The Uselessness of Phenylephrine
May 15, 2022 8:12 AM Subscribe
"The only reason it's sold is to have some alternative [to pseudoephedrine] to offer consumers, even if it's a worthless one." Pharmaceutical blogger Derek Lowe of In the Pipeline (previously) discusses phenylephrine, which does not work as a decongestant and is "indistinguishable from placebo in conditions like allergic rhinitis", saying it is "is of no real use and does not deserve its FDA listing."
But here in the US, if you go to the drugstore and purchase an over-the-counter nasal decongestant (as a single agent or a combination of drugs that includes a decongestant), you will in every single case be buying phenylephrine. Which does not work. It is found (according to the paper linked above) in 261 different OTC products, and it is a useless bait-and-switch on the consumer in every one of them. I have always told friends and family members to avoid these products if at all possible, and to go back to the pharmacy counter to get something that actually works.
Interesting. I knew it was dramatically less effective but not worthless. Fortunately my household’s congestion doesn’t require buying the good stuff more often than every couple of years. I still find it very stressful to purchase and always feel like a “drug seeker” when I ask for it by generic name, but I don’t need to pay for the Sudafed brand name.
posted by obfuscation at 8:30 AM on May 15, 2022 [5 favorites]
posted by obfuscation at 8:30 AM on May 15, 2022 [5 favorites]
This is an issue I have been enraged about for years. And I am so sad when people I know in dire allergic straits say "Sudafed doesn't work." It does! You just have to talk to your pharmacist!
The author says "here in the US" like the US is unique. There are many other countries where phenylephrine is over the counter and pseudoephedrine is only available by prescription, or not at all. When we accidentally got stuck in NZ due to COVID, I metered out my last few expired Sudafed like they were gold nuggets. (Ironically, for most of that time I could still get paracetamol with coedine over the counter.) Thinking on it, pseudoephedrine is easier to access in the US than most other countries.
And because it has been so linked with meth in the public mind some people I know think that it IS meth. I offered a friend with diabolical hay fever a Sudafed and she reacted like I'd offered her heroin. It's not speed! If you take it you won't need a new facial tissue every minute!
posted by rednikki at 8:31 AM on May 15, 2022 [16 favorites]
The author says "here in the US" like the US is unique. There are many other countries where phenylephrine is over the counter and pseudoephedrine is only available by prescription, or not at all. When we accidentally got stuck in NZ due to COVID, I metered out my last few expired Sudafed like they were gold nuggets. (Ironically, for most of that time I could still get paracetamol with coedine over the counter.) Thinking on it, pseudoephedrine is easier to access in the US than most other countries.
And because it has been so linked with meth in the public mind some people I know think that it IS meth. I offered a friend with diabolical hay fever a Sudafed and she reacted like I'd offered her heroin. It's not speed! If you take it you won't need a new facial tissue every minute!
posted by rednikki at 8:31 AM on May 15, 2022 [16 favorites]
(My reading is that Lowe says "here in the US" just to ensure he's limiting what he's saying to the specific jurisdiction he knows the most about, not to say the US is completely unique.)
I knew phenylephrine was LESS effective but it wasn't till reading this piece I found out it is COMPLETELY INDISTINGUISHABLE FROM PLACEBO! Arrrrgh!
rednikki that is a maddening response from your misinformed friend! Aaarrgh again!!
The next time I go to the pharmacy counter to get my eight free monthly insurance-covered COVID antigen tests I suppose I may as well also stock up on pseudoephedrine for the next time I need it....
posted by brainwane at 8:38 AM on May 15, 2022 [8 favorites]
I knew phenylephrine was LESS effective but it wasn't till reading this piece I found out it is COMPLETELY INDISTINGUISHABLE FROM PLACEBO! Arrrrgh!
rednikki that is a maddening response from your misinformed friend! Aaarrgh again!!
The next time I go to the pharmacy counter to get my eight free monthly insurance-covered COVID antigen tests I suppose I may as well also stock up on pseudoephedrine for the next time I need it....
posted by brainwane at 8:38 AM on May 15, 2022 [8 favorites]
I thought the whole "it's used to make meth" thing is exactly why you can't just get Sudafed without difficulty?
posted by jenfullmoon at 8:40 AM on May 15, 2022 [5 favorites]
posted by jenfullmoon at 8:40 AM on May 15, 2022 [5 favorites]
One thing that's really annoying about phenylephrine is that if you buy, say, DayQuil, it'll have phenylephrine so it can say it has a decongestant (as the blogger says). And then I don't want to take "real" Sudafed on top of the DayQuil, because I already TOOK a (fake, bad) decongestant. But it's also really annoying to have to make sure I have all the meds in DayQuil independently and some of them are "every 4 hours" and some are "every 6 hours" and some are "extended release every 12 hours" and it's all just very annoying compared to taking a shot of DayQuil every however many hours.
I used to feel like a drug-seeker buying sudafed when they first put in the rules, but now I just rock on up to the pharmacy counter and say, "generic sudafed please" "how many?" "the largest amount I can legally buy at once" and they just grab that and consider it totally normal. I think because all customers AND employees are annoyed by the extra steps to buy it, so they're like "obviously you want to do this as rarely as possible."
posted by Eyebrows McGee at 8:41 AM on May 15, 2022 [41 favorites]
I used to feel like a drug-seeker buying sudafed when they first put in the rules, but now I just rock on up to the pharmacy counter and say, "generic sudafed please" "how many?" "the largest amount I can legally buy at once" and they just grab that and consider it totally normal. I think because all customers AND employees are annoyed by the extra steps to buy it, so they're like "obviously you want to do this as rarely as possible."
posted by Eyebrows McGee at 8:41 AM on May 15, 2022 [41 favorites]
I knew pheylephrine did fuckall for my allergies; it's comforting in a grim way that it does fuckall for anyone. I used to really need to use pseudo a few times a year to get into breathing mode during particularly bad seasonal spikes, though at this point with flonase having done a really great overall job on my allergies it's more of a "once a year, maybe" thing when something more than just fuckin' pollen et al is going on.
