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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#281

Post by cortesoft »

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…

> For the average healthy adult, the generally recommended maximum daily dose is no more than 4,000 milligrams (mg) from all sources. But in some people, doses close to the 4,000 mg daily limit for adults could still be toxic to the liver.

https://www.health.harvard.edu/pain/acetaminophen-safety-be-...

4,000 mgs is easy to hit for people who don't realize that it can be dangerous. I know lots of people who would say "Well, my pain is bad, let me take double"... which for extra strength would be 4 x 500 MG, which is 2000 MGs in a single dose... which then if you do it twice in a day is right there at the 4000 MG mark. Most people are fine with that, but some people can get really sick.

If the person then does it 3 times a day, they are close to the danger zone for most people and over the danger zone for some people. Then multiply that by a few days....

You can easily say, "Well, they are taking more than they are supposed to!", but it is really common to take a bit extra if you feel really bad without realizing how dangerous it is, because Tylenol is `safe`

Re: The Uselessness of Phenylephrine

#282

Post by 60secz »

The herb ephedra (Ma Huang/Mormon Tea) contains appreciable amounts of ephedrine and is prepared as a tea in Chinese medicine as a remedy for asthma and cold congestion.

It can easily be purchased online and the ephedrine ban does not apply to it.

https://melmagazine.com/en-us/story/mormon-tea-ephedra-plant...

Re: The Uselessness of Phenylephrine

#283

Post by lowbloodsugar »

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…

In the US medicine is a business. Their job is not to make you better. Their job is to get as much money as possible out of you.

Re: The Uselessness of Phenylephrine

#284

Post by zerocrates »

seszett wrote: post #267
paulmd wrote: post #186

Earlier quoted context omitted.

> 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).

There are drugs that come just in bottles: the typical OTC pain relievers (acetaminophen/paracetamol, ibuprofen, etc.) are all offered this way and you can easily buy bottles containing hundreds of pills. And of course there are others.

Prescription drugs are pretty routinely dispensed in just pill bottles also, though I'm sure there are some for which this isn't allowed.

Re: The Uselessness of Phenylephrine

#285

Post by csnover »

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…

The messaging in the US most commonly used to justify the lack of universal coverage and unreasonable cost of care is that we pay the most because we get the best treatments and best doctors and best outcomes, so I don’t think it’s fair to blame laymen for believing that.

Also, it’s not just patients that think this way. (Or, at least, if the clinicians know, they aren’t saying much to their patients.)

I’ve had docs gush about amazing wonder drugs, then I go and read the actual Phase 3 trial data on the patient information sheet and it has a 15% response (not remission) rate. I’ve been told I’m being given a “gold standard” treatment—but not that the “gold standard” response rate is actually only about 33%, and in another ~33% of cases it makes things worse.

I’ve had doctors refer me for surgery, tell me about how amazing the surgeon is, what a great job they’ll do, that if their own kids were sick they’d send them to this person. When I ask for hard data on the surgeon’s actual success rate for this type of surgery, well, they don’t track that—but look, just trust me, the guy’s realllyyy good.

Out of dozens of specialists I’ve seen over the years, I’ve only had one ever explicitly acknowledge that, yes, I had a real problem, but modern medicine just was not advanced enough yet to identify the cause, so they’re just kind of winging it. For the rest, there are “many new options”, “great responses”, “positive outcomes”, “extremely effective”—or there’s nothing wrong with you, it’s all in your head, and the princess is in another castle.

Re: The Uselessness of Phenylephrine

#286

Post by mypalmike »

leetbulb wrote: post #170
arkades wrote: post #54

Earlier quoted context omitted.

Pseudoephedrine is still available -behind the counter-. You literally just have to ask the pharmacist for it. Let’s not turn grad students having a laugh into an actual statement on public policy.

In my state, I'm able to walk down the road to a 24/7 chain pharmacy and buy pseudoephedrine whenever I want. The pharmacy, in combination with the state, uses ID to regulate how much an individual may purchase over some time frame(s). Most doctors will just write you a prescription and you can get it delivered to your home. Super easy.

Same here. But I think the edge cases are worth listening to as well. Green card residents, for instance. Sudafed is kind of a lifesaver for me at times and I feel fortunate to be able to buy it relatively easily.

Re: The Uselessness of Phenylephrine

#287

Post by refurb »

caymanjim wrote: post #162
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…

> 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…

I doubt it.

Ibuprofen and other NSAISDs were approved not that long ago, cause plenty of GI bleeds, have nephrotoxicity when used chronically and increase the risk of cardiovascular events.

And they’re OTC.

Acetaminophen is actually very safe considering the number of serious events and the facts it’s in hundreds of different OTC combinations.

Re: The Uselessness of Phenylephrine

#288

Post by astrange »

joecool1029 wrote: post #150

Phenylephrine does have one use that the author missed: It's used in ophthalmology to dilate the pupils before eye exams. On the topic of other use case medications, I used to take Sudafed (the real pseudoephedrine kind) during allergy season for a few weeks each year and noticed my productivity skyrocketed during that time, when I normally had issues context switching. Eventually I narrowed it down to taking Sudafed…

Bit disappointing that everyone starts commenting about amphetamines on a post about Sudafed working the same way as Strattera, which isn't a stimulant.

Though him telling people Strattera has no side effects hopefully didn't surprise anyone when they went on it, it feels (literally) like being kicked in the stomach and can make you quite nauseous.

Re: The Uselessness of Phenylephrine

#289

Post by p_j_w »

nanidin wrote: post #189
arkades wrote: post #54

Earlier quoted context omitted.

Pseudoephedrine is still available -behind the counter-. You literally just have to ask the pharmacist for it. Let’s not turn grad students having a laugh into an actual statement on public policy.

My state attempted to make pseudoephedrine require a prescription. One of the state lawmakers that was opposed was a doctor and he cited studies where phenylephrine was less effective than placebo. I wrote to my representative, who called me after voting for the bill to tell me that some sheriff told him phenylephrine is equally effective. Every time you buy the stuff from the pharmacist, they're logging the purchase…

Good to see your representative was getting his information on the effectiveness of medicine from a cop and ignoring the doctor. Emblematic of modern America.

Re: The Uselessness of Phenylephrine

#290

Post by orthecreedence »

astrange wrote: post #260
orthecreedence wrote: post #204

Earlier quoted context omitted.

> the system is rigged in a way that it consistently produces bad outcomes. Yes. That one. "Real" change (ie, still a useless liberal democracy, but at least a bit more in service to the people) would start with voter reform and getting rid of FPTP entirely.

You wouldn't like the results of either of those if you like "extreme" positions. - The most popular replacement for FPTP (which is biased away from centrism) is RCV (which is biased towards it). - FPTP does turn it into a two-party system, but US parties are weak. They don't control who joins them, who gets elected, or how anyone votes. In the UK you can actually get fired from the party for voting wrong.

I don't care about "extreme" positions in the context of liberal democracies. I can confidently say that there are great improvements we can make within them while also supporting abolishing them entirely. I like to be at least somewhat pragmatic.

RCV/STV is absolutely an improvement on FPTP in almost every way.

As far as strong vs weak parties, that seems to be an issue with the UK. FPTP and weak-parties are separate sets. You could have FPTP with closed party membership, or RCV/STV with weak parties.

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