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posted by hubie on Sunday September 17 2023, @08:56PM   Printer-friendly
from the dirty-pool dept.

https://arstechnica.com/health/2023/09/the-spectacular-downfall-of-a-common-useless-cold-medicine/

After spending decades on pharmacy shelves, the leading nasal decongestant in over-the-counter cold and allergy medicines has met its downfall.

Advisers for the Food and Drug Administration this week voted unanimously, 16 to 0, that oral doses of phenylephrine—found in brand-name products like Sudafed PE, Benadryl Allergy Plus Congestion, Mucinex Sinus-Max, and Nyquil Severe Cold & Flu—are not effective at treating a stuffy nose.

The vote was years in the making. In 2007, amid doubts, FDA advisers called for more studies. With the data that has trickled in since then, the agency's own scientists conducted a careful review and came to the firm conclusion that oral phenylephrine "is not effective as a nasal decongestant."


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  • (Score: 5, Insightful) by Anonymous Coward on Sunday September 17 2023, @09:05PM (22 children)

    by Anonymous Coward on Sunday September 17 2023, @09:05PM (#1325084)

    The only reason they put it in was because it sounds a bit like psuedoephedrine which does work.
    The reason they don't use psuedoephedrine is because evil toothless rednecks and bogans might use cold pills to make meth.

    • (Score: 4, Insightful) by Anonymous Coward on Sunday September 17 2023, @09:30PM

      by Anonymous Coward on Sunday September 17 2023, @09:30PM (#1325090)

      And the only reason anyone makes meth in their kitchen or interacts with a shady drug dealer is because they can't pick up good, pure drugs legally and cheaply.

    • (Score: 5, Interesting) by aafcac on Sunday September 17 2023, @09:32PM (6 children)

      by aafcac (17646) on Sunday September 17 2023, @09:32PM (#1325091)

      I switched to peppermint tea. Between the water, steam and peppermint oil, I get some pretty decent drainage.

      • (Score: 5, Interesting) by driverless on Monday September 18 2023, @08:13AM (5 children)

        by driverless (4770) on Monday September 18 2023, @08:13AM (#1325140)

        I once accidentally used chlorine (was working with it and inhaled a noseful), and man, that's the most effective decongestant I've ever experienced, the effect was almost instant, like magic.

        Somehow I think I'll have trouble getting FDA approval for it though.

        • (Score: 4, Informative) by Dr Spin on Monday September 18 2023, @08:41AM (3 children)

          by Dr Spin (5239) on Monday September 18 2023, @08:41AM (#1325143)
          I think you will find there is adequate chlorine in your local public swimming pool. You may not even need to enter the water!

          I have found that a saline spray (put some salt in some water, and put it in an old pump action spray) will often remove the root cause.

          --
          Warning: Opening your mouth may invalidate your brain!
          • (Score: 3, Insightful) by driverless on Monday September 18 2023, @08:52AM

            by driverless (4770) on Monday September 18 2023, @08:52AM (#1325144)

            Ah, good point, and definitely better than breathing chlorine gas.

          • (Score: 2) by krishnoid on Monday September 18 2023, @05:25PM

            by krishnoid (1156) on Monday September 18 2023, @05:25PM (#1325203)

            Between the salt and the chlorine in the swimming pool, when I got enough in my sinuses (yuck), after about 45 minutes in the water they'd completely empty out (double yuck). Also functions as a CAPTCHA [youtu.be].

          • (Score: 2) by krishnoid on Monday September 18 2023, @06:38PM

            by krishnoid (1156) on Monday September 18 2023, @06:38PM (#1325207)

            Comparable to a saline spray, I recently tried a neti pot which cleared things out, but the congestion kept coming back after about a week. I then used Flonase and/or Nasonex which I then helped suppress inflamation in the longer-term.

            I think the combination of:

            • the saline flushing out the nasal/sinus discharge and exposing the tissue surface, followed by
            • the (mild) nasal corticosteroid then accessing and treating the exposed tissue surface,

            made the difference where either one in isolation couldn't solve the longer-term problem by itself.

