I keep feeling a weird sense of disconnect with reality on this (and it's not just the decongestant causing it.) Because I remember reading research back when the formulations changed and coming...
I keep feeling a weird sense of disconnect with reality on this (and it's not just the decongestant causing it.) Because I remember reading research back when the formulations changed and coming to the same conclusion then, that "new" Sudafed didn't work. I wonder now if I wasn't on a corner of the internet with some expert or something and just happened to get pointed to good information.
I just don't know how that wasn't a bigger louder deal at the time - and I get that these researchers tried but like... It doesn't freaking work.
I think consumers have observed that the new formulations don't work as well for some time but without actual studies it's hard to tell whether this is just "it doesn't work as well" vs "it...
I think consumers have observed that the new formulations don't work as well for some time but without actual studies it's hard to tell whether this is just "it doesn't work as well" vs "it doesn't work at all".
Though ofc based on this article... it has indeed been a long time since they came to this conclusion, damn. It really shines a light on how flawed the buteaucratic side of this is.
Yeah I just remember reading research, or an article, and have had "this is no better than a placebo" in my brain for, what, 15-ish years now? I literally haven't bought anything but the...
Yeah I just remember reading research, or an article, and have had "this is no better than a placebo" in my brain for, what, 15-ish years now? I literally haven't bought anything but the pseudoephedrine formulation.
So that data was out there and ignored by the FDA on the premise that it "wasn't harmful"
yeah tbh that's the craziest part of the article to me. I'm young enough that I don't really remember the days of OTC pseudoephedrine (I was like 10 when it got moved behind the counter) so I've...
yeah tbh that's the craziest part of the article to me. I'm young enough that I don't really remember the days of OTC pseudoephedrine (I was like 10 when it got moved behind the counter) so I've just been used to life without any effective cough suppressants tbh.
...though better than here in Germany when the pharmacist said the only thing I could buy without a prescription was an herbal cough medicine whose most well-tested active ingredient was licorice root extract. My wife and I just sucked on fisherman's friend all night instead and took our risks sleeping with lozenges.
Yeah when we couldn't sleep from coughing the menthol blast plus having a lozenge at all was the most effective thing we could go for without a prescription lol.
Yeah when we couldn't sleep from coughing the menthol blast plus having a lozenge at all was the most effective thing we could go for without a prescription lol.
Everyone in my family has seasonal allergies. My "standard" is Allegra and Sudafed (generics). So when the switch to phenylephrine happened, we -- especially my mom and I -- noticed right away...
Everyone in my family has seasonal allergies. My "standard" is Allegra and Sudafed (generics). So when the switch to phenylephrine happened, we -- especially my mom and I -- noticed right away that something wasn't working. And so we immediately went back to pseudoephedrine. My mom's a nurse, so I do wonder if she knew or at least heard something about it beforehand.
But I assumed it was just us. My brother and dad didn't complain too much about it, but I also don't think their allergies are as bad as what my mom and I can experience. So they don't typically use Sudafed as much as we did/do.
I was explicitly told by a family member to make sure I got "old" sudafed because the new stuff doesn't work. I have no idea how they knew that (not at all in the medical field), but I 100%...
Because I remember reading research back when the formulations changed and coming to the same conclusion then, that "new" Sudafed didn't work
I was explicitly told by a family member to make sure I got "old" sudafed because the new stuff doesn't work. I have no idea how they knew that (not at all in the medical field), but I 100% remember because I was dealing with all sorts of crazy issues at the time.
I had no idea this wasn't common knowledge. Even before the behind the counter switch pharmacists complained the high blood pressure "equivalents" didn't work.
I had no idea this wasn't common knowledge. Even before the behind the counter switch pharmacists complained the high blood pressure "equivalents" didn't work.
Ahhhh, as a clinical pharmacist in the US I absolutely love to see this. I have told my family and friends for years to not waste their money on phenylephrine ever since learning about it's...
Ahhhh, as a clinical pharmacist in the US I absolutely love to see this. I have told my family and friends for years to not waste their money on phenylephrine ever since learning about it's uselessness in pharmacy school.
Honestly when it comes to the OTC management of cough/cold, there aren't a ton of products out there that help drastically. Pseudoephedrine is the only decongestant that works, and otherwise I always tell people to stay properly hydrated (drinking a minimum of 2L water daily) and then use cough drops to help with any throat soreness.
There are a ton of issues with the FDA and how drugs/compounds are labeled (and don't even get me STARTED on the supplement industry lmao), but unfortunately the incentive to improve things just doesn't seem to be there...
