What Is An Alternative To Pseudoephedrine?

[tfc]

I used to use Tiffy for sinus pain but with the new ban can only get the one with phenylephrine which does next to nothing to clear my sinuses. Does anyone know an alternative that will work?

[Sheryl]

Alas, no.

And to make matters worse, it looks like there will be further restrictions placed on dispensing this even at hospitals.

Making Thailand a VERY bad place to have a cold in.

The Cambodian tourism folk would do well to promote Cambodia as a destination for "cold and flu sufferer vacations".

[mommysboy]

Just at the worst time for me too, as alas my sinus pain is back due to the hot dry weather, hurts like hell. I can't take any more beconase for a while and I feel I'm on rebound for meds anyway, any suggestion anybody, it really is painful around my left eye.

[FBN]

Just at the worst time for me too, as alas my sinus pain is back due to the hot dry weather, hurts like hell. I can't take any more beconase for a while and I feel I'm on rebound for meds anyway, any suggestion anybody, it really is painful around my left eye.

The sinuses are air filled cavities; pain means negative pressure inside the cavity due to blockage of the drainage tube as air in the sinus gets absorbed by the mucus membrane lining of the cavity. Infection happens next which increases the symptoms. Antibiotics don't work here very well.

The only solution here is to restore the drainage and air in the sinus. Local sprays such as the nasal decongestants work sometimes but has side effects such as nasal mucus membrane atrophy with loss of the mucus producing cells as well as the small hair cells which are essential to capture all small contaminants we normally breathe in. There is also a rebound action after prolonged use of oxymetasoline based products, of the underlying cavernous tissue which causes the blockage especially when supine. The steroid based sprays reduces this effect but also has other side effects. Another spray which is not primarily decongestant but is supposed to enhance the mucus membrane lining function is "Vibrocil" which is available as a spray or a nasal gel. This seems to cause very little "rebound" effect but the decongestant effect usually does not last that long.

Pseudoephedrine reduces congestion but also causes drying out of the mucus membranes with the same effects as above.

If the underlying condition is an allergy, antihistamines should be used orally but in combination with nasal cavity rinses with a physiological solution.

Not sure if this is still the case but "Clarinase" (loratadine combination with pseudoephedrine) was a good local product.

For nasal rinses use a saline solution with is available locally in a sealed plastic bottle with a special tip to facilitate application. For better effect add about 10-15ml of medicinal grade of sodium bicarbonate powder to the saline. The mix is ideal when it does not cause a burning sensation when applying it.

This dilutes the mucus causing the blockage and facilitates drainage; it also has a rinsing effect that removes any other material.

Alternatively, use a "facial sauna" and inhale the steam or a steam bath with some eucalyptus added. Steam has the same effect but has to be applied at least 3 times per day.

This "natural" approach usually has much better results than oral medication or treatment with antibiotics.

Other underlying causes such as a deviated nasal septum which breaks up normal air flow must also be ruled out or managed.

[mommysboy]

Yes the main problem is a narrowed nasal passage due to deviated septum, and of course living in dirty Bangkok. I'll try the natural approach, a lot of the dryness may be exacerbated by all the meds I have been using on and off.

[astral]

Firstly try the salt water rinse.

I bought it in a small metered dose bottle, which I now refill

Secondly ask your pharmacist for a nasal spray containing Fluticasone,

sorry I can't give you a brand name in Thailand.

Lastly, consider surgery. I had allergies and consequential blocked and infected sinuses

for over 50 years. Then my ENT man recommended Functional Endoscopic Sinus Surgery

Basically he reamed out my sinus passages.

The improvement in my health as result is unbelievable.

[gennisis]

Probably no help to you,but back in UK my boss suffered very badly with his sinus's and had to attend hospital every 3 months to be drained.

I introduced him to 'Albas oil'. After putting a few drops in his nostrils,his eyes started watering,his nose dripped liquid mucus for a good 10 mins. He gave a few deep breaths and said that he had not breathed so well for many years...he continued to use it for many week and was well pleased with it.

Time came to go to the hospital for his usual appointment,he told the doctor of his Albas Oil treatment,the doctor told him to stop using it,and gave no reasons....so he stopped and within a week his sinus problems returned.

I've not seen Albas oil in Thailand...probably Tiger Balm is something similar but with a different mix of oils.

[mommysboy]

Great suggestions. I'll get on to them right away. I have noticed already that staying indoors more has greatly reduced the problem, and am also trying to phase out the air conditioner at night as my room gets too cold and peculiarly this cause the problem too.