And I mean the real stuff tends to have backlash symptoms even when I need it, like I'm getting a day or two of relief from severe symptoms in exchange for also feeling low-level shitty for a couple days afterward. It's not exactly a fun way to decongest. But at least it does what it's supposed to fucking do.
posted by cortex at 8:45 AM on May 15, 2022 [5 favorites]
And I mean the real stuff tends to have backlash symptoms even when I need it, like I'm getting a day or two of relief from severe symptoms in exchange for also feeling low-level shitty for a couple days afterward. It's not exactly a fun way to decongest. But at least it does what it's supposed to fucking do.
posted by cortex at 8:45 AM on May 15, 2022 [5 favorites]
I know less than nothing about organic chemistry, but I was still entertained by mentally reading that article in Walter White's voice. Also, I'll get the real stuff from now on instead of fucking around with Dayquil when I need some cold treatment.
posted by Halloween Jack at 8:49 AM on May 15, 2022 [1 favorite]
posted by Halloween Jack at 8:49 AM on May 15, 2022 [1 favorite]
Yeah, I tried Sudafed PE once, concluded that it doesn't work, and went back to using regular pseudoephedrine. In a sense it is somewhat gratifying that my initial impression was correct and that I did not waste any more time on it.
posted by anhedonic at 8:58 AM on May 15, 2022 [3 favorites]
posted by anhedonic at 8:58 AM on May 15, 2022 [3 favorites]
Here in my part of the US, I don't know if the legislation is just that badly written (probably) or if it's misunderstanding by the pharmacy staff, but buying pseudoephedrine is always such a frustrating task, especially now with the ongoing supply issues. Sometimes, all they'll have is a box of like six 12-hour brand-name Sudafed, and that's it. So I'll take what I can get, but that's "my box" for the month. If I try again later or the next week, my ID is rejected because I already bought "a box" of Sudafed. If they happen to have the 48-count generic, that's fine, and still counts as "my box" of Sudafed for the month. It makes no sense, and, judging by the ongoing and escalating meth problem in my area, all that these onerous regulations have accomplished is to inconvenience legitimate consumers. Keep it controlled by the pharmacist, fine. Track it by my ID with every purchase, fine. But don't limit it by some arbitrary and senseless metric. Let people buy what they need; if someone appears to be buying a suspiciously large amount, it is known and can be investigated further.
posted by xedrik at 9:00 AM on May 15, 2022 [28 favorites]
posted by xedrik at 9:00 AM on May 15, 2022 [28 favorites]
I like when I buy a four pack of pseudoephedrine and they still check my ID, just in case I'm making like small-batch artisanal meth.
posted by DirtyOldTown at 9:05 AM on May 15, 2022 [76 favorites]
posted by DirtyOldTown at 9:05 AM on May 15, 2022 [76 favorites]
I like when I buy a four pack of pseudoephedrine and they still check my ID, just in case I'm making like small-batch artisanal meth.
My driver's license expired last year, which completely escaped my notice because I basically don't drive anywhere anymore. I only noticed when I went to the CVS for my monthly prescription refills, and added a 12-pack of Claritin-D to my normal regimen of extremely-controlled substances. The expired license I'd been giving them to scan for the last six months to prove my identity and pick up ADHD meds (which is to say, pharmacologically-controlled meth) was just dandy for their internal tracking system, but threw up all sorts of alarm bells when I tried to use it to buy OTC allergy meds with pseudoephedrine in them.
posted by Mayor West at 9:10 AM on May 15, 2022 [23 favorites]
My driver's license expired last year, which completely escaped my notice because I basically don't drive anywhere anymore. I only noticed when I went to the CVS for my monthly prescription refills, and added a 12-pack of Claritin-D to my normal regimen of extremely-controlled substances. The expired license I'd been giving them to scan for the last six months to prove my identity and pick up ADHD meds (which is to say, pharmacologically-controlled meth) was just dandy for their internal tracking system, but threw up all sorts of alarm bells when I tried to use it to buy OTC allergy meds with pseudoephedrine in them.
posted by Mayor West at 9:10 AM on May 15, 2022 [23 favorites]
>I like when I buy a four pack of pseudoephedrine and they still check my ID, just in case I'm making like small-batch artisanal meth.
They aren't just checking your ID, they are probably recording you and your purchase in NPLEx, the nationwide database. If you tried to buy another 4 pack and then another, you'd hit your limit and they would refuse to sell to you. [caveat, i think not all states participate, maybe this doesn't apply to you]
If I buy my wife's OTC asthma pills for her, it puts me close enough to the max that I can't buy myself real Sudafed for a while.
posted by mrgoldenbrown at 9:21 AM on May 15, 2022 [2 favorites]
They aren't just checking your ID, they are probably recording you and your purchase in NPLEx, the nationwide database. If you tried to buy another 4 pack and then another, you'd hit your limit and they would refuse to sell to you. [caveat, i think not all states participate, maybe this doesn't apply to you]
If I buy my wife's OTC asthma pills for her, it puts me close enough to the max that I can't buy myself real Sudafed for a while.
posted by mrgoldenbrown at 9:21 AM on May 15, 2022 [2 favorites]
This is unfair. Phenylephrine definitely works as a nasal decongestant. You just have to dissolve it and squirt 100 µg up somebody’s nose. I think it is also the case that you would expect zero CNS stimulation from phenylephrine.
posted by a robot made out of meat at 9:41 AM on May 15, 2022 [1 favorite]
posted by a robot made out of meat at 9:41 AM on May 15, 2022 [1 favorite]
Pseudoephedrine raises blood pressure so I never recommend it to my elderly patients and you shouldn't use it unless you know that your blood pressure is good.
Nasal steroid sprays are pretty effective for most if taken regularly. I recommend them for seasonal rhinitis but discourage their year-round use.
Antihistamines are good for a runny nose and also for sneezing and itching. They vary in effectiveness. Diphenhydramine (Benadryl et al.) and chlorpheniramine (Chlor-Trimeton) are very effective but will definitely make you sleepy. The others in order of effectiveness from most to least: cetirizine (Zyrtec), fexofenadine (Allegra), loratatine (Claritin). Zyrtec makes me sleepy. Claritin is ineffective for most people. Allegra is the sweet spot for me: effective with no drowsiness. All of these are available generically. I'm probably forgetting a medication or two.
posted by neuron at 9:50 AM on May 15, 2022 [55 favorites]
Nasal steroid sprays are pretty effective for most if taken regularly. I recommend them for seasonal rhinitis but discourage their year-round use.
Antihistamines are good for a runny nose and also for sneezing and itching. They vary in effectiveness. Diphenhydramine (Benadryl et al.) and chlorpheniramine (Chlor-Trimeton) are very effective but will definitely make you sleepy. The others in order of effectiveness from most to least: cetirizine (Zyrtec), fexofenadine (Allegra), loratatine (Claritin). Zyrtec makes me sleepy. Claritin is ineffective for most people. Allegra is the sweet spot for me: effective with no drowsiness. All of these are available generically. I'm probably forgetting a medication or two.
posted by neuron at 9:50 AM on May 15, 2022 [55 favorites]
I like when I buy a four pack of pseudoephedrine and they still check my ID, just in case I'm making like small-batch artisanal meth.
