Dr. Paul Ehrlich
As our faithful readers are aware, we take a backseat to no one when it comes to endorsing over-the-counter medicine when it is effective and safe. However, one element that pulls us up short is the drug pseudoephedrine, sold most familiarly as Sudafed, which has for generations been a fast and cheap decongestant. When you see the D on a cold medicine or antihistamine, that’s what it refers to. The problem as most of us know is that it is also the precursor drug for crystal meth, which has ruined thousands of lives and millions of teeth, and allowed criminals, organized and disorganized, to diversify their product line.
Many states have sought to curb crystal meth production by requiring that products containing it be moved behind the counter, to provide better control, and sell it only a little at a time. Anyone whose nose is so clogged he needs to buy it by the armful really ought to see a doctor. The Missouri Senate is now entertaining a bill to make pseudoephedrine available only by prescription, and one Senator, Rob Schaaf, an MD, asserts that he’ll filibuster, if need be, to stop it in the Missouri Senate:
Pseudoephedrine is one of the best and safest drugs used to treat allergies and colds, and that it doesn’t make sense to force patients to make costly office visits, which also takes “valuable time away from medical professionals to get something as simple as pseudoephedrine.” But it also amounts to a freedom issue, he said.”The need to make it a prescription drug does not rise to the level of decreasing our freedom,” said Dr. Schaaf. (full article here)
This may be splitting hairs, but pseudoephedrine treats a symptom of allergies and colds, not the conditions themselves. It is a good drug. Too bad it has this dual usage. As for the symptoms, the alternatives, such as phenylephrine—the active ingredient in Neo-Synephrine and Afrin, which are inhaled through the nose—have troubles of their own. As we write in our book: “[Phenylephrine] constricts dilated blood vessels and shrinks swollen nasal passages. But it is also temporary. When it wears off, the vessels dilate again, wider than before. That’s why the label says, ‘“If symptoms persist, consult your physician.’” Soon you’re spraying just to counteract the effect of the medicine itself (called rhinitis medicamentosa)… Over-the-counter drugs like these have their place in today’s busy world, but they are to long-term health what a Big Mac is to a balanced diet: good for an occasional treat, but disastrous day-in, day-out.”
I acknowledge that someone who has a severely congested nose on a Saturday night shouldn’t have to make a doctor’s appointment to relieve his symptoms. He ought to be able to go to a pharmacy, or even a convenience store, for relief, although elevating the discussion to the level of “freedom” strikes me as something out of the Tobacco Institute playbook; one man’s freedom is another man’s second-hand smoke. Then, too, drugs like oxycodone, which are produced legally and available by prescription, can also be abused—just ask Rush Limbaugh.
That said, if you do have nasal allergies—also known as allergic rhinitis—you should treat both the disease and the symptoms.
Use OTC anti-histamines or prescription nasal steroids. And irrigate your nasal passages with saline solutions with high concentrations of salt, 2%–3%, because the salt draws moisture into the mucous membranes from surrounding tissues by osmosis, thus hastening the restoration of the membranes’ natural irrigating function. To make your own: one quart of tap water, two to three heaping teaspoons of sea salt or kosher salt (both have no additives), and one level teaspoon of baking soda. Marketed as SaltAire among other names, hypertonic saline solutions come ready-made in plastic squeeze bottles. You may buy a similar bottle or purchase a 30-cc bulb syringe for administering your own low-cost nasal solution.