[spiritrace]

I used to take actifed until it became impossible to get....I used to give all my pediatric patient Chlortrimeton (chlorpheniramine Maleate) it comes in 4 and 8 mg tabs. I get the 4 mg 100 Tab bottles at Walmart (very cheap)under the label Chlortabs, it only lasts about 5-6 hours but the cost makes it worth taking more often. You can safely take 6 of the little 4 mg tabs. but I only need 4 for good results. It is one of the oldest and safest allergy medicines we have. I avoid a lot of the pricy stuff because of price and ingredients. In Thailand it is under the label Histatab and is also very cheap. It comes the same way as chlortabs, 4mg 100's. Much smaller bottle which I like.

If you are taking other antihistimines you may have to ween yourself off the others before the Chlortabs are effective.

I don't recommend using Afrin for a long time because it will make your mucous tissue soft and raw. That leads to very painful leisons and even infections.

The salt water is a good fix for temporary stuffieness. But over doing it can lead to problems as well. It can strip the mucosa as well. Mix it on the lean side.

We humans have a huge problem with allergies. Quite often it is inherited. It is simply how our body reacts for all the foreign substances around us. Severe allergies such as foods like peanuts is extra scairy. I really feel for people with food allergies because they miss out on all those delicious things in life that could kill them.

Some antihistamines work better on some people than others. It is wise to try different labels. Read the ingredients to make sure you don't repeat any you have tried already.

[astral]

Great suggestions. I'll get on to them right away. I have noticed already that staying indoors more has greatly reduced the problem, and am also trying to phase out the air conditioner at night as my room gets too cold and peculiarly this cause the problem too.

Get the AC thoroughly cleaned, especially the internal filters

and consider replacing it with a modern unit.

Some thoughts here

[TallGuyJohninBKK]

I had been using an electric powered Water-Pik spraying device with a special tip for sinus irrigation, using a homemade saline and bicarb solution mix. But I kept having problems with some of the solution getting into my ear canals and causing problems.

So lately I've switched to using a different non-medical rinse product called Alkalol that's relatively inexpensive to use and available for order from the U.S. from online places such as Amazon and Walgreens. Not sure if it's available anywhere in Thailand, though I'd like to know if it is...

Alkalol -- a mixture of various natural oils and cleansing agents -- can be used mixed with saline. But for me, I've been using it just fine at 100% strength once in the morning and once in the night, and it's been working pretty well the last couple months. Very refreshing for the sinuses as well. Quite pleasant in fact.

I've been using two small 3 ml syringes (no needle) to pull the solution out of the bottle. Then lay down on the bed face up with my head hanging down over the edge. Then use one syringe with about 2 ml of 100% Alkalol for each nostril... Then lay there and let it soak in my sinuses for about 10 minutes... Then off to the bathroom and blowing my nose to expel the solution.

Feeling much better, and no problems about the Thai government interfering with drug restrictions.

Also good suggestions about having the air con service guys spray clean your bedroom aircon units every couple months, monthly cleaning of any removable filters in the unit, keeping the bedroom bedding well washed, cleaning or mopping the bedroom floor frequently to get rid of accumulated dust.

Using a small and inexpensive Vicks-type personal facial steamer with the flexible rubber type face cone is also a good thing... just fill the small reservoir and added 6-8 drops of pure eucalyptus oil, and then steam by breathing in thru your nose until the water has evaporated.

For eucalyptus oil, I have an existing supply I've bought/brought from the U.S. specifically for that purpose. But folks here have told me that most Thai pharmacies carry a local Thai brand called Kangaroo in red and green packages that's relatively inexpensive. I have a bottle, but haven't used it as yet.

When back in the U.S., I also had three rounds of FESS sinus surgery... and I guess it helped from where I was then. But if you read up on the subject, it's often not any kind of solution to sinus problems, since the procedures often remove mucosal tissue and cilia that normally would help clear your sinuses, and the post surgery condition, while having opened your sinuses, doesn't leave them in a condition conducive to natural clearing/draining, meaning the potential for more and ongoing problems. At times, the surgeons are quick to promise the benefits, and remiss in explaining the long-term potential downsides.

[TallGuyJohninBKK]

BTW, from what I've been able to read on the subject, the alternate medication phenylephrine is widely considered to be pretty useless for the kinds of sinus symptoms we're talking about here.

[tropo]

Not sure if this is still the case but "Clarinase" (loratadine combination with pseudoephedrine) was a good local product.

Clarinase has always been my choice of medication for a cold. Is it no longer available? The last time I bought some would have been about the middle of last year.

[IsaanUSA]

For you guys doing the nasal irrigation (Neti pot), do you use tap water, bottled water, or what? Even in the USA they advise people not to use tap water since that one person died.

[TallGuyJohninBKK]

When I was using the Water-Pik device that used about two cups of water per session, I was using tap water here in BKK that I first boiled to sterilize and then kept warm in an electric water boiler... Then added my own non-iodized salt and bicarb soda. Did that for several years here and never had any problem.

Back in the States, just used regular tap water without boiling at all, along with adding non-iodized salt and baking soda, and never had any problem.