I guess that that's one way to describe "shake-and-bake" meth. Since large-scale meth production is basically now the province of the cartels, I'd assume that whenever local LE busts someone's "lab", it's a shake-and-bake setup.
posted by Halloween Jack at 9:52 AM on May 15, 2022
I guess that that's one way to describe "shake-and-bake" meth. Since large-scale meth production is basically now the province of the cartels, I'd assume that whenever local LE busts someone's "lab", it's a shake-and-bake setup.
posted by Halloween Jack at 9:52 AM on May 15, 2022
I thought the whole "it's used to make meth" thing is exactly why you can't just get Sudafed without difficulty
It has apparently been successful, in that meth production is currently dominated by the cartels, the strongest and cheapest product in years, but not made from pseudoephedrine.
posted by atoxyl at 9:58 AM on May 15, 2022 [14 favorites]
It has apparently been successful, in that meth production is currently dominated by the cartels, the strongest and cheapest product in years, but not made from pseudoephedrine.
posted by atoxyl at 9:58 AM on May 15, 2022 [14 favorites]
I can remember in the way-back, before-times, when I was a kid and the real stuff was easy to get, I would get these raging allergy attacks, stuffy nose, postnasal drip, constant sneezing, watery red eyes, and Sudafed was like magic. My mom would give me one and I would get drowsy and take a nap for two hours and wake up like it never happened.
A medication that Actually Works as Advertised, so of course we can't just easily get it anymore. My pharmacy looks at me like I have two heads when I ask for it. They give it to me eventually, but it's a pain in the ass process. Which, I gather, it's supposed to be. Hasn't stopped any local overdoses though.
Anyway, just a little miracle pill.
posted by Ray Walston, Luck Dragon at 10:28 AM on May 15, 2022 [10 favorites]
A medication that Actually Works as Advertised, so of course we can't just easily get it anymore. My pharmacy looks at me like I have two heads when I ask for it. They give it to me eventually, but it's a pain in the ass process. Which, I gather, it's supposed to be. Hasn't stopped any local overdoses though.
Anyway, just a little miracle pill.
posted by Ray Walston, Luck Dragon at 10:28 AM on May 15, 2022 [10 favorites]
Meanwhile, buy OTC decongestants in Italy and you'll be ready to fly home under your own power.
posted by snuffleupagus at 10:30 AM on May 15, 2022 [12 favorites]
posted by snuffleupagus at 10:30 AM on May 15, 2022 [12 favorites]
that meth production is currently dominated by the cartels
I'm pretty sure I remember an FPP here about how drug cartels were laundering their cash through China in exchange for the chemical feedstocks for manufacturing meth. Chinese people want cash for saving under their mattresses, and the cartels want clean money to diversify their interests.
posted by Bee'sWing at 10:34 AM on May 15, 2022
I'm pretty sure I remember an FPP here about how drug cartels were laundering their cash through China in exchange for the chemical feedstocks for manufacturing meth. Chinese people want cash for saving under their mattresses, and the cartels want clean money to diversify their interests.
posted by Bee'sWing at 10:34 AM on May 15, 2022
They aren't just checking your ID, they are probably recording you and your purchase in NPLEx, the nationwide database.
Washington and Pennsylvania, I think, share access to the same underlying database. I caught a sinus infection when visiting my folks and had a lot of trouble getting the medication I needed in one state.
Firstly, because my ID was out-of-state, and, secondly, I had bought some in the other about a month and a half prior due to a previous sinus infection.
Thank the gods for rhinoplasty. I haven't had to buy as much Sudafed in years, or work around the useless roadblocks. Meth is still rolling along, as near as I can tell.
posted by They sucked his brains out! at 10:40 AM on May 15, 2022 [1 favorite]
Washington and Pennsylvania, I think, share access to the same underlying database. I caught a sinus infection when visiting my folks and had a lot of trouble getting the medication I needed in one state.
Firstly, because my ID was out-of-state, and, secondly, I had bought some in the other about a month and a half prior due to a previous sinus infection.
Thank the gods for rhinoplasty. I haven't had to buy as much Sudafed in years, or work around the useless roadblocks. Meth is still rolling along, as near as I can tell.
posted by They sucked his brains out! at 10:40 AM on May 15, 2022 [1 favorite]
Nasal steroid sprays are pretty effective for most if taken regularly. I recommend them for seasonal rhinitis but discourage their year-round use.
Flonase basically changed my life and dramatically increased the quality of life. I used to get sudden-onset allergy attacks that would make me nonfunctional and rapidly turn into sinus infections that would debilitate me for weeks. "Just blow your nose!" people would tell me not understanding that my sinuses had swelled shut. This would happen 3 times per year or so.
Haven't had that happen since starting on nasal steroids eight years ago or so.
posted by entropone at 10:46 AM on May 15, 2022 [12 favorites]
Flonase basically changed my life and dramatically increased the quality of life. I used to get sudden-onset allergy attacks that would make me nonfunctional and rapidly turn into sinus infections that would debilitate me for weeks. "Just blow your nose!" people would tell me not understanding that my sinuses had swelled shut. This would happen 3 times per year or so.
Haven't had that happen since starting on nasal steroids eight years ago or so.
posted by entropone at 10:46 AM on May 15, 2022 [12 favorites]
my minor quibble with this piece is that it kind of obfuscates the meaning of over-the-counter.
Alanis ironically, once you have a prescription (I have chronic sinus issues), it's easier to buy pseudoephedrine not-over-the-counter than it is over-the-counter.
posted by Candleman at 10:50 AM on May 15, 2022 [5 favorites]
Alanis ironically, once you have a prescription (I have chronic sinus issues), it's easier to buy pseudoephedrine not-over-the-counter than it is over-the-counter.
posted by Candleman at 10:50 AM on May 15, 2022 [5 favorites]
It's not speed! If you take it you won't need a new facial tissue every minute!
It’s not, but on the other hand every time I’ve taken max-strength Neo-Citran, while my cold symptoms have immediately gone I’ve spent the next few hours in a (not at all unpleasant tbh) mildly cranked up and dissociated state. It is pretty powerful for what is supposed to just be a cold medicine!
posted by Jon Mitchell at 10:55 AM on May 15, 2022 [4 favorites]
It’s not, but on the other hand every time I’ve taken max-strength Neo-Citran, while my cold symptoms have immediately gone I’ve spent the next few hours in a (not at all unpleasant tbh) mildly cranked up and dissociated state. It is pretty powerful for what is supposed to just be a cold medicine!
posted by Jon Mitchell at 10:55 AM on May 15, 2022 [4 favorites]
Claritin is ineffective for most people
It is weirdly great for controlling Neulasta-related bone pain though.
posted by rhamphorhynchus at 10:58 AM on May 15, 2022 [1 favorite]
It is weirdly great for controlling Neulasta-related bone pain though.
posted by rhamphorhynchus at 10:58 AM on May 15, 2022 [1 favorite]
" still counts as "my box" of Sudafed for the month."
