The Dim-Post

August 25, 2009

Ask your pharmacist about pseudoephedrine

Filed under: health — danylmc @ 7:24 am

I started feeling sick on Thursday and the symptoms – sore throat, headache, runny nose – were close enough to those of the H1N1 virus that I went to the chemist on my way home to stock up on supplies.

My usual drug regime for a cold is to take pseudoephedrine during the days and codeine and whiskey at night, but the chemist I went to didn’t have any medications containing pseudoephedrine – they all had an alternative decongestant called phenylephrine. This rang a dim bell at the back of my mind – hadn’t I read a paper or study about phenylephrine? – but I was too sick to care. I paid and went home to bed.

Yesterday I was still sick as hell but I ventured out anyway to buy some more drugs: the first and nearest chemist didn’t have pseudoephedrine, the second did but not on display – you had to ask the pharmacist and he bought me some from the drug locker in the back of his store. There are indications that the government will make pseudoephedrine a prescription only drug, but it seems like they’re already half way there. The chemists don’t want to stock it because people try to break into the store and steal it to manufacture P, and when they sell it they have to go through the hassle of recording peoples name and drivers license details. So they’re switching over to phenylephrine based solutions.

The big problem with this is that phenylephrine doesn’t do anything. Take it from me, I’m a walking control set – I took it for three days and I went through more tissues than a teenage boy with broadband internet. For the last two days I’ve been on pseudoephedrine based medication and the difference is stark, especially since I soaked the pills in ether, mixed them up with red phosphorus and HCl and smoked them.

Just my little joke – but if you (wisely) consider me an unreliable source then there are plenty of studies on Pubmed contesting the efficacy of phenylephrine. The pharmaceutical companies insist that it works but most independent clinical trials indicate that it’s little better than a placebo. This study from the University of Vienna seems to be the most recent one, the results:

Phenylephrine was not significantly different from placebo in the primary end point, mean change in nasal congestion score at more than 6 hours (P = .56), whereas pseudoephedrine was significantly more effective than both placebo (P < .01) and phenylephrine (P = .01)

It’s unfortunate that P hysteria and the swine flu are peaking at the same time so that chemists are de-stocking one of the only drugs that’s effective at treating the symptoms; my advice is not to waste your money on phenylephrine: go to the counter and ask for the good shit, although you might not want to use those exact words.

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29 Comments »

  1. I had a bad cold two weeks ago. When I developed a nasty sinus and chest infection I bowed to the inevitable and went straight to the doctor (because in this country the doctors have a nice little extortion racket where they keep antibiotics as prescription only) and also made sure I got some pseudo-ephedrine from her as well. Up to then, I’d be using the other stuff. The difference is like light and day, one works and one doesn’t.

    Comment by Tom Semmens — August 25, 2009 @ 7:29 am

  2. All of the phenylephrine drugs are combinations that also contain paracetamol and a cough suppressent, so I think they rely on those to trick people into thinking they’ve bought an effective drug – but it is basically a scam.

    Comment by danylmc — August 25, 2009 @ 7:34 am

  3. hmmmm…. might stock up on coldrex or sudafed…

    any respectable citizen knows the majority of pseudoe for P is imported as the drug, not as coldrex, because you can steal enough to supply the market. a knee-jerk reaction to ban it in pharmacies is just plain stupid.

    Comment by Che Tibby — August 25, 2009 @ 8:13 am

  4. “can‘t steal enough…”

    Comment by Che Tibby — August 25, 2009 @ 8:14 am

  5. As a pharmacist of 30 plus years in community pharmacy (but not an owner) some professional comment might be in order. Firstly, Tom, have you not read the notices in your Dr’s surgery about antibiotics. Most winter sinus and chest infections are caused by viruses on which antibiotics have no effect. As a person who tries to get customers to see some sense about self medication with drugs like anti-inflammatories I would hate to be put in a position of being able to sell antibiotics over the counter. The reason for their rapidly increasing ineffectiveness is their vast overuse for trivial indications.
    Re the pseudoephedrine/phenylepherine debate – I agree with you about phenylepherine’s ineffectiveness. As well, phenylepherine causes a significant and sustained rise in blood pressure and heart rate – not good for older citizens (like myself) or those with cardiovascular problems (like myself). If I can remember the history of this correctly, phenylepherine was the first decongestant used for OTC sale in cough/cold remedies – it was replaced with pseudoephedrine for the above reasons. The rise of home labs for speed manufacture and the somewhat undesirable characters who service those by buying pseudoephedrine OTC has led to a lot of pharmacies, understandably, giving it the skip. Suggestion? Create a relationship with your local community pharmacy – perhaps ask to see the pharmacist or ask in advance if they continue to stock the drug and be prepared to give your name and address as a condsition of the sale.If that doesn’t work and you think you need pseudoephedrine – it is still available on prescription from your doctor who according to Tom S has a (ahem) nice little extortion racket?

