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Old Sudafed (pseudoephedrine) vs. new Sudafed PE (phenylephrine)

Discussion in 'Pharmacy' started by Moxxie, 01.20.06.

  1. Moxxie

    Moxxie Rained out

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    SDN Members don't see this ad. (About Ads)
    For those of you who are already practicing, what do you think about Sudafed PE so far? I've seen it pimped pretty heavily on TV, but I haven't heard anything about the efficacy of phenylephrine vs. pseudoephedrine (I imagine that they have similar modes of action).

    Do you have a lot of patients coming up to the counter to ask for the "old" sudafed or are they going to the shelf to get the PE tabs? My husband brought some of the PE home the other day because he didn't even know that there was a difference. I haven't tried any myself, but my husband seemed a little more stuffed up with the PE than he does when he takes pseudoephedrine. (Of course, I could be imagining things).

    Give a curious girl some answers :p
  2. Moxxie

    Moxxie Rained out

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    Oh, and one thing that I just noticed (I found a box of normal sudafed in the medicine cabinet) - the PE tabs look almost identical to the old pseudoephredine tabs, BUT the adult dosage is one of the PE tabs (10mg Phenylephrine) vs. two of the "old" sudafed tabs (total = 60 mg pseudoephedrine). The packaging on the Sudafed PE is also VERY similar to the "old" packaging. This could be a problem for patients that don't know that the tabs themselves have changed and pop "two of the little red pills" like they normally do.

    Anyone run into any problems with this? I don't know how terrible an unintentional double dose of PE would be, but I can't imagine it would be good for someone with hypertension.
  3. npage148

    npage148 Senior Member

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    Ive heard PE does not work nearly as good and at my store we have lots of people coming to the counter to get it. I, myself, have not tried it becasue im too attached to my old school pseudo. Thanks for the heads up on teh dosage difference, i have not noticed taht
  4. WVUPharm2007

    WVUPharm2007 "I hear the WMD is the bomb."

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    Phenylephrine doesn't come close to pseudoephedrine as I've learned in class and in experience.
  5. ultracet

    ultracet 1K Member

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    i've had complaints about increased side effects with the PE as well
  6. bananaface

    bananaface Pharmacy Supernerd Staff Member Administrator SDN Senior Moderator Lifetime Donor

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    ditto. We need to start a movement to get PPA back on the market.
  7. Sosumi

    Sosumi Senior Member

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    I agree with Bananaface. Silly FDA removing PPA from the market due to one silly case control study in which the authors didn't even think it was worth removing and because there were alternatives out there (Sudafed). :laugh:
  8. npage148

    npage148 Senior Member

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    PPA was before my time. Did it work well? and why was it pulled?
  9. sdn1977

    sdn1977 Senior Member

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    My thoughts on Sudafed & Sudafed PE are they are fine & interchangeable for the short term "cold" symptoms - I reassure folks their cold will resolve in 5-7 days anyway. Whether this cold is worse than the one they had last year - who knows, so difficult to compare. Now...its different for those folks who use it on a more regular basis - flyers who have chronically obstructed eustachian tubes & really need dependable decongestion or others like them. I agree...not as good. Now - you asked about PPA & why its not around? Most all decongestants stimulate alpha adrenergic receptors of vascular smooth muscle. Both phenylpropanolamine & pseudoephedrine stimulate both alpha & beta. PPA was great because it caused less central stimulation than ephedrine, but it caused greater peripheral stimulation than pseudoephedrine. Part of its peripheral action was due to release of norepinephrine which resulted in increased BP - in a small way due to vasoconstriction, but mostly due to cardiac stimulation. None of this was bad for years because it was used, like the other decongestants, for use in colds, hay fever, etc....However, in the late 70's, early 80's...there was a big push for anoriexants. It was good at that too - better than pseudoephredine and it was marketed as an anorexiant in addition to a decongestant (are you old enough to remember Dexatrim, Acutrim??-these were phenylpropanolamine). I'm not sure how many actual deaths were in official "studies", but there were many in the press and often they were young women (teens-20's, but there was a famous model in her 30's, but I can't remember her name). Now...as is usually the case....the drug is not the sole reason for the deaths - it was a combination of electrolyte disorder which comes with the quest of weight loss, other anoriexants used with it (I think this was the model's case) & abuse (one works....just think how much weight I'd lose if I took 2). So...it was probably a good thing the drug was removed from anorexiants, but as is the case with Sudafed...the baby gets thrown out with the bathwater in an attempt to resolve an issue that is much bigger than accessibility of an OTC medication. So...now we are stuck with only mildly effective nasal decongestants - I just hope folks don't start abusing the topical ones!
  10. WSU2007