Yeah, that's bad legislation. My state has a milligram-per-day limit, and a second milligram-per-month limit (which is about 3x the "day" limit), which I think is probably in line with the federal rule. I just went and looked and apparently I can buy a 96-pill box of regular sudafed within my daily limit, as that is what I have.
posted by Eyebrows McGee at 11:10 AM on May 15, 2022 [1 favorite]
Yeah, that's bad legislation. My state has a milligram-per-day limit, and a second milligram-per-month limit (which is about 3x the "day" limit), which I think is probably in line with the federal rule. I just went and looked and apparently I can buy a 96-pill box of regular sudafed within my daily limit, as that is what I have.
posted by Eyebrows McGee at 11:10 AM on May 15, 2022 [1 favorite]
I can't take the real stuff as it makes my blood pressure sky-high. Afrin is my friend when I need that kind of relief.
posted by COD at 11:50 AM on May 15, 2022 [1 favorite]
posted by COD at 11:50 AM on May 15, 2022 [1 favorite]
That not-sudafed is garbage, I've always known that.
My folks used to be able to get all the sudafed they wanted from the local military base hospital. You just had to fill out a form for some OTC meds and they'd hand them out. Kept us stocked up through allergy season. That was a long time ago now.
I used to work a certain popular desert festival and would spend many weeks out there in the dust. Nothing was better for drying you up than those little red pills when you've been irritating your sinuses for weeks. But I did find that if I had too much coffee in the mornings combined with the sudafed, combined with the heat, mid-day I'd want to murder people. (Didn't help that everyone working out there is some variety of asshole.) My crew took our end of lunch shaded chill, nap and relax sessions very seriously.
posted by Catblack at 12:13 PM on May 15, 2022 [5 favorites]
My folks used to be able to get all the sudafed they wanted from the local military base hospital. You just had to fill out a form for some OTC meds and they'd hand them out. Kept us stocked up through allergy season. That was a long time ago now.
I used to work a certain popular desert festival and would spend many weeks out there in the dust. Nothing was better for drying you up than those little red pills when you've been irritating your sinuses for weeks. But I did find that if I had too much coffee in the mornings combined with the sudafed, combined with the heat, mid-day I'd want to murder people. (Didn't help that everyone working out there is some variety of asshole.) My crew took our end of lunch shaded chill, nap and relax sessions very seriously.
posted by Catblack at 12:13 PM on May 15, 2022 [5 favorites]
As I understand it, the US anti-pseudoephedrine laws have basically been successful in mostly eliminating the aforementioned "shake and bake" small scale production, which is good, as basically every one of those labs was a Superfund pollution site, and bad, because it shifted production almost entirely to the cartels.
But since they were finding the majority of shake and bake labs BECAUSE OF THE EXPLOSIONS, I am for once slightly in favor of a puritan American anti-drug law on environmental grounds.
posted by ivan ivanych samovar at 12:22 PM on May 15, 2022 [8 favorites]
But since they were finding the majority of shake and bake labs BECAUSE OF THE EXPLOSIONS, I am for once slightly in favor of a puritan American anti-drug law on environmental grounds.
posted by ivan ivanych samovar at 12:22 PM on May 15, 2022 [8 favorites]
a Superfund pollution site
One of those blew up across from a house I had been renting in SE Portland a few months after I moved out; and while I'm sure the remediation is bad for the homeowners it would seem to obey the fiction of the property line and it did not become any kind of public health project.
posted by snuffleupagus at 12:27 PM on May 15, 2022 [4 favorites]
One of those blew up across from a house I had been renting in SE Portland a few months after I moved out; and while I'm sure the remediation is bad for the homeowners it would seem to obey the fiction of the property line and it did not become any kind of public health project.
posted by snuffleupagus at 12:27 PM on May 15, 2022 [4 favorites]
But since they were finding the majority of shake and bake labs BECAUSE OF THE EXPLOSIONS, I am for once slightly in favor of a puritan American anti-drug law on environmental grounds.
What if we just made quality government made meth legal for those that really want to do it (and recovery treatment free) so we don't have Superfund sites, explosions, or highly profitable and violent cartels (which to be honest just externalize the damage made by creating the meth to people outside the US for the most part)?
The current policy isn't working and the cartel production methods are still environmentally damaging but it's to (mostly) Mexicans rather than people in the US. I don't count that as a win.
it would seem to obey the fiction of the property line and it did not become any kind of public health project.
Are you sure it was properly remediated and not just swept under the rug to give the next unknowing person to live there cancer?
posted by Candleman at 12:38 PM on May 15, 2022 [21 favorites]
What if we just made quality government made meth legal for those that really want to do it (and recovery treatment free) so we don't have Superfund sites, explosions, or highly profitable and violent cartels (which to be honest just externalize the damage made by creating the meth to people outside the US for the most part)?
The current policy isn't working and the cartel production methods are still environmentally damaging but it's to (mostly) Mexicans rather than people in the US. I don't count that as a win.
it would seem to obey the fiction of the property line and it did not become any kind of public health project.
Are you sure it was properly remediated and not just swept under the rug to give the next unknowing person to live there cancer?
posted by Candleman at 12:38 PM on May 15, 2022 [21 favorites]
Not at all, I just mean that at least that particular meth house didn't become a 'superfund site' in the sense that public resources were consumed to remediate it to any kind of standard. Let alone the houses surrounding it.
posted by snuffleupagus at 12:41 PM on May 15, 2022
posted by snuffleupagus at 12:41 PM on May 15, 2022
you know those times when it seems metafilter is reading your mind? Ok, no, but I've been going through allergies since last year. Pseudoephedrine is like speed to me but in small doses ok. I've had left ear blockage for 4 months flonaise helps ALOT. So doc said Claritin-D but that loggies me out. Doc said no 'Ps' and Phenylephrine, the nurse said was just low grade upper that just dehydrates but helps little or nil with nasal conjestion. Air pressure from a 2nd floor apartment which I'm spring cleaning today, and no AC in the kitchen at work...Yeah...2/3 quit or out sick in last week. That constant pressure does not helps conjestion and it can create problems for the body to cool properly. Smoking does not help.
