Phenylephrine is a perfectly fine decongestant… when administered intravenously, injected, or topically as a nasal spray. It’s just not particularly effective in low OTC dosages, nor is it particularly long lasting. Larger doses are more effective but they also cause increased blood pressure (fun fact: it’s used as a vasopressor in clinical settings).
Pseudoephedrine is much more effective as a decongestant, but much more annoying to purchase. You can’t get large quantities, and it’s OTC in that you literally have to get it “over the counter” and go through the FDA dance with your driver’s license. It’s time consuming and super annoying but the FDA wants to make sure you’re not making meth from it
Now that’s a novel approach! Stupid problems with stupid solutions indeed.
This BB summary is misleading. The FDA is only saying the oral form of phenylephrine is ineffective. As a nasal spray it is still considered effective. Apparently it is broken down very quickly in the stomach before it has a chance to get absorbed. The NYT article has slightly more clarity about this point.
As a side note with this… I had an issue with glue ear one time and the ENT recommended taking Afrin for 4 days on / 4 days off and see if it helped with drainage. I think this might be one of the few OTC drugs that works immediately. I sprayed it in each nostril and felt my sinuses open up and then was able to pop my ears and feel the gunk come out of the eustachian tubes. I keep a bottle of it on hand for when I feel like my ears are getting stopped up.
OMG So much This! Don’t be tempted to use more non-plain-old-saline nose spray nor more often than directed, or the stuffed-up’edness you’re trying to alleviate will get much worse! Beware getting hooked, too, or your stuffed-up’dness will last longer than it should, like during a cold or summat. Diluting the medicated stuff with some saline nose spray can be very helpful, including when it’s running low & you’re not up to going to the store, or you’re breaking an addiction to it.
I’ve had the same experience with Claritin. Makes my brain not work right. I avoid it totally. But others have no such issues. Brains are weird. The wiring is idiosyncratic and unpredictable. That’s why we are all unique.
Claritin does that to me, too! But only sometimes. I figure those are the days when my congestion is actually due to allergies. Zyrtec seems to work for me without side effects.
Mentioned upthread, my sister swears by Afrin, but it doesn’t seem to do anything for me. I’m not sure, but I’m getting the impression that biology is complicated and medicine is hard…
Biggest issue with ephedra was that in certain, unforeseeable people, it could cause dramatic spikes in blood pressure. A few folks stroked out from it. That is why you can’t get it (pharma-wise) anymore. My usual warning about herbal meds: as natural products, there is no predicting the concentration of the active ingredient in any given batch. I use herbals quite frequently in my practice, but for something like that, where the therapeutic window is narrow and, worst of all, unpredictable, I would probably steer clear.
I caught COVID last year from an anti-vax/mask person. As I was vaxed, it was quite mild, but I was very congested. I boiled a cup of water and I put about ten drops of peppermint oil in it, then I inhaled the steam. I experienced prompt, temporary relief, as the drug commercials say.
I’m not a doctor. This worked for me. Results may vary, etc.
(The anti-vax/mask person wound up in the hospital, but survived.)
I think that’s what’s Pesco is trying to say by calling them the “OTC versions”. Legally speaking, yes, the pseudoephedrine versions of these don’t require a prescription, but they do require you to talk to the pharmacist, get your license scanned, get your retina scanned, provide a blood sample, swear a blood oath, etc. (possibly some /s in there). They are not available “OTC” anymore in the way people typically think of.
Imprecise? Yeah, sure. I don’t know if I would say “misleading” though. I think this also extends to his name-dropping other drugs that are often offered in formulations that bundle the main drug with a decongestant.
In any case it’s pretty clear that he’s not trying to besmirch the magical compound known as pseudoephedrine. We love you, pseudo-fed. Phenyl-E can go rot.
Like arsenic, cyanide, asbestos, anthrax, tetrodotoxin, formaldehyde, chlorine, and plenty of other “natural products” I don’t want any part of in my health routine. People love to justify things by uncritically saying, “it’s fine, it’s natural!”
Stories on this topic aren’t muddy simply because the reporting is sloppy - The landscape itself is a mess because some years ago Kenvue decided to use Benadryl as a wide-ranging trademark covering things beyond just diphenhydramine instead of simply a brand name for its diphenhydramine.
Similar abuses occurred by the other brands in the title.
Products sold under the “Benadryl” trademark include
Oral tablets, capsules, chewable tablets, and liquid solution containing diphenhydramine hydrochloride, an antihistamine that relieves allergy symptoms.
Oral tablets and capsules containing diphenhydramine hydrochloride and phenylephrine hydrochloride, a nasal decongestant that reduces nasal congestion and sinus pressure.
Topical cream, gel, spray, and stick containing diphenhydramine hydrochloride and other ingredients that soothe and relieve skin irritation and itching.
Cough liquid containing diphenhydramine citrate and other ingredients that suppress cough and ease throat pain.