    WSU2007 Member

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    From personal experience and patient feedback pseudoepehdrine has better efficacy as a nasal decongestant over PE. Pseudoephedrine is still available OTC in Michigan, but you have to be 18 and are only allowed to purchase 2 packages not to exceed 48 tablets. All products containing pseudoephedrine are kept in the pharmacy to enforce these measures unless it is a liquid or pediatric formulation. It has been kind of a hassle squezzing all these products in an already cramped space, but I have noticed that it gives us a great opportunity to counsel patients and make recommendations.
  11. Moxxie

    Moxxie Rained out

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    Thanks to everyone for their responses! I wasn't aware of PPA's use as a decongestant. I've learned so much from y'all - this is what SDN is for. :thumbup:
  12. mistakeprone

    mistakeprone New Member

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    In my state (Tennessee), pseudoephedrine can only be sold at the pharmacy counter, where a customer's name, address, birthdate, driver's license number, etc., must be entered into a record book.

    I regularly take extended-release pseudoephedrine at night during the winter months to avoid having terrible sinus headaches in the morning. (I don't know why this happens to me in the winter, but I have learned that I can avoid the headaches by taking pseudoephedrine every evening in the winter.)

    Today I tried to buy some 12-hour pseudoephedrine at a local chain pharmacy, and I was told that it had "been recalled" and that only Sudafed PE was available. PE does not come in an extended-release version, as far as I can tell.

    I don't know if this "recall" is limited the chain that I visited (maybe they have decided it's not worth their staff's time to enter all that information into a record book) or if the pharmaceutical companies are withdrawing pseudoephedrine from the market in favor of Sudafed PE.

    Do I need to panic, or do I merely need to check other pharmacies? :confused:

    -- Concerned patient (not a medical professional)
  13. meg

    meg Member

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    Maybe your headaches are a withdrawl symptom of not having pseudoephedrine?

    I prefer NyQuil. Man that stuff is addictive!
  14. ultracet

    ultracet 1K Member

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    and yes..
    it really is
  15. bananaface

    bananaface Pharmacy Supernerd Staff Member Administrator SDN Senior Moderator Lifetime Donor

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    PPA was found to be:

    1) safe in decongestant labeled doses
    2) safe in weight loss supplement labeled doses
    3) unsafe when abusers of weight loss supplements taking PPA took massive doses

    There are plenty of other drugs out there that are unsafe when not taken according to labeled instructions. Pulling PPA was unwarranted, IMO. If they were to do anything, there should have been a requirement for extra labeling to warn people that recommending the labeled dose could be harmful.
  16. WSU2007

    WSU2007 Member

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    Talk to your pharmacist about sinus pressure that you experience in the winter, probnably as a result of the dry air we all breathe in the winter. He/She might a have a better suggestion than pre-medicating with sudafed. :)
  17. bananaface

    bananaface Pharmacy Supernerd Staff Member Administrator SDN Senior Moderator Lifetime Donor

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    for mistakeprone -

    There is not currently a withdrawl of pseudoephedrine from the market. It's just more challenging to access. Perhaps it was an isolated recall.
  18. alwaystired

    alwaystired

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    I am glad that it is more challenging to access it. Today on the news, Las Vegas has an overabundance of kids who need foster homes/adoption and they said it is directly related to an increase in methamphetamine use. At the pharmacy (at least once a week) questionable people come to buy pseudoephedrine and they know exactly how many they can have and they want the max and then they often try to sneak and buy it again that same hour (hoping we won't recognize them). Not to be judgemental for all of you who have a need for it long term, but lots of people in las vegas act very suspicious when purchasing 2 boxes of 48 and then trying to come back 1 hour later and buy more......I have a feeling they are up to no good and I would like the laws to be strict for the sake of our community.
  19. WSU2007

