[HN Gopher] FDA proposes ending use of oral phenylephrine as OTC...
___________________________________________________________________
FDA proposes ending use of oral phenylephrine as OTC nasal
decongestant
Author : impish9208
Score : 236 points
Date : 2024-11-08 00:56 UTC (22 hours ago)
(HTM) web link (www.fda.gov)
(TXT) w3m dump (www.fda.gov)
| ClassyJacket wrote:
| Finally. I hope this reaches Australia and the rest of the world.
| Phenylephrine doesn't work, it never worked, it's obvious that it
| doesn't work, it's a literal scam, and the companies selling it
| are fraudulent.
| denkmoon wrote:
| Half the products in chemist warehouse are pretty blatant
| scams. It's insane how effective, important pharmaceuticals are
| sold side by side with products known to be ineffective and
| that exist purely to strip uneducated customers of their money.
| tdeck wrote:
| Next I hope they do cough medicines, I looked a few years ago
| when I had a cough and it seems like literally none of the OTC
| ones are more effective than placebo.
| hammock wrote:
| Dextromethorphan (DM or DXM) is the OTC cough suppressant.
| Marketed as Delsym comes in an orange box, or you can find it
| in various combo formulations, and it works
| realce wrote:
| Delsym is dextromethorphan-polistirex, a long-acting
| formulation of DXM that is supposed to last 12 hours. DXM is
| available in almost all cough syrups.
| hammock wrote:
| The 12 hour formula is the only way you can get it OTC by
| itself. That's because it's a recreational drug that is
| commonly abused ("robo tripping") and extended release
| prevents that. Otherwise you have to get it in a combo drug
| like NyQuil, which I don't prefer because I can't manage
| distinct symptoms and dosages independently with a combo
| HideousKojima wrote:
| Can also give you incredible diarrhea as a nice side effect
| deelowe wrote:
| Dextromethorphan is the only otc cough medicine that works and
| pretty much the only prescription stuff that works is opiate
| based. Of course both are regulated.
| pitaj wrote:
| DXM can be more or less effective. I wish codeine cough syrup
| was still available without a prescription.
| yubiox wrote:
| Exactly. Why do I have to cough my head off because some
| idiot abuses codeine?
| rustcleaner wrote:
| Because you and your neighbors think you can interfere
| with people through your voting decisions. Government has
| grown so out of line, 'crime' has no meaning anymore
| beyond "doing that which some group of humans with guns
| and cages says, who nobody _really_ consented to or
| contracted with (they 've always been there bullying
| everyone into paying taxes and obeying edicts)." It
| certainly doesn't mean what it used to mean anymore!
|
| We as a people need to become even more ungovernable, we
| need to be the opposite of German and be the most
| annoying red blooded American caricatures we can be.
|
| Don't join the beehives, they're not worth it! My
| corollary to Franklin: those who would give up essential
| sovereignty to gain inclusion into a society deserve and
| shall receive neither.
| master_crab wrote:
| Back to Pseudoephedrine! It's behind the counter at your local
| pharmacist.
| bsder wrote:
| Unfortunately there is an absurdly low limit on purchasing
| amount in the US.
|
| In addition, I can't seem to find the 24 hour versions
| _anywhere_ right now. I could probably buy meth more
| conveniently. :(
|
| Cue: "A Simple and Convenient Synthesis of Pseudoephedrine From
| N-Methylamphetamine"
| https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
| hadlock wrote:
| I've only had to buy it in three states, but generally my
| experience has been that you can buy a "30 day supply" per
| month. How often are you sick that you need more than 30 days
| of the stuff every month? If we run out I'll buy a 30 day
| supply and that generally lasts the whole family a year or
| more.
| HideousKojima wrote:
| You definitely don't have anyone in your family who gets
| severe congestion from allergies then. The "funnest" form
| it takes for me is when I start going partially blind in
| one eye due the the sinus pressure
| rootusrootus wrote:
| When it's that bad why wouldn't you just get a
| prescription for an appropriate amount for your
| situation?
| JumpCrisscross wrote:
| > _When it's that bad why wouldn't you just get a
| prescription for an appropriate amount for your
| situation?_
|
| Prescriptions take time and money.
| rootusrootus wrote:
| I could do it with less effort and cost than OTC. Online
| message my PCP, prescription sent to pharmacy, mailed to
| me at my house, cost $0 since it's just a generic. And I
| have a cheap as shit high deductible plan with a steep
| out of pocket maximum, not some cadillac plan.
|
| OTC would be faster, but if I have a chronic need for
| large amounts of pseudoephedrine I'm not waiting until it
| hurts before I run to the store. I'm getting my doc to
| make sure I have a hell of a good stash (and I checked,
| just to be sure -- the limits don't exist if it's
| prescription; at least not in Oregon, which is famously
| restrictive on pseudoephedrine).
|
| Would it be better to relax the restrictions that now
| seem pointless on the OTC version? Yep. But if someone is
| bitching on HN about how they can barely get what they
| desperately need, I'd say it's time to stop being
| idealistic and go get the damn drugs already.
| Brian_K_White wrote:
| "I don't have this problem, therefor this problem doesn't
| exist, and so you don't have this problem."
| mike_d wrote:
| > Unfortunately there is an absurdly low limit on purchasing
| amount in the US.
|
| The maximum safe dose for an adult is 240 mg in a 24 hour
| period. Current guidelines allow for getting a 10 day supply
| (the average cold lasts 7-10 days) in a single visit, and
| basically a limitless supply with a few visits (37 days worth
| every 30 days).
|
| If you are running into purchasing limits, you are either
| making meth or blowing out your liver.
|
| Edit: Math is hard. The 30 day limit is 7.5 grams (a 31 day
| supply), or 3.6 grams per trip (a 15 day supply).
| PittleyDunkin wrote:
| > If you are running into purchasing limits, you are either
| making meth
|
| This would also be an insanely expensive way to make meth.
| bsder wrote:
| I seem to only be able to buy 10 days of Sudafed 24 Hour
| every 14 days. That doesn't work if you have allergies.
|
| Presumably because places like Walgreen's can't adjust
| compliance per state and places like Alaska have "No person
| may purchase or possess more than 6 g of PSE, EPH or PPA
| per 30 days unless dispensed pursuant to a prescription"
|
| Note that 6g / .240g = 25. So I can only buy 25 days worth
| of pills every 30 days. Or 12.5 pills every 15 days which
| is _suspiciously_ close to that 10 every 14 days number.
| ahazred8ta wrote:
| This is where you need to bring a buddy on every trip...
| mike_d wrote:
| > Note that 6g / .240g = 25
|
| Fortunately we are both wrong. I have updated my previous
| post up thread.
| bsder wrote:
| How am I wrong? I quoted the Alaska requirements. Are
| those not correct? Please reference.
| mike_d wrote:
| I guess you found the one state who isn't in line with
| federal law. :)
|
| https://www.deadiversion.usdoj.gov/meth/cma2005.html
| https://worldpopulationreview.com/state-
| rankings/pseudoephed...
| stephen_g wrote:
| Aren't there better things to take longer term for
| allergies? Pseudoephedrine is amazing for colds etc. but
| I've always seen warnings not to take it for more than a
| few days at a time...
| fragmede wrote:
| What's 10 days/4 people? like... a family that lives
| together? Who will almost inevitably get each other sick?
| If the average cold lasts 7-10 days, one of them's going
| shopping for more while sick.
|
| Sounds like great public health and safety policy there.
| terribleperson wrote:
| At least some states track it on a household (address)
| basis.
| PittleyDunkin wrote:
| I was denied this the last time I tried to buy it and the
| pharmacist couldn't even tell me why aside from "the system
| won't let me". I went to a different chain a half mile away and
| walked out with a month's supply of the stuff. Hilariously
| incompetently-designed regulation.
|
| Meanwhile meth making is more efficient, cheaper, and delivers
| purer-grade glass than ever.
| adrr wrote:
| Most worthless law. Now i have to wait in line for 10 minutes
| to get it and yet meth is still widely available and usage
| actually increased. Did nothing except shift manufacturing to
| outside of the US.
| HideousKojima wrote:
| And I can't stockpile it for allergy season (which is about 9
| months out of the year for me). I have to make regularly
| scheduled trips to the pharmacy every two weeks which is a
| huge pain in the ass
| deelowe wrote:
| You take 48 pills in two weeks?!
| ksenzee wrote:
| That's pretty easy when the dose is two pills every six
| hours.
| pitaj wrote:
| They make twelve hour extended release versions now.
| There are twelve per box and you can get three boxes at a
| time. That's 18 days but only if you take them twice a
| day, which you probably shouldn't if you like sleeping.
| If you take one a day, that's a whole month's worth.
| deelowe wrote:
| You're going to have serious issues if you take that
| much. It's causes major problems after a few days.
| HideousKojima wrote:
| I can get 15 of the 24 hour generic Claritins every 2
| weeks. Works out to about 1 a day
| 01HNNWZ0MV43FF wrote:
| My life on an ADHD med, a mental health med, and 3 other
| meds for transgender stuff.
|
| I am very lucky to have a backlog of estradiol, my main HRT
| drug, because I was purposely "playing under speed" for
| most of a year, otherwise all 5 drugs would be randomly
| running out at 5 different times throughout the month.
| Almost nothing gets assigned to 90-day fills for some
| stupid fucking reason.
| terribleperson wrote:
| So from personal experience you can often just ask docs
| for a longer prescription if something isn't particularly
| restricted (like stimulant-type ADHD medications).
|
| From friends, I know that some therapists and
| endocrinologists are willing to give 6 mo or even 1 yr
| scripts of hormones, though some will only do so under
| certain conditions. You might want to find a different
| doc. I know one person who gets a 3 mo supply of
| estradiol from a telehealth provider.
| caturopath wrote:
| I once actually got denied and had to buy a smaller box
| (for the same price). What the hell happens to families
| with multiple teens who all get sick at the same time?
| philjohn wrote:
| Any reason you choose to take PE rather than a
| corticosteroid nasal spray?
| zxexz wrote:
| Corticosteroids are powerful substances, and have lots of
| potential adverse effects - and long-term usage can wreak
| havoc. The physiological side-effects of corticosteroid
| withdrawal can be quite awful. They are amazing,
| necessary, drugs for society. But, when something as safe
| and effective as pseudoephedrine can do the trick (it
| really is _quite_ safe, and even has less potential
| interactions with things than plenty of OTC drugs do),
| there is literally no reason for anything else.
|
| When I get a cold, (pseudo)ephedrine is the only
| medication that actually really helps. I don't need it
| often, I just try to remember to buy some once in a blue
| moon when I'm already at the pharmacy so that when I need
| some, it will be there. But for people with allergies or
| those who get sick a lot, the current process is yet
| another completely pointless annoyance.
| mfru wrote:
| Corticosteroid nasal spray does not have the same effects
| as when it is administered in other ways and is safe even
| for long-time use as three different doctors in my
| country told me.
| philjohn wrote:
| Yep - I think parent poster is conflating the effects of
| oral corticosteroid use (which believe me, I know, and
| they SUCK) with topical usage.
| zxexz wrote:
| Yes, I was. Thank you both for pointing this out.
| zxexz wrote:
| I just spent dug in to this and, wow, I was wrong! Most
| all the negatives that occur with parenteral and oral
| routes appear to be absent in the intranasal form. And
| there is quite a lot of research to back that up.
|
| Thank you for correcting me. And likely sending me down
| another rabbit hole.
| quickthrowman wrote:
| Pseudoephedrine should be unrestricted, there's no way to
| compete on price with meth cooked in an industrial lab in
| Mexico by using pseudoephedrine as a precursor. Keep it
| behind the counter (to prevent theft) but let adults buy as
| much as they want.
| adrr wrote:
| There was actually a push to make it rx only. Oregon and
| Mississippi passed laws to make it RX, luckily those laws
| have been rolled back.
| loeg wrote:
| Bring back domestic manufacturing jobs!
| cyberax wrote:
| Small batch, organic, artisanal, fair trade meth for the
| win!
| yellowapple wrote:
| Or just straight ephedrine, which is also behind the counter at
| your local pharmacist (brand name Bronkaid).
| zeroonetwothree wrote:
| Great. I always have to explain to people not to buy this crap
| and get the good stuff instead
| peterldowns wrote:
| Just as a reminder, you are completely allowed to buy
| pseudoephedrine without a prescription, you just have to ask your
| pharmacist. My local pharmacy keeps it behind the counter already
| pre-compounded, and it's cheap and effective. One of those little
| things that I never used to purchase because I was somehow not
| certain if I could actually get it. Yes, you can.
| jey wrote:
| What country are you in? In the US, pseudoephedrine has to be
| requested at the pharmacy counter, but it's not a compounded
| medication. Instead it's sold as pills in the usual "blister
| pack" format.
| peterldowns wrote:
| I live in the US. You're right, it's not compounded by my
| pharmacy, I was confused because of the branding on the
| package -- it's manufactured somewhere else and just
| repackaged by my pharmacy:
|
| https://files.catbox.moe/9pbj43.jpg
| khuey wrote:
| Ohm Laboratories appears to be a subsidiary of Sun Pharma
| which is one of the largest generic drug manufacturers in
| the world. This looks like a pretty standard generic drug
| with store branding package to me.
| mikeweiss wrote:
| It's not repackaged by your pharmacy, Good Neighbor
| Pharmacy is a generic drug brand for pharmacies and
| supermarkets that don't have their own generic brand.
| bluedino wrote:
| You need a drivers license though. And they enter something
| into the computer.
| toast0 wrote:
| My local pharmacies keep it behind the counter, but the counter
| has shorter hours than the rest of the store. And you've got to
| submit your license to be entered into their system (and who
| knows what happens with that data).
| elric wrote:
| In Belgium it's no longer available without prescription since
| this month. Reasoning is that it can trigger cardiac issues,
| neurological issues, and even psychiatric issues in some
| people.
| biglyburrito wrote:
| So stupid. It was plainly obvious how ineffective it was,
| compared to pseudoephedrine, anytime you got sick.
| nimbius wrote:
| whats wild is this was a solution to a problem that was directly
| caused by neoliberal capitalism.
|
| in the 90s and 2000s when meth first began to spike, the rural
| economy was changing. Jobs weren't paying as well or were going
| away altogether. Meth found a niche as a kind of performance
| enhancement drug for people working long hours at physically
| demanding jobs. journalist Nick Reding found this in the pork
| industry in Iowa, and anthropologist Jason Pine found in general
| in Missouri.
|
| neoliberalisms solution was a ham fisted market based restriction
| that turned a normal cold drug into a rarity. we didnt start
| working to treat methamphetamine addiction as a disease until it
| began to spread into more affluent white-collar neighborhoods.
|
| this could have been avoided with competent market reforms and
| regulation, as well as stronger labor protections and minimum
| wage law.
| realce wrote:
| And it's much more profitable to scrape every ounce of working
| life out of the poor, then use them as slave labor in a prison
| once their addictions get them into a critical situation or
| farm them out to a rehabilitation facility that pays councilors
| 20 bucks an hour and gets a large chunk of it's funding from
| taxpayer subsidies. If there's any issue, blame the overworked
| poor for turning to drugs, then sell them energy drinks.
| userbinator wrote:
| You mean caused by the war on drugs.
| refurb wrote:
| > whats wild is this was a solution to a problem that was
| directly caused by neoliberal capitalism.
|
| Did you pull a muscle stretching that argument into place?
