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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#231

Post by genewitch »

throwawayboise wrote: post #62
EamonnMR wrote: post #21

Sometimes I wonder if NSAIDs are the same deal, or if there's just a subset of people they don't work well on.

Tylenol (acetaminophen) does nothing for me. Advil (ibuprofen) does usually work. I used to get more headaches when I was younger, but I rarely get them now. Two things that have changed that might be related: I no longer use CRT screens, and I no longer drink diet soda (used to drink 4-6 cans a day, most days). Aside from headaches, Advil does better on other aches and pains than Tylenol, which does almost nothing.…

better for the liver, worse for the stomach. It's a sliding scale, you have to decide how much you care about whatever hurts not hurting anymore versus damage to organs you can't even see.

Also i used to get wicked headaches from diet soda when i was younger, too. Is it possible to be "slightly" Phenylketonuric? I had to google the spelling, and it's interesting that "hyperactivity and behavioral issues" is listed as one of the symptoms. I doubt "slightly" is possible, that was tongue-in-cheek.

Also as an aside, for pain that the standard dose of ibuprofen doesn't seem to help, emergency medicine studies have found that an additional standard dose of acetaminophen alongside the ibuprofen has greater pain reduction efficacy than vicodin.

Re: The Uselessness of Phenylephrine

#232

Post by emerged »

genghisjahn wrote: post #182
caymanjim wrote: post #162

Earlier quoted context omitted.

> OTC medicines that by current standards would not be made OTC Acetaminophen would almost certainly be in this category, if it could even get FDA approval at all. The effective dose is dangerously close to a toxic dose that causes liver damage, and not comfortably-far from the LD50. The only reasons acetaminophen is OTC is that it's been informally grandfathered in, makes an absolute fortune for pharmaceutical compa…

How is this "dangerously close to toxic"? Extra strength is 500mg. Adults should not take more than 3000mg in a day. Taking 7000 more more can lead to liver problems. https://medlineplus.gov/ency/article/002598.htm Common dosage forms and strengths: Suppository: 120 mg, 125 mg, 325 mg, 650 mg Chewable tablets: 80 mg Junior tablets: 160 mg Regular strength: 325 mg Extra strength: 500 mg Liquid: 160 mg/teaspoon (5 mill…

Well I was in the ER 2 days ago and my liver enzymes were bad. I don’t drink, he said it was the acetaminophen I’ve been taking. I had been taking significantly less than the recommended amount for less than a week.

Re: The Uselessness of Phenylephrine

#233

Post by svnt »

ianai wrote: post #190
nostromo wrote: post #115

Earlier quoted context omitted.

American law is so disjointed. On one hand, we're decriminalizing drugs. Pot is widely legal now. Other states are allowing mushrooms and LSD. Cocaine and heroin are not legal, but have all but been decriminalized on the West Coast. Meanwhile it's harder than ever to get pain killers from your doctor, even when you have a demonstrated need for them. Same with ephedrine -- a very useful drug -- it's very difficult to…

“Cocaine and heroin are not legal, but have all but been decriminalized on the West Coast.” Citation needed. Never heard this before now. Or is this just some California thing?

In several cities they are now citations. You may get a fine for possession but you will not be arrested. In Portland for example the ticket is around $150, which is about the same as the fee for an expired vehicle registration. This change in policies has basically stopped enforcement. As you can imagine it is not a profitable practice to ticket the unhoused.

Re: The Uselessness of Phenylephrine

#234

Post by sniperjoe360 »

klodolph wrote: post #219
sniperjoe360 wrote: post #193

Earlier quoted context omitted.

Although perhaps true about FDA clearance, I wouldn't be alarmist and characterize the effective dose as "dangerously" close to the LD50. The highest dose that therapeutically is used is about 1000mg per dose. The fatal dose is about 15 times that amount. To put it into perspective, a patient would have to be willfully taking 45 tylenol (325mg/pill) all at once to cause lethal liver damage. Doses like that are usuall…

Not accidental, but very tragic. It's the #1 cause for calls to poison control, and accounts for 26,000 hospitalizations every year, and 500 deaths. Dying from an acetaminophen overdose is not a good way to go out, you spend a couple days in the hospital suffering as your organs fail and your loved ones watch. Other OTC drugs are much safer. I don't allow acetaminophen in the house. Pseoudoephedrine? Yes. Acetaminoph…

Yes, agree with everything factual you said. I guess the problem isn't the compound itself but rather not enough information regarding its use.

I personally keep tylenol in the house because it's probably the best non-narcotic non-NSAID pain medicine.

We use it all the time in patients who are elderly with decreased renal function because they don't do well with opiates or NSAIDs (ibuprofen)

Re: The Uselessness of Phenylephrine

#235

Post by hilbert42 »

Derek Lowe makes a good point that we're wasting everyone's time and money with useless phenylephrine and the fact that pseudoephedrine is so much better as a decongestant.

The fact is that pseudoephedrine is not only banned in the US but it is also banned in many other counties for the same reason that it's a precursor for meth.

The trouble is that banning pseudoephedrine seems to have only made matters considerably worse as I learned from this HN story a few months back: https://news.ycombinator.com/item?id=29027284

Banning pseudoephedrine has led drug cartels to ramp up production of the precursor P2P, phenylacetone, which, it seems, is a better precursor anyway. It's worth reading this story in conjunction with this one. As Lowe hints, given the circumstances, we'd be better off going back to a decongestant that actually works.

Quote from the earlier HN story:

"Meth in the US shifted to P2P synthesis between 2009 and 2012.