    WSU2007 Member

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    True Story: I work for a chain grocery pharmacy and at a location not too far from where I work a store walker (undefcover store LP detective) observed two suspicious characters that appeared to not be together purchase a large amount of sudafed and they left together. The LP detective wrote down their license plate number and the information was given to the local police. That info led to a house that was set up as a meth lab. This was sometime in the summer before the products were moved behind the counter. I wonder if your local police would be interested in learning of those people in your store.
  20. alwaystired

    alwaystired

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    It would be nice since so many children are being placed into state custody ultimately due to meth abuse by their mothers. I think that limiting it to 2 makes it take longer to get the psuedoephedrine, but it is still possible. Esp. with multiple people going to multipile stores. As much as a pain it would be on the pharmacist and pharmacy staff, i hate to say it, but maybe logs are necessary due to the prevalence of homemade meth labs. Maybe my city is just worse (being Vegas).
  21. SomeGuy

    SomeGuy Senior Member

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    With a little bit of research, you'll find that PPA has the same problem as pseudoephedrine.

    Hopefully the restrictions on purchase don't result in more complicated/frequent thefts. I doubt they really thought this one through though. Interesting how there are no regulations on locking it up, keeping it out of sight, or maximum amounts to have on-hand at one time.

    Given that a "very strong" dose of methamphetamine is 50mg, even assuming a 50% yield (just picking a number out of my ... for the yield), 48 60mg tabs works out to quite a bit, especially considering that the effects are generally long-lasting.
  22. f_w

    f_w 1K Member

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    If it wasn't for unscrupulous vendors selling sudafed by the 1000 pill bucket, the ICE problem would be far less prevalent. How stuffy can your nose be that you need a thousand sudafed at a time.

    The yield for the cookers is actually pretty low, most of the batches don't work and the extraction process for the active substance is archaic. All the other chemicals are basic industrial stuff which can easily diverted or they are accessible to theft at agricultural businesses (NH3). The supply bottleneck is the sudafed.

    While I do support the move to curtail sales, I don't think keeping a paper log is going to fix anything. Around here, there are 3 drug-stores/pharmacies on any given higway interchange, the cookers just employ 'buyer ants' who crawl from store to store picking up the allowable amout at each of them. (Later, they get paid back in meth.) A central database with buyers drivers-license numbers would be the only way to limit this.

    When the state moved sudafed behind the counter, you would have thought that they outlawed cancer treatment. I wasn't aware of the life-saving properties of sudafed until this sudden 'shortage' made people scramble to get their hands on a stash.
  23. SomeGuy

    SomeGuy Senior Member

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    That was my guess.

    I can't say that I've used phenylephrine, but I can say that when I've needed pseudoephedrine, it has worked wonders. I could usually care less about the cough or mucous production, but dangit I want to breathe!
  24. f_w

    f_w 1K Member

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    I am not saying that it doesn't work. I just don't see anything wrong with having to go through the pharmacist to get it. It is a medication with a high diversion potential, it is reasonable to make it just a little bit more difficult for the wrong people to get their hands on large amounts of it.
  25. Sosumi

    Sosumi Senior Member

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    I've been sick with the cold this past week with annoying congestion and have begun my own n of 1 unblinded experimention on this. I've been using ibuprofen(200mg) + pseudoephedrine(30mg) and seeing how it worked compared to 2 acetaminophen(500mg) + phenylephrine(5mg). Both seemed to work a little, kicking in about 30 minutes after taking them and lasting for 1 hour or 2. I couldn't tell which was better since I still felt miserable regardless.

