FDA proposes ending use of oral phenylephrine as OTC nasal decongestant

The restrictions on purchasing pseudeophedrine should be repealed. Their imposition led methamphetamine manufacturers to switch to a more efficient process based on different ingredients. Purity and production volume increased substantially.

A repeal won't turn back the clock on that of course, but it will make life easier for people with congestion.

https://dynomight.net/p2p-meth/

The need to show an ID to purchase real pseudoephedrine (feels like an oxymoron to write that) can be a legitimate PITA. I am American who lives abroad but is frequently back in the U.S. for family reasons. I suffer from sinus problems, so I periodically need to purchase pseudoephedrine-based products. Because I have no state ID, the show-ID-based workflow essentially fails. For whatever reason, the pharmacies won't take a U.S. passport (or foreign ID card), so they end up spending 15 minutes futzing with the data entry software, only to resign to entering garbage into the system.

And as OP points out: Phenylephrine is 100% useless.

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..

Additional context on why phenylephrine was ever approved to begin with—apparently it is effective if you use it as a spray, but apparently nobody bothered to check what happens when consumed orally, and it turns out your digestive system degrades it quickly and it doesn’t even make it into the bloodstream.

This is a perennial topic on HN, which is generally inhospitable to drug prohibition to begin with; it's possible to lay out the schematics of the counterargument:

* While there can't be any defense for the marketing of phenylephrine as a pseudoephedrine replacement, restrictions on pseudoephedrine are not irrational (that doesn't make them right, though I think they are).

* Pseudoephedrine by itself practically is methamphetamine, just in an unproductive chemical configuration. It is extraordinarily simple (though: not safe) to convert pseudoephedrine into meth.

* Pseudoephedrine is widely, practically universally available in the US without a prescription. It's a "behind the counter" drug, and, because of rampant abuse, access requires ID, like alcohol. Further, because the point of restricting pseudoephedrine is effectively a "rate limit" (to prevent people from acquiring enough Sudafed to make meth production practicable), Sudafed purchases are tracked.

* We've hashed out on HN the argument about whether that tracking results in spurious prosecutions. The one case I've seen us come up with, the arrest and prosecution of William Fousse, concerned someone who had a pseudoephedrine addiction (he was using it to come up from habitual alcohol benders).

* Restriction of pseudoephedrine does basically zero to staunch the flow of high-quality methamphetamine, which is produced at industrial scale with more sophisticated chemistry in Mexico and Asia.

* But restriction of pseudoephedrine might reduce the incidence of garage meth labs, which pose their own distinctive dangers to communities.

The argument in favor of continued pseudoephedrine restriction would be that the cost of the policy is relatively low (it inconveniences allergy sufferers, but most of those sufferers only marginally) vs. the public safety benefit (which is also probably low, but also probably nonzero).

Only thing I'd quibble with is the reason most consumers switched off of pseudoephedrine. The manufacturers knew that the inconvenience of having to go to the counter would reduce sales so they just replaced it in the aisle with an identically branded product with a different active ingredient. Most people made no affirmative choice at all; they're just buying "Sudafed", but now it's a placebo.

I’ve had two doctors and two NPs tell me to stop using sudafed. It dries out the mucus membranes and allows infections to start. If you’ve had sinus infections before, they suck and you don’t want them again. Give the Sudafed away.

(It also gives me horrible insomnia if I take it at night so it wasn’t a huge hardship).

Guaifenesin thins the mucus instead, makes it more watery so it drains down the throat with no further complications like sore throat and coughing. And the extra volume helps flush bacteria out of the sinuses.

An interesting tidbit to add, for working in the industry:

The restricted process around buying pseudoephedrine is imposed by state governments and not the federal government. A number of the states coordinate their policies, so it looks like nation-wide action but really isn't (in a legal sense).

FDA doesn't have the legal authority to put medications "behind the counter" like you would see in Europe or Canada. So untangled this is a weird mess of overlapping jurisdictions.