Hydrocodone itself has no decongestant effects. More likely your pain receptors were inhibited, so you "felt" the congestion less Decongestion as a principle requires vasoconstriction, however...
Hydrocodone itself has no decongestant effects. More likely your pain receptors were inhibited, so you "felt" the congestion less
Decongestion as a principle requires vasoconstriction, however opioids actually cause vasodilation so they simply are not able to decongest. Essentially you want the blood vessels in the respiratory passages to shrink and shrivel up so there is less space being occupied by fluids/blood/tissues, which affords more space for air to flow through
The only thing an opioid could do is desensitize your pain receptors so you're less bothered by congestion. Ironically if you're less bothered by it, you're less likely to make the congestion worse (by frequently blowing your nose, or further irritating the nasal passages) so it's possible that by not being bothered, you mess with things less which allows it to resolve on its' own, but at the end of the day an opioid would not directly decongest
Also the best cough syrup I ever had. Codeine being a close second. I get why it's not the first go-to but I'm lucky to have a doc that doesn't think I'm med seeking when I ask for the latter...
Also the best cough syrup I ever had. Codeine being a close second. I get why it's not the first go-to but I'm lucky to have a doc that doesn't think I'm med seeking when I ask for the latter after a persistent cough.
My partner takes opiates. It's been a rough five years as the guidance on prescribing them has changed back and forth from "prescribe them" to "prescribe less, cut everyone back" back to "oh...
My partner takes opiates. It's been a rough five years as the guidance on prescribing them has changed back and forth from "prescribe them" to "prescribe less, cut everyone back" back to "oh that's causing suicides, maybe that's bad, prescribe them"
A lot of users of decongestants, such as people affected by seasonal allergies, already "knew" that phenylephrine didn't work. The few times I'd buy it was when the pharmacy was already closed,...
A lot of users of decongestants, such as people affected by seasonal allergies, already "knew" that phenylephrine didn't work. The few times I'd buy it was when the pharmacy was already closed, but I needed some immediate relief from bad allergies. Yet I knew it was a Hail Mary at that point. I was very glad to see the confirmation of this when it came out recently. How much money did people waste over that last 18yrs?
Other nonprescription drugs like guaifenesin (sold in Mucinex and Robitussin), dextromethorphan (sold in Robitussin DM), and antihistamines for a cold like chlorpheniramine likely don't help with coughs and colds. They are usually not dangerous, but their effects are likely to be a placebo response; more modern research is needed.
I always suspected guaifenesin didn't work that well, but just chalked it up to something with me. But I didn't know there were efficacy issues with DXM, too. Sounds the like the FDA needs to so some serious review of older drugs.
Guaifenisin is considered an expectorant, which is described as "closely related" on Wikipedia. Decongestants are basically peripheral nervous system stimulants, corticosteroids, and...
Guaifenisin is considered an expectorant, which is described as "closely related" on Wikipedia. Decongestants are basically peripheral nervous system stimulants, corticosteroids, and antihistamines, all of which in one way or another reduce the mucus production. Expectorants reduce actual congestion as well, but the amount of mucus tends to increase by volume. So, a decongestant "dries up" your overproductive membranes, either directly or by soothing whatever signal they're receiving, also usually reducing swelling, and an expectorant just makes it easier to unclog your sinuses and/or cough up whatever's drained into the lungs.
This is unintuitive, but that's pharmacology for ya.
To add to this, guaifenesin in theory helps to clear out more mucus from the system, but as the article discussed the efficacy is questionable. Here's what Lexicomp (drug database we use in the...
To add to this, guaifenesin in theory helps to clear out more mucus from the system, but as the article discussed the efficacy is questionable. Here's what Lexicomp (drug database we use in the hospital) says for the mechanism of action:
Thought to act as expectorant by increasing the effective hydration of the respiratory tract, maintains the sol layer needed for ciliary clearance and reduces the viscosity of respiratory mucus, thereby further facilitating its removal by natural clearance processes. Guaifenesin may inhibit cough reflex sensitivity in subjects with upper respiratory tract infections whose cough receptors are transiently hypersensitive, but not in healthy volunteers. Possible mechanisms include a central antitussive effect, or a peripheral effect by increased sputum volume serving as a barrier shielding cough receptors within the respiratory epithelium from the tussive stimulus Dicpinigaitis 2003
Dextromethorphan is a cough suppressant (antitussive), that tbh still has very mediocre effect. MOA:
Decreases the sensitivity of cough receptors and interrupts cough impulse transmission by depressing the medullary cough center through sigma receptor stimulation; structurally related to codeine
Pseudoephedrine is a true decongestant on the other hand. MOA:
Congestion is typically related to the nose. So sudafed is a decongestant, since it opens up nasal passageways and stops the runny nose. Guaifenisen, like @noblepath mentioned, is supposed to make...