    Neither beats the effect of Nyquil though :sleep: (doxylamine + pseudoephedrine + acetaminophen + dextromethorphan). I love that stuff!
  26. sdn1977

    sdn1977 Senior Member

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    .....& 25% alcohol (50 proof) ;) - sometimes its the "best medicine" - won't cure you, but makes you feel better while you wait!
  27. DAW2

    DAW2 Social Outcast

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    also read pe doesn't raise bp as much as pse but still shouldn't recommend it to pts wif hbp. from pharmacist's letter me thinks...
  28. CelesteWolffe

    CelesteWolffe New Member

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    I use the extended-release tabs too, but for chronic allergies that regularly cause blockage in my ears. When I tried to buy them at Wal-Mart (in KY) recently, I too was told that pseudoephedrine was being pulled and replaced with phenylephrine. I can still get the 30mg pseudoe at the pharmacy by registering my driver's license, phone number and address with each purchase (limited to 48 pills) but no-can-do on the extended tabs. Also, I am not a professional, but I have used Sudafed for a long time and PE does not compare in efficacy, at least not in keeping that stubborn ear clear.

    celeste in KY


  29. REALDAVID

    REALDAVID

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    Consumer reports, previously stated that Sudafed P.E. is NOT Effective!
    They subsequently stated taht Sudafed P.E. is just to keep/increase manufacturers market share!!
  30. CelesteWolffe

    CelesteWolffe New Member

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    Amen to that! It doesn't matter to me that I've been told they are "very much alike" and "it works the same". My nose and sinuses know that is bologna. Here in Kentucky, it's as easy as putting lipstick on a fish to get pseudoephedrine at the pharmacy counter. But it is worth it to go to the trouble. Addressing the "take two sudafed" vs "take one sudafed PE"--well, for me, it takes at least two sudafed PE to come close to the same benefit as a recommended dose of pseudoephedrine. My money is on the pseudoephedrine.

    CelesteWolffe
    Kentucky :)
  31. Old Timer

    Old Timer SDN Advisor SDN Advisor

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    To: CelesteWolffe and REALDAVID:

    You do realize this thread is over two years old? The last post was: 02-25-2006, 05:38 PM
  32. f_w

    f_w 1K Member

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    And now the good news:

    Over the past two years (since this thread was posted), the number of meth labs busted in my state has dropped massively (92%). The relative inaccessability of pseudoephedrine for the cookers has driven many of the small rural operations out of business. The number of rural trailer homes that mysteriously burst into flames has also dropped.

    The number of meth addicts otoh has held pretty steady. The locally produced meth has been largely replaced by industrially made product from mexico.

    Overall a good trend. You can't stop people from killing themselves with meth. At least now they don't put firemen and sheriffs deputies at risk with the ensuing fires and chemical spills.
  33. Idesiretosling

    Idesiretosling

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    How dare they comment on an old thread! Old threads and old people should be ignored and left alone.
  34. Farmercyst

    Farmercyst Lowest common denominator Moderator Emeritus

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    This is actually true in some instances. Not this one, but some.
    :uhno:
  35. CelesteWolffe

    CelesteWolffe New Member

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    I apologize for responding to such an old thread. I have the 'new message posted' feature activated on this site to notify me of new activity to threads to which I have taken part. My failure to see that this discussion is quite old is indeed my faux pas. I beg your pardon. My apology. :(
    Celeste Wolffe
    Kentucky
  36. CYP3A4

    CYP3A4 P450

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    Sudafed PE is crap. I'd rather take nothing than waste my money.

    I used to buy it to avoid the hassle of asking for regular Sudafed at the pharmacy counter but when I am really stuffed up with a cold it is worth the extra 2 minutes.
  37. Moxxie

    Moxxie Rained out

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    Wow. I hadn't even been accepted into pharmacy school yet when I started this thread - and now I'm about to start my P3 year!

    And phenylephrine still sucks :p
  38. bashprompt

    bashprompt

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    I believe this was their intent. To slip it through, harping on paranoia that sudafed is solely purchased by mafioso's looking to cook meth and guilt be upon anyone who dares to ask. I remember being interrogated when PE first came out and I had the audacity to ask for the 'old stuff.'

