methamphetime one bit and ancillary costs to the healthcare system in the billions of dollars.

Off the top of my head, https://pubmed.ncbi.nlm.nih.gov/19230461 from 2009 but there are many earlier studies as I recall.

tobinfricke3• 3 years ago

I often wondered why German pharmacies continue to stock homeopathic remedies. Maybe phenylephrine was our equivalent?

As someone who suffered chronic congestion, and had experienced the effectiveness of pseudoephederine, it was immediately obvious that phenylephrine did nothing. It's just surprising that this "open secret" has taken 20+ years to be publicly confronted.

bitwize• 3 years ago

Zinc gluconate is often promoted as "homeopathic", but the formulations sold e.g. as Zicam do contain the active ingredient in significant amounts and, apparently, are effective at shortening or mitigating colds if taken early enough.

RCitronsBroker• 3 years ago

fellow german and medical student here. the reason is twofold. The first part is pretty obvious, it’s a great way to make money for pharmacists and physicians, it’s pretty much unregulated, has huge margins and is often paid by the patient instead of the gesetzliche Krankenkassen.

The second part, why they are getting away with it, is that naturalistic and pseudoscientific healing BS has a long, long history in Germany. Schulmedizin, at least somewhat, had the image of being perverted by Jewish influences. "Völkische Medizin" the OG Heilpraktiker in some sense, started most of the Quack stuff you see today. The same circles are also still infested with nationalist and anti-jewish sentiments á la "the globalists" to this very day. It’s a crazy, crazy world if you take a closer look.

tjohns3• 3 years ago

Even outside of healthcare circles, most folks I know were aware from anecdotal experience that the OTC phenylephrine was practically useless, and that the psuedoephedrine behind the counter was the way to go if you had a cold. Night and day difference between the two.

The only problem is that the pharmacy always seems to be closed when you need it.

dan_quixote• 3 years ago

For the last 20+ years, I've lived in states where you had to show ID at the pharmacy counter to get your hands on the real thing. So I made it my (probably annoying) mission to ask every pharmacist if phenylephrine was effective for anyone. I don't recall a single time I got a "yes".

whatshisface• 3 years ago

It shows you something about the priorities of the system that the company got a similarly-named substitute to sell (that's what they need out of medicine), but we didn't get a substitute for what we needed out of the medicine.

tootie3• 3 years ago

From what I've read there are basically no effective treatments for coughing. Dextromethorphan and guafenesin are equally useless. Or at least no better than staying hydrated.

toast05• 3 years ago

Dextromethorphan has some effect at least. Not sure that it helps much with coughing, but it does something. I've heard codine can help with coughing although again the primary effect seems to be sedation.

IME, guafenesin can be helpful for making coughs more productive, hydration helps with that too, and again IME, so do spicy foods. Mixing cough suppresants and expectorants together makes no sense, but is common --- if I'm trying to clear the junk in my lungs with an expectorant, why am I supressing the coughs that are needed?

no_identd• 3 years ago

I wouldn't call either useless, but which to use depends on the exact scenario. There's basically three options for coughs with support behind them, the problem is most professionals neglect distinguishing when to use which and just prescribe willy-nilly:

For suppression of 'ticklish' coughing (i.e. where any form of very minor irritant in the air will set off a coughing fit): Dextromethorphan, which is an antitussive (and which is psychoactive and depending on genetics WILL make you trip even at therapeutic non-abuse doses)

For 'sticky' coughs where the mucus refuses to depart: Ambroxol, which functions as a Mucolytic, i.e. it makes the mucus/phlegm thinner by causing partial breakdown of them, i.e. it fucks with phlegm composition which in turn fucks with the phlegm's rheological parameters

For 'dry' coughs, where there isn't enough mucus: Guaifenesin, which functions as an expectorant (albeit as explained below, "Secretolytic" seems like the better term by far), ramping up mucus production/bronchial secretions/hydration. (avoid confabulating with Guanfacine.)

And then of course for ticklish coughs/antitussive action, there's two other, much better solutions, but ones with it's own issues: Codeine & Dihydrocodeine. Works wonders — as long as your CYP2D6 doesn't function in an atypical manner, in which case it'll either not work at all or get you way too high.

Part of the problem is that a lot of the literature uses the word "expectorant" in the same way I used it above, but really, the more appropriate word to describe guaifenesin is "Secretolytic".

Obligatory disclaimer:

this comment isn't medical advice, I'm neither a medical professional nor a medical paraprofessional, in case of concerns, contact/consult an appropriate medical professional and/or appropriate medical paraprofessional.

I wish I knew why no combination of Guaifenesin & Ambroxol seems to exist on the market, but there probably exists SOME reason.

To any professionals reading this:

Sorry for the low quality content, I know it's very flawed

tehwebguy• 3 years ago

Incredible — DEA couldn’t harm enough people directly with their budget so they laundered the task out to CVS and Johnson & Johnson!

sfn42• 3 years ago

Welcome to the war on drugs - Ruining lives and wasting huge amounts of money for absolutely zero benefit since forever.

quickthrower23• 3 years ago

pseudopseudoephedrine?