Congestion is typically related to the nose. So sudafed is a decongestant, since it opens up nasal passageways and stops the runny nose.
Guaifenisen, like @noblepath mentioned, is supposed to make your coughs more productive, by getting that mucus out. It's for lower respiratory issues, like bronchitis. I've tried it many times when I'm sick with lower respiratory ailments, but I feel like it's never worked for me. And that's usually paired with DXM, which is an antitussive (stops/slows coughing). So combined, they're supposed to make you cough less (which I do think works on me, but maybe that's just placebo), but those coughs should get crap out of your lungs quicker, making it easier to breathe.
I only found out about chlorpheniramine because it was in a Nyquil "less drowsy" product, and I did actually experience some success with that. I wanted to know what they used in it that was...
I only found out about chlorpheniramine because it was in a Nyquil "less drowsy" product, and I did actually experience some success with that. I wanted to know what they used in it that was different than the usual Nyquil and saw chlorpheniramine and found out it was a 1st gen antihistamine along with diphenhydramine yet I never saw it in anything else up til that point. Apparently it was used more often in veterinarian settings. The only reason I was really even drawn to a Nyquil less drowsy product is because Dayquil was worthless.
I looked for a generic pill which Walmart happened to have them in the aisle but you'd hardly even notice it existed if you weren't actually looking for it. It made a world of difference for me with allergies. Nothing else I tried worked except diphenhydramine but I can barely get through a day if I take that because it makes me too drowsy. So I was always caught in a bad spot. Fexofenadine, loratadine, or any of the other oral ones you can name, they did next to nothing or nothing for me. So now I just take chlorpheniramine and it inhibits my allergies and doesn't knock me out. The one side effect that did used to be noticeable to me was dry throat. I did read that 1st gen antihistamines could have some negative long term effects so I try to spot-take it but some parts of the season its an everyday thing for me. I did also find some nasal spray that works but I really hate the experience of spraying something up my nose.
I doubt a 1st gen antihistamine is helping much with a cough, and since most of them has dry throat/mouth as a side effect it might make things a little worse on that front, but other symptoms of a cold related to the nasal passages are probably improved. That was my experience generally at least. Chlorpheniramine most definitely is more than just a placebo drug.
Mirror, for those hit by the paywall: https://archive.is/wLY8e p.s. Changed the title, since it's specifically oral phenylephrine decongestants that don't work.
Because I'm that kind of wonk, I just looked up the $7.2 billion 2024 budget appropriation request [PDF warning] for the FDA as a whole. It seems like a lot of money until you skim through that...
Because I'm that kind of wonk, I just looked up the $7.2 billion 2024 budget appropriation request [PDF warning] for the FDA as a whole.
It seems like a lot of money until you skim through that document and realize how much the FDA is responsible for - everything from food to medicines (including pandemic preparedness) to devices to radiological heath to veterinary products.
Yes, there are a great many ways in which the FDA could do better, with the topic post as an example. It's also prone to regulatory capture and Pharma influence, as shown by the Aduhelm approval. There isn't enough funding for proper inspection of overseas generic drug manufacturers.
I don't know how much money it would take to make the FDA great again, but it's overdue.
My recent run in with covid makes much more sense! Dayquil and Nyquil we beneficial, but did not prevent mucus build up and I still had a lot of trouble sleeping until I started using different...
My recent run in with covid makes much more sense! Dayquil and Nyquil we beneficial, but did not prevent mucus build up and I still had a lot of trouble sleeping until I started using different decongestants!
I keep feeling a weird sense of disconnect with reality on this (and it's not just the decongestant causing it.) Because I remember reading research back when the formulations changed and coming to the same conclusion then, that "new" Sudafed didn't work. I wonder now if I wasn't on a corner of the internet with some expert or something and just happened to get pointed to good information.
I just don't know how that wasn't a bigger louder deal at the time - and I get that these researchers tried but like... It doesn't freaking work.
I think consumers have observed that the new formulations don't work as well for some time but without actual studies it's hard to tell whether this is just "it doesn't work as well" vs "it doesn't work at all".
Though ofc based on this article... it has indeed been a long time since they came to this conclusion, damn. It really shines a light on how flawed the buteaucratic side of this is.