|
| People like meth. People in capitalist countries and non-
| capitalist countries alike.
|
| It was in fact a hamfisted government regulation that drove
| this.
| treflop wrote:
| Neoliberals believe in free market and deregulation, not market
| restrictions.
|
| Nixon was the one that started the war on drugs and also
| enacted price controls. I would not call him a neoliberal. He
| also primarily interested in foreign policy and not the
| economy.
|
| Also, Sudafed was only banned from being purchased easily in
| 2006. The bill was introduced by a random congressman from
| Indiana, a congressman was also easily offended by an offensive
| joke written on someone's else cake.
| rustcleaner wrote:
| I blame Progressivism(tm) and the expansion of the role of
| government. Laissez Faire is the ideal policy for a force-
| monopolist to perform by. It is better to have a weak
| government precisely because it's way easier to fell a badge-
| less gangster than a badged one.
| MBCook wrote:
| And yet homeopathy stuff is legal and often mixed in on the shelf
| with actual drugs.
|
| Sigh. Still an improvement.
| sodality2 wrote:
| I remember complaining to my friends about how frustrating it was
| to hear that a medicine I frequently used turned out to be
| placebo, exactly one year ago today. Opened this article up, I'm
| currently taking the _exact same_ one in the article photo - it's
| what I had lying around and I had forgotten the name of the "bad"
| sudafed (it's sudafed PE). They need to take it off the shelves
| quicker. Every day is tens of thousands of more people who are
| scammed.
|
| Putting my money where my mouth is and leaving a comment on the
| FDA proposal...
| jart wrote:
| How can you believe you've been taking a placebo for years?
| Phenylephrine is used for the illicit synthesis of
| methamphetamine, so there's an inherent bias towards anything
| that gets it off the shelves. Cherry picking studies that say
| it's ineffective is more velvet glove than using only the iron
| fist to ban the stuff. But make no mistake that the iron fist
| is taking your meds away either way.
| culi wrote:
| I think you're confusing Pseudoephedrine (which works and is
| used to produce meth) with Phenylephrine (which doesn't work
| and cannot be used to produce meth).
|
| This article is about removing phenylephrine (sudafed PE)
| from shelves. Studies have pretty thoroughly showed it is
| completely ineffective for what it is marketed for
| sodality2 wrote:
| I believe that it doesn't work wholeheartedly, because every
| time I try it, it is ineffective - but my sinus problems are
| rarely bad enough to warrant medication (it's been one year)
| and by then I've forgotten what works and what doesn't.
|
| Also, I suspect you're mixing up your drugs. Phenylephrine
| (the drug in this article) lacks the methyl structure to be
| used for the synthesis of methamphetamines. In fact, that's
| why it was popularized - pseudoephedrine, the truly effective
| sibling, was becoming too good for meth production, so they
| created a less potent alternative, phenylephrine, that lacks
| the ingredients necessary. They then locked pseudoephedrine
| behind the counter. Turns out the oral form of phenylephrine
| is less than "weaker" - it's largely useless - so they pumped
| out enough of this crap to the tune of $1.7B that the
| American public spent every year for 18 years after they
| knew.
| jart wrote:
| Ah gotcha. So the cynical thing I thought would happen
| already happened.
|
| Glad to hear we're on a road where peak cynicism is looking
| behind us.
| stephen_g wrote:
| _Pseudoephedrine_ is the one that is both proven to be
| effective and is the precursor to meth. Phenylephrine is the
| useless placebo that they put in the tablets on the shelf
| only because it _can't_ be used to make meth. It should be
| torn off the shelves because it's useless.
|
| The only reason the 'PE' (marketing term for the ineffective
| phenylephrine) tablets might be helpful is because they
| usually also have paracetamol (acetaminophen) in them which
| is probably the only bit that works. They don't work as a
| decongestant for most people like pseudoephedrine does
| though.
| mmazing wrote:
| My grocery store pharmacy has homeopathic stuff next to the
| Sudafed too. Is literally a placebo.
|
| At least the Sudafed has acetaminophen in it ...
| bitwize wrote:
| If you're referring to Zicam, there's actually evidence that
| zinc gluconate helps reduce the length and severity of
| colds... and it's actually present in more than trace amounts
| in Zicam. They market it as "homeopathic" in order to get
| around FDA regulations, and they've gotten in trouble because
| zinc in your nose can knock out your sense of smell, perhaps
| permanently. (The lozenges don't appear to have this issue.)
| matwood wrote:
| I remember when the law first went into place. I bought some
| meds and the next day was back at the store because the new
| stuff didn't work. For me it was even more obvious because
| pseudoephedrine works so well for me.
| cbau wrote:
| PE = Placebo Effect
| currymj wrote:
| phenylephrine is still pretty effective as a topical nasal spray.
| so don't write it off if you see it in that form.
| crb3 wrote:
| My anecdata is that, though it's not as effective as
| pseudoephedrine, phenylephrine actually _is_ effective in an
| inhaler, and a helluva lot better at clearing up a stuffy nose
| than "scents and essential oils". Of course, a cylindrical
| inhaler with a wick inside it doesn't go _near_ my digestive
| tract... Now I 'll have to look around for a replacement inhaler,
| something quick enough to avert choking-panic. Thanks, CVS.
| ksenzee wrote:
| No you won't! It's just the oral formulations that are being
| taken off the shelves. The inhaled version does indeed work and
| will still be available.
| crb3 wrote:
| It's off the shelf at my local CVS (e: and has been for
| weeks). I looked.
| lucubratory wrote:
| That's their company policy or a supply issue, not the
| FDA's decision.
| crb3 wrote:
| Thanks, CVS.
| lucubratory wrote:
| It's only the oral version which has no effect and is thus
| being pulled. The inhaled version has more evidence that it
| works and will remain available.
| ramenmeal wrote:
| Does anyone else feel like dayquil is an effective decongestant?
| I do. I can literally feel the gunk running down from my sinuses
| to the back of my throat when I take it. Confusing to me cause
| it's phenylephrine, which is what the article states is
| ineffective. I've had this experience after reading these reports
| about a year ago.
| solveit wrote:
| Might be the other ingredients reducing inflammation, widening
| your clogged pipes and letting stuff drain.
| pitaj wrote:
| It's probably the guaifenesin (Mucinex) that you're feeling.
| shagie wrote:
| As mentioned in a sibling, try looking at Mucinex a try. There
| is a 12h version that has Guaifenesin
| https://en.wikipedia.org/wiki/Guaifenesin and Dextromethorphan
| https://en.wikipedia.org/wiki/Dextromethorphan as the only two
| active ingredients.
|
| Compare with Dayquil - Acetaminophen 650 mg (pain
| reliever/fever reducer), Dextromethorphan HBr 20 mg (cough
| suppressant) and Phenylephrine HCI 10 mg (nasal decongestant).
|
| > Guaifenesin, also known as glyceryl guaiacolate, is an
| expectorant medication taken by mouth and marketed as an aid to
| eliminate sputum from the respiratory tract.
|
| > ...
|
| > Guaifenesin is used to try to help with coughing up thick
| mucus, and is sometimes combined with the antitussive (cough
| suppressant) dextromethorphan, such as in Mucinex DM or
| Robitussin DM.
|
| ---
|
| > Dextromethorphan (DXM), sold under the trade name Robitussin
| among others, is a cough suppressant used in many cough and
| cold medicines.
|
| > ...
|
| > The primary use of dextromethorphan is as a cough
| suppressant, for the temporary relief of cough caused by minor
| throat and bronchial irritation (such as commonly accompanies
| the flu and common cold), or from inhaled particle irritants,
| as well as chronic cough at a higher dosage.
|
| ---
|
| The combination of the two is designed to reduce coughing and
| when you _do_ cough, it is much more productive with the
| expectorant and cough suppression. It isn 't a decongestant,
| but it has (personal anecdotal take) a good effect on getting
| rid of the secondary effects of congestion.
| TheJoeMan wrote:
| Only issue is the bilayer tablets taste aweful! Why they
| can't do dual speed capsules is beyond me.
| SeanLuke wrote:
| Guaifenesin, like Phenylephrine, is now widely viewed as
| having no efficacy.
| toast0 wrote:
| I swear I read a report somewhere that said something like PE
| is effective iff you take twice the dose on the box or you take
| it with other drugs (I think ibuprofen was tested?), although I
| can't find it again, and I may have read it when I was
| congested and only had PE.
|
| My lived experince with PE is it never works most of the time.
| But if I realise I need psuedoephedrine and I'm not somewhere
| or sometime where I can access it, I'll get PE and hope.
| Sometimes hope works, but it usually doesn't clear my sinuses
| very effectively. But if I have sinus congestion related to
| flying, I might also have soreness related to flying and take
| PE (because you can get it at the airport) and ibuprofen
| together, and maybe it works.
|
| But also some people are more sensitive to some drugs, so it
| could work for you, while not being very effective in general.
| joecool1029 wrote:
| > I swear I read a report somewhere that said something like
| PE is effective iff you take twice the dose on the box or you
| take it with other drugs (I think ibuprofen was tested?)
|
| Oh yeah combine with Tylenol and increase the dose if you
| want to experience adverse cardiac events. The oral form of
| PE is really only good for jacking up blood pressure, it
| doesn't help with congestion more than placebo:
| https://pmc.ncbi.nlm.nih.gov/articles/PMC4500855/
| colechristensen wrote:
| Here's a solid completely factual reason why people don't trust
| the FDA or the government to give health advice. Pointless drug
| allowed for decades.
|
| If you want to be trusted you have to be consistently
| trustworthy.
|
| What else is the FDA wrong about and will continue to be wrong
| about for decades?
| OutOfHere wrote:
| It makes me wonder if it has anything to do with Trump winning
| the election.
|
| > What else is the FDA wrong about
|
| Too much. For one, numerous harmful additives are freely
| allowed. These additives may not cause immediate damage, but
| over the long term they really inflame the gut. They serve no
| good purpose in the medicines. Examples include: propylene
| glycol, sodium lauryl sulfate, titanium dioxide, talc, ammonium
| hydroxide, monoethanolamine, n-butyl alcohol.
| rileymat2 wrote:
| This conversation is confusing without the FDA isn't everything
| allowed by default and you get far worse like the current
| supplement industry?
| initplus wrote:
| Regulatory challenge is that the FDA have to combine 3
| related but seperate concepts:
|
| 1. Manufacturing quality/ingredients accuracy (is the product
| what is says on the tin) 2. Safety 3. Efficacy
|
| Medicines must pass all three, supplements don't have to meet
| any.
| rustcleaner wrote:
| FDA and DEA should be concerned mainly with the contents
| matching the box, and not on medical claims of effectiveness.
| rileymat2 wrote:
| In your opinion, should any government agency monitor truth
| of claims, or is this all outsourced to private things like
| consumer reports? Is it class action lawsuits?
|
| And in the case of drug effectiveness, isn't this a very
| expensive endeavor, where the primary source of funding
| would be the companies themselves biasing results?
|
| In this case we had companies happily selling us
| ineffective drugs, not because the FDA wanted it, but
| because they did not reject it. In a world without the FDA,
| what entity rejects?
| Brian_K_White wrote:
| Well? What else indeed? Is this the exception or the rule?
|
| I bet you think people should trust you even though I also bet
| you were wrong about something once.
| colechristensen wrote:
| >I bet you think people should trust you even though I also
| bet you were wrong about something once.
|
| Is there anything I've been wrong about which has been
| significant for a couple of decades?
|
| Pseudoephedrine left OTC in about 2006, phenylephrine has
| been the main decongestant available and there's been solid
| evidence out there for a long time that it didn't do
| anything.
| Brian_K_White wrote:
| Did you think this addressed the point?
|
| I don't hear anything that shows that this mistake is part
| of the majority or minority.
|
| How long ago it was made is insignificant.
|
| I have no reason to think that you do not have a similar 20
| year old ongoing error unless you are physically not yet 20
| years old. I'm sure I probably do. I'm sure everyone does.
| It's not a remarkable thing.
|
| They are also right now self-correcting this error, while I
| still have mine whatever they are.
|
| Regardless, it still doesn't answer the question of
| exception vs rule. No matter _how_ bad or long-running this
| error is, it doesn 't matter, what matters is, is it
| representative of most of their policies and actions? It
| might be, but you have not shown that it is and I have not
| shown that it's not.
| telgareith wrote:
| Easy: Foam of any type and any chemistry in CPAP or ventilators
| of any type. Also, "soclean" and any other ozone 'cleaners'
| refurb wrote:
| If you were informed on how we got to this point, you'd likely
| have a different opinion.
|
| But that would take some research, and hey, it's easier to just
| have a kneejerk reaction right?
| autoexec wrote:
| Companies lie to the public and sell products that contain a
| useless drug that does nothing, the FDA wants the products with
| the useless drug removed because the companies selling them are
| just ripping people off, and your conclusion is that the FDA is
| the problem?
| kens wrote:
| One of my favorite papers is "A simple and convenient synthesis
| of pseudoephedrine from N-methylamphetamine" [1].
|
| This is a satirical paper. Because pseudoephedrine (i.e. the good
| decongestant) is very difficult to obtain due to restrictions,
| but "N-methylamphetamine can be procured at almost any time on
| short notice", the paper describes how to synthesize
| pseudoephedrine from meth with a procedure that looks valid.
|
| [1]
| https://improbable.com/airchives/paperair/volume19/v19i3/Pse...
| hansvm wrote:
| I found out recently that you don't just need a decent
| government ID; it needs to be from the state you're purchasing
| the Sudafed from, because apparently each state administers its
| own database. If you run out and have a persistent cough
| (weakened immune system from not licking doorknobs the last few
| years of covid, or so do the doctor says) from a common cold
| while on vacation, you're shit out of luck unless you go back
| home or you and an accomplice are willing to procure your cough
| medicine with their license.
| randrus wrote:
| Seems like it varies by state - I've purchased Sudafed in at
| least two states other than my own.
| numbsafari wrote:
| Same here.
| schmidtleonard wrote:
| Me too.
| Gibbon1 wrote:
| My WAT.
|
| Refused sale of Sudafed because my license was expired.
| Apparently I accidentally tossed my new license and kept the
| old one. Doh! However they happily refilled my schedule III
| meds with the expired license.
|
| As I said WAT.
| pdonis wrote:
| _> you don 't just need a decent government ID; it needs to
| be from the state you're purchasing the Sudafed from_
|
| The FDA rule on this [1] doesn't appear to be quite that
| strict: it says the ID can be "a photo identification card
| issued by the State or the Federal Government or a document
| that is considered acceptable by the seller". It doesn't
| explicitly say it has to be from the same state as the one in
| which you are buying the medication, and it leaves the seller
| some latitude in what to accept.
|
| Possibly some states have more restrictive rules. Or
| particular sellers might be more leery about what they are
| willing to accept.
|
| [1] https://www.fda.gov/drugs/information-drug-class/legal-
| requi...
| _moof wrote:
| The FDA rule doesn't restrict the IDs but the phrase "that
| is considered acceptable by the seller" lets the pharmacy
| put any restrictions in place they want. They can tell you
| it has to be hot pink and glow-in-the-dark and you've got
| no choice but to deal with it.
| arcticbull wrote:
| While true as long as they're in compliance with the law,
| wouldn't they want to sell all the Sudafed they can? They
| can deny service to anyone for pretty much any reason. No
| shirt, no shoes, no Sudafed or anything else. So yeah,
| but in reality it isn't aligned with their interests and
| if they don't want to serve you they can always find a
| different justification.