Good summary. To add to what you've said, Sudafed (as an example brand name) opens your eustachian tubes which are passages from your inner ear to your throat. If you think you might be getting an ear infection, Sudafed increases draining and potentially helps prevent a worse infection. As mentioned, it helps air equalize to the atmosphere via these tubes. If you make a yawning motion now and hear your ears crackle, that's the air moving through your eustachian tubes. You'll notice that crackling decrease when an ear infection may be imminent. I tried the useless alternative and discovered on my own that it was, indeed, useless. And it was quite expensive, with great marketing on the box.

In my experience phenylephrine is worse than useless. Not only does it do nothing for congestion, but it makes me feel wired in a bad way and unable to sleep for at least 24 hours. I hate phenylephrine.

I read this and was puzzled, until I realized that you are talking about the pills. The nasal spray is effective, although probably not more effective than a saline solution.

Why not just use xylometazoline (aka Otrivin) at least as a nasal (spray) decongestant — or isn't it available in the U.S?

Xylometazoline is very effective. Sure that doesn't solve the oral/body-wide absorption of a decongestant but it's a good start.

From my personal experience phenylephrine (as a nasal spray) does work but it's one step off being useless. I've occasionally had to use it as a fallback when I haven't been able to get xylometazoline (where I am xylometazoline is only available in pharmacies whereas phenylephrine is also available in supermarkets and elsewhere).

It's interesting to note that the bans and restrictions on pseudoephedrine have had large negative consequences. Not only have ordinary users missed out on a good decongestant but it seems drug cartels have largely overcome the shortage of pseudoephedrine by substituting the precursor phenylacetone (P2P). Not only that but they've even managed to separate the chiral components of the final drugs which makes them indistinguishable from medical pharmaceuticals.

Incidentally, I prefer not to use pseudoephedrine as a decongestant, whilst I receive no mental stimulation from it, it nevertheless has stimulating properties that make me feel queasy. It's why my first choice is xylometazoline. There's also the related decongestant oxymetazoline, which I've found effective but it's not as good as xylometazoline (for me at least) but it's still vastly superior to the near-useless phenylephrine.

Well, phenylephrine is ineffective when used incorrectly. You're supposed to grind the pill and snort it. Works much better ;-D

It's not the only drug treated this way. You can go to any pharmacy and see a ton of things on the shelves that are just cards you have to take to the counter, and then see what's actually behind the counter. Insulin needles, for instance, even though you can also just buy those in bulk on Amazon. I'm not sure what does and does not get tracked in a statewide database, but at minimum, regular Ephedrine, typically sold under the brand name Bronkaid, is tracked this way, because it can also be used to manufacture meth. I don't even think in this case there is an alternative formulation like there is with Sudafed and generic equivalents.

The monthly purchase limits on these tend to be ludicrously high, though. I think they're state by state, but in Texas, you can purchase up to 9 grams a month.

But think about all the jobs the government by created running that registry, prompting the drug makers to formulate and manufacture bogus decongestants and then eventually studying that those bogus decongestants were in fact bogus.

(in case it wasn't obvious, this is broken windows fallacy)

I went to the doctor recently. I usually take what I am taking so they can see it. I was taking Sudafed and had just purchased it. She took it out of my hand and told me basically all that and threw it in the trash.

Great summary. It's a classic case of government action ending up a net negative for society. Everything would've been great if they'd just minded their own business.

It is darkly amusing to me that it took the FDA well over a decade to conclude what was immediately obvious to anyone who has ever tried phenylephrine: that it is not worth taking

This reminds me when EU banned some eye drops with the product name Proculin which have been very effective. The replacement Berberil is useless, literally no effect.

Proculin made your eyes white white constricting the blood vessels for hours. All the stoners had it in their pockets.

Since it constricted blood vessels one could use it also to reduce the local inflammation on pimples, which was a neat off label usage.

yes, well, the other part of the story you would not know it maybe unless you frequent among addicts or psych wards where the practice is done indeed there is a third such nasal decongestion / meth class drug known as BENZEDREX it is a OTC decongestant .. an inhaler.. okay, fine. but what drug addicts, and in my experience for whatever reason, people with hard psych illnesses like to do is pop the inhaler open. inside is a benzedrex-laden ball of cotton which is then chewed upon for the high

FWIW phenylephrine wasn't a new drug; it was and still is used all the time in IV form to increase blood pressure in anesthesia and critical care.