    Comment by John Thomson — August 25, 2009 @ 8:17 am

  6. Create a relationship with your local community pharmacy

    I’m off to a bad start there, after deliriously ranting at her yesterday about phenylepherine and P values and clinical trials. She looked a bit freaked out.

    Comment by danylmc — August 25, 2009 @ 8:50 am

  7. apparently, danlymc is the “unsavoury type” john is referring to.

    my only gripe is: having to pay up to $70 to get a prescription for something i already know i need… certainly adds to the air of “extortion racket”.

    Comment by Che Tibby — August 25, 2009 @ 9:03 am

  8. A couple of years ago I found myself in Amsterdam with a wicked head-cold. Not willing to waste a day lying in bed I headed to the pharmacy to get the good stuff. What an ordeal. I was questioned at length, needed to provide two forms of ID, phone number and address. Outside on the street were dozens of guys trying to sell me heroin, speed, or anything I may have wanted. It was actually easier to buy crack than coldrex.

    Comment by Philonz — August 25, 2009 @ 9:59 am

  9. Try Duro-Tuss, powered by the excellent cough suppressant qualities of pholcodine. Alas, it does nothing as a decongestant.

    Comment by Will de Cleene — August 25, 2009 @ 10:12 am

  10. I’ve had the same ineffective experiences. If the controlled studies shows it as well, a complaint to the Commerce Commission about misleading advertising might be in order.

    Comment by vibenna — August 25, 2009 @ 10:13 am

  11. I was in Thailand a year ago, and I got a whole pile of stuff over-the-counter at a fraction of the price I would pay here and without the need for a doctors trip for a prescription – some things I need, like ventolin inhalers, and some thing I didn’t like antibiotics (a just in case purchase that ha aved me two doctors trips back here before I ran out).

    Thailand doesn’t appear to be collaping under some sort of public health crisis because you can buy ventolin and antibiotics over the counter at the local chemist. I can’t see any harm in allowing people access to these things after talking to a qualified pharmacist or a public health nurse. But of course GP’ss would hate it, because it would slash the ticket clipping component of their incomes.

    Comment by Tom Semmens — August 25, 2009 @ 11:35 am

  12. Who cares about pseudoephedrine or phenylephrine, just give me something with codeine and I’ll grin all though the day.

    I just checked my supply of Codral and whadaya know, it is the pseudo-free edition.

    “Thailand doesn’t appear to be collaping under some sort of public health crisis”. That’s because they don’t have socialised medicine like here or like Obama is peddling to the people in the US. A win for the free market… apart from the growing resistance to antibiotics, I guess.

    Comment by Clunking Fist — August 25, 2009 @ 11:47 am

  13. apart from the growing resistance to antibiotics

    And not making new ones, because the first thing people do with a new antibiotic is not use it (p3).

    http://www.newyorker.com/reporting/2008/08/11/080811fa_fact_groopman

    Triumph of the free market there. But seriously – the further you are from lab-confirmation of bacterial infection, the more pointless the risk of using antibiotics.

    The PM’s Science advisor is investigating the restrictability of Psuedo (or has done, apparently the report is late), and seeing if alternatives actually work is part of that.

    Comment by lyndon — August 25, 2009 @ 12:08 pm

  14. Sorry I was forgetting he did do the report, it’s just not on the website…

    It had options, from memory.

    Comment by lyndon — August 25, 2009 @ 12:12 pm

  15. i might actually get out and protest in the street if they ban pseudoe.

    or i might pretend to. a kind of pseudo-protest for pseudoe. i’ll leave you to guess the soundtrack for that funky, funky trip to town.

    Comment by Che Tibby — August 25, 2009 @ 12:29 pm

  16. Sorry, lyndon, as I am eating my lunch, I gave up at about the third paragraph! The irony was in Tom Semmens wishing we were all laisse-faire like Thailand rather than the socialised model we have here where government-enforced barriers to entry exist “for our own good”.