0x500x79• 3 years ago

Another thing -- if you are ever need Sudafed (the real stuff) and they are out ask for one of the allergy medicines, the -d version. Claritin-D, Zertec-D all have the primary active ingredient as Sudafed bundled with the Allergy medicine.

dools• 3 years ago

Yeah no shit!

EDIT: in Australia you can still buy pseudo you just have to show ID. Everyone knows PE doesn’t work.

jeffparsons• 3 years ago

Yeah, it's pretty weird here. Pharmacies stock both: the placebo on the shelves, and the real one behind the counter, usually called "such-and-such ORIGINAL" or something.

So if you don't want a placebo, you have to know that the real one exists, ask for it, and then present ID so they can track how much you're buying.

I've only bought the real one a couple of times. One was to help with a long-lasting post-viral cough in advance of an important meeting. I can't for the life of me recall how I already knew about the distinction.

siliconc0w• 3 years ago

I think we need like three or four different certifications escalating in terms of difficulty to get:

0) generally recognized as safe and free of containments - it won't kill you and you get what is on the label. This should be applied and enforced through some kind of mandatory batch testing. Supplements desperately need this because you really have no idea about what you're getting.

1) Plausible Efficacy - this is 0 plus a plausible efficacy for the marketing claim. I.e there is some mechanism of action or reasonable amount of evidence this could work. Marketing would have to make this clear. Most OTC medications should be under this standard.

2) FDA proven efficacy - this is the highest standard of proof, basically the current standard. Prescription medications should be held to this standard.

maybe 3) YOLO/Emergency/Terminal illness authorization - can't be marketed, only listed in a government index and you need a DR co-sign and acknowledge that it may kill you, is unproven and the outcome is recorded for the purposes of later study.

peyton2• 3 years ago

The FDA doesn’t prove anything. They evaluate claims.

B1FF_PSUVM2• 3 years ago

I'd take "FDA proven" to be shorthand for "proven to FDA's satisfaction".

jalapenos8• 3 years ago

Or we could just dissolve it and go back to being responsible for our own outcomes.

p1mrx• 3 years ago

How can an individual without a laboratory be responsible for the contents of a pill they purchased?

soared• 3 years ago

#3 exists - drug trials occur in hospitals (research hospitals?). My only knowledge is late stage cancer where death is all but a certainty, so they can test new cancer drugs with doctor/patient/etc/drug company consent and oversight. Your ability to enter a trial is largely out of your hands though - if your case fits the conditions for a test you can ask around or your doctor may offer, but plenty of factors can rule you out.

bruce511• 3 years ago

Taking "no hope" patients into a clinical trial is something of a bad-science dillema.

On one hand you have patients either a certain death diagnosis. They'll take anything, they have nothing to lose.

From the drug trial point of view its more complex. Your death and side-effects are recorded. It's not great if half the people in a study die. What if 90% die? Adding lots of one type of patient yo one side of a study, without adding similar to the control group, invalidates the whole study.

And people who are already "hopeless" may end up masking the good outcomes for people earlier in treatment.

Currently there's no mechanism for random unproven drugs to be disseminated outside of a study, but equally its a rare study that wants to add "certain death" candidates to the roster.

If we want "hail mary" options in drug administration then we need that to exist outside of nedical studies. And formalising this would be difficult because one senses that moves in this direction would open the door to massive exploitation and profiteering by both snake-oil salesmen and big pharma.

SuperNinKenDo• 3 years ago

Nice to be vindicated. To this day people look at me like some kinda maniac when I talk about the difference in effect before and after they took pseudo out.

The only reason I know is because someone's mother hoarded pseudo tablets and had probably 30 years supply.

One year as a teenager I got such bad hayfever that my nose was literally just running constantly and I was losing 2 litres of water an hour in just watery eyes, I could barely see, my skin was inflamed, and I was having trouble breathing.

All the hayfever medicine I took was totally ineffective.

She gave me a single pill, and the effect was actually incredible. I've never seen such an enourmous effect in such a short time from any medicine except maybe morphine. In the space of 15 minutes I was almost completely back to normal. My nose not only stopped running, but became completely unclogged. My eyes stopped watering and subsequently completely lost any irritation, my skin cleared up and my breathing was completely normal.

Not only that, but after suffering like that for days, I was completely normal for the rest of the season. The drug just completely broke some kind of inflammation cycle and the hayfever never returned.

I really think that the gaslighting around this was a kind of crime perpetrated on people. Rarely has there ever been a drug that can improve quality of life so effectively. Hayfever for those who suffer it significantly is truly hell. It's not a scratchy throat or itchy eyes, it's a full body experience. Imagine having a bad flu,but it can last months, and nobody has any sympathy for you whatsoever. And then society takes away a completely effective treatment, substitutes with one that has essentially zero impact, and gaslights you incessantly that you're wrong and it works at least almost as well.