But it's useless as an oral decongestant.

I swear phenylephrine works... so I'm just falling for placebo?

pseudoephedrine have serious side effects, they are rare but could be fatal

Only the second to last paragraph was necessary.

It comes full circle if you go back far enough.

Before Sudafed was common in pills, they had the small disposable inhalers where the pseudoephedrine was not in crystal form but was dissolved in vaporous liquids like menthol. Inside the inhaler there is a cotton piece soaked with the pleasant-smelling liquid. The aroma vapors are drawn right up into the sinuses along with the active ingredient.

The inhaler itself was first marketed during World War II by the well-established 19th century Vicks company, already very successful for decades with it's earlier VapoRub aromatic topical OTC formulations. People are probably aware that this is one of the companies that is older than the US FDA. Older than the Fed & income taxes too, for those who are keeping score ;)

Natural products like ephedrine have long been the inspiration for medicinal chemists to synthesize similar compounds for potential screening as new drugs, so a number of new experimental relatives such as pseudoephedrine were produced eventually.

As the name implies, people did not always know what the real difference was between ephedrine and pseudoephedrine, since both molecules have the same molecular weight, naturally because both have the same number of carbons, hydrogens, oxygen, and nitrogen content.

Only a slight difference in chemical structure between the two, which got figured out soon enough.

Some of the less-similar new drug candidates were ordinary amphetamines. They are the ones that really got popular fast, especially in wartime :\

Now when the unique inhalers were born, it was a bit of the new synthetic ingredient along with the traditional aromatic mixture that Vicks was famous for, and the Vicks Inhaler was deemed safe & effective as recommended for OTC use. People loved it. Nobody had ever had anything as effective as that.

IIRC it was 50 milligrams per inhaler soaked into a few hundred milligrams of aromatic essential oil mixture. As expected they were a lot stronger when you first started smelling one.

That's because it was 50 mg of meth-amphetamine in the Vicks inhalers.

Parents would buy them for their kids, because they were so "safe", for self medication naturally, even at times when they would not consider dosing them up with cough syrup.

There was never any FDA-approved prescription for methamphetamine in any other form, only this one OTC product.

I would think the inhalers themselves were patent encumbered until the 1960's (remind you of an Epipen?) and by the 1970's other companies like Sudafed offered their own version, only not containing meth, give me a break.

The meth version of amphetamine became recognized as a dangerous drug in the after-war years when the negative effects became apparent with soldiers who had been given it in pill form habitually as stimulants, often when facing the most serious combat.

No other company ever was able to put meth in their inhalers, but Vicks slipped in under the wire and couldn't even be stopped for decades until some time after the DEA came into being. Everybody else was using pseudoephedrine from the start. By this time crystal meth was just beginning to emerge, which people were trying to avoid when they saw what it was like, at the same time different people started seeking meth more intently. Orders of magnitude more out-of-hand now.

The way Vicks stayed under the radar the whole time with meth in it, was hiding in plain sight.

Right there on the inhaler in fine print where it always was, active ingredient desoxyephedrine 50 mg.

Simply a less-common alternative chemical name for meth, and desoxyephedrine had become a very uncommon rapidly deprecated name quite early. Way before any amphetamines were commercialized, they were instead marketed using the well-known convention based on the Alpha-MethylPHenylEThylAMINE type nomenclature.

Anyway, back in the 1970's when it was first becoming known that shady operators were cooking meth by starting with inhalers, I looked at one of them and sure enough, 50 mg meth per Vicks inhaler. Who knew?

For a while there I figured they must be starting with way over 20 inhalers and probably would not extract nearly a gram of meth but it sounded feasible. I wasn't going to be the one to do it, my first job out of college was working for a company that was a real pharmaceutical manufacturer. So I wasn't going to tell anybody either. There was already talk among law enforcement about cracking down on this kind of thing. Suspicion of inhalers was beginning to barely arise, it was thin but widespread among anybody who had heard anything about this.