Yeah I just remember reading research, or an article, and have had "this is no better than a placebo" in my brain for, what, 15-ish years now? I literally haven't bought anything but the pseudoephedrine formulation.
So that data was out there and ignored by the FDA on the premise that it "wasn't harmful"
yeah tbh that's the craziest part of the article to me. I'm young enough that I don't really remember the days of OTC pseudoephedrine (I was like 10 when it got moved behind the counter) so I've just been used to life without any effective cough suppressants tbh.
...though better than here in Germany when the pharmacist said the only thing I could buy without a prescription was an herbal cough medicine whose most well-tested active ingredient was licorice root extract. My wife and I just sucked on fisherman's friend all night instead and took our risks sleeping with lozenges.
Ow my back 😅
Fisherman's friend is excellent for when you need your sinuses sandblasted with menthol!
Yeah when we couldn't sleep from coughing the menthol blast plus having a lozenge at all was the most effective thing we could go for without a prescription lol.
Everyone in my family has seasonal allergies. My "standard" is Allegra and Sudafed (generics). So when the switch to phenylephrine happened, we -- especially my mom and I -- noticed right away that something wasn't working. And so we immediately went back to pseudoephedrine. My mom's a nurse, so I do wonder if she knew or at least heard something about it beforehand.
But I assumed it was just us. My brother and dad didn't complain too much about it, but I also don't think their allergies are as bad as what my mom and I can experience. So they don't typically use Sudafed as much as we did/do.
I was explicitly told by a family member to make sure I got "old" sudafed because the new stuff doesn't work. I have no idea how they knew that (not at all in the medical field), but I 100% remember because I was dealing with all sorts of crazy issues at the time.
I had no idea this wasn't common knowledge. Even before the behind the counter switch pharmacists complained the high blood pressure "equivalents" didn't work.
I feel comforted that it wasn't just me 😅
I never felt that the 4 hour did anything, but the 12 hour always clears me out.
Of which version? Statistically only the pseudoephedrine works
Ya pretty sure that is what's in the 12 hour
They sell (or sold) both formulations in short acting and long acting varieties. So it depends what you bought!
Ahhhh, as a clinical pharmacist in the US I absolutely love to see this. I have told my family and friends for years to not waste their money on phenylephrine ever since learning about it's uselessness in pharmacy school.
Honestly when it comes to the OTC management of cough/cold, there aren't a ton of products out there that help drastically. Pseudoephedrine is the only decongestant that works, and otherwise I always tell people to stay properly hydrated (drinking a minimum of 2L water daily) and then use cough drops to help with any throat soreness.
There are a ton of issues with the FDA and how drugs/compounds are labeled (and don't even get me STARTED on the supplement industry lmao), but unfortunately the incentive to improve things just doesn't seem to be there...
Hydrocodone itself has no decongestant effects. More likely your pain receptors were inhibited, so you "felt" the congestion less
Decongestion as a principle requires vasoconstriction, however opioids actually cause vasodilation so they simply are not able to decongest. Essentially you want the blood vessels in the respiratory passages to shrink and shrivel up so there is less space being occupied by fluids/blood/tissues, which affords more space for air to flow through
The only thing an opioid could do is desensitize your pain receptors so you're less bothered by congestion. Ironically if you're less bothered by it, you're less likely to make the congestion worse (by frequently blowing your nose, or further irritating the nasal passages) so it's possible that by not being bothered, you mess with things less which allows it to resolve on its' own, but at the end of the day an opioid would not directly decongest
I mostly see them reducing coughing (for similar pain reception reasons) but I could see that feeling like a lower congestion even if it isn't.
Oh, well they have a very well-understood and described direct effect on suppression of the cough reflex
Also the best cough syrup I ever had. Codeine being a close second. I get why it's not the first go-to but I'm lucky to have a doc that doesn't think I'm med seeking when I ask for the latter after a persistent cough.
My partner takes opiates. It's been a rough five years as the guidance on prescribing them has changed back and forth from "prescribe them" to "prescribe less, cut everyone back" back to "oh that's causing suicides, maybe that's bad, prescribe them"
Thankfully he is right now, but it's a fun adventure of what problems will each Rx refill bring.
A lot of users of decongestants, such as people affected by seasonal allergies, already "knew" that phenylephrine didn't work. The few times I'd buy it was when the pharmacy was already closed, but I needed some immediate relief from bad allergies. Yet I knew it was a Hail Mary at that point. I was very glad to see the confirmation of this when it came out recently. How much money did people waste over that last 18yrs?
