Pseudoephedrine vs phenylephrine is a years old conversation in various forums and research with consensus findings. The conversation is once again rising with the annual flu season.
A cynic might think the regulators are promoting what seem to be placebos as useful medicines. It seemingly is one of those ‘profits are important’ decisions dressed as ‘we have not taken something that works off the market without a replacement; while phenylephrine as marketed does no good it does no harm (excepting to the pocketbook)’ which is one of the TGA’s major litmus tests, so it must be all right?
In allergy season the interrogations from the chemists gets old pretty quickly and the price is up, up, and up while the dispensation is smaller, smaller, and smaller, all as an additional ‘tool’ to dissuade buyers.
For the non-cynics I would like to hear their defence of allowing marketing of ‘medicines’ that do not work in the form they are mass marketed.
From a market research firm a view for the real stakeholders (businesses).
Disclaimer: A family member has chronic allergies and has treatments from A-Z through to surgery. Nothing worked well excepting pseudoephedrine as required.
A good point, the phenylephrine ingredient is a poor cousin to pseudoephedrine. For those not aware the latter was being used to manufacture amphetamines, but also used itself by long-distance truck drivers in large quantities, to stay awake and was implicated in hallucinations and truck crashes. Now it is behind the pharmacy counter and you need to hand over ID to the pharmacist who if they agree to supply (ie you don’t have high blood pressure or bad peripheral circulation or on certain other medicines) then they have to add it to a central database, which would alert people to those shopping around.
These days, if it is an allergy that is the cause (their ‘allergy season’), the non-sedating antihistamine tablets are available, including at supermarkets. I think if anyone has severe congestion and needs something more, or it is not an allergy then they will need a medicated nasal spray or a washout with a saline spray or saline rinse. However, these are also not so good because you get rebound congestion (when you stop) if you use the medicated spray more than a few days and the saline nasal rinse is a bit unpleasant and something you would really only do at home.
Unfortunately there are many things in over the counter medicines (OTC) that don’t work that well, but until there are serious side effects they seem to be accepted by the regulator and industry and continue being used in OTC products.
There have been accusations for years phenylephrine and all the cold meds that use it are not effective. The US FDA is being pushed into a re-evaluation. Will the TSA be far behind or continue to support it because it is ‘safe’ regardless it might not work?
Sudafed has never worked for me In fact most of the advertised “decongestant” meds have never worked for me. I get horrendous congestion in nose and sinuses with my CPAP… so I have to tolerate hours of nose blowing after I wake. I’ve been using oxymetazoline nose sprays (Drixine, Dimetapp, etc) as a way of having clear airways before I go to sleep, and whilst its supposed to last 12 hours, I have my doubts, but it does work n the short term.
Would that be the original Sudafed with pseudoephedrine, or its replacement Sudafed PE with phenylephrine?
Once the ‘feds’ decided to control pseudoephedrine the formulations with phenylephrine became commonplace, including with advertising the TSA, FDA, and all the others were happy with - even though from the early days of phenylephrine based ‘meds’ there was scepticism it worked in tablet form, and at the approved doses.
Do we need more detailed advice?
I’ve found it very effective the few times each year I use the product to manage the effects of grass and plant pollens in our rural setting. I doubt it is a placebo in that instance.
On Tuesday, the committee voted no on the specific question: “Do the current scientific data that were presented support that the monograph dosage of orally administered phenylephrine is effective as a nasal decongestant.”
In pill form, some scientists say, phenylephrine gets absorbed by the gut and is metabolized so well that only a tiny bit makes it to the bloodstream, where it is needed to reach the nose
Perhaps you are one of those who is sensitive enough to the ingredient you do not need much but I’ll refrain from speculating further. I have also read reports it works in some inhaled forms, just not in tablets.
One of the largest pharmacy chains in the US has responded by taking products off their shelves. Any expectation of if or when our own ‘abandon’ these placebos and stop ripping off customers, even if it was done innocently for decades?