Eventually I figured out that the clandestine cookers were synthesizing their meth by using the pseudoephedrine in non-Vicks inhalers as starting material for their reactions ! Well, what do you know? Was I wrong the whole time?

I "guessed" so.

With not-so-blurry 20/20 hindsight, I would estimate that before I got around to figuring this out, a clandestine chemist had come along way before I knew a thing and had started out extracting grams of meth directly from Vicks inhalers. And the meth heads loved it, found out it was coming from inhalers and the word got around among them.

Some other chemist picks up the inexact word-of-mouth and by this time Vicks inhalers are outnumbered, sharing shelf space with numerous alternative brands, all of them containing pseudoephedrine as expected, and cheaper too. If they look at Vicks, it's the odd ball out, that doesn't look like the same kind of "ephedrine" as everything else. So they figured out how to do some home made reactions starting with Sudafed. And this is what was just starting to go through the roof.

This was before the Sudafed pills really took over, once they showed up they flew off the shelf way faster than the inhalers because there were more milligrams.

One day in the '70's I was in Walgreens and there was somebody buying over a dozen Sudafed inhalers so I knew what they were up to.

I went over to the aisle and looked at the then-current Vicks Inhaler, which I hadn't checked in a while, sure enough 50 mg of desoxyephedrine, active ingredient, same as ever.

The poor Sudafed buyer wasn't the least bit aware that real meth was right there on the shelf next to it.

And I wasn't going to say a thing :)

Most doctors and pharmacists didn't even have a clue.

Within a few years Vicks stated putting in pseudoephedrine themselves instead of meth.

Until it got way too far out of hand and the pseudoephedrine became tightly controlled, much more tightly than the meth was, as can be seen.

Edit:

"And now you know the rest of the story" - Paul Harvey

PSA: Kroger and Kroger-owned supermarkets require ID to purchase any "cold medication" including those only containing phenylephrine. It's a stupid policy.

Buy your cold medication at Walgreens. Good luck finding a non-Kroger grocer.

> Their preliminary review of studies suggested that it is probably, in fact, useless. This proceeding is now proposing to ban it on the grounds that it's ineffective

Is ineffectiveness really a good reason to ban a substance? Why not just ban labeling it as a medicine instead?

No worries, "Meth" was largely unknown in my area, until you guys exported "Breaking Bad". Roughly a year or two later, it started to be available here as well. Thanks for that, media industry, that was a wonderful move! /s

I found out recently that you don't just need a decent government ID; it needs to be from the state you're purchasing the Sudafed from, because apparently each state administers its own database. If you run out and have a persistent cough (weakened immune system from not licking doorknobs the last few years of covid, or so do the doctor says) from a common cold while on vacation, you're shit out of luck unless you go back home or you and an accomplice are willing to procure your cough medicine with their license.

Pseudoephedrine being pulled from the shelves is one of the biggest crimes of our time.

Pseudoephedrine should be easy and plentiful to obtain. I don't care if people use it to make meth. What they do in their private time doesn't concern me. Not being able to get Sudafed when I'm sick kills me. It's not like those people won't be able to get meth some other way.

We let people buy cars and cause 43,000 automobile deaths a year. People should be able to live life without stuffy noses. Maybe license people to buy meds and take it away if they abuse it? That's better than the draconian system we have now.

And don't get me started on ADHD medication and their shortages.

Edit: and there are 178,000 alcohol related deaths per year in the US. If you're going to allow that without prohibition, then please let us unstuff our noses.

I'm tired of living in a nanny state when we let people buy and own guns and swords and flamethrowers. Simply hiking on a mountain can kill you. Must we install guardrails on all the high places?

It's not that bad of a negative externality. Honestly. Not relative to all the other ones we've deemed acceptable. This is weird picking and choosing that doesn't make sense.

Fun fact, there (was?) is a isomer of methamphetamine that is actually over the counter, levomethamphetamine was often found in Vicks brand inhalers, though they appear to be discontinued, being replaced with a ‘non-medicated’ version. There are apparently generic inhalers that still do contain it though.

https://www.science.org/content/blog-post/other-methamphetam...