| safety1st wrote:
| Maybe they want that, maybe they don't. Retail drug
| stores in the US are an oligopoly, that industry may not
| be a monopoly (yet) but they don't function under perfect
| competition. Maybe if you're the management or the
| shareholders of a retail drug chain you're just kind of
| shrugging your shoulders and working on the next merger
| at this point since the fewer competitors you have, the
| less hard you have to work for the customer's dollar.
| jkaplowitz wrote:
| The "acceptable by the seller" wording only applies if
| the ID is not issued by "the State" or "the Federal
| Government". Wouldn't the latter option mean that a US
| passport, a green card, a Global Entry card, or a NEXUS
| card must be accepted as suitable ID by any seller in any
| state? All of those are issued by the feds.
| potato3732842 wrote:
| And the pharmacy has the state regulators breathing down
| their neck so being super uptight about it is the obvious
| choice.
|
| Of course all of this is stupid in a world where the real
| junkies use fentanyl and there's other easy ways to make
| meth.
| vrc wrote:
| States like MA legally only accept MA IDs and federal
| govt IDs for age verification. That's why a lot of bars
| and packies will turn people away or ask for additional
| proof like CC's. You're more likely to be held liable for
| misconduct if the license you accepted is out of state.
| jkaplowitz wrote:
| Any seller in any state should have to accept a federally
| issued ID such as a US passport, no?
| vrc wrote:
| Yes but then you'd have to carry that for domestic
| travel.
| seattle_spring wrote:
| That's not universally applicable, as I've purchased it in
| Washington plenty of times with an Oregon ID.
| bigfatkitten wrote:
| I've purchased Sudafed in Nevada with a foreign drivers'
| license with no issues.
| esperent wrote:
| Here in Vietnam it's completely impossible to get
| pseudoephedrine at all and I think it's the same in all Asian
| countries. I even resorted to trying to buy some ephedra tea
| (Chinese medicinal herb from which ephedrine was first
| discovered). I ordered a box of tea bags from Shopee.vn and
| rather amusingly received an envelope with the amount I had
| paid including shipping in cash and an apology letter saying
| they could no longer sell this herb and please don't leave a
| bad review.
|
| However, a few months earlier due to a Google translate mixup
| where I thought I was ordering peppermint oil, I got 100ml of
| sassafras oil [0]. It's a precursor to MDMA and at least as
| restricted as pseudoephedrine.
|
| https://en.m.wikipedia.org/wiki/Safrole
| exe34 wrote:
| just been banned in the UK. was the only thing that worked
| on my allergies.
|
| edit: my bad, no it's codeine linctus that was banned,
| there was talk of making pseudoephedrine prescription only
| but that hasn't gone through.
| pj1115 wrote:
| Pseudoephedrine, banned? That's news to me, I bought some
| OTC a couple of weeks ago.
| angry_octet wrote:
| It's readily available in Thailand and Indonesia. You can
| get it mixed with paracetamol OTC in Singapore, but almost
| everything in Singapore requires a prescription (even e.g.
| throat lozenges) so find a doctor if you're staying for a
| while. In Malaysia you need a prescription.
| cowsandmilk wrote:
| I've definitely purchased Sudafed in Seattle with a Virginia
| Drivers License.
| Pxtl wrote:
| Once again, big thanks to paranoid "mark of the beast"
| conspiracy theorists with funny ideas about federal
| government IDs and digital IDs.
|
| We have the technology. "Behind the counter" could just mean
| a vending machine with good ID tech instead of queuing up for
| an overworked pharmacist behind a dozen people.
| echelon wrote:
| Pseudoephedrine being pulled from the shelves is one of the
| biggest crimes of our time.
|
| Pseudoephedrine should be easy and plentiful to obtain. I don't
| care if people use it to make meth. What they do in their
| private time doesn't concern me. Not being able to get Sudafed
| when I'm sick kills me. It's not like those people won't be
| able to get meth some other way.
|
| We let people buy cars and cause 43,000 automobile deaths a
| year. People should be able to live life without stuffy noses.
| Maybe license people to buy meds and take it away if they abuse
| it? That's better than the draconian system we have now.
|
| And don't get me started on ADHD medication and their
| shortages.
|
| Edit: and there are 178,000 alcohol related deaths per year in
| the US. If you're going to allow that without prohibition, then
| please let us unstuff our noses.
|
| I'm tired of living in a nanny state when we let people buy and
| own guns and swords and flamethrowers. Simply hiking on a
| mountain can kill you. Must we install guardrails on all the
| high places?
|
| It's not that bad of a negative externality. Honestly. Not
| relative to all the other ones we've deemed acceptable. This is
| weird picking and choosing that doesn't make sense.
| equestria wrote:
| > Maybe license people to buy meds and take it away if they
| abuse it? That's better than the draconian system we have
| now.
|
| I sympathize with your broader point, but... how is that
| better? "Sorry, you were buying too much nasal decongestant a
| decade ago, so no cancer medication for you"?
| PeeMcGee wrote:
| I think they were deliberately pointing out the absurdity
| by comparing it to other far more dangerous things we just
| waive off if you have a license.
| otherme123 wrote:
| I understood your parent comment in a specific drug way:
| you can buy pseudo until your license to buy that specific
| compound, or maybe a group or related chemicals, is
| revoked. But you can still get any other compound.
|
| Not that different from current situation: we have all our
| "license" to buy scheduled compounds revoked, but we still
| can get a lot of other compounds.
| renewiltord wrote:
| How is that any better than the current system which is
| just "no cancer medication for you"?
| Nursie wrote:
| I read a study here in Australia a little while ago that
| showed that removal of easily accessible pseudoephedrine had
| done nothing to either stop the proliferation of clandestine
| labs, nor curtail the availability of crystal meth. They just
| switched to different syntheses, and there are still large-
| scale imports that sometimes get caught, sometimes don't.
|
| People were still trying to claim the program was a success
| because they had stopped gangs getting pseudo as a precursor.
|
| But so what? it's done literally nothing to stop criminals
| profiting, nor to stop people getting addicted to meth, with
| all the associated public health and petty-criminal
| consequences of that. And now it's harder for ordinary people
| to get effective decongestant.
|
| It just seems that nobody is willing to admit the whole thing
| was pointless.
| EdwardDiego wrote:
| Same in New Zealand, we removed pseudoephedrine as an
| option unless you had a special dispensation from the
| Ministry of Health - mainly due to pharmacies being ram-
| raided for the pseudo.
|
| The end result? The gangs just started importing pseudo,
| before later just switching to importing methamphetamine
| directly (something that Australia's deportation policies
| really helped with as the "501s" as we call them that were
| deported back to NZ often had existing connections that
| could facilitate the direct importation of meth).
|
| It's a really interesting supply chain that involves
| organised crime groups in multiple countries, often starts
| in India for the precursors, then clandestine labs in
| Laos/Vietnam/Thailand overseen by Chinese groups in
| conjunction with local groups, then smuggled via the
| Pacific Islands, notably Fiji and Samoa where the Chinese
| groups have established transshipment facilities, before
| being smuggled into Australia and NZ by local groups who
| then distribute and supply it.
|
| A new development has been the Central American cartels
| branching out from cocaine to meth so there's been a bunch
| of meth coming directly from the Americas.
| epistasis wrote:
| The car stat is a good example of trying new policies to
| lower car deaths! They are the greatest risk to my children's
| lives and I find it terrifying that we let them roll around
| everywhere so close to people, like we do in parking lots.
|
| >Maybe license people to buy meds and take it away if they
| abuse it?
|
| I'm a bit confused, because you can buy it already with an
| ID, correct? You don't even need a purchasing license, just a
| drivers license or other government ID.
| 0x457 wrote:
| No, they mean you get a license to buy meds and that
| license gets revoked if you abuse them. Not that you need a
| _driving_ license to buy meds.
| loopdoend wrote:
| It is even easier to get in Singapore.
| radicality wrote:
| Really? As in, in spite of how bonkers the overall import
| rules in Singapore are?
|
| I just travelled there few weeks ago, and the government
| websites made it sound like it's best to just not bring any
| pills at all (or chewing gum).
|
| - Tool you can to use to check active ingredients and
| whether its allowed: https://www.hsa.gov.sg/personal-
| medication/check-requirement...
|
| - Anything that might be controlled/require prescription,
| have to apply for permit it to bring it:
| https://www.hsa.gov.sg/personal-medication/submit-
| applicatio...
|
| - They provide a tool to show illegal health products.
| Better not bring one of them: https://oscar.hsa.gov.sg/Publ
| ication/ahpdm/faces/AHPPublicat...
| refurb wrote:
| It's the same in Singapore.
|
| You can only buy from a pharmacist (behind the counter) and
| you need to provide your national ID number. Your purchase
| is put in a database that any pharmacist can see.
| cyberax wrote:
| > Pseudoephedrine being pulled from the shelves is one of the
| biggest crimes of our time.
|
| What's even worse, modern pseudoephedrine is produced in a
| form that makes meth synthesis from it extremely tedious and
| generally impossible in home conditions:
| https://pmc.ncbi.nlm.nih.gov/articles/PMC3793278/
| 15155 wrote:
| 99% of pseudoephedrine sold is not this form and this
| specific product has already been debunked years ago with
| Mississippi's complete ban (and their refusal to allow it.)
|
| I remember the video of the pharma rep or cop or whoever
| trying to make meth out of the new pills and the product
| getting squishy. Months later, a different video was
| published, where some household solvent was used to easily
| pull the very-dissolvable pseudoephedrine salts from the
| paste.
| JumpCrisscross wrote:
| > _Pseudoephedrine should be easy and plentiful to obtain_
|
| Anything that isn't directly physically addictive ( _e.g._
| opiates) or subject to a tragedy of the commons ( _e.g._
| antibiotics) should be over the counter.
| AnthonyMouse wrote:
| Addictive is the argument _in favor_ of making it over the
| counter. Addicts will do whatever it takes to get their
| fix, so if there isn 't a legal path, they buy on the
| street, creating a funding source for organized crime and
| spurring gang violence.
|
| Then, because the black market is already in violation of
| the law, there are no purity standards. The customer who
| thinks they're getting Adderall or codeine is actually
| getting fentanyl because fentanyl's much higher potency
| makes it easier to smuggle, but for the same reason makes
| it much more prone to addiction and overdose, especially
| when careless street dealers get their proportions wrong.
| All of which is avoided if you just let them buy it from
| the pharmacy.
|
| Notice that there is no thriving black market for
| antibiotics propping up international drug cartels, because
| they're not addictive.
| JumpCrisscross wrote:
| > _Addictive is the argument in favor of making it over
| the counter_
|
| You want to control the general population's access to
| physically-addictive substances to control addiction.
| Managing addicts is not a pharmaceutical matter.
| echelon wrote:
| We don't control access to alcohol, paints/volatiles,
| aerosols, and so many other things people abuse.
|
| Just yesterday on Reddit there was a thread that went
| viral for "cutter" reviews on Shein razor blades, with
| cutesy language like "beautiful beans for my followers"
| (referring to subcutaneous dermal appearance when deeply
| cut open). Every product can be abused in horrible ways.
| It's the nature of the stochastic bubble we're in. People
| will find every nook and cranny of the human experience.
|
| You can't stop this stuff from happening. So at least let
| the normal use cases that benefit society through. Don't
| put everyone else in the same straight jacket. We don't
| deserve to be punished for the bad gradients some people
| fall into.
| marcosdumay wrote:
| Ok, if you want to control it, than mediate access
| through a public health institution.
| TeMPOraL wrote:
| Strongly agreed, with one correction: black markets are
| driven by _shortage_. The role of addiction is in
| creating demand, and at the same time making authorities
| restrict access.
|
| There is no thriving black market for antibiotics,
| because they are accessible when you need them (and most
| people need them very infrequently for a short duration).
| In contrast, I believe there _is_ a black market for
| _insulin_ in the US, and that 's because of how
| ridiculously expensive it is. Exuberant pricing is a form
| of restricting access, too.
| cnity wrote:
| You can get it in the UK, fortunately.[0]
|
| 0: https://www.nhs.uk/medicines/pseudoephedrine/about-
| pseudoeph...
| qzw wrote:
| It is a bit silly to ban a useful drug like pseudoephedrine
| while large parts of the US is in an opioid crisis. Kind of
| like how lawn darts have disappeared from stores but you can
| still buy all sorts of weapons. That said, a lot of laws are
| based on established traditions. Alcohol use goes back
| thousands of years, and the other things you mentioned such
| as vehicles and weapons are tools going back even longer.
| They are dangerous tools, to be sure, and often employed
| unnecessarily in this society, but tools nonetheless. Once
| upon a time most people depended on their weapons and
| vehicles to survive, and differences in the quality and
| quantity of weapons and transportation technology have
| historically led to the rise and fall of entire
| civilizations.
| heartbreak wrote:
| > I don't care if people use it to make meth. What they do in
| their private time doesn't concern me.
|
| You ever seen a meth lab that blew up?
| cyberax wrote:
| How did I miss this article before?!? Love it!
|
| > Other side effects may include violent urges or, similarly,
| the urge to be successful in business or finance. ... > We
| expect that the simultaneous trends of restricting
| pseudoephedrine sales while N-methylamphetamine becomes less
| expensive and of higher purity will make the methods presented
| here increasingly attractive.
| LM358 wrote:
| "simple and convenient" does a lot of heavy lifting in this
| paper - _n_ -BuLi, chromium hexacarbonyl and MoOPH (had to look
| that one up!) is not something you find outside of a well
| equipped lab and shouldn't be touched by anyone who isn't
| highly experienced.
| winocm wrote:
| Fun fact, there (was?) is a isomer of methamphetamine that is
| actually over the counter, levomethamphetamine was often found
| in Vicks brand inhalers, though they appear to be discontinued,
| being replaced with a 'non-medicated' version. There are
| apparently generic inhalers that still do contain it though.
|
| https://www.science.org/content/blog-post/other-methamphetam...
| stzsch wrote:
| See also selegiline, which partially metabolizes to
| levoamphetamine and levomethamphetamine. Not OTC though
| (antidepressant).
| winocm wrote:
| Oh man, I have fun stories about selegiline.
| hyperdimension wrote:
| Come on, you can't be vague like that and expect no one
| to ask. Do tell!
| winocm wrote:
| If you _really_ would like to know and enjoy mortal
| suffering, just contact me privately.
| hinkley wrote:
| The problem I found was that nobody wanted to deal with the
| database after a certain time in the evening. Odds are good you
| don't admit you're coming down with something until after work.
| Or at least admit to yourself that medicine would be helpful.
| So by the time you see you're out of Sudafed or can't find the
| old pack, it's often too late to go to the store to get a new
| one before morning.
| ykonstant wrote:
| That's actually hilarious.
| Spivak wrote:
| Am I taking crazy pills, because I've been taking PE for years
| and it works just fine? Like yes the behind the counter stuff is
| _stronger_ but it also comes with more annoying side effects.
|
| I use it to sleep during allergy season and I can tell when I
| don't take it when I mouth breathe the whole night. I might try
| some experiments to see if I can tell but I didn't think you
| could placebo while sleeping.
| ClassyJacket wrote:
| You're almost certainly experiencing the placebo effect.
| There's mountains of evidence phenylephrine does exactly
| nothing.
| readthenotes1 wrote:
| The US government, hard at work.
