Oral Decongestants

Feb 16, 2016

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

In the AMC Show Breaking Bad, high school chemistry teacher Walter White, starts making crystal meth to pay for his cancer treatments. Although his cancer goes into remission, making illegal drugs turns into a less than healthy lifestyle choice for Walter. To hide his true identity from his deadly competitors and the law, Walter White starts going by the pseudonym Heisenberg. As I long time science geek, I love that he picked Heisenberg. German physicist Werner Heisenberg introduced the Heisenberg Uncertainty Principle in 1927. This Principle is most important with very small particles. It says the more precisely we know a particle's position in space, the less we know about how fast it is going and visa versa. So, if we know exactly where a sub-atomic particle is, we have no idea how fast it is going. Or if we know exactly how fast a particle is going, we have no idea where it is.

Heisenberg was writing about the physics of the very small 89 years ago. Einstein was writing about the physics of the very large exactly 100 years ago. In Einstein's theory of General Relatively, he predicted gravitational waves back in 1916. Late last year, Einstein must have been spinning is his grave saying "I knew it! What took you guys take so long!" On September 14, 2015 scientists at the LIGO observatories in Louisiana and Washington state measured a gravity wave for the first time. A gravity is wave in the actual fabric of space and time. The one detected was from two black holes colliding a billion years ago. I know how ghost Einstein must have felt. Because at almost the same time, Meltzer et. al. published a paper in the Journal of Allergy and Clinical Immunology saying phenylepherine doesn't work any better than placebo. I could have told you that.

I should back up a little. If you get a cold, your nose will probably get plugged up. My favorite decongestant pills used to have just pseudoephedrine in them. Then about 10 years ago, they stopped making decongestants with just pseudophedrine in them. That is because real life Walter White's were using the pseudoepherine tablets to make crystal meth. That's when the decongestant aisle of the pharmacy became full of phenylepherine containing products.

Decongestants work by constricting the blood vessels inside the nose. That means there is less blood in the nasal mucosa, which leads to less snot production. That makes decongestants very useful to treat the nasal symptoms of a cold. Oral decongestants have some potential side effects though. They can stimulate the heart which can cause high blood pressure, and fast heart rate. They can stimulate the nervous system and cause anxiety and sleeplessness. They can also cause urinary retention.

I've tried both phenylepherine and pseudoephedrine on my stuffy nose. I've had patients talk to me after I switched them from pseudoephedrine to phenylepherine. Almost to a person, we all agreed the pseudoepherine products worked better than the phenylepherine products. So we were all annoyed with the people who made crystal meth out of pseudoephedrine. The amateur chemists were making it harder to treat a head cold.

Eventually, decongestants with pseudoephedrine combos with things like ibuprofen came back. My favourite is Advil Cold and Sinus. This meant I could treat my stuffy nose and the amateur chemists still couldn't easily make crystal meth.

If you want to try non-drug measures for nasal congestion, start with drinking lots of fluids and getting lots of rest. Then you can try nasal saline sprays to help loosen the snot build up. The ones that put lots of salt water up the nose like neti-pots and Hydrasense work, but using them can feel like you are drowning the first time you try them. Breathe Right strips open up your nostrils and some people find that helps them breathe better. Humidifiers might work, but use the cool mist ones. The warm or hot ones can cause burns if a child pulls them onto themselves.

It isn't completely clear why phenylepherine doesn't work any better than placebo for nasal congestion. It might be that phenylepherine isn't absorbed into the body very well. Whatever the reason, some experts are even calling on the FDA in the US to review whether phenylepherine should be approved to treat nasal congestion.

Although I like Walter White's hair cut and his bright yellow contamination suit would be a good color on me, Walter does turn out to be quite evil. The real life Walter White's screwed up our access to pseudoepherine for our stuffy noses for a while. Now though, if you ask your pharmacist, they can find you a pseudoephedrine containing product for your nose. Which is good, because the phenylepherine might not work at all. Despite all the dead bodies that piled up around Walter White, I still really like his pseudonym of Heisenberg. One hundred years after General Relativity scientists found gravity waves, so Einstein is still getting accolades. The name Einstein is still rightly synonymous with genius. Heisenberg is synonymous with uncertainty. Thanks to Walter White, now it even sounds a little ominous. Now, say my name.

As always if you have any questions or concerns about these or other products, ask your pharmacist

Breaking Bad: http://www.amc.com/shows/breaking-bad

Gravitational Waves - http://www.nytimes.com/2016/02/12/science/ligo-gravitational-waves-black-holes-einstein.html?_r=0

Meltzer article on Phenylepherine - http://www.sciencedirect.com/science/article/pii/S1081120615007073

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

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