Oral Decongestants

Mar 2, 2021

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

"Far better is it to dare mighty things, to win glorious triumphs, even though checkered by failure ... than to rank with those poor spirits who neither enjoy nor suffer much, because they live in a gray twilight that knows not victory nor defeat." In 1899, Teddy Roosevelt said that in a speech called "The Strenuous Life" just before becoming US President. That sentiment, to "Dare Mighty Things" is plastered on the walls of the Jet Propulsion Lab in California. JPL has made many advancements for NASA over the decades, including to help build the Mars Rover Perseverance that just landed on the Red Planet. Another group that was involved in the Perseverance Rover is a little closer to Dauphin. Canadian Photonic Labs from Minnedosa, developed a high-speed camera for Perseverance that you could run over with your truck and not damage it. I think that qualifies it as a Mighty Thing.

It turns out that one of the decongestants in the pharmacy cough and cold aisle might not be a Mighty Thing. In January 2016, Meltzer et. al. published a paper in the Journal of Allergy and Clinical Immunology saying phenylepherine doesn't work any better than placebo. I knew it! But maybe 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 15 years ago, companies stopped making decongestants with just pseudophedrine in them. Do you remember the Series Breaking Bad? In the show, high school chemistry teacher Walter White, starts making crystal meth to pay for his cancer treatments. Well, in real life, bad guys were using 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.

When the parachute opened above the Perseverance rover, it unfurled a secret message to all the people back on Earth. Strings of 1's and 0's coded for some particular letters and numbers. They spelled out "Dare Mighty Things" on the canopy. This is a fantastic message to any science types in the Parkland who might want be involved in space exploration. Maybe a future space flight will have Dauphin technology on it as well as cameras from Canadian Photonic Labs in Minnedosa. The Perseverance parachute had one more message: "34o 11' 58" N, 118o 10' 31" W". That's the GPS location of JPL Labs in California. Just in case any of our Dauphin space explorers need directions.

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

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

Mars Rover's giant parachute carried a secret message - Washington Post - www.washingtonpost.com/lifestyle/kidspost/mars-rovers-giant-parachute-carried-secret-message/2021/02/24/0103b276-6765-11eb-8468-21bc48f07fe5_story.html

Manitoba Company Helps land Perseverance rover on Mars with high-speed camera - https://www.cbc.ca/news/canada/manitoba/mars-rover-perseverance-landing-minnedosa-manitoba-company-1.5930798

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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