    I was told that they no longer sell Sudafed regular because we live in a low socio-economic area. Mind you properties in this area are all above the million dollar mark, however across the railroad track are six apartment buildings. Because of those buildings they decided that an entire suburb and it's surrounding townships who relied upon this pharmacist not have access to things that work.

    PE has been thoroughly debunked as junk. There are quite a few studies linked to the wikipedia article on the subject that found it had little to no affect beyond placebo (for some fast and hard papers on the subject) yet they've rolled it out everywhere. In fact, one chemist I spoke to said that he had been given assurances by the rep that 'there is no difference,' I had to draw into question of his credentials. To add insult to injury if you do track down a place that sells the old stuff; expect to have to hand over the same amount of identification as is require to purchase a handgun.

    Making matters even worse--for me, as an Australian--is the fact the Australian Pharmacy Guild cite US crime statistics in their recommendations of outlawing things over here. They're perpetually after codeine and sudaphed even though abuse rates are minimal. The most frustrating part is, the legislative changes they push for cost several thousand fold more than the good that they do. The huge electronic database that they pushed for to be brought in called FAST had a precisely 0% effect on the local production of methamphetamines from pseudoephedrine precursors but cost 13 million. 13 million that could have taken care of thousands upon thousands of sick people, almost all our countries homeless people, or provided every child currently at school in the country with a laptop free of charge (an initiative our government did do; however there would have been the source funds instead of taking away from other budgets).

    We shouldn't be citing American statistics and applying them to our country. We should be using America's failed 'war on drugs' as a prima facie argument as to why attempts to legislate and write frivolous laws just to satisfy a vocal special interest group here and there is more damaging than comforting.

    So to answer your question. Yes, Sudafed PE really is ****ty. But ****ty in so many more reasons that it has caused clandestine expenses and damage to entire countries while the company that puts out these covertly changed defective medications is laughing all the way to the bank riding off on the gold plated arse of John Public and his eternally emptied wallet.

    This angry sperglord rant was brought to you by the letter C and the number 2.
  39. BidingMyTime

    BidingMyTime Lost Shaker Of Salt

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    Studies show the effectiveness of Sudafed PE is pretty minimal. I've seen some studies saying its the dosing, that higher doses are needed for effectiveness, I'm guessing there are safety concerns which have kept the doses low.

    PPA worked tremendous. I think it killed like 80 women over 100 years....more people die of Tylenol every year. I believe the real reason PPA was taken off the market was to hamper meth production, of course, meth users then just switched to pseudoephedrine. I would like to see PPA return to legal status.
    Last edited: 08.27.13
  40. All4MyDaughter

    All4MyDaughter SDN Mommystrator Staff Member Administrator SDN Senior Moderator Lifetime Donor Partner Organization

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    Do you mean PPA? PSE is still legal, but restricted.

    I would also like to see PPA back on the market. It was great.
  41. BidingMyTime

    BidingMyTime Lost Shaker Of Salt

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    Yes, I mixed up my letters. Thanks for pointing that out, I edited my post for clarification.
  42. BenJammin

    BenJammin No Apologies

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    Sudafed > Oxymetazoline nasal spray > water > Sudafed PE
  43. 297point1

    297point1 5 years of this $#!+?

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    Fixed
  44. twobanger

    twobanger

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    Are you insane? Are you trying to blame methamphetamine use for foster children? Blame drug and alcohol abuse, blame the low life's inability to function in today's society. Blame the loss of a moral compass. Methamphetamine does not cause this, people cause this. Vegas is the cesspool of America. You must of voted for obama!
  45. DrWrong

    DrWrong Give me knowledge.

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    http://www.ncbi.nlm.nih.gov/pubmed/17264159

    Personally worked/was mentored by this author. He hates phenyephrine. The guy once took the approval of phenylephrine before the FDA I believe. He has his email set-up to notify him whenever a study on phenylephrine comes out so he can bash it to hell. He's still waiting for the FDA to require proof of efficacy.
    Last edited: 12.04.13
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