If you're stuffed up, blame Pfizer

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Pseudoephedrine hydrochloride, the active ingredient in the decongestant Sudafed is also a basic ingredient in the standard recipe for methamphetamine. Over the past 10 years or so, states have been making it increasingly difficult to buy pseudoephedrine. In a number of states, you can now only buy it in a pharmacy.

Naturally, this distresses manufacturers of pseudoephedrine, and Pfizer, the maker of Sudafed, is responding by marketing an alternative. The new drug, "Sudafed PE" replaces pseudoephedrine with phenylephrine. However, it's not entirely clear that it's as good. From the abstract of Leslie Hendeles's Selecting a decongestant (Pharmocotherapy, Nov-Dec 1993):

Phenylpropanolamine, pseudoephedrine, and phenylephrine are the most common decongestants. Although all are sympathomimetic amines, their efficacy varies. In particular, phenylephrine is subject to first-pass metabolism and therefore is not bioavailable in currently recommended doses. In addition, phenylpropanolamine and pseudoephedrine, but not phenylephrine, are effective decongestants.

There appear to be conflicting studies, but unfortunately, I'm working only from the abstract--the paper doesn't seem to be online.

For the moment, at least, you'll still be able to buy pseudoephedrine, but don't be surprised if the states start using the availability of phenylephrine as a reason why it's OK to make pseudoephedrine even harder to get.

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6 Comments

Interesting. I generally find even pseudoephredine hydrochloride as not that effective (except in Aleve Cold and Sinus, which doesn't make much sense to me - the packaging shouldn't matter that much). More recently I ended up being prescribed a different decongestant applied directly to the nose (as drops) and found it remarkably effective, so I'm thinking that is going to be my strategy for future colds.

I use pseudoephedrine during the day and nasal spray at night--but I'm always really careful about the use of nasal spray because of rebound congestion. Which drops were you prescribed?

Interestingly enough, Warner-Lambert performed significant development and testing of a mirror-image pseudoephedrine; they were granted a patent on this substance in 2002. According to their testing, it performs even better as a decongestant than pseudoephedrine does, and has potentially fewer side effects (such as inteference with antihistimines). Of course, the closest substance to meth that can be processed from it is mirror-image meth, which has little to no stimulant or psychoactive properties. Warner-Lambert stopped short of seeking FDA approval for mirror-image pseudoephedrine. This work was discontinued before Pfizer bought Warner-Lambert, and Pfizer has allowed it to remain inactive.

Pseudoephedrine never had any effect on me, perhaps phenylephrine will?

Pseudophrine can interfere with antihistamines? That is news to me (and potentially explains much because I have fairly bad allergies - bad enough that if I get congested and forget my antihistamines it tends to get worse).

As for the drops I was prescribed they were Xylometazoline Hydrochloride. I also had some saline drops that helped when my nose felt dry (after much blowing), but it was the prescription nasal drops (prescribed because I was worried about congestion while flying - and landing in particular) that made the biggest difference.

Bi yan pian (a common Chinese patent remedy) works fine for me. It decongests without drying me out, and doesn't give me the jitters. YMMV.

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