I always suspected guaifenesin didn't work that well, but just chalked it up to something with me. But I didn't know there were efficacy issues with DXM, too. Sounds the like the FDA needs to so some serious review of older drugs.
Guaifenesen is not meant to decongest. It’s meant to make the gunk, especially in lungs, runnier and therefore easier to move out.
What's you definition of a decongestant then? Because its mechanism seems designed to make you no longer congested.
Guaifenisin is considered an expectorant, which is described as "closely related" on Wikipedia. Decongestants are basically peripheral nervous system stimulants, corticosteroids, and antihistamines, all of which in one way or another reduce the mucus production. Expectorants reduce actual congestion as well, but the amount of mucus tends to increase by volume. So, a decongestant "dries up" your overproductive membranes, either directly or by soothing whatever signal they're receiving, also usually reducing swelling, and an expectorant just makes it easier to unclog your sinuses and/or cough up whatever's drained into the lungs.
This is unintuitive, but that's pharmacology for ya.
Ah, thank you. So one dries you out, and the other makes it easier for you to get out what's already there.
To add to this, guaifenesin in theory helps to clear out more mucus from the system, but as the article discussed the efficacy is questionable. Here's what Lexicomp (drug database we use in the hospital) says for the mechanism of action:
Dextromethorphan is a cough suppressant (antitussive), that tbh still has very mediocre effect. MOA:
Pseudoephedrine is a true decongestant on the other hand. MOA:
Congestion is typically related to the nose. So sudafed is a decongestant, since it opens up nasal passageways and stops the runny nose.
Guaifenisen, like @noblepath mentioned, is supposed to make your coughs more productive, by getting that mucus out. It's for lower respiratory issues, like bronchitis. I've tried it many times when I'm sick with lower respiratory ailments, but I feel like it's never worked for me. And that's usually paired with DXM, which is an antitussive (stops/slows coughing). So combined, they're supposed to make you cough less (which I do think works on me, but maybe that's just placebo), but those coughs should get crap out of your lungs quicker, making it easier to breathe.
I knew that. I'm just saying guaifenesin doesn't seem to make my coughs any more productive than without it.
I only found out about chlorpheniramine because it was in a Nyquil "less drowsy" product, and I did actually experience some success with that. I wanted to know what they used in it that was different than the usual Nyquil and saw chlorpheniramine and found out it was a 1st gen antihistamine along with diphenhydramine yet I never saw it in anything else up til that point. Apparently it was used more often in veterinarian settings. The only reason I was really even drawn to a Nyquil less drowsy product is because Dayquil was worthless.
I looked for a generic pill which Walmart happened to have them in the aisle but you'd hardly even notice it existed if you weren't actually looking for it. It made a world of difference for me with allergies. Nothing else I tried worked except diphenhydramine but I can barely get through a day if I take that because it makes me too drowsy. So I was always caught in a bad spot. Fexofenadine, loratadine, or any of the other oral ones you can name, they did next to nothing or nothing for me. So now I just take chlorpheniramine and it inhibits my allergies and doesn't knock me out. The one side effect that did used to be noticeable to me was dry throat. I did read that 1st gen antihistamines could have some negative long term effects so I try to spot-take it but some parts of the season its an everyday thing for me. I did also find some nasal spray that works but I really hate the experience of spraying something up my nose.
I doubt a 1st gen antihistamine is helping much with a cough, and since most of them has dry throat/mouth as a side effect it might make things a little worse on that front, but other symptoms of a cold related to the nasal passages are probably improved. That was my experience generally at least. Chlorpheniramine most definitely is more than just a placebo drug.
Mirror, for those hit by the paywall:
https://archive.is/wLY8e
p.s. Changed the title, since it's specifically oral phenylephrine decongestants that don't work.
Because I'm that kind of wonk, I just looked up the $7.2 billion 2024 budget appropriation request [PDF warning] for the FDA as a whole.
It seems like a lot of money until you skim through that document and realize how much the FDA is responsible for - everything from food to medicines (including pandemic preparedness) to devices to radiological heath to veterinary products.
Yes, there are a great many ways in which the FDA could do better, with the topic post as an example. It's also prone to regulatory capture and Pharma influence, as shown by the Aduhelm approval. There isn't enough funding for proper inspection of overseas generic drug manufacturers.
I don't know how much money it would take to make the FDA great again, but it's overdue.
My recent run in with covid makes much more sense! Dayquil and Nyquil we beneficial, but did not prevent mucus build up and I still had a lot of trouble sleeping until I started using different decongestants!