CVS is getting ahead of the curve:
CVS Health is pulling some of the most common decongestants from its shelves and will no longer sell them, after advisers to U.S. health regulators recently determined that an ingredient doesn’t work. The products contain oral phenylephrine, an almost-century-old ingredient in versions of decongestants and over-the-counter pills, syrups and liquids to clear up congested noses.
CVS is doing this because the FDA has concluded that phenylephrine pills don't work. The problem is that they get metabolized in the gut before the drug has a chance to enter the bloodstream.
But that's only pills. In my previous post about phenylephrine I failed to mention that it works fine in nasal spray form. So I figure this is as good a time as any to correct that.
I don't know why anyone uses phenylephrine nasal spray anymore. Oxymetazoline (Afrin) is so much better.
An ENT I worked with on a research project some years ago told me that cocaine was the best decongestant nasal spray (and also had the beneficial side effect of being an anesthetic, useful for endoscopic procedures), but it's a bit harder to obtain.
pubmed:
Comparison of vasoconstrictors for functional endoscopic sinus surgery in children
Three different vasoconstricting agents were evaluated during functional endoscopic sinus surgery (FESS) in 57 children. Oxymetazoline hydrochloride 0.05%, phenylephrine hydrochloride 0.25%, or cocaine 4% was applied to the nasal mucosa in a prospective, randomized, double-blind fashion.
And the conclusion was……?
Heart rate and blood pressure changes were recorded 5 and 10 minutes after application of the study vasoconstrictor to each nostril. The surgeon's subjective impressions of bleeding and visualization were recorded for each side of the nose, as were total blood loss and anesthesia time. Although all three vasoconstrictors were tolerated well by the children, there was a suggestion that heart rate decreased more at 5 minutes with phenylephrine than with oxymetazoline or cocaine (P = .08) and that blood pressure increased more at 10 minutes with phenylephrine than with oxymetazoline or cocaine (P = .1). No arrhythmias were noted. Subjective scoring for bleeding showed that children receiving oxymetazoline were less likely to receive scores of "more" bleeding than usual (3/38 vs. 10/34 for phenylephrine and 10/35 for cocaine, P less than .02). Subjective scoring for visualization showed that children receiving oxymetazoline were also less likely to receive scores of "worse" visualization than usual (3/38 vs. 12/38 for phenylephrine and 9/35 for cocaine, P less than .01). There was no difference in surgical bleeding or visualization between children receiving phenylephrine and children receiving cocaine. In our institution, 0.05% oxymetazoline is the preferred vasoconstrictor for FESS in children.
I've had to use these products over the years. Phenylephrine has worked better for me than has Oxymetazoline. And yes cocaine is even better except for the horrible drain. I recieved it as a nasal spray from my ENT after a car crash.
I once inadertently bought phenylephrine spray instead of oxymetazoline, which I was (am) "addicted" to. The phenylephrine worked only somewhat, which I suppose may relate to it being just an alpha-1 agonist, while oxy is also a partial alpha-2 agonist.
CVS still sells homeopathic remedies though. Why not just sell the phenylephrine tablets on the same shelf?