"simple and convenient" does a lot of heavy lifting in this paper - n-BuLi, chromium hexacarbonyl and MoOPH (had to look that one up!) is not something you find outside of a well equipped lab and shouldn't be touched by anyone who isn't highly experienced.

How did I miss this article before?!? Love it!

> Other side effects may include violent urges or, similarly, the urge to be successful in business or finance. ... > We expect that the simultaneous trends of restricting pseudoephedrine sales while N-methylamphetamine becomes less expensive and of higher purity will make the methods presented here increasingly attractive.

The problem I found was that nobody wanted to deal with the database after a certain time in the evening. Odds are good you don’t admit you’re coming down with something until after work. Or at least admit to yourself that medicine would be helpful. So by the time you see you’re out of Sudafed or can’t find the old pack, it’s often too late to go to the store to get a new one before morning.

That's actually hilarious.

I remember when the law first went into place. I bought some meds and the next day was back at the store because the new stuff didn’t work. For me it was even more obvious because pseudoephedrine works so well for me.

PE = Placebo Effect

My grocery store pharmacy has homeopathic stuff next to the Sudafed too. Is literally a placebo.

At least the Sudafed has acetaminophen in it ...

How can you believe you've been taking a placebo for years? Phenylephrine is used for the illicit synthesis of methamphetamine, so there's an inherent bias towards anything that gets it off the shelves. Cherry picking studies that say it's ineffective is more velvet glove than using only the iron fist to ban the stuff. But make no mistake that the iron fist is taking your meds away either way.

> Do be aware of the need to use sterilized water to avoid a possible dangerous infection, though. Distilled water is the easiest way.

It must be noted that the infection is incredibly rare and requires multiple conditions (like dysfunction of the immune system, unsafe tap water...)

- https://en.wikipedia.org/wiki/Naegleria_fowleri#Pathogenicit...

- https://charlotte.floridahealth.gov/newsroom/2023/03/DOHChar...

For example here in France tap water is disinfected with chlorine and hot water must be heated to at least 50°C which is enough to kill the microorganism.

On the other hand, depending how the distilled water is sourced (container bought in a supermarket...) & used (opened/closed daily...), it can actually create a much riskier source of infection.

I tried this once when I was a teenager. As far as I remember, I took the precautions of sterilized water, getting the right salt, etc.

Guess I didn’t know how to properly use it, since I gave myself an awful sinus infection and was bedridden for next two weeks. To this day it’s the worst I’ve ever felt. Never touching a neti pot since then :/

It works wonders on me and family members. Except we just always go for the Neil Med bottles from Costco or Target. They are also easy to disinfect in the microwave.

Always distilled water, though. It’s not worth waiting to boil the water, let it cool down, and then manage the dish used after. It’s also easy to get just the right temperature using distilled water in the microwave.

I would strongly advise against broadly recommending this across the board, because while rinsing your sinuses can help with some infections, it can make the situation considerably worse if you're working with e.g. inflammation instead. For a lot of people the difference isn't easy to tell and they end up making their own situation worse. As always, ask a medical professional, even your pharmacist can tell you what to do or not to do once you describe the symptoms.

Total anecdata, but when I was college age I would get bronchitis about annually that usually started from something that would have at least 1 nostril completely blocked for a week or so. I read about neti pots, bought a pharmacy "sinus rinse" and started using it daily.

I'm 58 now and I haven't had bronchitis like I used to since.

My theory is that it not only washes out stuff that might lead to infection, but also keeps your membranes from drying out and cracking, opening a vector for them.

If you're worried about the possible infection or don't want to mix it yourself, check out Arm & Hammer Simply Saline. It can be used like a neti pot for sinus rinse.

In the US everywhere has it, but it’s behind the counter and you have to show ID so they can track how much buy. It’s ridiculous, but it’s not hard to get, and has never stopped an illegal drug chemist from making crystal meth, but regular folks pay the price in inconvenience

Interesting. I was just in the UK (Scotland), and picked up a cold on the plane. I was unable to locate any pseudoephedrine.