|
| Next up: FDA proposes ending use of panaceas marked as overpriced
| drugs.
| spoonsies wrote:
| Next up, eliminating the work of the Fiendish Fluoridators
| wombatpm wrote:
| I've hearing great things about this new drug called placebo.
| You can apparently prescribe it for anything and in many cases
| it's just as good as existing medications.
| jabits wrote:
| Well, I guess I'm here because of one of these miracle drugs.
| My kidneys would have crapped out year ago without it. I
| guess call me a fan...
| dudeinjapan wrote:
| It's also a great band!
| evanjrowley wrote:
| Phenylephrine worked great for clearing my mucus overproduction.
| Unfortunately, this has little to do with allergy relief, so I
| can see why many here hold that it's ineffective. I can imagine
| how frustrating it must be to have actual allergy issues and be
| prescribed something that doesn't solve the problem.
| Nursie wrote:
| It's not just allergies - taken orally there is no evidence it
| works for anything, and there's pretty good evidence it is
| basically metabolised away.
|
| The frustration largely comes from pharmacists and
| pharmaceutical companies selling decongestant remedies that do
| nothing and are known to do nothing.
| tobinfricke wrote:
| Well, it doesn't work.
| gnabgib wrote:
| Discussion (136 points, 76 comments)
| https://news.ycombinator.com/item?id=42083559
| dang wrote:
| Merged hither. Thanks!
| schoen wrote:
| Context for readers from countries where this isn't an issue, or
| anyone who hasn't followed decongestant news: one of the most
| effective decongestants is called pseudoephedrine.
|
| https://en.wikipedia.org/wiki/Pseudoephedrine
|
| In the past this was easily available, with the most popular
| brand being Sudafed. My parents always told me that one should
| take Sudafed when flying after having had a cold, in order to
| avoid severe ear pain from the pressure changes, but people would
| also obviously take it when not flying, just in order to reduce
| the discomfort of the congestion itself.
|
| Pseudoephedrine is very effective. It is also used to synthesize
| the somewhat related illegal drug methamphetamine ("meth").
| Historically, meth manufacturers would hire people to buy large
| amounts of pseudoephedrine pills at pharmacies and supermarkets,
| then grind them up and synthesize meth from them.
|
| In order to deter this, authorities in the U.S. restricted the
| availability of pseudoephedrine, while not making it
| prescription-only, by limiting the amount that people could buy,
| and requiring buyers to show ID and be put on a registry (which
| law enforcement could use in investigations). I think this is the
| only drug that is treated this way. Some people stopped buying
| pseudoephedrine entirely, either because they were offended by
| these rules or because they were afraid that they could wrongly
| be implicated in meth investigations if they appeared to buy it
| too often.
|
| The pharmaceutical industry produced an alternative called
| phenylephrine, the substance that this proceeding relates to.
| Most manufacturers of pseudoephedrine-based drugs, including
| Sudafed, formulated alternative decongestants using
| phenylephrine. There are no legal restrictions on phenylephrine
| drugs; one can buy them anonymously and in any quantity.
| Customers have complained for years that these are much less
| effective than the original formulations.
|
| A couple of years ago this regulatory authority started looking
| into the question of whether phenylephrine is actually
| _completely useless_ as a decongestant (rather than just much
| worse than pseudoephedrine). Their preliminary review of studies
| suggested that it is probably, in fact, useless. This proceeding
| is now proposing to ban it on the grounds that it 's ineffective
| and so people should not be encouraged to buy and use it as a
| medicine for purposes for which it doesn't actually work.
|
| (There doesn't seem to be much corresponding initiative to remove
| or reduce the restrictions on pseudoephedrine.)
| gniv wrote:
| I read this and was puzzled, until I realized that you are
| talking about the pills. The nasal spray is effective, although
| probably not more effective than a saline solution.
| notpushkin wrote:
| > although probably not more effective than a saline solution
|
| I guess saline is a baseline against which effectiveness
| should be measured here, especially since nasal sprays are
| usually saline plus something. (I guess? Not sure about
| Sudafed specifically.)
| bottom999mottob wrote:
| I'd argue that saline should be the panacea here. I doubt
| very many people do at-home saline rinses with filtered,
| sterilized water and a simple mixture of salt and baking
| soda.
|
| Do people really want to spray PFAS water directly into
| their mucus lining?
|
| I bought an Arm and Hammer Saline spray out of curiosity.
| It smelled awful, and the BPS lined can had an awful smell
| despite the ingredients being: water, salt, baking soda,
| and no suspicious preservatives.
| dreamcompiler wrote:
| True except it is definitely more effective than saline.
| Phenylephrine nasal spray is not as effective or long-lasting
| as oxymetazoline, but it's also not as dependency-inducing.
| rrrrrrrrrrrryan wrote:
| The efficacy of the nasal sprays had already been
| demonstrated when they introduced the pills. Surprisingly,
| the efficacy of the pills was never properly demonstrated,
| and now that it's being investigated, they're pulling it from
| the shelves.
| seattle_spring wrote:
| In my experience phenylephrine is worse than useless. Not only
| does it do nothing for congestion, but it makes me feel wired
| in a bad way and unable to sleep for at least 24 hours. I
| _hate_ phenylephrine.
| joeevans1000 wrote:
| Good summary. To add to what you've said, Sudafed (as an
| example brand name) opens your eustachian tubes which are
| passages from your inner ear to your throat. If you think you
| might be getting an ear infection, Sudafed increases draining
| and potentially helps prevent a worse infection. As mentioned,
| it helps air equalize to the atmosphere via these tubes. If you
| make a yawning motion now and hear your ears crackle, that's
| the air moving through your eustachian tubes. You'll notice
| that crackling decrease when an ear infection may be imminent.
| I tried the useless alternative and discovered on my own that
| it was, indeed, useless. And it was quite expensive, with great
| marketing on the box.
| deng wrote:
| So at least here in Germany, we pretty much all use nasal spray
| with xylometazoline, and it's very effective as it also binds
| to adrenergic receptors. It does not seem to be available in
| the US, and at least from a cursory search I cannot find out
| why...?
|
| EDIT: After looking a bit more, the simple answer seems to be
| that it's not FDA approved for nasal congestion, and since
| there's not much money to be made, there's simply no incentive
| to go through the costly approval process..
| relistan wrote:
| I've wondered this also. As an American who lived in Germany
| and found this while living there, I can attest that it's
| quite effective for me. There are other quite useful and safe
| drugs that are not available in the US.
| Aurornis wrote:
| The US equivalent is oxymetazoline
| https://en.wikipedia.org/wiki/Oxymetazoline
|
| It's actually slightly more selective for a1 receptors than
| the German alternative. They both have the same dependence
| potential and rebound liability.
| robinduckett wrote:
| They have oxymetazoline but I think the problem with this
| class of decongestants is that it is ineffective and
| dependency is basically guaranteed if used for more than a
| couple of days
| deng wrote:
| Oxymetazoline is different from Xylometazoline, although it
| was derived from it. Xylometazoline is pretty harmless for
| adults when not used over extended periods (it is advised
| to not use it longer than 6 days, but that will cover your
| typical cold). It is true that if you take it regularly
| over extended periods, you will have a rebound effect and
| your nose will get congested when not taking it, so in that
| way, you develop a "physical dependency", but that's
| obviously much more harmless than other medication
| dependencies. Getting off a Xylometazoline dependence means
| that you'll have to deal with a congested nose for a few
| weeks...
| sph wrote:
| I don't see from your comment how the risk from congested
| nose for a few weeks deems it "harmless" for you. Two
| fully congested nostrils is hell for one night alone,
| imagine a few weeks of that. A few weeks of terrible
| sleep, if any. It's torture.
|
| It can also cause permanently enlarged turbinates with
| chronic use.
| deng wrote:
| I said it's more harmless than other medication
| dependencies, like getting hooked on pain medication or
| benzos. Even here in tightly regulated Germany,
| Xylometazoline can be bought without a prescription. It
| is very effective and, compared to other drugs, pretty
| harmless.
|
| Look, there are always extreme cases. Just look up how
| many people need a liver transplant or even die each year
| from misusing paracetamol. So should we make it a
| prescription drug? Maybe, I don't know, it's always a
| trade-off.
| gojomo wrote:
| Is there any basis to think xylo- is better than the
| similar oxymetazoline available in the US? Both the
| efficacy and downsides seem similar from discussion so
| far.
| sph wrote:
| > I said it's more harmless than other medication
| dependencies, like getting hooked on pain medication or
| benzos.
|
| I've never taken any opiod, but two weeks of being unable
| to breathe properly or sleep sounds as hellish as my idea
| of quitting heroin.
|
| I mean, I quit smoking, hardest thing I've ever done, and
| the physical withdrawal effects were insignificant
| compared to that.
|
| It's funny; looking back, I quit smoking exactly BECAUSE
| I was suffering from crazy congestion, and after a week
| of Afrin and poor sleep I thought quitting smoking
| altogether would help me regain my sanity.
| deng wrote:
| > I've never taken any opiod, but two weeks of being
| unable to breathe properly or sleep sounds as hellish as
| my idea of quitting heroin.
|
| Let me assure you that there's (yet?) no Xylometazoline
| epidemic ravaging though Europe, with tens of thousands
| of people dying each year, destroying families and
| communities, in effect causing endless grief for people
| and huge profits for pharma companies. There's also no
| black market for Xylometazoline, with people overdosing
| because there's nasal spray on the street that is
| contaminated with a much more potent derivative than can
| kill pretty much instantly. I've also never heard of
| babies born with congested noses that spend their first
| weeks of life going through a Xylometazoline withdrawal.
|
| So to summarize, I think my initial statement that a
| physical dependence on Xylometazoline is less harmful
| than a dependence on opioids is probably correct.
| qwerty456127 wrote:
| Many medicines pose some risk to some people who would
| abuse it for too long. Xylometazoline just is crazy
| effective (instantly eliminates congestion and running
| nose completely in most cases) and completely harmless in
| what looks like 99% cases of usage - nearly-everyone here
| in the EU uses it happily and has no problems. I would
| really dread a cold without it and never travel without
| having it with me. Just try to not over-use habitually.
| The sense of measure is always a key to healthy and happy
| living.
| jorvi wrote:
| That's why if you developed a dependence you don't quit
| cold turkey.
|
| The strategy I've heard is purchasing a normal bottle,
| and refilling it with boiled cool water when it's 1/2
| empty. Then refilling it again when it's 3/4 empty.
|
| Xylometazoline is an absolute godsend, and has even more
| efficacy in a dual-action spray with saline water.
|
| It feels nothing short of magical to do one spray per
| nostril, and be completely uncontested in less than 10
| minutes.
| gojomo wrote:
| In my experience oxymetazoline has similar fast-action -
| even "10 minutes" seems a bit on the long side.
| sph wrote:
| Worse, the symptoms gets worse after you stop using it, see
| _rhinitis medicamentosa_.
|
| Many people have used decongestants so much they cannot
| quit them or will have to suffer weeks of nasal congestion.
| I risked going through that; later I swore I will never
| touch one ever again.
| wruza wrote:
| Same. I'd rather start and quit smoking again than this.
| Terr_ wrote:
| > Worse, the symptoms gets worse after you stop using it,
|
| Very tangentially, "iatrogenic" is a nice niche
| vocabulary word: Something unintentionally caused by a
| medical activity, usually undesirable.
| morsch wrote:
| Kind of funny to see a medication that's super common in
| Germany, widely recommended by doctors, given to
| children, etc. to be discussed in those terms.
| Moto7451 wrote:
| This isn't that strange in the context that all
| medicines, while generally safe in OTC form, can have
| negative side effects if used for too long or at the
| wrong dose or in the wrong circumstance.
|
| My wife has one kidney and as such is told to avoid
| NSAIDs as a class of medicine. She's realistically fine
| taking it every so often but her doctors are asking her
| to avoid using kidney capacity that could hypothetically
| be needed to filter and excrete something else.
|
| Acetaminophen/Paracetamol is great alternative for her
| since it's processed in the liver. However if you're a
| frequent drinker, have a liver deficiency, or have to
| take some other drug straining your liver, it's
| contraindicated.
|
| For most of us most of the time you're completely correct
| though.
|
| In the case of these nasal spray decongestants I had a
| case of rebound congestion due to over-reliance on them
| while surviving some family bringing really bad colds
| into the house and my son starting daycare. It was really
| bad. I then managed by switching to an alternating
| schedule of pseudoephedrine and the nasal spray so I
| could reduce the physical dependency on the latter and
| get a good night's sleep.
|
| My doctor eventually cleared me to take an allergy spray
| medication (Fluticasone propionate) that is safer for
| long term use but generally not used for colds because it
| inhibits immune response and mask the symptoms which can
| cause new infections and hurt your ability to heal. Yet
| another case of the mundane medicine that is
| contraindicated. While seemingly being the wrong thing to
| be put on while fighting off infections it worked out
| great.
|
| After four months I had seen enough child germs and no
| adult has brought their own plague or food poisoning (it
| was a very bad summer for me) and I finally became
| healthy again.
| deng wrote:
| > Acetaminophen/Paracetamol is great alternative for her
| since it's processed in the liver. However if you're a
| frequent drinker, have a liver deficiency, or have to
| take some other drug straining your liver, it's
| contraindicated.
|
| What many people don't know: Overdosing on paracetamol is
| the leading cause of acute liver failure. It's also
| contraindicated for people with Gilbert's syndrome, which
| is actually pretty common (~5% of people in the US) and
| most people don't even know they have it, as it's
| harmless and usually only found accidentally through high
| bilirubin levels in the blood.
| pfdietz wrote:
| What is very common is hepatosteatosis, or fatty liver
| syndrome. Something like 1/3rd of American adults have
| it.
| marcosdumay wrote:
| Go read the side-effects and restrictions of commonly
| used medicine some day, it's unsettling.
| Eddy_Viscosity2 wrote:
| I've been through this and sucked hard. Never will I use
| a decongestant nasal spray again.
|
| If there was a way to somehow sum up all of the suffering
| caused by these sprays from dependency (which lasts
| weeks, months, years even) and compare that with the
| suffering alleviated from a cold (which lasts a fews
| days), my bet is these cause more harm than good.
| bondarchuk wrote:
| Did you really develop such heavy dependence after using
| it a few days at a time? I don't get that at all.
| pull_my_finger wrote:
| It's not a dependence like mental addiction. Your body
| becomes dependent on it. Your sinuses "rebound" and all
| but completely block in absence of the spray. I had a
| cold that blocked my nose up so bad I couldn't sleep
| because I was afraid of suffocating so I tried one of the
| sprays and it opens you up like magic, super effective.
| But about an hour after use if would completely block up
| again where you literally can't inhale through your nose
| at all. That's how it is even after you get over the
| cold/illness. You have to continue to use the spray to
| keep your airway open until you suffer through breaking
| the "addiction" by not using it for however long that
| takes. It really does immediately open your airway, but I
| won't EVER use it again because it's really scary to be
| completely blocked like that and have to get a dose in
| every 30mins-hour just to breath.
| karmonhardan wrote:
| The best thing I ever did for decongestion was to get
| outside and start wearing a mask during the winter. The
| air entering my nose is clearer and warmer, which causes
| less mucus production. The mucus that is produced is more
| likely to drain, rather than sit around thickening and
| waiting to be blown out. I wish I'd thought to wear a
| mask while out when I was younger; could have saved
| myself much suffering waiting at the bus stop and during
| the subsequent schoolday.
