Status of pseudoephedrine and oral decongestants

[connda]

I've got a deviated septum and when I get seasonal sinus problems it's difficult to breath though my nose.  I haven't be able to find an oral decongestant that contains pseudoephedrine over the counter or though my provincial government hospital.  My doctor says the pharmacy only has nasal sprays and allergy meds, but no oral decongestants. 
So I dealt with my congestion using child-strength oxymetazoline HCL that I further diluted and placed in an atomizer.  The original problem cleared up but I'm left with rebound sinusitis which I knew would happen.  Now I need an oral decongestant and some time to get over the Rhinitis medicamentosa.  I quit cold-turkey two nights ago.  That didn't work.  Woke up at 2am with my nose either pouring watery snot or being completely blocked (or both) and nothing in between.  So used enough spray in order to sleep.  Last night I tried again after taking the last of the medicine I had containing pseudoephedrine. I was able to sleep, but now I"m out of meds.  So back to the doctor this morning with the same request: "Do you have an oral decongestant so that I can tackle the oxymetaoline rebound?"  Answer: "No"
So I'm on oral prednisolone which seems to be like using a bulldozer to do a job that only needs a shovel but I need something to decrease the nasal pressure at night so I can sleep. 

So anyway - What's the problem with pseudoephedrine or other oral decongestants that seem so difficult to obtain.  Are they illegal or something, or am I just going to the wrong hospital?  

Edited June 5, 2018 by connda

[Sheryl]

They are legal only at a hospital. This was made law a few years ago because of concerns about their use to produce amphetamines. It is a ridiculous law (in fact, turned out the people selling large quantities of the stuff to meth labs were hospital pharmacists!) but there you have it, we now all have to go to a hospital to get a decent oral decongestant in Thailand.

 

ENT doc in any hospital OPD will usually be able to prescribe it.

 

I have no idea why your particular provincial hospital could not. First I have heard of that. Suggest you try another hospital. Where do you live?

[poanoi]

i made the mistake of using nasal spray once,

i got dependent on it and it took a whole damned year

without means of breathing through my nose until i finally had

come off the addiction.

 

use with extreme caution and only briefly

[TallGuyJohninBKK]

Any decent hospital pharmacy ought to have pseudoephedrine available here via doctor's prescription, as per Sheryl's explanation above.

 

But in my experience, some Thai doctors, including ENTs, seem reluctant to prescribe it. Not sure why. Perhaps the hospitals try to discourage its use, or perhaps the doctors don't want to risk running afoul of the drug enforcement black shirts.

 

At any rate, in my experience, it's the best product on the market for relieving nasal congestion. And the replacement OTC drug often offered in its stead, phenylephrine, is often useless for a lot of people.

 

Quote

Is phenylephrine as effective as pseudoephedrine?

Yes. Most patients and healthcare providers will agree that Sudafed (pseudoephedrine) is more effective for congestion than its counterpart Sudafed PE (phenylephrine). This is likely due to the fact that the intestines will absorb only about 38% of the amount of Sudafed PE in one tablet, while Sudafed is 100% absorbed.Jul 18, 2014

Sudafed vs Sudafed PE: What's the Difference? - GoodRx

https://www.goodrx.com/blog/sudafed-vs-sudafed-pe-whats-the-difference/

 

Quote

What's the difference between phenylephrine and pseudoephedrine? Do they work the same?

Both pseudoephedrine and phenylephrine are decongestants used to treat nasal congestion due to allergies, colds, sinus infections, etc.

Since pseudoephedrine can be made into methamphetamine, the U.S. Senate passed a bill restricting its sale.
Pseudoephedrine products can still be purchased in limited quantities, but identification and signatures are required.
Some states also require a prescription for pseudoephedrine products.

Unfortunately, no studies have been done to confirm whether these two decongestants are equally effective.
There are some differences in the way the drugs are absorbed by the body:
 

• The intestines will absorb only about 38% of the amount of phenylephrine in one tablet, while pseudoephedrine is 100% absorbed.
• The effects of phenylephrine do not last as long as pseudoephedrine. Therefore, phenylephrine needs to be taken every four hours,
  while pseudoephedrine can be taken every four to six hours.

 

 

https://www.walgreens.com/topic/faq/questionandanswer.jsp?questionTierId=600002&faqId=600012

 

Edited June 5, 2018 by TallGuyJohninBKK

[connda]

36 minutes ago, Sheryl said:

They are legal only at a hospital. This was made law a few years ago because of concerns about their use to produce amphetamines. It is a ridiculous law (in fact, turned out the people selling large quantities of the stuff to meth labs were hospital pharmacists!) but there you have it, we now all have to go to a hospital to get a decent oral decongestant in Thailand.

 

ENT doc in any hospital OPD will usually be able to prescribe it.

 

I have no idea why your particular provincial hospital could not. First I have heard of that. Suggest you try another hospital. Where do you live?

It's an Amphur level hospital in Lamphun province, so maybe too small.  I'll try one of the private hospitals in Chiang Mai.  I'm not going to attempt hassling with the crowds at Lamphun provincial for what will end up being a strip of 10 decongestants tablets.  <laughs> 
Thanks Sheryl.

Edited June 5, 2018 by connda

[JAS21]

The ENT doctor gave me Cleanoze ... basically salt to dissolve in water and then fire up your nose.  Seems to clear mine ... you could use table salt  but use too much and it stings ...

[connda]

2 minutes ago, JAS21 said:

The ENT doctor gave me Cleanoze ... basically salt to dissolve in water and then fire up your nose.  Seems to clear mine ... you could use table salt  but use too much and it stings ...

I have a neti pot and sea salt.  It's somewhat useful but does not relieve really heavy congestion. 

[TallGuyJohninBKK]

3 minutes ago, JAS21 said:

The ENT doctor gave me Cleanoze ... basically salt to dissolve in water and then fire up your nose.  Seems to clear mine ... you could use table salt  but use too much and it stings ...

 

Saline rinsing is a good home remedy for sinuses. I've done it for years. But you have to be careful about a couple things:

 

1. No table salt, assuming it's iodized. For sinus rinsing, you should only use non-iodized, preferably natural sea salt.

 

2. If your sinuses are heavily congested/blocked, you probably don't want to do sinus rinsing at first, because the pressure you'll end up using can end up forcing the water into your ears and potentially causing an infection there.

 

3. There have been some cases (rare) where people using tap water for sinus rinsing have died from fatal brain infections caused by amoeba found in some tap water. So the guidance is to always use pre-boiled or otherwise purified water for sinus rinsing. Some say distilled, but personally, I wouldn't use distilled, because as best as I understand it, it can leach minerals out of your sinuses.

 

https://blog.aarp.org/2011/12/21/sinus-rinse-warning-two-deaths-from-using-tap-water/

 

https://blogs.scientificamerican.com/guest-blog/a-brush-with-brain-eating-amoebas-and-saltwater-nose-genies/