    Comment by Clunking Fist — August 25, 2009 @ 12:42 pm

  17. #2 “All of the phenylephrine drugs are combinations that also contain paracetamol and a cough suppressent, so I think they rely on those to trick people into thinking they’ve bought an effective drug – but it is basically a scam.”

    Lemsip Day & Night pills are paracetamol, phenylephrine, and a hint of caffine (‘day’ pils), at about $16 a box. Generic paracetamol is about $3 from a supermarket, for the same amount of pills.

    Comment by Miro — August 25, 2009 @ 1:27 pm

  18. my only gripe is: having to pay up to $70 to get a prescription for something i already know i need… certainly adds to the air of “extortion racket”.

    At that price, you’d be better off going to someone who deals the illegal stuff.

    Comment by georgedarroch — August 25, 2009 @ 2:54 pm

  19. For those of us who have the Mast Cell allergies, only the real thing will do. I have tried all the fancy decongestants in the market but the only thing which stops my nose running like a tap and my head feeling like my face has shrunk, is a good dose of pseudoephedrine.

    I am happy to provide all the identification in the world and I only need half a dozen tablets, so where am I a problem?

    Comment by Lindsey J Rea — August 25, 2009 @ 5:42 pm

  20. I am another person who swears by the pseudoephedrine. However, in saying that, I also enjoy gulping down some Robitussin, so maybe my opinion cannot be trusted.

    Comment by Jackson J Wood — August 25, 2009 @ 10:32 pm

  21. Nasty cold here. Wanted pseudoephedrine. Went to chemist who sold me the phenylephrine stuff, which didn’t *touch* it. The important meeting I went to, I snuffled and blew my way through a box of tissues. I’m so pissed off at the chemist I’m going to ask for my money back.

    I agree with the chemist who spoke above that perhaps we need to build relationships with our local chemist to get around the fact that all chemists now think that ordinary middle-class professionals are p-cooks.

    Comment by Chris — August 27, 2009 @ 12:01 pm

  22. “I agree with the chemist who spoke above that perhaps we need to build relationships with our local chemist to get around the fact that all chemists now think that ordinary middle-class professionals are p-cooks.”

    And all CYFS workers think us child abuses when we smack our naughty kids. All governments think us drunks so heavily tax our merlot.

    Comment by Clunking Fist — August 27, 2009 @ 4:32 pm

  23. Interesting how keen we are to take pills. Nasal spray – delivers the drug to where it’s needed. Works.

    Comment by macdo — August 29, 2009 @ 9:28 pm

  24. without knowing anything about the chensitry, Im wondering if real ephedrine would do as a substitute for pseudoephidrine? Or is that equivalent to trying to use real poo as a substitute for shampoo?

    Comment by kahikatea — August 31, 2009 @ 11:14 am

  25. 1. Very clever
    2. It doesn’t say so on the wikipedia page but I’d guess that pseudoephedrine is some kind of stereoisomer of the original molecule.

    Comment by danylmc — August 31, 2009 @ 11:38 am

  26. Sounds a bit like that old Brendan Behan line about champagne last night and real pain the next morning.

    Comment by joew — August 31, 2009 @ 12:15 pm

  27. … I’d guess that pseudoephedrine is some kind of stereoisomer of the original molecule

    Yes. See the page for ephedrine and the comment at the start about enantiomer names, or just compare the diagrams in the top right of the two pages.

    Comment by chiz — August 31, 2009 @ 6:52 pm

  28. I bought that useless coldrex yesterday off the shelf for my cold and it didnt do anything. So I walked up to a pharmacy just now and asked for the coldrex that works.. with the pseudoephedrine in it and the pharmacist said they dont stock it now! I said how useless the coldrex off the shelf is now and how I was annoyed at all these guys on p are making it hard for honest people with colds like me to buy the proper coldrex medication (she could hear i had a cold) and then she said.. oh wait, i do have one here behind the counter I think and.. voila, yes she did. I felt a bit discriminated against to be honest that she didn’t offer it when I first asked!

    Comment by James — September 25, 2009 @ 10:27 am

  29. James, did you finally show her your Kiwibank credit/eftpos card?

    Comment by Clunking Fist — September 25, 2009 @ 2:22 pm


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