| derekp7 wrote:
| Back when I was a kid, scarfs were more popular and
| served a similar purpose.
| dreamcompiler wrote:
| Oxymetazoline is an _extremely_ effective nasal
| decongestant. It works almost instantly and it lasts 24
| hours.
|
| It also creates dependency. A drug that is ineffective
| cannot cause dependency.
| admash wrote:
| Of course it can. You take drug A for 5 days to get rid
| of symptom X. The symptom X does not go away. It is
| ineffective! You stop taking drug A and immediately
| experience brutal migraines that go away when you start
| taking drug A again. Ergo, you have become dependent on
| drug A for normal functioning, even though it is
| ineffective at ridding you of symptom X.
| AdamN wrote:
| There are nasal sprays in the US - and yes they are more
| targeted and better in general than pills. But Americans love
| their pills ... almost as much as Germans love their
| homeopathic remedies :-)
| lynx23 wrote:
| No worries, "Meth" was largely unknown in my area, until you
| guys exported "Breaking Bad". Roughly a year or two later, it
| started to be available here as well. Thanks for that, media
| industry, that was a wonderful move! /s
| 2rsf wrote:
| pseudoephedrine have serious side effects, they are rare but
| could be fatal
| dreamcompiler wrote:
| Also true of aspirin, ibuprofen, acetaminophen,
| dextromethorphan, melatonin, vitamins, supplements, and
| practically every other over-the-counter drug that is not
| homeopathic.
| TeMPOraL wrote:
| Homeopathic too - water allergy is a thing.
| delecti wrote:
| Homeopathic pills are usually literally sugar pills,
| essentially small crummy candy, so not really any water,
| despite the purported basis of the "technology".
| immibis wrote:
| ESPECIALLY acetaminophen aka paracetamol aka Tylenol aka
| Panadol. This is the single drug with the smallest ratio
| between the effective does and the lethal dose, and it
| would not be approved today because of that. Oh, and you'll
| be fully conscious while you're dying and there's no known
| antidote.
| Aerroon wrote:
| > _and there 's no known antidote._
|
| Isn't NAC (N-acetyl-cysteine) used for that?
|
| https://www.ncbi.nlm.nih.gov/books/NBK537183/
| xienze wrote:
| My Googling says 7.5g-10g is a lethal (acute) dose for an
| adult. The extra strength Tylenol pills come in 500mg,
| and they recommend two of those at a time. Not saying
| it's wrong that the gap between "effective" and "lethal"
| is small, but at the same time it's hard to accidentally
| take 15-20 pills at a time.
| cloverich wrote:
| I've commonly been recommended 3-4 g per day by
| Physicians. I take 1 gram as my standard dose.
| dreamcompiler wrote:
| 1 gram is the standard dose for a full-sized adult with a
| healthy liver who is not taking the drug in conjunction
| with alcohol.
|
| As to frequency I limit myself to 2 g per day but that's
| just me giving my liver extra time to recover.
| NikkiA wrote:
| Now consider people with memory issues such as dementia
| where they might have a headache, take 2 pills, then 10
| minutes later think 'I have a headache...'
| 0x457 wrote:
| if we're talking about people with dementia and/or memory
| issues - almost everything becomes dangerous. Not an
| argument. Doors aren't dangerous, but now imagine a small
| child being hit with one.
| qwerty456127 wrote:
| > Their preliminary review of studies suggested that it is
| probably, in fact, useless. This proceeding is now proposing to
| ban it on the grounds that it's ineffective
|
| Is ineffectiveness really a good reason to ban a substance? Why
| not just ban labeling it as a medicine instead?
| drpossum wrote:
| If you read the article title it is not a ban on the drug.
|
| > Ending Use of Oral Phenylephrine as OTC Monograph Nasal
| Decongestant Active Ingredient
|
| It is a ban on marketing/listing this as an active ingredient
| on those products. If you read further into the article this
| is only for oral use and they're requesting comments for
| nasal use, which would be unaffected by this.
| qwerty456127 wrote:
| Makes sense. Thank you for clarifying.
| viciousvoxel wrote:
| That is actually what is happening, per the article. It's
| being banned as being labelled an "active ingredient" in OTC
| decongestant pills.
| potato3732842 wrote:
| But think about all the jobs the government by created running
| that registry, prompting the drug makers to formulate and
| manufacture bogus decongestants and then eventually studying
| that those bogus decongestants were in fact bogus.
|
| (in case it wasn't obvious, this is broken windows fallacy)
| a_c_s wrote:
| The "registry" is signing your name on a sheet of paper on a
| clipboard - less than 1% more work for the pharmacy
| employee's overall job, approximately 0 new jobs created.
| matttproud wrote:
| The need to show an ID to purchase real pseudoephedrine (feels
| like an oxymoron to write that) can be a legitimate PITA. I am
| American who lives abroad but is frequently back in the U.S.
| for family reasons. I suffer from sinus problems, so I
| periodically need to purchase pseudoephedrine-based products.
| Because I have no state ID, the show-ID-based workflow
| essentially fails. For whatever reason, the pharmacies won't
| take a U.S. passport (or foreign ID card), so they end up
| spending 15 minutes futzing with the data entry software, only
| to resign to entering garbage into the system.
|
| And as OP points out: Phenylephrine is 100% useless.
| slowmovintarget wrote:
| Phenylephrine is useless. As an extra added bonus, it will
| still spike your blood pressure, so it isn't just useless,
| it's dangerous to people with high blood pressure.
|
| Nasal irrigation is the way to go for sinus trouble. It's
| more work and takes a little getting used to, but no ID
| needed to buy saline and baking soda packets, and it actually
| works.
| Tagbert wrote:
| ORAL phenylephrine is useless, Nasal is not.
| Rebelgecko wrote:
| I was 17 for my first few months of college and got horribly
| sick and congested. The school pharmacy wouldn't sell me the
| real Sudafed because of my age... not sure if that was part
| of the nationwide Patriot Act restrictions on Sudafed or a
| specific state law. I thought about getting someone of age to
| buy it for me but I was too much of a goody two shoes to go
| through with it.
|
| I ended up going to the doctor and getting sent home with a
| bottle of opioid cough syrup. Fortunately didn't end up
| addicted or anything, but it was very frustrating at the
| time.
| bityard wrote:
| Stores around me stopped selling it altogether because they
| got tired of dealing with both the registry itself and the
| customers who get irate when told they're going on a list for
| buying cold medicine. It sucks but I can't say I blame them.
| Zak wrote:
| The restrictions on purchasing pseudeophedrine should be
| repealed. Their imposition led methamphetamine manufacturers to
| switch to a more efficient process based on different
| ingredients. Purity and production volume increased
| substantially.
|
| A repeal won't turn back the clock on that of course, but it
| will make life easier for people with congestion.
|
| https://dynomight.net/p2p-meth/
| Stevvo wrote:
| Wasn't that literally the plot of Breaking Bad? Walt's meth
| was p2p meth.
| jcpham2 wrote:
| Yes. Jesse couldn't score enough product via his smurfs, so
| they had to find an alternate industrial method for
| quantity purposes - in the show.
| mullingitover wrote:
| I'm just as annoyed with the hurdles to buying real
| pseudoephedrine as anyone else, but let's not make the
| production of bathtub meth any easier. It is not worth it.
| Clubber wrote:
| Why? Do you believe it made any dent in meth manufacturing
| what so ever? It's just drug war theatre.
| verteu wrote:
| It seemed to decrease the number of exploding meth labs
| in the country:
| https://www.statista.com/statistics/942043/laboratory-
| incide...
| Zak wrote:
| That seems to track pretty well with the rise of P2P
| meth. It's unlikely many people would return to setting
| up small labs using pseudoephedrine because large scale
| operations using P2P have driven the price down to the
| point that it wouldn't be profitable.
|
| There might be an increase in people making tiny batches
| for personal use if pseudoephedrine became easier to get,
| but nothing on the scale of 20 years ago.
| Zak wrote:
| Given the prevalence of P2P meth and apparent inability of
| governments to do anything about it, this does not seem
| like a rational position to me. If there was any reason to
| believe that large scale production will ever be
| substantially curbed, there might be a case for it.
| mullingitover wrote:
| Yes, P2p meth is rampant and cheap. However I look at it
| like this: Meth addicts will absolutely decide to become
| chefs if the ingredients are readily available, even if
| there's a McDonalds down the street. You're approaching
| this rationally, which is not what meth addicts are going
| to do.
| marcosdumay wrote:
| If it is readily available down the street, it looks to
| me that people cooking their own is a superior outcome
| for society in every single way than they buying it down-
| street.
|
| Even more if the professional labs close down due to lack
| of customers.
| mullingitover wrote:
| A buddy of mine worked his way through college cleaning
| out meth labs in homes and motels after they had
| (typically) blown themselves up. They are toxic
| nightmares. He was especially shaken when he'd find the
| family photos indicating that the labs were operating
| while children were in the home.
|
| The professional labs would absolutely not close down due
| to lack of customers, there would just be even more meth
| available, more contaminated, with the bonus of hazmat
| sites peppering communities.
| busterarm wrote:
| Right, but would reopen the door to your random tweakers
| setting up shit labs in squats/rental properties and
| destroying property values.
|
| That stuff's toxic AF even if the labs don't blow up.
| standardUser wrote:
| Restrictions on pseudoephedrine did nothing to curtail the
| manufacture, sale or use of amphetamines in this country.
| It didn't even raise the price. If anything, speed of all
| kinds is easier to get today.
| HDThoreaun wrote:
| The restrictions centralized production though. Now
| almost all meth is being made in a lab that can import
| Phenylacetone from china. That's safer than someone next
| door setting up an explosive cookhouse.
| willcipriano wrote:
| Even safer if they sold it at Walmart.
| 0x457 wrote:
| meth production didn't stop, in fact it switched to far
| more efficient ingdidient and made meth much worse than it
| was before.
|
| It's cheaper and pure than it was ever been since the ban.
| jjice wrote:
| > ...but it will make life easier for people with congestion
|
| I haven't purchased pseudeophedrine, but my understanding was
| that you just walked up to the counter and had to sign your
| name at the pharmacy. Is that not the case? Doesn't seem like
| a big pain if that's the case.
| jcpham2 wrote:
| You can can do this or your doctor can write you a
| prescription. I've never stopped using pseudoephedrine and
| depending on how congested I am sometimes it's the little
| red 4 hour pills or sometimes it's the big monster 12 hour
| version - but your doctor can write a generic prescription
| for pseudoephedrine and the quantity and amount and you can
| buy a box that way via cash or insurance too.
| Zak wrote:
| It means you have to go to the pharmacy when it's open.
| That's a significant hurdle if you're sick, especially if
| you have something contagious and you're trying not to
| expose people to it, or if you work weird hours, or if you
| don't have reliable transportation, or if you're the
| primary caregiver for young children, etc....
|
| It also means you can't get it delivered, can't stock up,
| might have trouble sending someone else to get it, etc....
| It's a big pain for some people, and particularly for
| people who already have a harder life than average.
| ultrarunner wrote:
| GP said:
|
| > Some people stopped buying pseudoephedrine entirely,
| either because they were offended by these rules or because
| they were afraid that they could wrongly be implicated in
| meth investigations if they appeared to buy it too often.
|
| This has actually happened [0], and I seem to remember more
| instances (at least when the law was first passed). I know
| I have also gone to buy it in a headache-induced fog and
| found that I've forgotten my ID, and on at least one
| occasion the national drug whatever system was down and
| they refused to sell it. Because it has to be run through
| the specific national database, it has to be run through
| one department and I have been unable to purchase because
| that department has closed for the day.
|
| These are just what comes to mind when I think about
| purchasing pseudoephedrine over the years; it's just
| generally become a pain to get. It makes me wonder if it'd
| be quicker and easier to just buy meth and reintroduce the
| hydroxyl group to get my cold medicine.
|
| [0] https://reason.com/2009/09/28/hoosier-grandmother-
| arrested-f...
| tptacek wrote:
| That happened 15 years ago, just a couple years after the
| policy is created. A more compelling example of a
| spurious prosecution would be one more recent, say, after
| 2016. We can probably find some! The last time people
| looked, we found a pretty interesting story.
| Lammy wrote:
| > It makes me wonder if it'd be quicker and easier to
| just buy meth and reintroduce the hydroxyl group to get
| my cold medicine.
|
| Relevant: "A Simple and Convenient Synthesis of
| Pseudoephedrine from Meth"
| https://news.ycombinator.com/item?id=33444852
| https://maggiemcneill.com/wp-
| content/uploads/2012/03/synthes...
| wormius wrote:
| It's still a pain in the ass you can't just go to the gas
| station and get some, etc... There shouldn't be a need to
| go to a pharmacy for what should be an over the counter
| drug that's far more effective than synephrine ever was.
| The difference between the 2 is night and day, probably
| because one actually works and the other maybe kinda sorta
| barely does.
| devilbunny wrote:
| Depends on the state; at least some have made it
| prescription-only.
|
| It's much less convenient than going to the nearest 24-hour
| store and grabbing it off the shelf. And I'm a doctor
| married to a doctor; I don't have to get an appointment to
| get a prescription for a non-scheduled drug, but I do have
| to go during pharmacy hours and wait to pick it up.
| standardUser wrote:
| It's a huge pain if the pharmacy is closed or has a long
| line. A pointless, purposeless pain. Another sacrifice the
| the always-ineffective yet never underfunded drug war gods.
| fullspectrumdev wrote:
| The downstream effects in other countries are pretty
| annoying.
|
| Because of US restrictions on pseudo, bizarrely other
| countries have followed suit - it's next to impossible to
| find a decongestant with pseudo here in Ireland, they will
| sell you the useless phenylephrine shit instead, and the
| packaging is almost indistinguishable unless you spend a
| while looking and arguing with a pharmacist who is
| convinced phenylephrine works just as good.
| abraae wrote:
| > Because of US restrictions on pseudo, bizarrely other
| countries have followed suit
|
| Replace pseudo with cannabis and the statement remains
| true.
| jrockway wrote:
| It's a big pain. The prescription line at my pharmacy is
| never shorter than 15 minutes. Thus the drug is $11/month
| but costs me $60 in time to wait in that line. Meanwhile,
| other drugs are just mailed to me, including my
| prescriptions.
|
| The prescription line is always fun. I remember some dude
| coughing on everyone, picking up his cell phone, "oh it was
| positive? great, I'm in line to get the medication"
| referring to COVID. In my opinion, the easiest place to get
| sick is waiting in the prescription line. Yet another tax
| on congestion sufferers.
|
| Having said all that, your doctor can write you a
| prescription and all the restrictions go away, including
| the ID check. It has always delayed my fills even further
| so we don't bother anymore.
|
| The most positive outcome from buying pseudoephedrine in
| line was being told "hey, your ID expires tomorrow" which
| was a good catch. I wasn't paying any attention to that. (I
| don't drive, so it's just a piece of plastic with my name.
| But necessary for paying taxes online in NYS.)
| woodruffw wrote:
| This is a complete tangent, but FWIW: you can pay taxes
| in NY with an expired license.
|
| Source: I've been paying taxes in NY with a _learner 's
| permit_ that's been expired for well over a decade.
|
| Edit: I've also used said expired permit to buy
| pseudoephedrine. In my experience, they get frustrated
| and put random garbage into the tracking system when the
| card doesn't verify, demonstrating that it's all theater.
| It did take a while, though, so your point about this
| being a waste of time holds.