Thanks for listening.
posted by clavdivs at 12:41 PM on May 15, 2022 [5 favorites]
Thanks for listening.
posted by clavdivs at 12:41 PM on May 15, 2022 [5 favorites]
All restricting the sale of Sudafed really did was to increase the price by one box of Sudafed, at least until the cartels took over.
posted by wierdo at 1:38 PM on May 15, 2022 [1 favorite]
posted by wierdo at 1:38 PM on May 15, 2022 [1 favorite]
I learned this the hard way shortly after moving to the USA from Canada. Why wasn't Sudafed doing anything? After reading the label carefully I went back to the pharmacy and had to show my god damned passport just to get the real thing.
posted by Evstar at 2:00 PM on May 15, 2022 [2 favorites]
posted by Evstar at 2:00 PM on May 15, 2022 [2 favorites]
→
Bilastane (Blexten). Not generic, expensive as antihistamines go, but man! your histamines will be gone.
posted by scruss at 3:11 PM on May 15, 2022
I'm probably forgetting a medication or two
Bilastane (Blexten). Not generic, expensive as antihistamines go, but man! your histamines will be gone.
posted by scruss at 3:11 PM on May 15, 2022
Diphenhydramine (Benadryl et al.) and chlorpheniramine (Chlor-Trimeton) are very effective but will definitely make you sleepy.
Benadryl wakes me up. Histamines make me sleepy (the most debilitating symptom when I developed allergies in my early 30s, before figuring out how to deal with them, was fatigue), so part of that is it being affective at being an antihistamine; but even when my histamine response is very mild, I’ve never had Benadryl make me sleepy.
posted by eviemath at 3:25 PM on May 15, 2022 [2 favorites]
Benadryl wakes me up. Histamines make me sleepy (the most debilitating symptom when I developed allergies in my early 30s, before figuring out how to deal with them, was fatigue), so part of that is it being affective at being an antihistamine; but even when my histamine response is very mild, I’ve never had Benadryl make me sleepy.
posted by eviemath at 3:25 PM on May 15, 2022 [2 favorites]
There’s also levoceterizine and desloratidine. As you can tell from the names, they are related to ceterezine and loratidine. Both are supposed to have reduced side effects with similar or greater efficacy but I don’t know about that. (I’m trying the levoceterizine now that it’s OTC, but I can’t say for sure yet even for me). Oh and montelukast which is good for those of us with allergic asthma, but it’s still prescription.
I prefer to get the decongestant separately, so I’ve been a purchaser of sudafed for eons. (I also can’t take the steroid nasal sprays due to a weird side effect). When I lived in Michigan my allergies were worse and the restrictions on purchase were tighter and so it was actually kind of hard to get enough sudafed; I looked into getting a prescription (they make you try other things first, which is how I know the nasal sprays aren’t good for me), but moved out of the country before that happened.
I then lived in Denmark for three years; there was only one drug on the formulary there that had pseudoephedrine (a different antihistamine that I don’t remember there name of, combined with pseudoephedrine ). I also had to convince the doc that I wasn’t at risk for addiction; the drug is flagged the same way a narcotic would be. (I am addicted to breathing, and I would like to keep doing it, however).
But I couldn’t take enough of it, because the antihistamine had a tighter upper limit. So I would buy sudafed whenever I went to another country (frequently, I traveled for work). The UK was easiest; they wouldn’t sell you much but they didn’t track it at all so it was easy to go to a different Boots and get more if needed. (Note what I was doing is sketchy, and some countries are much more persnickety about importing even personal use amounts; pseudoephedrine is a highly controlled substance in some places and it’s not always obvious what the import rules are or how tightly they will be enforced). If you are trying to find an OTC drug while traveling, it may not be OTC but even if it is the brand name is probably different; knowing the technical name of the drug (ceterizine instead of Zyrtec, pseudoephedrine instead of Sudafed) can help.
Now in AZ it’s back to 96 pills per purchase, and to glaring at the Little Red Placebo (aka phenylephrine) that has been my nemesis for years.
Although don’t knock the placebo effect, can be very useful. I just sorta wish they were actually selling sugar pills instead of their moral equivalent.
posted by nat at 3:52 PM on May 15, 2022 [6 favorites]
I prefer to get the decongestant separately, so I’ve been a purchaser of sudafed for eons. (I also can’t take the steroid nasal sprays due to a weird side effect). When I lived in Michigan my allergies were worse and the restrictions on purchase were tighter and so it was actually kind of hard to get enough sudafed; I looked into getting a prescription (they make you try other things first, which is how I know the nasal sprays aren’t good for me), but moved out of the country before that happened.
I then lived in Denmark for three years; there was only one drug on the formulary there that had pseudoephedrine (a different antihistamine that I don’t remember there name of, combined with pseudoephedrine ). I also had to convince the doc that I wasn’t at risk for addiction; the drug is flagged the same way a narcotic would be. (I am addicted to breathing, and I would like to keep doing it, however).
But I couldn’t take enough of it, because the antihistamine had a tighter upper limit. So I would buy sudafed whenever I went to another country (frequently, I traveled for work). The UK was easiest; they wouldn’t sell you much but they didn’t track it at all so it was easy to go to a different Boots and get more if needed. (Note what I was doing is sketchy, and some countries are much more persnickety about importing even personal use amounts; pseudoephedrine is a highly controlled substance in some places and it’s not always obvious what the import rules are or how tightly they will be enforced). If you are trying to find an OTC drug while traveling, it may not be OTC but even if it is the brand name is probably different; knowing the technical name of the drug (ceterizine instead of Zyrtec, pseudoephedrine instead of Sudafed) can help.
Now in AZ it’s back to 96 pills per purchase, and to glaring at the Little Red Placebo (aka phenylephrine) that has been my nemesis for years.
Although don’t knock the placebo effect, can be very useful. I just sorta wish they were actually selling sugar pills instead of their moral equivalent.
posted by nat at 3:52 PM on May 15, 2022 [6 favorites]
Phenylephrine didn't work AND gave me insomnia when I had a bad cold and needed to sleep. I accept that I have a weird nervous system and that I sometimes have adverse reactions to stuff that works well for most people. But it's infuriating to have an adverse reaction to something that doesn't work for anybody.
posted by creepygirl at 9:06 PM on May 15, 2022 [5 favorites]
posted by creepygirl at 9:06 PM on May 15, 2022 [5 favorites]
I don't know if the legislation is just that badly written (probably) or if it's misunderstanding by the pharmacy staff [...] Sometimes, all they'll have is a box of like six 12-hour brand-name Sudafed, and that's it. So I'll take what I can get, but that's "my box" for the month.
I think the restrictions on real-deal Sudafed are, in keeping with the rest of the drug war, fucking stupid, and I am offended on principle that I now have to interact with someone behind the counter just to get goddamn stuffy-nose pills, but I think your pharmacy has chosen to comply with the law in a particularly dumb/bad way.
The "Combat Methamphetamine Epidemic Act of 2005" is what put us in this idiotic situation at the Federal level, and it sets a sales limit of 3.6 grams pseudoephedrine per purchaser per day, enforced on the sales end, and then further makes it illegal for a buyer to purchase more than 9 grams in a 30 day period (regardless of the number of transactions or sellers).