        • (Score: 0) by Anonymous Coward on Monday September 18 2023, @12:02PM

          by Anonymous Coward on Monday September 18 2023, @12:02PM (#1325167)

          Chlorine?

          Try opening up a 1kg canister of sodium metabisulphite that has been lying around for some time, having a bit of a brainfart and completely forgetting what lovely gas that shit decomposes/reacts to produce, and then taking in a goodly lungfull...

          Oh, that was a fun couple of hours, and it painfully reminded me as to why we switched from using the metabisulpite to the percarbonate for sterilising/cleaning the winemaking and brewing gear in the first place.

    • (Score: 4, Interesting) by Runaway1956 on Sunday September 17 2023, @09:40PM (9 children)

      by Runaway1956 (2926) Subscriber Badge on Sunday September 17 2023, @09:40PM (#1325093) Journal

      +1 informative. I eyeballed TFS once, twice, thrice, trying to decide why it made no sense. At center of the confusion was the use of the brand name, Sudafed. I will vouch for the efficacy of psuedoephedrine. I don't know anything about Sudafed PE. Had I seen it on a shelf, I would have assumed it was psuedoephedrine. I have never associated the other brands mentioned with psuedoephedrine.

      People can still get psuedoephedrine today, but government puts hurdles in the way. See the pharmacist, show an ID, have your name and address recorded so the cops and the DEA can find you easily - - - it's all bullshit.

      --
      We've finally beat Medicare! - Houseplant in Chief
      • (Score: 2) by krishnoid on Monday September 18 2023, @05:11AM (4 children)

        by krishnoid (1156) on Monday September 18 2023, @05:11AM (#1325123)

        Too bad they won't just let you buy one Sudafed pill at a time, and have the pharmacist drop it right down your throat while you're standing in line. Nobody makes methamphetamine and you get your sinuses cleared up [youtu.be] without compromising your privacy.

        Incidentally, one article I found [accidentalscientist.com] describes Sudafed's mechanism of action, which has off-label diagnostic value for an unrelated mental health-ish syndrome. It led me down a few other pathways to investigate neurochemical origins of that syndrome and related issues.

        • (Score: 2) by Freeman on Monday September 18 2023, @02:05PM (3 children)

          by Freeman (732) on Monday September 18 2023, @02:05PM (#1325182) Journal

          Pharmacists aren't allowed to administer medicine. They aren't nurses and they aren't doctors.

          --
          Joshua 1:9 "Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee"
          • (Score: 2, Informative) by Anonymous Coward on Monday September 18 2023, @02:31PM (1 child)

            by Anonymous Coward on Monday September 18 2023, @02:31PM (#1325187)

            They give plenty of vaccines.

            • (Score: 3, Informative) by Rich26189 on Monday September 18 2023, @03:47PM

              by Rich26189 (1377) on Monday September 18 2023, @03:47PM (#1325194)

              and they, the one giving the injections, are not even pharmacists, they are "Pharamacy Tech's", CVS is always looking to hire new ones.

          • (Score: 3, Informative) by janrinok on Monday September 18 2023, @03:54PM

            by janrinok (52) Subscriber Badge on Monday September 18 2023, @03:54PM (#1325195) Journal

            That might not be permitted in the USA, but pharmacists in various countries have different responsibilities.

            Here in France they can take care of many of the routine coughs, colds, injections, and also treat minor injuries. Many of the pharmaceutical assistants here can elect to do additional training to permit them to do routine care etc.

            --
            I am not interested in knowing who people are or where they live. My interest starts and stops at our servers.
      • (Score: 2) by krishnoid on Monday September 18 2023, @05:18AM (3 children)

        by krishnoid (1156) on Monday September 18 2023, @05:18AM (#1325124)

        That's why I always look at the back of the box for the active ingredient, and then find the store brand with the same ingredient (usually mentioned on the front). Then if ingredient lists on the back of both boxes match by chemical name and quantity per dose, I buy the store brand.

        I might be missing something, but a molecule is a molecule (modulo the marketing on the box), and in the USA, if you adulterate or misrepresent the composition of medicine that you can pull off a retail shelf and send to a lab for assay, you're *really* hanging your legal liability out in the wind for anyone to collect a quick buck from.