| Alupis wrote:
| > Thus the drug is $11/month but costs me $60 in time to
| wait in that line
|
| In what reality? You were not being paid $60 to grocery
| shop or whatever else you might have done with that 15
| minutes. Nor did it actually reduce your bank account by
| $60 to wait 15 minutes. If you applied this logic to
| everything in life, reading this very comment probably
| "cost" you a dozen bucks too. What a fun way to live?
|
| > Meanwhile, other drugs are just mailed to me, including
| my prescriptions.
|
| How often are your anticipating needing pseudoephedrine?
| For most people it's a once a year, _at most_ , thing.
| jrockway wrote:
| I take it every day; deviated septum and allergic to
| everything even after decades of immunotherapy. Maybe I
| should get surgery. But this is easier.
| Alupis wrote:
| You can't take pseudoephedrine every day. Nor is
| pseudoephedrine used for allergies - it is a
| decongestant, not an antihistamine. Nor does
| immunotherapy "solve" allergies.
|
| A simple google search before posting would have made
| your fictitious scenario a little bit more believable.
| jrockway wrote:
| Guess what happens when allergens irritate the inside of
| your nose? You get congested.
| jjtheblunt wrote:
| have to produce a government id also
| jmcclell wrote:
| I suffer from seasonal allergies that last anywhere from
| 2-4 months out of the year. During the height of allergy
| season, I take Claritin-D - a mixture of loratadine and
| pseudoephedrine.
|
| Claritin-D 24-hour caplets come in boxes of 10. You need 3
| boxes to get a full month's supply. Each caplet has 240mg
| of pseudoephedrine - 2.4g per box.
|
| In my state, individuals can purchase up to 9g of
| pseduoephedrine per month, but only up to 3.6g per day.
|
| So, while I can technically purchase a full month's supply
| of Claritin-D, I can't buy more than one box at a time.
|
| These sorts of rules are minor inconveniences for an
| individual compared to the rest of life's challenges, but
| they exist in a special category of stupid that make them
| all the more frustrating.
|
| But, here's a thought: what if I had children who needed
| the same medication? Who's going without?
| withinrafael wrote:
| Tangent; you reminded me about the Robitussin liquid
| (Dextromethorphan) in my pantry. It prescribes 20 mL
| doses but the bottle contains 118 mL total. Really grinds
| my gears this is legal.
| jfk13 wrote:
| Some years ago I was very frustrated, as a UK citizen
| visiting the States and suffering from congestion, that I
| was completely unable to buy it because I wasn't carrying
| suitable ID that the pharmacy would recognize.
| cogman10 wrote:
| I did not know that pseudeophendrine could be bought
| without a prescription until last year I think. I was
| deterred from buying it not because I fear putting my name
| down, but because I wrongly assumed I needed a prescription
| and thus a doctors visit to go purchase it.
|
| There aren't exactly signs that say "Hey, the good stuff is
| behind the counter and you don't need a prescription to get
| it".
| diebeforei485 wrote:
| You can't get it delivered using standard delivery apps
| (you can get phenylephrine, or medications containing it
| such as DayQuil, delivered using uber eats or doordash).
| That is an issue when you're sick.
| buildsjets wrote:
| I was refused purchase because I had an out of state
| driver's license. Despite very visibly and audibly
| suffering from severe nasal congestion.
| BurningFrog wrote:
| According to my friend who suffers when there is
| pollen/smoke in the air, it is typically sold out when he
| needs it, because other people breathe the same
| contaminated air.
|
| So he has to drive around to ~5 pharmacies to occasionally
| score a a box.
|
| He does try to stock up during low season, but it's hard to
| do.
| ibejoeb wrote:
| It was a real win/win. Tens of millions of people lost access
| to an effective drug in order to penalize maybe a few
| thousand that were using it as a precursor to making mamp.
|
| But, hey, we beat street meth, right?
| CrazyStat wrote:
| > Tens of millions of people lost access
|
| This is a bit hyperbolic. You just have to ask for it at
| the counter and show ID.
| ibejoeb wrote:
| Only certain documents are accepted: photo documents
| issued by a US state and certain federal documents. There
| are some exceptions in the initial act text, but in
| practice, nobody is going to accept your nursery school
| record.
|
| There are certainly 10s of millions of people who don't
| have direct access to this drug.
| hinkley wrote:
| I've had two doctors and two NPs tell me to stop using sudafed.
| It dries out the mucus membranes and allows infections to
| start. If you've had sinus infections before, they suck and you
| don't want them again. Give the Sudafed away.
|
| (It also gives me horrible insomnia if I take it at night so it
| wasn't a huge hardship).
|
| Guaifenesin thins the mucus instead, makes it more watery so it
| drains down the throat with no further complications like sore
| throat and coughing. And the extra volume helps flush bacteria
| out of the sinuses.
| Dr_Birdbrain wrote:
| The insomnia effect is no joke! It's an amphetamine.
|
| I used to take 24-hour allergy medicine with pseudoephedrine,
| and it took me years to realize it was the thing that was
| giving me insomnia during allergy season--for years I thought
| I just had periodic bouts of intense insomnia.
| hinkley wrote:
| In college I told the clinic I wanted anything but Sudafed
| (joke on campus was they'd give you Sudafed for a broken
| arm). Gave me Sudafed anyway.
|
| First 100% sleepless night in college. And the only
| sleepless night that wasn't having too much fun or
| stressing over a final exam. Trash can.
| hinkley wrote:
| I forgot the worst part: Still had a sniffle the entire
| night. So mad.
| SoftTalker wrote:
| I stopped taking pretty much any OTC meds about 10 years ago.
| My sinuses seem much healthier. I hardly ever get congestion
| or runny nose anymore. Not sure there's a correlation here
| but for me, they don't seem to have any benefit.
| bombcar wrote:
| In general, things like medicine/drugs (even caffeine!)
| should be used as sparingly as possible, so they're
| maximally powerful when you do need them.
|
| If you pop OTC meds at the first sign of anything, your
| body gets used to it and it becomes a baseline; whereas
| before it would blow all the symptoms away, now you need it
| just not to get significantly worse.
| marcosdumay wrote:
| > your body gets used to it and it becomes a baseline
|
| That doesn't happen for every drug. But side-effects
| still exist for them all, so yeah, there are several
| reasons to limit how much you use them.
| kube-system wrote:
| Everyone's body and ailments are different. For some people
| in some situations, the benefits of pseudoephedrine outweigh
| the side effects. For others, it doesn't. Drugs should be
| used on an individualized basis.
| alexjplant wrote:
| The two aren't mutually exclusive. I take pseudophedrine
| whenever I have a serious sinus infection or blocked
| eustachian tubes because it's the only thing that promotes
| drainage. I also take guaifenesin for its mucosal thinning
| effects as a matter of course. I supplement these with nasal
| irrigation, DXM (if the cough is impacting my sleep), and
| diphenhydramine in lieu of the pseudo (again for sleep).
|
| These drugs all have different mechanisms of action and
| specialties and should be used only as needed, i.e. if a
| symptom abates then you should stop taking whatever it is
| that treats it. The problem is that people are too used to
| combination formulations or, even worse, treating all of
| these drugs interchangeably. A chest cold has a different OTC
| treatment regimen than a sinus infection.
| Dr_Birdbrain wrote:
| Additional context on why phenylephrine was ever approved to
| begin with--apparently it is effective if you use it as a
| spray, but apparently nobody bothered to check what happens
| when consumed orally, and it turns out your digestive system
| degrades it quickly and it doesn't even make it into the
| bloodstream.
| freealf wrote:
| An interesting tidbit to add, for working in the industry:
|
| The restricted process around buying pseudoephedrine is imposed
| by state governments and not the federal government. A number
| of the states coordinate their policies, so it looks like
| nation-wide action but really isn't (in a legal sense).
|
| FDA doesn't have the legal authority to put medications "behind
| the counter" like you would see in Europe or Canada. So
| untangled this is a weird mess of overlapping jurisdictions.
| dragonwriter wrote:
| > The restricted process around buying pseudoephedrine is
| imposed by state governments and not the federal government.
| [...] FDA doesn't have the legal authority to put medications
| "behind the counter" like you would see in Europe or Canada.
|
| Someone should tell the FDA, because they seem to think that
| the "locked cabinet or behind the counter" rule, the per
| person per month quantitative limit, the photo ID
| requirement, and the requirement for retailers to track
| personal information of buyers are all federal rules either
| directly in or imposed by the FDA under the authority of the
| Combat Methamphetamine Epidemic Act of 2005.
|
| https://www.fda.gov/drugs/information-drug-class/legal-
| requi...
| fuzzfactor wrote:
| It comes full circle if you go back far enough.
|
| Before Sudafed was common in pills, they had the small
| disposable inhalers where the pseudoephedrine was not in
| crystal form but was dissolved in vaporous liquids like
| menthol. Inside the inhaler there is a cotton piece soaked with
| the pleasant-smelling liquid. The aroma vapors are drawn right
| up into the sinuses along with the active ingredient.
|
| The inhaler itself was first marketed during World War II by
| the well-established 19th century Vicks company, already very
| successful for decades with it's earlier VapoRub aromatic
| topical OTC formulations. People are probably aware that this
| is one of the companies that is older than the US FDA. Older
| than the Fed & income taxes too, for those who are keeping
| score ;)
|
| Natural products like ephedrine have long been the inspiration
| for medicinal chemists to synthesize similar compounds for
| potential screening as new drugs, so a number of new
| experimental relatives such as pseudoephedrine were produced
| eventually.
|
| As the name implies, people did not always know what the real
| difference was between ephedrine and pseudoephedrine, since
| both molecules have the same molecular weight, naturally
| because both have the same number of carbons, hydrogens,
| oxygen, and nitrogen content.
|
| Only a slight difference in chemical structure between the two,
| which got figured out soon enough.
|
| Some of the less-similar new drug candidates were ordinary
| amphetamines. They are the ones that really got popular fast,
| especially in wartime :\
|
| Now when the unique inhalers were born, it was a bit of the new
| synthetic ingredient along with the traditional aromatic
| mixture that Vicks was famous for, and the Vicks Inhaler was
| deemed safe & effective as recommended for OTC use. People
| loved it. Nobody had ever had anything as effective as that.
|
| IIRC it was 50 milligrams per inhaler soaked into a few hundred
| milligrams of aromatic essential oil mixture. As expected they
| were a lot stronger when you first started smelling one.
|
| That's because it was 50 mg of _meth_ -amphetamine in the Vicks
| inhalers.
|
| Parents would buy them for their kids, because they were so
| "safe", for self medication naturally, even at times when they
| would not consider dosing them up with cough syrup.
|
| There was never any FDA-approved prescription for
| methamphetamine in any other form, only this one OTC product.
|
| I would think the inhalers themselves were patent encumbered
| until the 1960's (remind you of an Epipen?) and by the 1970's
| other companies like Sudafed offered their own version, only
| not containing meth, give me a break.
|
| The meth version of amphetamine became recognized as a
| dangerous drug in the after-war years when the negative effects
| became apparent with soldiers who had been given it in pill
| form habitually as stimulants, often when facing the most
| serious combat.
|
| No other company ever was able to put meth in their inhalers,
| but Vicks slipped in under the wire and couldn't even be
| stopped for decades until some time after the DEA came into
| being. Everybody else was using pseudoephedrine from the start.
| By this time crystal meth was just beginning to emerge, which
| people were trying to avoid when they saw what it was like, at
| the same time different people started seeking meth more
| intently. Orders of magnitude more out-of-hand now.
|
| The way Vicks stayed under the radar the whole time with meth
| in it, was hiding in plain sight.
|
| Right there on the inhaler in fine print where it always was,
| active ingredient desoxyephedrine 50 mg.
|
| Simply a less-common alternative chemical name for meth, and
| desoxyephedrine had become a very uncommon rapidly deprecated
| name quite early. Way before any amphetamines were
| commercialized, they were instead marketed using the well-known
| convention based on the _Alpha_ -MethylPHenylEThylAMINE type
| nomenclature.
|
| Anyway, back in the 1970's when it was first becoming known
| that shady operators were cooking meth by starting with
| inhalers, I looked at one of them and sure enough, 50 mg meth
| per Vicks inhaler. Who knew?
|
| For a while there I figured they must be starting with way over
| 20 inhalers and probably would not extract nearly a gram of
| meth but it sounded feasible. I wasn't going to be the one to
| do it, my first job out of college was working for a company
| that was a real pharmaceutical manufacturer. So I wasn't going
| to tell anybody either. There was already talk among law
| enforcement about cracking down on this kind of thing.
| Suspicion of inhalers was beginning to barely arise, it was
| thin but widespread among anybody who had heard anything about
| this.
|
| Eventually I figured out that the clandestine cookers were
| _synthesizing_ their meth by using the _pseudoephedrine_ in
| _non-Vicks_ inhalers as starting material for their reactions !
| Well, what do you know? Was I wrong the whole time?
|
| I "guessed" so.
|
| With not-so-blurry 20/20 hindsight, I would estimate that
| before I got around to figuring this out, a clandestine chemist
| had come along way before I knew a thing and had started out
| extracting grams of meth directly from Vicks inhalers. And the
| meth heads loved it, found out it was coming from inhalers and
| the word got around among them.
|
| Some other chemist picks up the inexact word-of-mouth and by
| this time Vicks inhalers are outnumbered, sharing shelf space
| with numerous alternative brands, all of them containing
| pseudoephedrine as expected, and cheaper too. If they look at
| Vicks, it's the odd ball out, that doesn't look like the same
| kind of "ephedrine" as everything else. So they figured out how
| to do some home made reactions starting with Sudafed. And this
| is what was just starting to go through the roof.
|
| This was before the Sudafed pills really took over, once they
| showed up they flew off the shelf way faster than the inhalers
| because there were more milligrams.
|
| One day in the '70's I was in Walgreens and there was somebody
| buying over a dozen Sudafed inhalers so I knew what they were
| up to.
|
| I went over to the aisle and looked at the then-current Vicks
| Inhaler, which I hadn't checked in a while, sure enough 50 mg
| of desoxyephedrine, active ingredient, same as ever.
|
| The poor Sudafed buyer wasn't the least bit aware that real
| meth was right there on the shelf next to it.
|
| And I wasn't going to say a thing :)
|
| Most doctors _and pharmacists_ didn 't even have a clue.
|
| Within a few years Vicks stated putting in pseudoephedrine
| themselves instead of meth.
|
| Until it got way too far out of hand and the pseudoephedrine
| became tightly controlled, much more tightly than the meth was,
| as can be seen.
|
| Edit:
|
| "And now you know the rest of the story" - Paul Harvey
| rscho wrote:
| Well, phenylephrine is ineffective when used incorrectly.
| You're supposed to grind the pill and snort it. Works much
| better ;-D
| adastra22 wrote:
| You joke, but that would actually work.
| rscho wrote:
| I don't joke. I'm a serious doctor :-D
| EricDeb wrote:
| I swear phenylephrine works... so I'm just falling for placebo?
| j0hnyl wrote:
| Maybe you're feeling relief from the other ingredients like
| if there's also an inflammatory or caffeine, etc. bundled
| with the pill.
| sigzero wrote:
| I went to the doctor recently. I usually take what I am taking
| so they can see it. I was taking Sudafed and had just purchased
| it. She took it out of my hand and told me basically all that
| and threw it in the trash.