My search was far from comprehensive, so it might merely have required looking harder. But I gave up early, on the assumption that the UK was similarly restrictive to the US.

I was denied this the last time I tried to buy it and the pharmacist couldn't even tell me why aside from "the system won't let me". I went to a different chain a half mile away and walked out with a month's supply of the stuff. Hilariously incompetently-designed regulation.

Meanwhile meth making is more efficient, cheaper, and delivers purer-grade glass than ever.

Most worthless law. Now i have to wait in line for 10 minutes to get it and yet meth is still widely available and usage actually increased. Did nothing except shift manufacturing to outside of the US.

Unfortunately there is an absurdly low limit on purchasing amount in the US.

In addition, I can't seem to find the 24 hour versions anywhere right now. I could probably buy meth more conveniently. :(

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

Or just straight ephedrine, which is also behind the counter at your local pharmacist (brand name Bronkaid).

Cough medicine in the UK is sugar + paracetamol.

My wife's a pharmacists so always laughs at it (and the decongestants) when we visit the UK.

>I can't take pseudoephedrine due to high blood pressure

I really miss being able to take pseudoephedrine. I mentioned to my doctor that it seemed to affect my blood pressure and he looked scandalized and told me I should never take it again. Apparently someone should have told me when I was diagnosed with high blood pressure. The only real information I got was a handout for a DASH diet.

There was some article about it on HN a while ago. If I remember right the problem was that its bioavailability is super low. You can take all you want, but only a tiny percent makes it through to get absorbed. In theory you could increase the the dose a lot but I imagine that might have other issues.

Half the products in chemist warehouse are pretty blatant scams. It's insane how effective, important pharmaceuticals are sold side by side with products known to be ineffective and that exist purely to strip uneducated customers of their money.

Also the stores that stock it, honestly

No you won’t! It’s just the oral formulations that are being taken off the shelves. The inhaled version does indeed work and will still be available.

It's only the oral version which has no effect and is thus being pulled. The inhaled version has more evidence that it works and will remain available.

Ambroxol is not a decongestant, it's an expectorant. If you take Ambroxol expecting to clear your sinus pressure like pseudoephedrine, you're going to be disappointed.

I've used it. I thought it was going to be better than guaifenesin (equivalent available in the US). In my experience, it was not.

That entire blog post appears to be based on a second-hand report from someone who went on vacation in France and was told something by the person at the pharmacist selling them Ambroxol. I don't understand why rationalist bloggers are so keen to rely on anecdotes and hearsay when it supports a point they're trying to make.

> Maybe a shorter duration(<5yrs) patent(for lack of better word) for unapproved generics might do the trick.

There already is something similar - the NDA exclusivity period. You get 3-5 years where the FDA won't approve any other versions of the product.

https://www.tandfonline.com/doi/pdf/10.4155/ppa.14.30

But ambroxol isn't a decongestant - it supposed to help with phlegm.

You're almost certainly experiencing the placebo effect. There's mountains of evidence phenylephrine does exactly nothing.

A faculty member clued me in when I worked for a college of pharmacy 20 years ago! FDA should be embarrassed. This shouldn't even have been hard. How many drugs have been p-hacked into efficacy and would need expensive trials to disprove? Oral PE is metabolized too quickly make it to the bloodstream and can't be more than a placebo.

Dextromethorphan (DM or DXM) is the OTC cough suppressant. Marketed as Delsym comes in an orange box, or you can find it in various combo formulations, and it works

Dextromethorphan is the only otc cough medicine that works and pretty much the only prescription stuff that works is opiate based. Of course both are regulated.

I had a student once from Sofia (capital and largest city of Bulgaria), she told me her mother mailed her all sort of antibiotics because they were not available here (western Europe) and "what if she'd catch a cold or the flu?" (Both are viruses so antibiotics don't even do anything other than kill the useful bacteria in your body!)

I don't think it's done any damage, it's just not effective.

It was on the market more like fifty years.

No you're believing in conspiracies.

It would require the whole scientist communities and the sanctioning organisations to work together in order to validate a drug that is basically infective. Because you see before a drug is out on the market there are a lot of testing on animals, then humans and they have control group to measure how effective (or not) it is.

