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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#261

Post by paulmd »

astrange wrote: post #238
paulmd wrote: post #215

Earlier quoted context omitted.

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…

No, I am not. It's a dune reference.

Ulcers ("destroying your stomach lining") is less bad than "destroying your liver", and typically you will have to screw up harder before other NSAIDs reach that level. Tylenol literally is dangerous following the directions on the bottle, because those directions aren't calibrated for chronic usage, when they say "daily max" they don't mean you take it daily, that dose is even lower.

Re: The Uselessness of Phenylephrine

#262

Post by cwkoss »

scythe wrote: post #237
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 recreat…

Ah, yeah the social aspect probably can't be replaced by pseudoephedrine.

However, meth can be functional enough that I would guess it's used for wakefulness/focus among a significant proportion of users (especially in early stages of addiction): truckers using it to drive longer, students using it to study, graveyard shift workers using it to stay alert while operating dangerous equipment, etc. These use cases seem like they could potentially substitute pseudoephedrine, and in doing so, could function as an "anti-gateway-drug": users who solve their use case without the euphoria are less likely to get addicted or transition into social usage.

Re: The Uselessness of Phenylephrine

#263

Post by astrange »

A4ET8a8uTh0 wrote: post #64
baggy_trough wrote: post #28

Earlier quoted context omitted.

Very difficult. Regulations live on regardless of their negative effects because there's very little incentive to get rid of them.

Worse, there is an incentive to keep them going as there are entire industries and associated careers built around them.

That's actually evidence they're good, since nobody's built a country with so many successful industries and no regulation. They wouldn't be able to solve the coordination problems.

Re: The Uselessness of Phenylephrine

#264

Post by pwned1 »

hilbert42 wrote: post #235

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…

Pseudoephedrine isn't banned, you just have to ask the pharmacist for it.

Re: The Uselessness of Phenylephrine

#265

Post by FireBeyond »

m-p-3 wrote: post #246
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…

> official sounding diagnoses that on inspection are actually defined as "we have no idea" 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, i…

Before my gout became more obviously gout (I had elevated uric acid, but there was often little to no crystallization), one of my diagnoses was "seronegative arthritis" - "It looks like you have arthritis, but you have neither RF or CCP in your blood, so... huh."

Re: The Uselessness of Phenylephrine

#266

Post by astrange »

AaronM wrote: post #8

If you get the chance, go read all of his (Derek Lowe) blog posts about things he refuses to work with. Highly entertaining read.

The problem with this advice (which gets posted to all of his articles) is those posts aren't meant to all be read at once. They're basically all the same thing, which is why he hasn't written any new ones recently.

I still want to know what isocyanide smells like.

Re: The Uselessness of Phenylephrine

#267

Post by seszett »

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…

Not sure I understand what you're saying about blister packaging? Are there drugs that don't come in blister packaging in the US?

Here all I can think about are the paracetamol/acetaminophen effervescent tablets that come in tubes of 8 x 1g (or 16 x 500mg).

Re: The Uselessness of Phenylephrine

#268

Post by skyechurch »

freedomben wrote: post #225
thedailymail wrote: post #207

Earlier 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)

This also is silly, illegal drug users constantly take their dosages mixed with much worse things than Tylenol with no noticeable dissuasion effect that I am aware of. Acetaminophen is mixed with oxycodone etc bc it increases the pain relieving effect of the opiate drug (which for many people (e.g. me), are of limited effectiveness relative to the side effects/"buzz"), and because, unlike NSAIDs, it doesn't thin your blood so it can be taken after surgeries.

Having chronic pain sucks, having something that you can take for it, especially something boring like Tylenol that can't be snatched away from you by doctors/police/etc, is a huge quality of life issue.

Re: The Uselessness of Phenylephrine

#269

Post by vidanay »

bcrescimanno wrote: post #98
hammock wrote: post #57

Earlier quoted context omitted.

NyQuil is a combination medicine. The cough, cold and flu formula contains Tylenol (fever/pain reliever), DXM (stops cough) and an antihistamine (dries out your runny nose/postnasal drip). NyQuil can be a great all-in-one product when it's what you need. It's useful to know what it is composed of and why. All of the medicines in it treat symptoms, not the underlying cause, which will be fought off by your immune syst…

Prior to the regulation of pseudoephedrine, NyQuil also contained pseudoephedrine and since the nasal congestion from a a virus can often be the most disruptive factor for sleep (at least, in my personal experience, that's the case) it's considered by some to the be most important component. NyQuil with pseudoephedrine included is now marketed as "NyQuil D" and is available behind many pharmacy counters with the same…

We haven't been able to find NyQuil D for almost a year here in Illinois

Re: The Uselessness of Phenylephrine

#270

Post by rscho »

perlgeek wrote: post #178
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…

My impression of the medical system (both here in Germany, and through reports from the US) is that it's very much like everything else: much is crap, much is mediocre, some good, and a very small, excellent sliver. This goes for doctors, drugs, surgeries, devices. If you want good results, you really have to take matters into your own hands, search for possible treatments yourself, evaluate several doctors until you…

Robot?
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