| letmeinhere wrote:
| Only thing I'd quibble with is the reason most consumers
| switched off of pseudoephedrine. The manufacturers knew that
| the inconvenience of having to go to the counter would reduce
| sales so they just replaced it in the aisle with an identically
| branded product with a different active ingredient. Most people
| made no affirmative choice at all; they're just buying
| "Sudafed", but now it's a placebo.
| nonameiguess wrote:
| It's not the only drug treated this way. You can go to any
| pharmacy and see a ton of things on the shelves that are just
| cards you have to take to the counter, and then see what's
| actually behind the counter. Insulin needles, for instance,
| even though you can also just buy those in bulk on Amazon. I'm
| not sure what does and does not get tracked in a statewide
| database, but at minimum, regular Ephedrine, typically sold
| under the brand name Bronkaid, is tracked this way, because it
| can also be used to manufacture meth. I don't even think in
| this case there is an alternative formulation like there is
| with Sudafed and generic equivalents.
|
| The monthly purchase limits on these tend to be ludicrously
| high, though. I think they're state by state, but in Texas, you
| can purchase up to 9 grams a month.
| 0x457 wrote:
| Lots of what you described is very location-store specific.
| That's why you can buy a lifetime supply of clean needles on
| amazon, but buying any in CVS is requires waiting in line
| longer than it take for amazon to deliver.
| devilbunny wrote:
| FWIW phenylephrine wasn't a new drug; it was and still is used
| all the time in IV form to increase blood pressure in
| anesthesia and critical care.
|
| But it's useless as an oral decongestant.
| tptacek wrote:
| This is a perennial topic on HN, which is generally
| inhospitable to drug prohibition to begin with; it's possible
| to lay out the schematics of the counterargument:
|
| * While there can't be any defense for the marketing of
| phenylephrine as a pseudoephedrine replacement, restrictions on
| pseudoephedrine are not irrational (that doesn't make them
| right, though I think they are).
|
| * Pseudoephedrine by itself practically is methamphetamine,
| just in an unproductive chemical configuration. It is
| extraordinarily simple (though: not safe) to convert
| pseudoephedrine into meth.
|
| * Pseudoephedrine is widely, practically universally available
| in the US without a prescription. It's a "behind the counter"
| drug, and, because of rampant abuse, access requires ID, like
| alcohol. Further, because the point of restricting
| pseudoephedrine is effectively a "rate limit" (to prevent
| people from acquiring enough Sudafed to make meth production
| practicable), Sudafed purchases are tracked.
|
| * We've hashed out on HN the argument about whether that
| tracking results in spurious prosecutions. The one case I've
| seen us come up with, the arrest and prosecution of William
| Fousse, concerned someone who had a pseudoephedrine addiction
| (he was using it to come up from habitual alcohol benders).
|
| * Restriction of pseudoephedrine does basically zero to staunch
| the flow of high-quality methamphetamine, which is produced at
| industrial scale with more sophisticated chemistry in Mexico
| and Asia.
|
| * But restriction of pseudoephedrine _might_ reduce the
| incidence of garage meth labs, which pose their own distinctive
| dangers to communities.
|
| The argument in favor of continued pseudoephedrine restriction
| would be that the cost of the policy is relatively low (it
| inconveniences allergy sufferers, but most of those sufferers
| only marginally) vs. the public safety benefit (which is also
| probably low, but also probably nonzero).
| Zak wrote:
| This issue is symptomatic of an underlying problem for me: we
| do not regularly re-evaluate laws to see if they are having
| the intended effect.
|
| American politics might have bigger problems at the moment,
| but under normal circumstances, I consider this pretty
| important. I'm not sure what the solution is, but an
| expiration date on nearly all laws comes to mind as a start
| to an interesting discussion on the matter.
| ryandrake wrote:
| It would be great if laws worked like software deployments:
|
| 1. Roll out law to 2%, look for any obvious unintended
| effects (like we check for crashes)
|
| 2. Roll out law to 50%, study for effectiveness. Is the
| intended positive effect happening in the experiment
| population? Any effect on the control population?
|
| 3. Finally, roll out law to 100% and keep monitoring.
|
| 4. Be ready to roll back to 0% if failures seen at any
| stage.
|
| 5. Be ready to apply a zero day patch after it's at 100% if
| edge cases are found.
|
| But, we don't do any of this! Lawmakers make a law and yolo
| it into production on a fixed date, and it's often
| impossible to roll it back or modify it.
| justinpombrio wrote:
| We do sort of do that, with state laws. Different states
| try out different laws, and copy laws from other states.
| Ideally a state will repeal laws that don't work well,
| and copy laws from other states when they work well. In
| practice it's all a mess of course.
|
| California is the experimental group.
| FireBeyond wrote:
| > This issue is symptomatic of an underlying problem for
| me: we do not regularly re-evaluate laws to see if they are
| having the intended effect.
|
| Even the Constitution. It was intended to be revisited for
| appropriateness and currency every 20 years.
|
| Instead, a significant number of people, including some on
| the Supreme Court, believe that the Founding Fathers[1]
| could speak no wrong words and that the Constitution is the
| perfect document, to be taken at its word, with no
| deviation, until the end of time.
|
| [1] Pop Quiz: "How old were the Founding Fathers when they
| signed the Declaration of Independence and crafted the
| Constitution?" You'd be forgiven for thinking they were
| world-weary, wizened old men. In fact, the majority were
| under forty. Indeed, it was also signed by a sixteen-year-
| old, a 21-year-old, two 26-year-olds, a 27-year-old, and a
| 29-year-old.
| tptacek wrote:
| Yes but the life expectancy was only 35 so in relative
| terms they were all senior.
| bloopernova wrote:
| _Average_ life expectancy.
|
| Once past your childhood, you had a good chance of making
| it to 60 at least.
| ibejoeb wrote:
| > access requires ID, like alcohol.
|
| Not like alcohol. I know you know, but to spell it out for
| those that dont: there is a universal registry. Each purchase
| is tracked and tallied by name and residential address. Best
| case scenario is you are denied access, but you could also be
| raided.
|
| It doesn't just require any old ID. Many, if not most, will
| not accept military ID. No foreign ID is accepted.
| Essentially, if your ID isn't a recent scannable ID issued by
| a US state, you don't get it. And I can't go a week without
| hearing that ID is a kind of ism.
| tptacek wrote:
| Do we have stories about people being raided?
| ibejoeb wrote:
| None that I have on hand, no. Not in the US, at least.
| But do you agree that it's possible? The registry afford
| that capability. There are raids for far less.
|
| I'm not trying to needle you. It's just nothing like
| alcohol, tobacco, etc. It's not even really like opioids.
|
| Anyway, I think your conclusion is reasonable, even if we
| come to different conclusions. Mine is based on common
| benefit. I think the benefit that comes from the drug far
| surpasses the detriment.
| Retric wrote:
| I'd hope people get raided or at least some police
| investigation. Much of the process seems pointless
| otherwise.
| sharpshadow wrote:
| This reminds me when EU banned some eye drops with the product
| name Proculin which have been very effective. The replacement
| Berberil is useless, literally no effect.
|
| Proculin made your eyes white white constricting the blood
| vessels for hours. All the stoners had it in their pockets.
|
| Since it constricted blood vessels one could use it also to
| reduce the local inflammation on pimples, which was a neat off
| label usage.
| clarkdale wrote:
| Only the second to last paragraph was necessary.
| politician wrote:
| PSA: Kroger and Kroger-owned supermarkets require ID to
| purchase any "cold medication" including those only containing
| phenylephrine. It's a stupid policy.
|
| Buy your cold medication at Walgreens. Good luck finding a non-
| Kroger grocer.
| snvzz wrote:
| Just take N-A-C instead. Actually works and your liver will be
| happy as well.
| adrianmonk wrote:
| As long as we're giving decongestant advice, in my experience a
| neti pot (sinus rinse) really helps.
|
| I also take pseudoephedrine when things get bad. I'm not trying
| to push a natural stuff only approach.
|
| The neti pot really seems to reduce the odds that sinus
| congestion will spiral into a terrible sinus headache.
|
| Do be aware of the need to use sterilized water to avoid a
| possible dangerous infection, though. Distilled water is the
| easiest way.
| iscrewyou wrote:
| It works wonders on me and family members. Except we just
| always go for the Neil Med bottles from Costco or Target. They
| are also easy to disinfect in the microwave.
|
| Always distilled water, though. It's not worth waiting to boil
| the water, let it cool down, and then manage the dish used
| after. It's also easy to get just the right temperature using
| distilled water in the microwave.
| radicality wrote:
| I tried this once when I was a teenager. As far as I remember,
| I took the precautions of sterilized water, getting the right
| salt, etc.
|
| Guess I didn't know how to properly use it, since I gave myself
| an awful sinus infection and was bedridden for next two weeks.
| To this day it's the worst I've ever felt. Never touching a
| neti pot since then :/
| whamlastxmas wrote:
| The infection may have happened despite the neti pot, not
| because of it
| Etheryte wrote:
| I would strongly advise against broadly recommending this
| across the board, because while rinsing your sinuses can help
| with some infections, it can make the situation considerably
| worse if you're working with e.g. inflammation instead. For a
| lot of people the difference isn't easy to tell and they end up
| making their own situation worse. As always, ask a medical
| professional, even your pharmacist can tell you what to do or
| not to do once you describe the symptoms.
| wiether wrote:
| > Do be aware of the need to use sterilized water to avoid a
| possible dangerous infection, though. Distilled water is the
| easiest way.
|
| It must be noted that the infection is incredibly rare and
| requires multiple conditions (like dysfunction of the immune
| system, unsafe tap water...)
|
| -
| https://en.wikipedia.org/wiki/Naegleria_fowleri#Pathogenicit...
|
| -
| https://charlotte.floridahealth.gov/newsroom/2023/03/DOHChar...
|
| For example here in France tap water is disinfected with
| chlorine and hot water must be heated to at least 50degC which
| is enough to kill the microorganism.
|
| On the other hand, depending how the distilled water is sourced
| (container bought in a supermarket...) & used (opened/closed
| daily...), it can actually create a much riskier source of
| infection.
| margalabargala wrote:
| Infection with Naegleria fowleri is incredibly rare.
|
| A run-of-the-mill bacterial infection is much more common.
| There's more than one type of infection you can give yourself
| by putting water into your sinuses.
|
| You're correct that it does require a source of the pathogen,
| be it the water, a poorly cleaned neti pot, or the interior
| of your nostril.
| bradyd wrote:
| If you're worried about the possible infection or don't want to
| mix it yourself, check out Arm & Hammer Simply Saline. It can
| be used like a neti pot for sinus rinse.
| DidYaWipe wrote:
| Way overdue. I wonder if the purveyors of this fraud have ever
| been sued.
|
| One refrain I got tired of hearing was that it "wasn't a safety
| issue." WRONG. Anyone who has ever had a ruptured eardrum can
| tell you that it is 100% a safety issue.
|
| If you're about to take a flight with any congestion, you're
| relying on decongestant to save your ears. I've had ruptured
| eardrums; it's probably the worst pain I've experienced. I had to
| take a flight a couple years ago with only this crap, and must
| have come extremely close to rupturing them again. It was
| EXCRUCIATING.
| JumpCrisscross wrote:
| Do we know the story around the people who pushed this? (EDIT: By
| "this" I mean phenylephrine.)
|
| Had they never had a stuffy nose?
| gambiting wrote:
| Phenylephrine doesn't work though. It never did. It was
| "pushed" as an alternative to pseudoephedrine which _can_ be
| used to synthesize meth, but afaik every single study done on
| this shows that phenylephrine does absolutely nothing, it 's a
| placebo drug. The faster it's phased out the better.
| raverbashing wrote:
| How it was approved in the first place should have been
| reviewed
| Suppafly wrote:
| It was approved back in the 70s after there being some
| studies that showed it was somewhat effective against
| congestion. I suspect it was no better than a placebo, but
| once it gets over the hurdle of being shown to be safe to
| use it probably didn't take much to get it approved. I
| don't think it was ever a popular product until the
| government starting making pseudoephedrine, which is highly
| effective, hard to buy.
| riahi wrote:
| Strictly speaking, phenylphrine works when it's injected. It
| is approved and used every day for this indication in the
| service of general anesthesia.
|
| However, the oral bioavailability is zero.
|
| This is an example of using something off label that's
| approved for something else. Sometimes it's fine. And
| sometimes, it's dumb.
| gambiting wrote:
| That's cool to know - I had no idea! I assumed that it
| literally did nothing in every scenario.
| Cthulhu_ wrote:
| People bought sudafed / they earned a lot of money from it, and
| they wanted to continue to earn money off of it. That's
| basically it. But they will point the blame at legislation I'm
| sure, both for making the effective stuff more difficult to
| get, and for being OK with the ineffective stuff being sold.
| User23 wrote:
| It's rather annoying that the only actually effective nasal
| decongestants are amphetamines or otherwise closely related
| compounds. Sudafed is great for daytime relief, but there really
| is no good sleep time decongestant. Sure Nyquil is a thing, but
| it just relies on the antihistamine to produce drowsiness without
| any actual decongestant effect. And Dextromethorphan is arguably
| even more useless than Phenylephrine since at least the latter
| could conceivably be effective if you shot it up.
| rustcleaner wrote:
| Time to hand rifles to everyone (including felons) and ban the
| State.
| User23 wrote:
| I do find it amusing reading hundred year old stories where
| characters walk into a pharmacy to buy a pint of whiskey, a
| sandwich, and a vial of cocaine and it's just an everyday
| normal thing.
| mrbonner wrote:
| I can't pronounce either one of the Sudafed substances. One time,
| an old lady asked me which Sudafed work for her as she pointed to
| a shelf full of Sudafed plus other decongestant drugs. I told her
| just buy the one that you need to take the flyer and bring it to
| the pharmacist to get it. Others are just scam. The real one is
| used to make meth so they put it behind the counter.
|
| She was surprised that the US gov would allow fake decongestant
| to be sold.
| modeless wrote:
| Really hard to trust the FDA when they let this obvious scam go
| on for so long.
| CodeWriter23 wrote:
| Junk Science invalidates effective medication. I'm calling this
| right now, in 5-10 years we'll be discussing how it counteracts
| the spike protein.
| phtrivier wrote:
| Cue:
|
| - the entry of trolls everywhere demanding that they can keep the
| medecine they've been using for ages
|
| - the new administration's agreeing with "popular demand" and
| disagreeing with the FDA, because that's their thing
|
| - and the companies selling the drug be like "uh, ok, fine".
|
| At least it will be an interesting distraction from trying to fix
| the opioids epidemic ?
| tigen wrote:
| The brands who have continued to sell this ingredient should be
| considered untrustworthy. It's basically fraud.
| whamlastxmas wrote:
| Also the stores that stock it, honestly
| tonymet wrote:
| So a useless drug has made billions and took 30 years to be taken
| off the market . And who knows what damage it's done ? Can we go
| back to being suspicious of pharmaceutical companies and the fda
| ?
| relistan wrote:
| It was on the market more like fifty years.
| tonymet wrote:
| Wow that's even more alarming
| Suppafly wrote:
| I don't think it's done any damage, it's just not effective.
| mrob wrote:
| Wasting people's money is damage.
| whamlastxmas wrote:
| Preventing people from getting real medical care due to
| fraud is absolutely damage.