        • (Score: 4, Informative) by pTamok on Monday September 18 2023, @08:03AM (1 child)

          by pTamok (3042) on Monday September 18 2023, @08:03AM (#1325139)

          I do the same.

          There is a fly in the ointment, though. The formulation of the medication can affect the efficacy, so even though the different medication has the 'same' chemical in it, it might have different effects. The medical regulators are fully aware of this, and provide guidance for pharmacists about what generics are suitable to replace non-generic medication, but that information is not necessarily easily available to the general public.

          J Pharmacol Pharmacother. 2013 Dec; 4(Suppl1): S110–S114. -- Safety and efficacy of generic drugs with respect to brand formulation [nih.gov]
          [PDF]EMA: Interchangeability of generics [europa.eu]
          [PDF]EMA: Questions and answers on generic medicines [europa.eu]

          As many people who need medication will tell you, the different versions of both generic and non-generic can have different effects for them, Of course, it might be the placebo/nocebo effect but many patients taking anti-depressants will say that particular brand/generics are less effective for them.

          If you are making choices based on reading just the ingredients list, I would advise confirming your conclusions with a professional pharmacist.

          • (Score: 2, Informative) by shrewdsheep on Monday September 18 2023, @09:06AM

            by shrewdsheep (5215) on Monday September 18 2023, @09:06AM (#1325150)

            Formulation is one of the crucial determinants of drug action determining bio-availability. That being said, bioequivalence studies have to be performed for new formulations of existing drugs. Therefore, in theory, one should be able to buy any formulation for the same indication and expect same efficacy. However, bioequivelence is always up to a margin, which can be substantial. As bioequivalence studies are usually with respect to a single registered drug, chains of bioequivalence studies can evolve losing comparability to the original drug.

        • (Score: 3, Informative) by driverless on Monday September 18 2023, @09:17AM

          by driverless (4770) on Monday September 18 2023, @09:17AM (#1325154)

          Yup, I do the same thing. And then you find out that pretty much all of the cold treatments are the same, paracetamol, phenylephrine, and some first-gen antihistamine like chlorphenamine or occasionally brompheniramine. That's pretty much all of them no matter what the brand except for the woo-woo natural-ingredient ones.

    • (Score: 5, Funny) by sjames on Sunday September 17 2023, @09:45PM

      by sjames (2882) on Sunday September 17 2023, @09:45PM (#1325094) Journal

      I saw instructions once for cooking meth back into psuedoephedrine in case someone needs a decongestant that works.

    • (Score: 2) by Opportunist on Monday September 18 2023, @06:14AM (2 children)

      by Opportunist (5545) on Monday September 18 2023, @06:14AM (#1325126)

      Could we please call it pseudoephedrine [wikipedia.org]? My inner Grammar Nazi always has the urge to invade my sinuses (and then some) every time someone writes psuedoephedrine.

      Thank you.

      • (Score: 0) by Anonymous Coward on Monday September 18 2023, @08:24AM

        by Anonymous Coward on Monday September 18 2023, @08:24AM (#1325141)

        That's your inner spelling nazi.
        And,
        sorry about that.

      • (Score: 4, Funny) by krishnoid on Monday September 18 2023, @06:25PM

        by krishnoid (1156) on Monday September 18 2023, @06:25PM (#1325206)

        Pseudoephedrine is similar to ephedrine, but psuedo-ephedrine is a smoother, suede-like form of ephedrine. Two entirely different compounds.

  • (Score: 3, Insightful) by SomeGuy on Sunday September 17 2023, @10:07PM (2 children)

    by SomeGuy (5632) on Sunday September 17 2023, @10:07PM (#1325097)

    Next step, replace it with something even LESS effective that has a fancier name that they can market out the yingyang and still make f-tons of money.

    • (Score: 0) by Anonymous Coward on Sunday September 17 2023, @10:54PM

      by Anonymous Coward on Sunday September 17 2023, @10:54PM (#1325099)

      I guess they have to since the most effective cure is just rest and fluids. Not much of a profit margin in that.

