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…
And now I am reminded of https://dx.doi.org/10.1136%2Fbmj.327.7429.1459 and the fact that there is no randomised controlled trials that show the effectiveness of parachutes either.
The Uselessness of Phenylephrine
241–250 of 613 posts
Re: The Uselessness of Phenylephrine
#242Earlier 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…
Ignoring them is unethical. Treating them with an unscientific treatment is unethical.
Look at every wastebasket diagnosis (yes, that's a real term) out there. There is no "ethical", approved treatment. In fact, there's not even an understanding of what the condition is. Instead, doctors work down a list of bad ideas with their patients: all the various medications, supplements, and even surgeries that have ever reputedly worked. Many have uncertain evidence, many more have no evidence at all. Some patients eventually hit on something that works for them. Others don't.
According to your short statement: that's unethical. Bad. Stop!
So what's the alternative? Suicide? Doing nothing is intolerable.
Re: The Uselessness of Phenylephrine
#243Earlier 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…
Note that metabolism of drugs is roughly proportional to bodyweight. A petite 100 lb person may only need 200mg for an effective dose. An obese 400 lb person may require ~4x that dosage for the equivalent effect. The one-size-fits-all drug dosing we do in this country seems crazy to me. "Research Chemical" drug users have developed techniques to calibrate doses of substances with unknown potency - start with ~100th o…
Re: The Uselessness of Phenylephrine
#244Earlier quoted context omitted.
Why not get a non-motorist ID card? Every US state has these; here's Washington's: https://www.dol.wa.gov/driverslicense/gettingidcard.html
But why get one? A passport/passport card is a _better_ ID document in almost every way. State non-motorist IDs should really cease to exist and we should increase access to passport cards
Re: The Uselessness of Phenylephrine
#245Earlier quoted context omitted.
My understanding is that acetaminophen toxicity has been a problem particularly for children, because 1) the toxic dose is lower, 2) many common OTC products for children include some amount of acetaminophen among their active ingredients and 3) parents may give their children multiple such products (one for runny nose, one for fever reduction, one for nighttime relief, etc.) over the course of a day and end up excee…
acetaminophen is often put in medications because it's toxic. It's there to dissuade people from *gasp* taking too much and possibly experiencing some positive feelings or enjoyment that offends the sensibilities of decision makers. Better that we destroy a few people's livers than that those people get a buzz. (to be clear, this last sentence is not my view. I'm mocking that view)
Edit: just to be clear, there are times when it might make sense to take oxycodone or hydrocodone alongside acetaminophen, but they should be prescribed separately and with caution. The reason they're combination drugs is because the toxicity is a "desirable" side-effect meant to discourage abuse. It's that reasoning that is evil.
Re: The Uselessness of Phenylephrine
#246I'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…
I suffer from IBS, and it's basically a diagnosis of exclusion of everything else.
> lack of consensus about how to treat some of the most common conditions in the human population (e.g. back pain)
Back pain isn't a condition, it's a symptom. And with the amount of conditions and diseases that have this symptom in their list, it's not surprising there isn't a "one-size-fits-all" remedy or cure to it.
Re: The Uselessness of Phenylephrine
#247Earlier 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…
Ignoring them is unethical. Treating them with an unscientific treatment is unethical.
Re: The Uselessness of Phenylephrine
#248Earlier quoted context omitted.
I believe this is the key element: > she gave up her license after getting an appointment at the DOL was difficult. I'm not sure what DOL is a reference to; however I now many individuals struggled to get appointments at the Secretary of State (SoS) and that is also where one (at least where I live) would need to get a non-motorist ID. Same amount of frustration / time spent to get a non-motorist ID as it would be to…
DOL ~= DMV = RMV
Maybe the most honest state is Missouri, where plates, stickers for them, and your driver's license are all handled by the state's Department of Revenue.
Re: The Uselessness of Phenylephrine
#249Earlier quoted context omitted.
From what I've read, d-amphetamine[0] was the decongestant of choice for much of the 20th century. It's just that the counterculture weirdos were abusing it and that led to its restriction. Compared to pseudoephedrine its way more useful with minimal side effects like drinking a cup of coffee. [0] https://www.theatlantic.com/health/archive/2012/04/the-lost-...
That's dangerous to think it's the same as coffee. You can have a daily coffee when pregnant but we don't know about a daily dl-amphetamine. Not even close to the same side-effect profile. Coffee doesn't dilate your eyes, for starters. It's just not the same as a dopaminergic
eg https://journals.sagepub.com/doi/10.1177/1087054719896857
Re: The Uselessness of Phenylephrine
#250Earlier 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…
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.
the "daily" recommended doses are for a single day. If you are taking it daily you need to at least halve the recommended dose. I wouldn't have said a week was a problem but... yeah. Tylenol is dangerous.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4913076/
Specifically this study referenced: https://jamanetwork.com/journals/jama/fullarticle/211014
> One study reported that ingestion of the recommended maximum amount of 4000 mg of APAP for 2 weeks resulted in the asymptomatic elevation of alanine transaminase, up to three times normal, in 40% of patients.19 These transaminase elevations did not amount to any clinical significance, and after the APAP was discontinued the transaminase levels returned to normal.19 Yet, while asymptomatic, chronically elevated aminotransferases may be of concern to healthcare providers, leading to further costly diagnostic studies or changes/restrictions in necessary medications
If anything the summary in that review is underselling it. Average was 2.78x baseline (3x is considered clinically significant) and 20% of the population was over 5x the peak (so, 20% had clinically significant elevations from the study). By peak levels, around 27% of the population saw peak levels of 8x baseline. So basically, even the "average" participant was almost to the threshold of clinical significance just from this study (at the recommended daily dose) and a cohort of around 20-25% will see clinically-significant warning signs at the recommended dosage, even among healthy patients. And risk factors significantly increase that.
That's basically a "liver stressor" enzyme, even if it's not killing the patients over the course of the study, it's not a good thing. That's your body's warning signal that it's stressed. And generally that's an uncontroversial finding I think, everyone agrees tylenol is a liver stressor, but they just have various thresholds of the acceptable risk. Would I do it daily? No.
And in med-speak, that's what they're saying here too. Use with caution, don't go above the recommended dosage in acute situations and use caution with chronic dosing. https://pubmed.ncbi.nlm.nih.gov/11847957/
Anyway, the rule of thumb I always heard is that half of the "daily" dose appears to be more appropriate for chronic daily usage. I am not a doctor and you can do whatever you want, but that is personally what I would hold to. Going less, or picking a different FDA-approved alternative like ibuprofen or aspirin, is always a perfectly acceptable choice.
That number appears to be reasonably supportable too. Instead of "half of our patients were over triple their baseline ALT level" this study found that 50% of the daily doage, chronically over 12 weeks, gets you to a 20% average increase in ALT levels. It's never not going to be a liver stressor and if you have other risk factors then you should probably stay away entirely (I think that's just good advice in general) but 20% increase in ALT after 12 weeks is a hell of a lot better than tripling your ALT in 2 weeks. But even then, during a 12-week study of 94 healthy adult patients, at half the recommended dose, they still had to withdraw one participant due to hepatotoxicity. https://pubmed.ncbi.nlm.nih.gov/25899926/
(as far as risk factors, see the first link above for a good review, aggravating factors for hepatoxicity can include things like non-alcoholic fatty liver or nutritional deficiency. Which basically describes an overweight computer-toucher with a poor diet to a tee.)