End rant I guess.

aidenn02• 3 years ago

No article touching on pseudoephedrine is complete without a link to A Simple and Convenient Syntheses of Pseudoephedrine From N-Methylamphetamine[1]

1: https://improbable.com/airchives/paperair/volume19/v19i3/Pse...

emaciatedslug• 3 years ago

I'm dead! "While N-methylamphetamine itself is a powerful decongestant, it is less desirable in a medical setting because of its severe side effects and addictive properties. Such side effects may include insomnia, agitation, irritability, dry mouth, sweating, and heart palpitations. Other side effects may include violent urges or, similarly, the urge to be successful in business or finance."

qup• 3 years ago

I will agree they're undesirable side effects, but I bet they'll get some takers.

WalterBright4• 3 years ago

the urge to be successful in business or finance.

That does appear to be frowned on today.

blindriver• 3 years ago

The thing no one will investigate is the obvious test data the pharma companies produced to show that phenylephrine supposedly worked. Any data that showed it worked was obviously fraud and yet companies made billions over 20 years from it. This is the real crime and I doubt this fraud started and ended with phenylephrine. How many other drugs are useless sold to us because no one bothered to doublecheck the data?

ern• 3 years ago

Most serious nasal congestion sufferers would have been wary of phenylephrine for some years.

I feel uncomfortable asking for pseudoephedrine by name, but I do so anyway, because my doctor told me that phenylephrine was hopeless 15 years ago.

refurb2• 3 years ago

There was no trial to prove phenylephrine was effective, thus there was no fraud.

Phenylephrine has been available for over a century. It was an unapproved drug. The FDA grandfathered it in (as it did many drugs) by just making sure it wasn't harmful.

sparrc• 3 years ago

Am I the only person who never takes oral decongestants anyways? Afrin or other nasal sprays work much better for me and have no side effects if used for just a couple days.

wslh• 3 years ago

BTW, Diego Armando Maradona [1] was suspended for doping in the 1994 FIFA World Cup because of phenylephrine which is now not considered doping.

[1] https://youtu.be/Da_CDPRG2j0

mise_en_place• 3 years ago

Can’t speak to the effectiveness of OTC decongestants but an ENT once gave me topical cocaine inside of my nostrils. That really opened me up and I could breathe for what seemed like the first time in a long time. The permanent solution is septioplasty with turbinate reduction in my case.

toasterlovin• 3 years ago

Sounds like we have similar issues (ENT also recommended septioplasty & turbinate reduction for me). Benadryl and Flonase work very well for me. Guessing you've tried those, but just in case you haven't...

zoklet-enjoyer• 3 years ago

This has been apparent to anyone who has taken both. Phenylephrine is garbage. I haven't taken a decongestant since pseudoephedrine went behind the counter.

mynameisnoone• 3 years ago

American pharmacies aren't just pharmacies, they're hypermarts. Combined with lax FDA regulations on supplements, beauty, and wellness products, totally useless crap like "wrinkle vanishing" creams, copper bands, Kino tapes, and CBD "pain relief" creams are heavily marketed to customers. Following that, it should come as no surprise that herbal remedies and marginally-useless OTC medications, tantamount to vitamin B12 shots, sell an apparent power to defy science and the appearance of agency in instances where only palliative care is possible. Emptor nimium pecuniam habet.

phyzome• 3 years ago

Wait wait hold up:

Other nonprescription drugs like guaifenesin (sold in Mucinex and Robitussin), dextromethorphan (sold in Robitussin DM), and antihistamines for a cold like chlorpheniramine likely don't help with coughs and colds.

I knew about phenylephrine, but is there specifically evidence against these other drugs?

notfed• 3 years ago

You really can't fault stores for selling a placebo if people keep buying it. The real question is why do people keep buying it?

This is a problem of knowledge, and a problem of trust. People have been generally ignorant about the ineffectiveness of phenylephrine, because most people have enough trust in their pharmacy that they would not expect the entire "decongestants" section at the store to be 100% snake oil. But our pharmacies sold us snake oil, did it for decades, and FDA backed them up on it. And we ate it up like innocent puppies.

I don't think this means capitalism is broken, and I don't think it means people are so stupid that we're doomed, and I don't think it means we need government intervention at every step.

But we shouldn't let this one slide by. We shouldn't let the pharmacies the ignorance card: they knew they were selling us a placebo. How many other products fall into this pattern? We should all think about taking a take a step back and performing a trust audit on our pharmacies.

Personally, I suspect we won't always have to keep facing this problem of never knowing which suppliers are trustworthy. I suspect there's something missing. I don't know what it is: an app, like a peer review app? A website? A law? A non-profit research group? A revolution? A man can have hope.

TomMasz• 3 years ago

Anyone who took it instead of pseudoephedrine knew this. If not for the crystal meth panic it would never have seen the market.

inemesitaffia2• 3 years ago

I figured it out myself

Two pharmacists figured out that oral phenylephrine doesn't work

Related Stories