Things like that CANT happen.

Obviously I'm being sarcastic, that's the usual argument: you can't possibly have all scientist and federal organisation work together on malicious drugs.

The truth is that it happens, see that drug or the oxycontin. It just requires some shity people and the rest of scientist community to not care.

Some of us were suspicious all along. Especially of Pfizer.

But such suspicions became socially dangerous right around the time that Pfizer stood to make multiple billions selling a novel treatment for a recent pandemic.

(Pfizer testing drugs on Nigerian children) https://pmc.ncbi.nlm.nih.gov/articles/PMC1471980/

(Pfizer pleads guilty to criminal charges over Neurontin) https://pmc.ncbi.nlm.nih.gov/articles/PMC416587/

Time to hand rifles to everyone (including felons) and ban the State.

The better thing is the original: psuedoephedrine. It was never impossible to buy, it just required going to the pharmacy counter and showing ID. I knew about this when it happened in the 2000's because my dad needed Sudafed often, but the changeover was almost certainly invisible to most people given that the packaging is essentially identical between the two versions of the product.

Make sure you’re using sterile water for this. https://en.wikipedia.org/wiki/Naegleria_fowleri?wprov=sfti1

The saline wash is also known as a Neti pot here.

It's 0.9% by mass. You can buy it easily in large bottles so you don't need to learn to disinfect and filter your water correctly.

As mentioned in a sibling, try looking at Mucinex a try. There is a 12h version that has Guaifenesin https://en.wikipedia.org/wiki/Guaifenesin and Dextromethorphan https://en.wikipedia.org/wiki/Dextromethorphan as the only two active ingredients.

Compare with Dayquil - Acetaminophen 650 mg (pain reliever/fever reducer), Dextromethorphan HBr 20 mg (cough suppressant) and Phenylephrine HCI 10 mg (nasal decongestant).

> Guaifenesin, also known as glyceryl guaiacolate, is an expectorant medication taken by mouth and marketed as an aid to eliminate sputum from the respiratory tract.

> ...

> Guaifenesin is used to try to help with coughing up thick mucus, and is sometimes combined with the antitussive (cough suppressant) dextromethorphan, such as in Mucinex DM or Robitussin DM.

---

> Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines.

> ...

> The primary use of dextromethorphan is as a cough suppressant, for the temporary relief of cough caused by minor throat and bronchial irritation (such as commonly accompanies the flu and common cold), or from inhaled particle irritants, as well as chronic cough at a higher dosage.

---

The combination of the two is designed to reduce coughing and when you do cough, it is much more productive with the expectorant and cough suppression. It isn't a decongestant, but it has (personal anecdotal take) a good effect on getting rid of the secondary effects of congestion.

It's probably the guaifenesin (Mucinex) that you're feeling.

I swear I read a report somewhere that said something like PE is effective iff you take twice the dose on the box or you take it with other drugs (I think ibuprofen was tested?), although I can't find it again, and I may have read it when I was congested and only had PE.

My lived experince with PE is it never works most of the time. But if I realise I need psuedoephedrine and I'm not somewhere or sometime where I can access it, I'll get PE and hope. Sometimes hope works, but it usually doesn't clear my sinuses very effectively. But if I have sinus congestion related to flying, I might also have soreness related to flying and take PE (because you can get it at the airport) and ibuprofen together, and maybe it works.

But also some people are more sensitive to some drugs, so it could work for you, while not being very effective in general.

Might be the other ingredients reducing inflammation, widening your clogged pipes and letting stuff drain.

Phenylephrine doesn't work though. It never did. It was "pushed" as an alternative to pseudoephedrine which can be used to synthesize meth, but afaik every single study done on this shows that phenylephrine does absolutely nothing, it's a placebo drug. The faster it's phased out the better.

People bought sudafed / they earned a lot of money from it, and they wanted to continue to earn money off of it. That's basically it. But they will point the blame at legislation I'm sure, both for making the effective stuff more difficult to get, and for being OK with the ineffective stuff being sold.