I have no idea what your pharmacy is doing with the whole "monthly box" thing, but it's well beyond what is required by law.
Standard red-pill Sudafed tablets are usually 30mg each, so a 48 ct box is only 1.44g. The Feds will let you buy 120 30mg pills per day, up to a total of 300 pills per 30-day period. So there's no reason why you can't buy a box of 48 tablets on Monday, then a box of 12 on Tuesday, etc.
Anyway: I'm sure the early-00s Congressional brain trust that wrote the CMEA thought—probably in between martinis and speedballs—that 300 pills/month was more Sudafed than a person ever ought to need, but in my experience the stuff is constantly hard to find, never around when you want it, and the swapping of phenylephrine for pseudoephedrine should be nothing less than scandalous.
posted by Kadin2048 at 11:44 PM on May 15, 2022 [2 favorites]
I think the restrictions on real-deal Sudafed are, in keeping with the rest of the drug war, fucking stupid, and I am offended on principle that I now have to interact with someone behind the counter just to get goddamn stuffy-nose pills, but I think your pharmacy has chosen to comply with the law in a particularly dumb/bad way.
The "Combat Methamphetamine Epidemic Act of 2005" is what put us in this idiotic situation at the Federal level, and it sets a sales limit of 3.6 grams pseudoephedrine per purchaser per day, enforced on the sales end, and then further makes it illegal for a buyer to purchase more than 9 grams in a 30 day period (regardless of the number of transactions or sellers).
I have no idea what your pharmacy is doing with the whole "monthly box" thing, but it's well beyond what is required by law.
Standard red-pill Sudafed tablets are usually 30mg each, so a 48 ct box is only 1.44g. The Feds will let you buy 120 30mg pills per day, up to a total of 300 pills per 30-day period. So there's no reason why you can't buy a box of 48 tablets on Monday, then a box of 12 on Tuesday, etc.
Anyway: I'm sure the early-00s Congressional brain trust that wrote the CMEA thought—probably in between martinis and speedballs—that 300 pills/month was more Sudafed than a person ever ought to need, but in my experience the stuff is constantly hard to find, never around when you want it, and the swapping of phenylephrine for pseudoephedrine should be nothing less than scandalous.
posted by Kadin2048 at 11:44 PM on May 15, 2022 [2 favorites]
Alas, Bilastane isn’t available pretty much anywhere outside Canada. My Canadian friends keep singing its praises like they’re taunting my swollen shut sinuses
posted by Bottlecap at 11:57 PM on May 15, 2022 [1 favorite]
posted by Bottlecap at 11:57 PM on May 15, 2022 [1 favorite]
It is pretty powerful for what is supposed to just be a cold medicine!
Turns out I was accidentally medicating adhd for most of my life, and when I had sinus surgery and was able to stop pseudoephedrine, I had all sorts of problems that turned out to be undiagnosed adhd.
I mean, it wasn’t perfect, Adderall works better and is actually less likely to elevat my bp. But I spent a year wondering why I was so distracted after the surgery and another few before a therapist figured there was something else going on.
posted by [insert clever name here] at 1:55 AM on May 16, 2022 [9 favorites]
Turns out I was accidentally medicating adhd for most of my life, and when I had sinus surgery and was able to stop pseudoephedrine, I had all sorts of problems that turned out to be undiagnosed adhd.
I mean, it wasn’t perfect, Adderall works better and is actually less likely to elevat my bp. But I spent a year wondering why I was so distracted after the surgery and another few before a therapist figured there was something else going on.
posted by [insert clever name here] at 1:55 AM on May 16, 2022 [9 favorites]
I knew phenylephrine was less effective, but not that it was completely ineffective.
My daily treatment is 2 sprays per nostril of fluticasone and 2 tablets of loratadine. This latter is part of my TINMA suggestion for fellow sufferers: the 10mg dosage on loratadine is shamefully low and is to some extent a marketing decision, because FDA trials didn't support labeling a higher dose as "non-drowsy", even though many people have no drowsiness from 20 or even 30 mg. Be careful with the increase (first few times you do it, maybe avoid operating heavy machinery), but a higher dose is likely safe.
My emergency treatment is azalastine. I had a prescription a few years back for it as a daily spray, which I stopped doing because of unpleasant side effects (see below), but those old bottle I keep as an emergency acute treatment because it definitely works over the short term and pretty quickly. The reason I don't take it much, though, is that it is exceedingly bitter, and has a way of losing at the back of your throat, so whole it can clear up allergies wonderfully, you're tasting it all day.
posted by jackbishop at 4:45 AM on May 16, 2022 [1 favorite]
My daily treatment is 2 sprays per nostril of fluticasone and 2 tablets of loratadine. This latter is part of my TINMA suggestion for fellow sufferers: the 10mg dosage on loratadine is shamefully low and is to some extent a marketing decision, because FDA trials didn't support labeling a higher dose as "non-drowsy", even though many people have no drowsiness from 20 or even 30 mg. Be careful with the increase (first few times you do it, maybe avoid operating heavy machinery), but a higher dose is likely safe.
My emergency treatment is azalastine. I had a prescription a few years back for it as a daily spray, which I stopped doing because of unpleasant side effects (see below), but those old bottle I keep as an emergency acute treatment because it definitely works over the short term and pretty quickly. The reason I don't take it much, though, is that it is exceedingly bitter, and has a way of losing at the back of your throat, so whole it can clear up allergies wonderfully, you're tasting it all day.
posted by jackbishop at 4:45 AM on May 16, 2022 [1 favorite]
This is very confusing as it sure seemed to help me very recently.
posted by timdiggerm at 5:25 AM on May 16, 2022
posted by timdiggerm at 5:25 AM on May 16, 2022
My emergency treatment is azalastine. I had a prescription a few years back for it as a daily spray, which I stopped doing because of unpleasant side effects (see below), but those old bottle I keep as an emergency acute treatment because it definitely works over the short term and pretty quickly. The reason I don't take it much, though, is that it is exceedingly bitter, and has a way of losing at the back of your throat, so whole it can clear up allergies wonderfully, you're tasting it all day.
I use Azelastine as my "emergency" nose spray as well. If I'm feeling a sneezing fit come on, I'll quickly take a shot in each nostril. It usually does the job. Tastes gross.
I use Flonase daily, as well as Xyzal (levocetirizine).
I knew Phenylephrine didn't work. It's nice to have it confirmed, though. Weird how it's allowed to be sold as an actual medication.
posted by Fleebnork at 5:35 AM on May 16, 2022
I use Azelastine as my "emergency" nose spray as well. If I'm feeling a sneezing fit come on, I'll quickly take a shot in each nostril. It usually does the job. Tastes gross.
I use Flonase daily, as well as Xyzal (levocetirizine).
