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The Uselessness of Phenylephrine

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Re: The Uselessness of Phenylephrine

#51

Post by djrogers »

patwolf wrote: post #19

I'm also irked by the fact that OTC cough suppressants like dextromethorphan are equally useless.

In the vast majority of cases for my family, Dextromethorphan is a miracle drug. We're in the middle of cold and allergy season here, and my kids (and I) stop coughing within 5-10 minutes of taking an appropriate dose.

Once every 3-4 years I'll get a cough so bad that DXM won't fix, and when that happens my doc gives me a prescription for a codeine based cough syrup that fixes it (and renders me useless as a human being).

Re: The Uselessness of Phenylephrine

#53

Post by eikenberry »

Zak wrote: post #17

I wonder how difficult it would be to get the restrictions on pseudoephedrine rolled back now that it appears unlikely they're accomplishing their original goal of limiting the methamphetamine supply. Concern (legitimate and otherwise) over ability to breathe is a popular topic in politics lately.

Pseudoephedrine restrictions were recently was rolled back in Oregon, where you had to have a prescription to get it. Now we're able to buy it over the counter with ID. So it can happen!

Re: The Uselessness of Phenylephrine

#54

Post by arkades »

p_l wrote: post #13

The lack of availability of proper pseudoephedrine in USA led to situation where there are papers describing how to turn methamphetamine into pseudoephedrine, not the other way around. With explanation in abstract that its easier to buy meth than pseudoephedrine.

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.

Re: The Uselessness of Phenylephrine

#55

Post by ericbarrett »

techsupporter wrote: post #44
p_l wrote: post #13

The lack of availability of proper pseudoephedrine in USA led to situation where there are papers describing how to turn methamphetamine into pseudoephedrine, not the other way around. With explanation in abstract that its easier to buy meth than pseudoephedrine.

> With explanation in abstract that its easier to buy meth than pseudoephedrine. People may laugh at this, as they should since it is an absurd situation, but this isn't entirely wrong. Neither my wife or I drive and during the pandemic she gave up her license after getting an appointment at the DOL was difficult. Both of us carry US passport cards as our ID. This has resulted in several situations where we've been t…

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

Re: The Uselessness of Phenylephrine

#56

Post by [deleted] »

reincarnate0x14 wrote: post #48
Zak wrote: post #37

Earlier quoted context omitted.

Every time she's mentioned, there's something to make me dislike Feinstein more than I already did. It does seem likely her strong opposition would be a high bar to clear, though as the oldest current senator, she may not be a factor for a long time.

It really is amazing how someone manages to be on the wrong side of seemingly everything, and yet is locked into office past the point of senility.

[deleted]

Re: The Uselessness of Phenylephrine

#57

Post by hammock »

munificent wrote: post #43

My drug of choice for colds is NyQuil. It's always been great for opening up my nasal passages enough to let me breathe easily and then knocking me the fuck out so I could sleep off most of the cold. I remember several years ago when all of a sudden NyQuil stopped doing anything useful. I had no idea why but I directly observed that it was like it had been replaced with a non-functioning placebo. Only a couple years…

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 system. If you have only one or two symptoms, you can always buy each drug separately - doing so allows you to more precisely control dosage and timing as well.

FYI, two other common symptoms not covered above are sinus congestion - which can be treated with Sudafed - and chest congestion (e.g. a phlegmy cough) - which can be treated with Mucinex.

Re: The Uselessness of Phenylephrine

#58

Post by tcherasaro »

jfengel wrote: post #2

I've certainly found it useless, and when I need a decongestant I make certain I'm getting actual pseudoephedrine. The 12 and 24 hour slow-release versions are fantastic. I've never done a proper blind trial on myself, but I feel quite certain that I could tell the difference. I suppose people must be buying it, and given how strong placebo effects are in general I guess it's doing something for them.

Same, Sudafed is a silver bullet for me. The 12 hour release absolutely works to clear my sinuses and relieves the sinus pressure headache (almost completely when combined with ibuprofen).

My wife insists Phenylephrine works for her and thats all she will take. She has offered it to me a couple times when we didn’t have any Sudafed and Phenylephrine had 0 noticeable effects for me.

Edit: I forgot to add that Alavert-D 12 also has Pseudoephedrine and works for me too and is what I take when my congestion is allergy related.

Re: The Uselessness of Phenylephrine

#59

Post by PragmaticPulp »

The article comes so close to explaining a way to make it work, likely due to his hesitancy to recommend exceeding the recommended dose:

> Why is oral phenylephrine so useless? It is extensively metabolized, starting in the gut wall. You can find a bioavailability figure of 38% in the literature, but that appears to be the most optimistic number possible, and you can also find studies that show 1% or less. Overall, the Cmax is highly variable patient-to-patient, and the lack of cardiovascular effects at low doses argues for very low systemic effects (and expected low efficacy as a decongestant). The bioavailability increases at higher doses as you apparently saturate out some of the metabolic pathways, but at the 10mg dose typically used for decongestants, you can forget it.

Phenylephrine has variable Bioavailability. The bioavailability doubles if you take it with Tylenol, which is actually common in the context of colds. (Source: https://pubmed.ncbi.nlm.nih.gov/25475358/ ) The maximum dose was probably chosen based on worst-case scenarios, whereas the average person who complains it doesn't work is probably absorbing much less.

Always consult with your doctor, but I've found that taking a second dose of phenylephrine if the first one hasn't worked within about 30 minutes usually does the trick. Or just take it with Tylenol. It's worth checking your blood pressure to make sure you haven't started entering the realm of side significant side effects, though.

Also I should point out that pseudoephedrine isn't available behind the counter everywhere. It's prescription-only in some places.

Re: The Uselessness of Phenylephrine

#60

Post by rootusrootus »

Zak wrote: post #17

I wonder how difficult it would be to get the restrictions on pseudoephedrine rolled back now that it appears unlikely they're accomplishing their original goal of limiting the methamphetamine supply. Concern (legitimate and otherwise) over ability to breathe is a popular topic in politics lately.

It's happening slowly. Oregon had pushed it all the way to requiring a prescription to get pseudoephedrine. It does still require a visit to the store pharmacy and showing your ID to prove you are an adult, but at least you can buy it without a prescription now. I think only a couple states ever went that far. But at least it is a step back in the right direction.
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