It’s not just allergies - taken orally there is no evidence it works for anything, and there’s pretty good evidence it is basically metabolised away.

The frustration largely comes from pharmacists and pharmaceutical companies selling decongestant remedies that do nothing and are known to do nothing.

What country are you in? In the US, pseudoephedrine has to be requested at the pharmacy counter, but it's not a compounded medication. Instead it's sold as pills in the usual "blister pack" format.

There's a limit to how much you can buy per day, per 30 days, and per year.

My local pharmacies keep it behind the counter, but the counter has shorter hours than the rest of the store. And you've got to submit your license to be entered into their system (and who knows what happens with that data).

In Belgium it's no longer available without prescription since this month. Reasoning is that it can trigger cardiac issues, neurological issues, and even psychiatric issues in some people.

You need a drivers license though. And they enter something into the computer.

Which is actually supported and documented here: https://pubmed.ncbi.nlm.nih.gov/26097788/

Lots of versions of Alka Seltzer use aspirin instead of acetaminophen, and aspirin in combination with phenylephrine is documented to reduce congestion more than either alone.

Note - avoid the cold & flu versions (the ones with orange bottoms) and the day & night versions (orange and green bottoms), because they're not aspirin, they're acetaminophen. The traditional blue bottom "Alka Seltzer Severe Cold" is the one with aspirin and phenylephrine.

You mean caused by the war on drugs.

I blame Progressivism™ and the expansion of the role of government. Laissez Faire is the ideal policy for a force-monopolist to perform by. It is better to have a weak government precisely because it's way easier to fell a badge-less gangster than a badged one.

> whats wild is this was a solution to a problem that was directly caused by neoliberal capitalism.

Did you pull a muscle stretching that argument into place?

People like meth. People in capitalist countries and non-capitalist countries alike.

It was in fact a hamfisted government regulation that drove this.

Neoliberals believe in free market and deregulation, not market restrictions.

Nixon was the one that started the war on drugs and also enacted price controls. I would not call him a neoliberal. He also primarily interested in foreign policy and not the economy.

Also, Sudafed was only banned from being purchased easily in 2006. The bill was introduced by a random congressman from Indiana, a congressman was also easily offended by an offensive joke written on someone’s else cake.

And it's much more profitable to scrape every ounce of working life out of the poor, then use them as slave labor in a prison once their addictions get them into a critical situation or farm them out to a rehabilitation facility that pays councilors 20 bucks an hour and gets a large chunk of it's funding from taxpayer subsidies. If there's any issue, blame the overworked poor for turning to drugs, then sell them energy drinks.

Merged hither. Thanks!

I’ve hearing great things about this new drug called placebo. You can apparently prescribe it for anything and in many cases it’s just as good as existing medications.

Next up, eliminating the work of the Fiendish Fluoridators

For the record, with regard to treatment, ivermectin was understood to benefit anyone who had a co-occurring worm infection (targeted by ivermectin) while also having Covid. This just rules out most people in the US as they typically don't have the corresponding worm infections. I myself tried two brands of ivermectin while having Covid, with no luck.

Are you suggesting I can get pseudophedrine via veternary suppliers instead of at a pharmacy counter?

This conversation is confusing without the FDA isn’t everything allowed by default and you get far worse like the current supplement industry?

Easy: Foam of any type and any chemistry in CPAP or ventilators of any type. Also, "soclean" and any other ozone 'cleaners'

Well? What else indeed? Is this the exception or the rule?

I bet you think people should trust you even though I also bet you were wrong about something once.

Companies lie to the public and sell products that contain a useless drug that does nothing, the FDA wants the products with the useless drug removed because the companies selling them are just ripping people off, and your conclusion is that the FDA is the problem?

It makes me wonder if it has anything to do with Trump winning the election.

> What else is the FDA wrong about

Too much. For one, numerous harmful additives are freely allowed. These additives may not cause immediate damage, but over the long term they really inflame the gut. They serve no good purpose in the medicines. Examples include: propylene glycol, sodium lauryl sulfate, titanium dioxide, talc, ammonium hydroxide, monoethanolamine, n-butyl alcohol.

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