    • (Score: 2, Insightful) by Anonymous Coward on Monday September 18 2023, @02:22AM

      by Anonymous Coward on Monday September 18 2023, @02:22AM (#1325114)

      People earn college degrees in the art of deceiving the customer. And business executives hire them.

      Its pretty obvious to me that a lot of companies, especially pharmaceuticals, consider their customer just another sheep to be fleeced.

  • (Score: 4, Interesting) by Barenflimski on Sunday September 17 2023, @11:54PM (1 child)

    by Barenflimski (6836) on Sunday September 17 2023, @11:54PM (#1325103)

    I always get my Sudafed from the pharmacy where they sell the pseudo-ephederine version.

    I tried the "new" stuff when they went meth stupid and decided we're all idiots and drug mules. It didn't work.

    It would be interesting to know how many folks never knew they could get the working stuff without a script; but you had to wait in line, turn over ID to be entered into the system and get it from the pharmacist while not looking too methy.

    • (Score: 2) by Freeman on Monday September 18 2023, @02:07PM

      by Freeman (732) on Monday September 18 2023, @02:07PM (#1325184) Journal

      "Not looking too methy", ah, you mean poor. It's definitely much better that they've turned to the likes of opiates, instead. https://en.wikipedia.org/wiki/Opioid_epidemic [wikipedia.org]

      --
      Joshua 1:9 "Be strong and of a good courage; be not afraid, neither be thou dismayed: for the Lord thy God is with thee"
  • (Score: 2, Insightful) by Anonymous Coward on Monday September 18 2023, @01:42AM (2 children)

    by Anonymous Coward on Monday September 18 2023, @01:42AM (#1325111)

    Zinc helps vs some colds. Shortens the duration of the symptomatic period[1]. And also boosts your immune system vs other stuff[2]. Not much profit margin in zinc though. For longer term supplementation make sure you're getting enough copper to balance your zinc intake.

    [1] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3273967/ [nih.gov]

    [2] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6628855/ [nih.gov]

    Also: https://www.sciencedaily.com/releases/2013/11/131111091136.htm [sciencedaily.com]
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3625079/ [nih.gov]

    • (Score: 0) by Anonymous Coward on Monday September 18 2023, @10:38AM (1 child)

      by Anonymous Coward on Monday September 18 2023, @10:38AM (#1325161)

      > Zinc helps vs some colds

      But be careful, Zinc may damage the sense of smell. While no way to prove it, a relative used a zinc preparation for sinus/cold relief and wound up with no sense of smell--made it very hard to enjoy food.

      https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5097460/ [nih.gov] From the online abstract:

      Zinc is both an essential and potentially toxic metal. It is widely believed that oral zinc supplementation can reduce the effects of the common cold; however, there is strong clinical evidence that intranasal (IN) zinc gluconate (ZG) gel treatment for this purpose causes anosmia, or the loss of the sense of smell, in humans.

      My personal experience with zinc was from arc (stick) welding some galvanized pipe. Even with the full coverage welding helmet the fumes left me with unpleasantly chalky skin for a week or two. This was c.1970 when I was a teenager, and almost no one worried about little things like this...if I had to do this now I'd be outdoors with a fan to blow the fumes away from me.

      • (Score: 0) by Anonymous Coward on Wednesday September 20 2023, @01:46PM

        by Anonymous Coward on Wednesday September 20 2023, @01:46PM (#1325387)
        Uh. You're supposed to swallow it, not stick it up your nose, nor breathe it in.

        On a related note, don't put whisky or spicy food in your eyes or nose.
  • (Score: 3, Insightful) by VLM on Monday September 18 2023, @12:50PM

    by VLM (445) on Monday September 18 2023, @12:50PM (#1325169)

    The industry is self regulating via the revolving door, so the only possible reason for activity is there will soon be a very expensive new patented medicine to replace it, and the pharma company told the employees in the FDA to remove their admittedly inadequate competition from the market. It could be as lame as a patented formulation of phenylephrine so gotta ban the competitive cheap generic.

    I wonder what other recent viral medical treatments will finally be permitted to be declared ineffective, someday.

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