In the before times, meth was made with ephedrine or pseudoephedrine. However, in 2006, the US banned over-the-counter sales of pseudoephedrine, and in 2008 Mexico banned almost all sales. In response to this, meth makers switched to a synthesis based on P2P, which can be made from many different, widely available, source chemicals."

Re: The Uselessness of Phenylephrine

#236

Post by edmundsauto »

paulmd wrote: post #186
caymanjim wrote: post #162

Earlier quoted context omitted.

> OTC medicines that by current standards would not be made OTC Acetaminophen would almost certainly be in this category, if it could even get FDA approval at all. The effective dose is dangerously close to a toxic dose that causes liver damage, and not comfortably-far from the LD50. The only reasons acetaminophen is OTC is that it's been informally grandfathered in, makes an absolute fortune for pharmaceutical compa…

> doesn't get you high. this is the big one. Phenyl-epinephrine doesn't work at all, it's consistently failed to outperform placebo, and the only reason it's on the market is because the FDA doesn't like pseudo-ephedrine (sudafed) because it can be used as a precursor for meth. Same reason they've required individual blister packs for sudafed (if only there was some illicit drug which gave you the focus and drive to…

What makes you say the FDA is actively adding poison to other drugs, are there first hand sources from them? This sounds like it could also be a case where they want to lower opiate consumption, and so adding some Tylenol increases pain relief without increasing opiate intake.

I am not sure that’s wise policy, but if you don’t think Tylenol is all that bad (again, I’m not sufficiently informed to say this, but the FDA obviously thinks it’s safe), then it’s not a bad overall policy.

It sounds like it could be either situation, I’m just looking for more evidence before making up my mind. (Yes, I am aware the US government poisoned people during prohibition in this exact manner, but I dispute that has any relevance as the decision makers and cultural awareness is very different now. We’ve come a long way since the 30s)

Re: The Uselessness of Phenylephrine

#237

Post by scythe »

cwkoss wrote: post #206

I had a friend who would keep pseudoephedrine in his glovebox to be used for alertness in case he became drowsy driving. He was a chem nerd, so was not particularly remarkable to me. I have to wonder if the restrictions on pseudoephedrine have driven anyone to purchase meth. The safety profile of pseudoephedrine is pretty good - I think it could be argued its a good legal stimulant to offer to the public. Could incre…

Doubtful. Caffeine is already a legal recreational stimulant. What distinguishes methamphetamine/cocaine is that they are, for want of a better word, prosocial. People don't just do meth, they seek out other people who are also doing meth. Pseudo will not fill that niche.

There may be other "safe(r)" substitutes, such as HDMP-28 or amfonelic acid or something, but they have to reproduce the social function of recreational stimulants to culturally substitute.

Re: The Uselessness of Phenylephrine

#238

Post by astrange »

paulmd wrote: post #215
genghisjahn wrote: post #182

Earlier quoted context omitted.

How is this "dangerously close to toxic"? Extra strength is 500mg. Adults should not take more than 3000mg in a day. Taking 7000 more more can lead to liver problems. https://medlineplus.gov/ency/article/002598.htm Common dosage forms and strengths: Suppository: 120 mg, 125 mg, 325 mg, 650 mg Chewable tablets: 80 mg Junior tablets: 160 mg Regular strength: 325 mg Extra strength: 500 mg Liquid: 160 mg/teaspoon (5 mill…

5:1 ratio (a dose is "take two 325mg") between therapeutic and danger doses is really low as far as modern drugs would be concerned. Most drugs are more in the 50:1 or 100:1 range, drugs with a 5:1 ratio typically would not be approved and certainly would require very close supervision. Tylenol being OTC is complete insanity (or rather, regulatory capture and general public comfort with it). Also note that those dosa…

Are you actually an MD?

I actually only ever hear about acetaminophen/paracetamol being dangerous from Americans - in other Anglo countries everyone will happily suggest you take it all the time, it is available OTC, and it comes as something kids will mistake for lemonade.

https://www.amazon.co.uk/Lemsip-Cold-Blackcurrant-Flavour-Sa...

> Ibuprofen and Aspirin are not perfect but they are much, much, much safer than tylenol is.

Only short term. Ibuprofen is less safe taken chronically, it'll destroy your stomach lining.

Re: The Uselessness of Phenylephrine

#239

Post by twofornone »

jl6 wrote: post #209
travisathougies wrote: post #159

Earlier quoted context omitted.

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. In reality, there are a plethora of conditions, some…

I feel proponents of evidence based medicine are perfectly aware of the enormity of the problem, and are working hard to improve the situation.

But the point is that laymen are not, and they put too much faith, on average, into our medical institutions.

Our understanding of the human body has advanced enormously with the advent of modern science, but it is still far less complete than most people probably realize when they interact with doctors. Not to mention systemic issues (common to any technical discipline) where medical professionals have to effectively practice with a degree of faith because no one has time to actually review the literature underpinning any given consensus, and that occasionally breeds long lived orthodoxies which do more harm than good...

Re: The Uselessness of Phenylephrine

#240

Post by tayo42 »

travisathougies wrote: post #159
dataangel wrote: post #146

I've recently had to deal with the medical profession a lot more than in the past and I'm finding this sort of thing everywhere. OTC medicines that by current standards would not be made OTC, surgeries that are extremely common but have never had quality randomized trials, official sounding diagnoses that on inspection are actually defined as "we have no idea", lack of consensus about how to treat some of the most co…

You seem to be under the impression that there is some 'advanced technology' out there that will magically solve your problems that the US fails to have. In my experience, many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle. This belief is typically held without any evidence whatsoever. In reality, there are a plethora of conditions, some…

> many people have a quasi-religious belief in the capability of modern medicine to perform what would otherwise be called a miracle.

That's probably because miracles are being pulled off on ocassion

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