| rustcleaner wrote:
| This is why sovereign immunity needs to be rescinded: bad
| law should get politicians incarcerated for long periods
| of time and their assets stripped to help pay back the
| treasury for the piles of money it should be printing and
| handing its victims. It should also be legal to lie to
| police while they're barred from lying to you (again, at
| threat of incarceration). We are supposed to be
| sovereign, not them!
| Suppafly wrote:
| >Preventing people from getting real medical care due to
| fraud is absolutely damage.
|
| Sure, but I don't think you could reliably charge that,
| at least in the US, where homeopathic medicines with
| absolutely no effect are allowed to be sold. We're
| talking about over the counter remedies for temporary
| sinus congestion often caused by pollen allergies, not
| prescription medicines that treat actual serious
| conditions.
| tonymet wrote:
| Every treatment has ill effects . Look at the number of liver
| failures from Tylenol
| Suppafly wrote:
| >Every treatment has ill effects
|
| Not necessarily.
| briandear wrote:
| Some of us were suspicious all along. Especially of Pfizer.
|
| But such suspicions became socially dangerous right around the
| time that Pfizer stood to make multiple billions selling a
| novel treatment for a recent pandemic.
|
| (Pfizer testing drugs on Nigerian children)
| https://pmc.ncbi.nlm.nih.gov/articles/PMC1471980/
|
| (Pfizer pleads guilty to criminal charges over Neurontin)
| https://pmc.ncbi.nlm.nih.gov/articles/PMC416587/
| rustcleaner wrote:
| I found a dirty nurse, he was willing to miss my arm and
| accidentally vaccinate the sink, for a short stack of
| benjamins.
| immibis wrote:
| Let's be honest about this: the reasons people were skeptical
| of COVID-19 vaccines had nothing to do with the actual
| corruption in the pharmaceutical industry, and everything to
| do with the corruption stories told by people who profit when
| more people die.
| tonymet wrote:
| I still don't get it . Is the corruption there or not ?
| aucisson_masque wrote:
| No you're believing in conspiracies.
|
| It would require the whole scientist communities and the
| sanctioning organisations to work together in order to validate
| a drug that is basically infective. Because you see before a
| drug is out on the market there are a lot of testing on
| animals, then humans and they have control group to measure how
| effective (or not) it is.
|
| Things like that CANT happen.
|
| Obviously I'm being sarcastic, that's the usual argument: you
| can't possibly have all scientist and federal organisation work
| together on malicious drugs.
|
| The truth is that it happens, see that drug or the oxycontin.
| It just requires some shity people and the rest of scientist
| community to not care.
| whamlastxmas wrote:
| You had me going, I was like Jesus this person is gullible
| thegrizzlyking wrote:
| Meanwhile generic decongestants like Ambroxol that actually work
| are too expensive to go through FDA approval.
|
| https://marginalrevolution.com/marginalrevolution/2024/05/th...
|
| Maybe a shorter duration(<5yrs) patent(for lack of better word)
| for unapproved generics might do the trick.
| refurb wrote:
| > Maybe a shorter duration(<5yrs) patent(for lack of better
| word) for unapproved generics might do the trick.
|
| There already is something similar - the NDA exclusivity
| period. You get 3-5 years where the FDA won't approve any other
| versions of the product.
|
| https://www.tandfonline.com/doi/pdf/10.4155/ppa.14.30
|
| But ambroxol isn't a decongestant - it supposed to help with
| phlegm.
| Aurornis wrote:
| Ambroxol is not a decongestant, it's an expectorant. If you
| take Ambroxol expecting to clear your sinus pressure like
| pseudoephedrine, you're going to be disappointed.
|
| I've used it. I thought it was going to be better than
| guaifenesin (equivalent available in the US). In my experience,
| it was not.
|
| That entire blog post appears to be based on a second-hand
| report from someone who went on vacation in France and was told
| something by the person at the pharmacist selling them
| Ambroxol. I don't understand why rationalist bloggers are so
| keen to rely on anecdotes and hearsay when it supports a point
| they're trying to make.
| noneeeed wrote:
| I've noticed that in the UK all phenylephrine based OTC
| medications also contain paracetamol (acetaminophen) and often
| caffine. They are just an expensive way to buy two very cheap
| compounds with an added bit of placebo effect from the flashy
| packaging.
|
| I can't take pseudoephedrine due to high blood pressure and I've
| found that the most effective thing for me, especially at night,
| is paracetamol, a blast from a nasal spray, and one of those
| nasal strips that help keep your nostrels open a bit more. It's
| not quite up there with the real Sudafed, but it's generally
| enough to get me a good night's sleep.
| Suppafly wrote:
| >I can't take pseudoephedrine due to high blood pressure
|
| I really miss being able to take pseudoephedrine. I mentioned
| to my doctor that it seemed to affect my blood pressure and he
| looked scandalized and told me I should never take it again.
| Apparently someone should have told me when I was diagnosed
| with high blood pressure. The only real information I got was a
| handout for a DASH diet.
| noneeeed wrote:
| Yeah, I don't think it was mentioned when I was diagnosed,
| but the pharmacist asked about it when I next went to buy
| some more. That was a very sad day.
|
| I miss being able to take Night Nurse and then sleep like a
| baby.
| astura wrote:
| I just checked the package for a random pseudoephedrine
| product
|
| https://www.cvs.com/shop/sudafed-sinus-congestion-maximum-
| st...
|
| It says consult your doctor before use if you have high blood
| pressure or heart disease.
| Suppafly wrote:
| How often do you consult your doctor about over the counter
| medicines that you've taken for years?
| astura wrote:
| Every time I have a new diagnosis or a new medication I
| absolutely double check any OTC medications.
| radicalbyte wrote:
| Cough medicine in the UK is sugar + paracetamol.
|
| My wife's a pharmacists so always laughs at it (and the
| decongestants) when we visit the UK.
| noneeeed wrote:
| Yep! OTC medicines here are really limited. Although you can
| always get something stronger from the pharmacist.
|
| I remember being ill in Switzerland and getting something for
| a nasty cold. I have no idea what it was other than magic in
| pill form.
| rootusrootus wrote:
| > OTC medicines here are really limited
|
| But you can get scopolamine there OTC. In chewables for
| kids, even! We can only get it as a patch, and only by
| prescription.
|
| Makes me want to find an importer I feel like I can trust,
| because I don't get over there often enough to bring it
| back myself.
| thecupisblue wrote:
| Not sure if it's still possible, but in eastern europe back in
| 2010s you could buy bottles of liquid ephedrine nose drops
| without a prescription. The pharmacists would get raw ephedrine
| and mix it in the back, filling the generic nose drop bottles.
| Tho they'd only give you 1 a month or so, looking at you
| suspiciously if you came multiple times in a row.
|
| Back when I was obsessed with sports and being the peak athlete I
| can be, I'd go to the different pharmacies around town and buy a
| bunch of nose drops. These would get mixed in with coffee to get
| a dumb version of EC stack. Not sure if it was worth it, but it
| definitely had me wired to the gills.
| teekert wrote:
| I had a student once from Sofia (capital and largest city of
| Bulgaria), she told me her mother mailed her all sort of
| antibiotics because they were not available here (western
| Europe) and "what if she'd catch a cold or the flu?" (Both are
| viruses so antibiotics don't even do anything other than kill
| the useful bacteria in your body!)
| EVa5I7bHFq9mnYK wrote:
| I have tried many nasal sprays, but what is really effective is a
| salt in water solution (slightly salty to taste) and a 10 ml
| syringe. Simply inject it into each nostril so that the water
| comes out through the mouth, a couple of times a day. Cleans out
| all the garbage really well.
|
| Among the medications, Flonase spray is effective, but saltwater
| is enough most of the time.
| ceejayoz wrote:
| Make sure you're using sterile water for this.
| https://en.wikipedia.org/wiki/Naegleria_fowleri?wprov=sfti1
|
| The saline wash is also known as a Neti pot here.
| marcosdumay wrote:
| It's 0.9% by mass. You can buy it easily in large bottles so
| you don't need to learn to disinfect and filter your water
| correctly.
| wink wrote:
| Wonder how many people "fell" for it though.
|
| I remember, many years ago, that I got some Antihistamine tables
| with Pseudoephedrine to take in 'light' emergencies for my
| allergies, cat hair in my case. I wasn't going to fall over like
| other people but have trouble breathing and a runny nose, so
| every time I visited people with cats, I could take one and
| everything was fine. When they banned it and my supply was used
| up, I got something with Phenylephrine and it just did...
| nothing. Then 5min of online research told me just as much.
| TomMasz wrote:
| It doesn't relieve nasal congestion and it never did. While it's
| certainly safe, it's not even slightly effective.
| Molitor5901 wrote:
| Thanks to the Administrative Procedures Act, and per the release
| from the FDA, the proposal will take some time. Comments are
| accepted until May 7, 2025. If the government moved with all
| legal alacrity, the order might get finalized by this time next
| year, that's if there are no lawsuits, petitions, etc.
|
| I mention this because I can't help but feel the APA takes _too_
| long when an agency is doing something proactive for the public
| good. This should take sixty days, not years, because it 's not a
| removal of a product for safety reasons, that's often done via
| the FTC.
|
| There is a hole between FDA's authority to create and amend
| regulations, order the removal of products due to safety, and
| what should be a more routine streamlining of the FDA cleaning
| up..
|
| APA - 5 U.S.C. SSSS 551-559
| viggity wrote:
| For most of my adult life, I was "addicted" to sudafed
| (pseudoephedrine, not phenylephrine). I had absolutely horrific
| sinus problems. Could never breathe, tons of sinus infections,
| etc etc. Things like sinus rinses (not a netipot which is gravity
| driven, but a positive pressure squeeze bottle) helped, but it
| was still a major inhibitor in life.
|
| I got a new ENT, and I started getting a quarterly "chemical
| nasal cautery". It has ABSOLUTELY changed my life. I can breathe
| sooo much easier, and I couldn't recommend it enough to anyone
| with persistent sinus issues. It is super easy. It doesn't even
| kind of hurt, the most mild of stings if anything at all. Doc
| will spray a lot of afrin up your nose, then lidocaine, then
| carbolic acid which kills a bunch of your immune cells (so they
| can't overreact to tree pollen and make you miserable). You get
| it done once a month for three months, then once every 3 months
| thereafter.
| daft_pink wrote:
| The outrageous thing about this is that people are getting
| accused of a crime for trying to buy the effective drug.
| pbhjpbhj wrote:
| You can still get pseudoephedrine containing Sudafed in UK
| sometimes, I've had difficulties finding it, but they package it
| almost identically to the phenylephrine containing placebo.
|
| To me this has always seemed like obvious fraud.
|
| We don't have class actions in the UK, but perhaps in USA there's
| a chance of punishing this sort of behaviour going forward?
|
| Basically they took the active ingredient out, added a similarly
| sounding chemical, continued to sell the new known-ineffective
| chemical in the virtually the same packet, under the same trade
| dress and branding...
|
| Pseudo was really effective for me. When I first bought Sudafed
| after they took the active ingredient out (of the easy to find
| product) I thought I'd misremembered, took a couple of illnesses
| before I twigged, then some very careful analysis of packaging to
| make sure to get the actual medicine.
| jfengel wrote:
| Interesting. I was just in the UK (Scotland), and picked up a
| cold on the plane. I was unable to locate any pseudoephedrine.
|
| My search was far from comprehensive, so it might merely have
| required looking harder. But I gave up early, on the assumption
| that the UK was similarly restrictive to the US.
| EasyMark wrote:
| In the US everywhere has it, but it's behind the counter and
| you have to show ID so they can track how much buy. It's
| ridiculous, but it's not hard to get, and has never stopped an
| illegal drug chemist from making crystal meth, but regular
| folks pay the price in inconvenience
| dang wrote:
| There's also https://arstechnica.com/health/2024/11/fda-proposes-
| ditching...
|
| (via https://news.ycombinator.com/item?id=42083559, but we merged
| the comments hither)
| Aurornis wrote:
| I'm sure this will be unpopular, but I think the real problem
| with Phenylephrine is that it isn't dosed appropriately in
| standard formulations.
|
| The standard 10mg dose is too low. Decongestants work by
| constricting blood vessels, which inherently increases blood
| pressure as a side effect.
|
| Pseudoephedrine at standard doses is known to raise blood
| pressure slightly. Phenylephrine at standard doses (10mg) shows
| no such effect (Source
| https://journals.lww.com/ebp/abstract/2018/03000/how_much_do... )
|
| Phenylephrine does increase blood pressure when delivered by IV
| at doses that work. The oral 10mg dose just isn't enough to get
| absorbed and do anything.
|
| It's not that phenylephrine is ineffective, it's that it's
| underdosed in the oral formulation.
| abbefaria27 wrote:
| There was some article about it on HN a while ago. If I
| remember right the problem was that its bioavailability is
| super low. You can take all you want, but only a tiny percent
| makes it through to get absorbed. In theory you could increase
| the the dose a lot but I imagine that might have other issues.
| steveBK123 wrote:
| It was obvious to consumers very quickly that it didn't actually
| do anything. Astonishing this charade went on so long.
| chankstein38 wrote:
| Clearly placebo for me, I guess? It's wild how many people are
| saying phenylephrine is completely ineffective. It saved my ass
| during a really long COVID stint. It was impossible to find by
| itself but when we finally found it we bought 2 boxes because we
| use it and, for us, it works wonders... Hope they release
| something else better I guess.
| ziml77 wrote:
| The better thing is the original: psuedoephedrine. It was never
| impossible to buy, it just required going to the pharmacy
| counter and showing ID. I knew about this when it happened in
| the 2000's because my dad needed Sudafed often, but the
| changeover was almost certainly invisible to most people given
| that the packaging is essentially identical between the two
| versions of the product.
| stronglikedan wrote:
| Good. I get food poisoning symptoms from it, but it's so popular
| that my other options are limited.
| mullingitover wrote:
| Everyone in the pharma and regulatory world has known this stuff
| is worthless for years. I feel like the pharma industry should be
| severely fined for knowingly perpetrating a fraud on the public.
| Sadly, they would likely be able to defend themselves on the
| grounds that the FDA allowed it.
| ahi wrote:
| A faculty member clued me in when I worked for a college of
| pharmacy 20 years ago! FDA should be embarrassed. This
| shouldn't even have been hard. How many drugs have been
| p-hacked into efficacy and would need expensive trials to
| disprove? Oral PE is metabolized too quickly make it to the
| bloodstream and can't be more than a placebo.
| sanex wrote:
| I find the Sudafed PE is useless but the Alka Seltzer with
| phenylephrine works and works really fast.
| horsawlarway wrote:
| Which is actually supported and documented here:
| https://pubmed.ncbi.nlm.nih.gov/26097788/
|
| Lots of versions of Alka Seltzer use aspirin instead of
| acetaminophen, and aspirin in combination with phenylephrine is
| documented to reduce congestion more than either alone.
|
| Note - avoid the cold & flu versions (the ones with orange
| bottoms) and the day & night versions (orange and green
| bottoms), because they're not aspirin, they're acetaminophen.
| The traditional blue bottom "Alka Seltzer Severe Cold" is the
| one with aspirin and phenylephrine.
| jonahbenton wrote:
| Looking forward to the FDA recommending ivermectin to take its
| place in late January 2025.
| SeanLuke wrote:
| It's been definitiely shown since at least 2010 that
| phenylephrine is useless for this purpose. How in the world did
| the FDA let the decongestant industry push this drug for 15 years
| before coming down on it?
| cryptonector wrote:
| Make pseudoephedrine great again.
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