I knew Phenylephrine didn't work. It's nice to have it confirmed, though. Weird how it's allowed to be sold as an actual medication.
posted by Fleebnork at 5:35 AM on May 16, 2022
Diphenhydramine (Benadryl et al.) and chlorpheniramine (Chlor-Trimeton) are very effective but will definitely make you sleepy.
Not necessarily. I'm one of those weird people who is not completely zonked out by diphenhydramine. I know a few others, and I don't know what in our bodies makes this the case. It is NOT the case for my spouse, who cannot take one of my allergy pills without a nap.
posted by dlugoczaj at 7:07 AM on May 16, 2022
Not necessarily. I'm one of those weird people who is not completely zonked out by diphenhydramine. I know a few others, and I don't know what in our bodies makes this the case. It is NOT the case for my spouse, who cannot take one of my allergy pills without a nap.
posted by dlugoczaj at 7:07 AM on May 16, 2022
This is very confusing as it sure seemed to help me very recently.
The placebo effect isn't just a fancy way of saying results no different than not doing anything. It's a real thing and can have physical results. Plus many people who are congested from say a cold will only be sick for a week anyways. If you take anything on day 3 or 4 it'll appear to work (because you are getting better) even though it is having no effect.
posted by Mitheral at 7:11 AM on May 16, 2022 [7 favorites]
The UK was easiest; they wouldn’t sell you much but they didn’t track it at all so it was easy to go to a different Boots and get more if needed.
Yep. Still like that, or was the last time I bought some (last year sometime). It's treated like any other medication from behind the pharmacy counter: they want to check you know what you're doing ("is it for you? have you had it before?"), and if you're buying it in the form of Day Nurse, they want to make sure you know there's paracetamol in there too, so you don't accidentally overdose on that. But they don't worry that you're going to turn it into meth, and so there's no ID checking or Serious Talk With A Pharmacist. I was very thrown by the whole third-degree thing when I needed some for a horrendous coldy thing in New Zealand.
You do have to ask for it though. If you just buy a cold remedy off the open shelves, at best it'll have phenylephrine, and I too am pleased to have my personal impression of that particular drug confirmed.
posted by ManyLeggedCreature at 9:09 AM on May 16, 2022
Yep. Still like that, or was the last time I bought some (last year sometime). It's treated like any other medication from behind the pharmacy counter: they want to check you know what you're doing ("is it for you? have you had it before?"), and if you're buying it in the form of Day Nurse, they want to make sure you know there's paracetamol in there too, so you don't accidentally overdose on that. But they don't worry that you're going to turn it into meth, and so there's no ID checking or Serious Talk With A Pharmacist. I was very thrown by the whole third-degree thing when I needed some for a horrendous coldy thing in New Zealand.
You do have to ask for it though. If you just buy a cold remedy off the open shelves, at best it'll have phenylephrine, and I too am pleased to have my personal impression of that particular drug confirmed.
posted by ManyLeggedCreature at 9:09 AM on May 16, 2022
While we're talking OTC allergy meds, I have a weird question. I have been an allergy sufferer all my life, and have tried a lot of different remedies. After years of using Claritin, I recently put two and two together and discovered that it triggers horrible depressive episodes in me. I get depressed easily, anyway, but apparently lortadine makes me borderline suicidal. Has anyone else experienced this, or is this a feature of my own personal messed up nervous system?
posted by vibrotronica at 9:45 AM on May 16, 2022
posted by vibrotronica at 9:45 AM on May 16, 2022
Plus many people who are congested from say a cold will only be sick for a week anyways.
"If you do nothing, a cold can last a whole week, but with proper treatment it'll clear up after seven days."
posted by jackbishop at 10:22 AM on May 16, 2022 [11 favorites]
"If you do nothing, a cold can last a whole week, but with proper treatment it'll clear up after seven days."
posted by jackbishop at 10:22 AM on May 16, 2022 [11 favorites]
Well damn. I'm sitting here on day 4 of Covid with neutered Dayquil. Good to know. Thanks for the FPP!
posted by kimberussell at 12:42 PM on May 16, 2022 [1 favorite]
posted by kimberussell at 12:42 PM on May 16, 2022 [1 favorite]
Check with your personal doctor before taking sudafed during covid! If you are having tachycardia or blood pressure things (common with covid) it may not be a good plan to add sudafed.
posted by Bottlecap at 1:10 PM on May 16, 2022 [1 favorite]
posted by Bottlecap at 1:10 PM on May 16, 2022 [1 favorite]
I apparently have very small nasal passages; the doc had to use children's sized scope on me and quipped "how do you get enough air through there?" ( years of practice, I replied....) so, I took a Sudafed to decongest as suggested, prior to a scuba dive.
Reader; that was not a good move because I did my standard backflip overboard and started down and into hyperventilating and overbreathing the regulator. My dive partner was completely agreeable to aborting the dive. I have never taken the stuff since. I guess I can see why meth is attractive to some, but wouldn't it be as effective to regulate it and cut out cartels; similar to how tobacco is regulated?
But, boy, would I love a treatment for my constant and worsening allergies. That treatment where you get some sortof parasites and you're cured?.... I would embrace it if it was available and affordable. I have about half the sense of taste as normal folks because very little can get through my constantly congested nasal passages. I live in perpetual fear of having stinky breath or body odor because I cannot smell most things.
All of the available medications don't work for me and allergy "shots" are astronomically unaffordable. And, I fear that if a workable medication were to become available it would also be unobtanium....just like Sudafed. A placebo can be appropriate but an effective medication isn't....according to regulators.
posted by mightshould at 1:52 PM on May 16, 2022 [1 favorite]
Reader; that was not a good move because I did my standard backflip overboard and started down and into hyperventilating and overbreathing the regulator. My dive partner was completely agreeable to aborting the dive. I have never taken the stuff since. I guess I can see why meth is attractive to some, but wouldn't it be as effective to regulate it and cut out cartels; similar to how tobacco is regulated?
But, boy, would I love a treatment for my constant and worsening allergies. That treatment where you get some sortof parasites and you're cured?.... I would embrace it if it was available and affordable. I have about half the sense of taste as normal folks because very little can get through my constantly congested nasal passages. I live in perpetual fear of having stinky breath or body odor because I cannot smell most things.
All of the available medications don't work for me and allergy "shots" are astronomically unaffordable. And, I fear that if a workable medication were to become available it would also be unobtanium....just like Sudafed. A placebo can be appropriate but an effective medication isn't....according to regulators.
posted by mightshould at 1:52 PM on May 16, 2022 [1 favorite]
→
I do apologize. I didn't mean to be a smug, itch-free Canadian there.
posted by scruss at 3:22 PM on May 16, 2022 [4 favorites]
Alas, Bilastane isn’t available pretty much anywhere outside Canada
I do apologize. I didn't mean to be a smug, itch-free Canadian there.
posted by scruss at 3:22 PM on May 16, 2022 [4 favorites]
I guess I can see why meth is attractive to some, but wouldn't it be as effective to regulate it and cut out cartels; similar to how tobacco is regulated?
