Phenylephrine or pseudoephedrine

[johnep]

Have we won the war and lost the peace? Went to sell a pack of Sudafed yesterday and note now contained phenylephrine. Checked BNF and no mention of the latter as decongestant.

Right you pharmacologists, whats the difference and how do they compare.?

If pharma changes to phenylephrine then we have fought for the right to sell pseudoephedrine in vain.

johnep

[Zoggite]

Re: Phenylephrine or pseudoephedrine

Sudafed Decongestant tabs = P med = pseudoephedrine 60mg;
Sudafed Congestion Relief caps = GSL = phenylephrine 12mg;
Both boxes are white and blue, and very very similar... I'm sure it's been done on purpose to mislead the public...

[pharout]

Re: Phenylephrine or pseudoephedrine

Here in the U.S., pseudoephedrine has been pulled off the OTC shelves and only kept "behind the counter", mainly due to many people using it to make "methamphetamine". Phenylephrine has replaced it as the decongestants sold on shelves. I believe, clinically, phenylephrine is considered less effective. However, I think the largest comparator between the two decongestants is that phenylephrine cannot be converted to methamphetamine. That's the reason in the U.S. and perhaps, maybe in the UK. The FDA here also just mandated certain OTC child cough/cold products containing decongestants be pulled altogether as there are no data to support using in children <6yrs and they are generally ineffective anyway. The biggest reason is there are many cases where parents giving these to their children overdosed them...

[Tony Schofield]

Re: Phenylephrine or pseudoephedrine

Both are drugs of limited clinical value. I never sell either, I tell 'em to inhale steam. However I don't have a numpty telling me what my sales target is every week!

[johnep]

Re: Phenylephrine or pseudoephedrine

I had a period some years ago when I suffered from nose bleeds. One Sunday was working in Banbury and woke up with a nose bleed that would just not stop. I tried using a nasal spray to constrict the blood vessels (like using adrenaline on a boxer), but not very effective. I drove some 50 miles to work with a plug of cotton wool in each nostril.

The bleeding steadily got worse and in desperation I took Sudafed to again try to constrict the blood vessels. Fortunately not very busy and customers and staff very understanding. I asked if any chance of relief but locum coordinator working at another branch said none available. I 'phoned local hospital (JR at Oxford) and was lucky to get through to the ENT duty Dr who advised that I would need my nose to be plugged and this would need at least an overnight stay.

At last got home and wife drove me to hospital where I stayed for three days.
BP was 220 plus and I was told lucky not to have had a stroke.

BP brought under control and nose was cauterised and no further trouble, and no more taking oral decongestants.

At least this episode ensured that I always checked re BP when selling decongestants.

Presume pseudoephedrine will be withdrawn by the manufacturers eventually as was phenylpropolamine in Contact. We seem to be driven by events in USA. We are lucky to still have codeine and diamorphine, although oxycodone seems to have taken over in palliative care. (Must study for cpd)

johnep



johnep

[Tony Schofield]

Re: Phenylephrine or pseudoephedrine

Pseudoephedrine possibly will be withdrawn despite it taking uneconomic quantities to produce meagre yields of methamphetamine. Most pseudoephedrine in "meth labs" comes from the Eastern bloc and China in industrial quantities but a medicine may be denied the public because of a knee jerk reaction. Thankfully therapeutically it is a drug of limited clinical value.

[paul2008]

Re: Phenylephrine or pseudoephedrine

I thought that the paracetamol combinations are ok because its very difficult to separate the paracetamol and psuedoephedrine. Or is this an myth?

I agree with Tony, except when a patient specially asked for a decongestant I try to encourage steam (or at one time back home: menthol crystals.... I think that pharmacy had a target)

[Raju]

Re: Phenylephrine or pseudoephedrine

Interestingly, pseudoephedrine has a less well known use: to treat priapism, although, I doubt that it will make any diference OTC!

[Tony Schofield]

Re: Phenylephrine or pseudoephedrine

At 53.........? That I should be so lucky!!

[Pharmanaut]

Re: Phenylephrine or pseudoephedrine

Interestingly, pseudoephedrine has a less well known use: to treat priapism, although, I doubt that it will make any diference OTC!

Don't get many rustic fertility gods visiting the pharmacy these days, so that might be why use has declined.

[Pharmanaut]

Re: Phenylephrine or pseudoephedrine

I thought that the paracetamol combinations are ok because its very difficult to separate the paracetamol and psuedoephedrine. Or is this an myth?

I agree with Tony, except when a patient specially asked for a decongestant I try to encourage steam (or at one time back home: menthol crystals.... I think that pharmacy had a target)

Disagree...
Pseudoephedrine every time.
For a few weeks when autumn changes to winter it works wonders for me.
It all started post-registration when I used to travel on a motorbike to do locums before passing driving test. Up to 250cc on a provisional in those days....
Remember driving around 3 miles with both feet sliding on the ice to borrow some ESTP from another village pharmacy. (Ether Soluble Tar Paste). Those were the days.

[Titch]

Re: Phenylephrine or pseudoephedrine

Interestingly, pseudoephedrine has a less well known use: to treat priapism, although, I doubt that it will make any diference OTC!

Wish I'd known that when I was a pre-reg. Had someone come into store on a Sunday wearing a brown mac (honestly!!!) He'd accidently stabbed his friend's syringe into his leg.....(didn't ask for anymore details)
The label on the syringe was papaverine......8 hours later it was agony and he thought "the pharmacist" might be able to help.

[pharout]

Re: Phenylephrine or pseudoephedrine

Interestingly, pseudoephedrine has a less well known use: to treat priapism, although, I doubt that it will make any diference OTC!

If I had priapism, the last thing I would do is walk into a pharmacy to buy it !!

[pharout]

Re: Phenylephrine or pseudoephedrine

I thought that the paracetamol combinations are ok because its very difficult to separate the paracetamol and psuedoephedrine. Or is this an myth?

I agree with Tony, except when a patient specially asked for a decongestant I try to encourage steam (or at one time back home: menthol crystals.... I think that pharmacy had a target)

I think it's a myth as these combos were also pulled in the U.S. I think people have figured out how to extract from these as well...

[admin]

Re: Phenylephrine or pseudoephedrine

If I had priapism, the last thing I would do is walk into a pharmacy to buy it !!

I have a feeling I might spot you coming........