Well, it is regulated, it’s a Schedule II controlled drug, the most tightly controlled category that is available by prescription. In practice it’s not prescribed much, arguably largely because of stigma - it’s unclear that it’s a whole lot different from amphetamine, good ‘ol Adderall/Dexedrine, if you take the pills at prescribed doses. It’s the people snorting or smoking or injecting 10x as much who tend to get into big trouble.
But it’s trickier to figure out a proper harm-reducing regulation scheme for stimulants than it is for, say, opioids - I’m not sure how well the motivations of “binge” meth users would be addressed by a maintenance sort of program and those folks are gonna be prone to more issues from the effect of the drug alone than people on opioids.
posted by atoxyl at 3:34 PM on May 16, 2022
Well, it is regulated, it’s a Schedule II controlled drug, the most tightly controlled category that is available by prescription. In practice it’s not prescribed much, arguably largely because of stigma - it’s unclear that it’s a whole lot different from amphetamine, good ‘ol Adderall/Dexedrine, if you take the pills at prescribed doses. It’s the people snorting or smoking or injecting 10x as much who tend to get into big trouble.
But it’s trickier to figure out a proper harm-reducing regulation scheme for stimulants than it is for, say, opioids - I’m not sure how well the motivations of “binge” meth users would be addressed by a maintenance sort of program and those folks are gonna be prone to more issues from the effect of the drug alone than people on opioids.
posted by atoxyl at 3:34 PM on May 16, 2022
But, boy, would I love a treatment for my constant and worsening allergies. That treatment where you get some sort of parasites and you're cured?.... I would embrace it if it was available and affordable.
I had to have my sinuses surgically roto-rooted as a teenager after a particular bad sinus infection (after a series of them). So that is a thing, but the recovery was awful so I cannot recommend it without the motivating factor of needing to avoid a brain infection.
posted by snuffleupagus at 3:56 PM on May 16, 2022 [1 favorite]
I had to have my sinuses surgically roto-rooted as a teenager after a particular bad sinus infection (after a series of them). So that is a thing, but the recovery was awful so I cannot recommend it without the motivating factor of needing to avoid a brain infection.
posted by snuffleupagus at 3:56 PM on May 16, 2022 [1 favorite]
nasal packing
Wish I hadn't googled this
posted by Ray Walston, Luck Dragon at 5:35 PM on May 16, 2022 [4 favorites]
Wish I hadn't googled this
posted by Ray Walston, Luck Dragon at 5:35 PM on May 16, 2022 [4 favorites]
I took a Sudafed to decongest as suggested, prior to a scuba dive.
Like you said not a good idea.
During the dive you breath through your mouth so nose congestion won't affect your air intake, BUT you need functional/unclogged airways to be able to equalize sinuses and the middle ear. Sudafed is never an issue when you start the dive, assuming you can establish buoyancy upon entry and not drop like an anchor, you can do a slow descent and call the dive if it's not clearing.
But there's no guarantees it'll let you end the dive normally. If your airways reblock themselves when at depth, that air will expand in the blocked cavities on ascent and this is really painful. In case of a light blockage it can forcefully clear itself when ascending (go slowly!), you'll even hear it clearing sometimes. But a full block may require many many tries at slowly ascending, and going down to release the pain if it doesn't clear. A light snorting of sea water can also help clear things (don't drown yourself while trying this!), and if all else fails and you run out of air, go for it, either your eardrum perforates or your eustachian tubes/nose will clear, it'll hurt a lot and probably bleed, but you're better breathing and hurting on the surface than drowning.
So Sudafed, is never a very good idea. It's super tempting on vacation when you're on the dock or the boat and it's Sudafed or you're missing that Manta Ray dive you paid and took a plane for. Divemasters in vacation spots do it all the time but that job self-select for people with airways that can tolerate a beating (mine are bit like this, I can equalize just by wiggling my jaw slightly). I've seen some DMs recommend it to clients, out of a real desire of wanting their clients to have a good time I'm sure, but I'm never quite comfortable when I witness this.
posted by WaterAndPixels at 7:03 PM on May 16, 2022 [4 favorites]
Like you said not a good idea.
During the dive you breath through your mouth so nose congestion won't affect your air intake, BUT you need functional/unclogged airways to be able to equalize sinuses and the middle ear. Sudafed is never an issue when you start the dive, assuming you can establish buoyancy upon entry and not drop like an anchor, you can do a slow descent and call the dive if it's not clearing.
But there's no guarantees it'll let you end the dive normally. If your airways reblock themselves when at depth, that air will expand in the blocked cavities on ascent and this is really painful. In case of a light blockage it can forcefully clear itself when ascending (go slowly!), you'll even hear it clearing sometimes. But a full block may require many many tries at slowly ascending, and going down to release the pain if it doesn't clear. A light snorting of sea water can also help clear things (don't drown yourself while trying this!), and if all else fails and you run out of air, go for it, either your eardrum perforates or your eustachian tubes/nose will clear, it'll hurt a lot and probably bleed, but you're better breathing and hurting on the surface than drowning.
So Sudafed, is never a very good idea. It's super tempting on vacation when you're on the dock or the boat and it's Sudafed or you're missing that Manta Ray dive you paid and took a plane for. Divemasters in vacation spots do it all the time but that job self-select for people with airways that can tolerate a beating (mine are bit like this, I can equalize just by wiggling my jaw slightly). I've seen some DMs recommend it to clients, out of a real desire of wanting their clients to have a good time I'm sure, but I'm never quite comfortable when I witness this.
posted by WaterAndPixels at 7:03 PM on May 16, 2022 [4 favorites]
Yeah, I have sticky wax (so vulnerable to swimmer's ear) and crackly tubes but when that causes issues it's at worst that's a visit to the ear doc for a flush. Flying on decongestants is reasonable, but it's a bad idea to rely on them to descend. (And never EVER use the OTC earwax removal kits, hot compress and the forbidden Q-tip AT MOST, but really just go to the doctor or family care.)
posted by snuffleupagus at 7:15 PM on May 16, 2022 [1 favorite]
posted by snuffleupagus at 7:15 PM on May 16, 2022 [1 favorite]
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My favorite response to this nonsense is this wonderful paper (pdf link) from that most prestigious of journals Annals of Improbable Research that clearly lays out how to synthesize pseudoephedrine from meth. As the paper notes: posted by Wretch729 at 8:25 AM on May 15, 2022 [74 favorites]