None of the sinus docs I've ever dealt with have advised against using tap water... provided you make it the correct salinity and such by adding non-iodized salt and baking soda.

What was the deal with the person dying you mentioned. Not aware of that.

[IsaanUSA]

Sorry, two deaths from a brain eating amoeba.

http://abcnews.go.com/Health/Wellness/fatal-infections-linked-neti-pots/story?id=15170230#.T4NRHdmVtYY

These things have been used for 100's of years, so two deaths doesn't scare me. But some people are really paranoid on here and don't even trust the bottled water, so I wasn't sure what you guys did here.

I guess next time I visit Thailand I'll have to bring a box of Pseudophedrine to give out to somebody.

[TallGuyJohninBKK]

Wow, interesting and weird news... Thanks for posting re that... Never heard of those deaths, and never heard of that parasite before...

But it's making me feel better for two reasons:

1. The method I'm using now with 100% Alkalol is a sterile solution and involves no tap water.

2. The method I'd been using previously involved only using tap water that had been boiled first in an electric water boiler, consistent with one of the recommendations from the health officials in that news report.

The chances of having that problem in the news report would seem very rare. But given that it's potentially fatal, sticking to boiled first or distilled water or sterile saline solutions seems wise.

BTW, steaming obviously is going to be fine and no problem in regard to this issue.. since you're just inhaling the steam from boiling water.

[Sheryl]

I guess next time I visit Thailand I'll have to bring a box of Pseudophedrine to give out to somebody.

Could get in serious legal trouble doing that.

[SpoliaOpima]

I bought a sheet of Actifed tabs last week at a pharmacy in Bangkok. The label says it contians pseudoephedrine. Is this just old stock or has the ban yet to take effect? Or is there actually a ban. Confused

[IsaanUSA]

I guess next time I visit Thailand I'll have to bring a box of Pseudophedrine to give out to somebody.

Could get in serious legal trouble doing that.

Maybe I should clarify. In the US, the pills are sold in boxes. Small boxes that contain a blister pack of 12 pills.

[Sheryl]

I bought a sheet of Actifed tabs last week at a pharmacy in Bangkok. The label says it contians pseudoephedrine. Is this just old stock or has the ban yet to take effect? Or is there actually a ban. Confused

To my understanding the ban is in effect but many pharmacies are still selling the stock they have on hand. Once they have, they won't be able to get more uness the policy changes.

[Arkady]

Secondly ask your pharmacist for a nasal spray containing Fluticasone,

sorry I can't give you a brand name in Thailand.

Brand name in Thailand is Flixonase from Glaxo Smith Kline. It is a corticosteroid but recommended dosage is believed low enough to be safe for long term usage.

[Arkady]

I guess next time I visit Thailand I'll have to bring a box of Pseudophedrine to give out to somebody.

Could get in serious legal trouble doing that.

I believe the new law coming into effect makes it an offence on a par with amphetamines to possess more than 5gm of pseudoephedrine. So you could go to prison and pay a large fine.

It is madness that Thailand has got to criminalising a safe and inexpensive medicine that is readily available over the counter, albeit with some restrictions on quantities or need to show ID, in many countries. The problems unearthed recently relate to corrupt public health officials. Surely it would be far more effective to strictly enforce existing laws and bang up corrupt government officials involved in the drug trade for at least 20 years without possibility of parole. Banning Tiffy etc is never going to stop the drug trade while it is so profitable and senior police, military, public health officials and politicians know they can enrich themselves fantastically in the drug trade without fear of any type of retribution. Banning cold and allergy medicine is just grandstanding by super corrupt politicians like Chalerm who have absolutely no desire to eliminate such profitable activities.

[IsaanUSA]

I guess next time I visit Thailand I'll have to bring a box of Pseudophedrine to give out to somebody.

Could get in serious legal trouble doing that.

I believe the new law coming into effect makes it an offence on a par with amphetamines to possess more than 5gm of pseudoephedrine. So you could go to prison and pay a large fine.

5 grams?? I think Sudafed pills only have 60 mg, so bringing in a box for personal use should be fine. Nowhere near 5 grams.

[tropo]

To my understanding the ban is in effect but many pharmacies are still selling the stock they have on hand. Once they have, they won't be able to get more uness the policy changes.

Could you please explain what the ban is and when it started. Thanks.

[mommysboy]

Tropo it is a blanket ban on said drug, as this substance is used in the making of illegal recreational drugs.

I've been using natural remedies for the past couple of days and am very pleasantly surprised. I'll stay cautiously optimistic but I'm doing the following:

1. Rinsing more thoroughly and frequently with a strong sodium bicarbonate solution.

2. Drinking and sniffing the vapour of tomato tea, which for me is basically hot tomato juice with garlic and a touch of chilli added.

My nasal passage has widened more than on any drug, and no pain from sinus area. Yesterday I got caught up in a traffic jam at Laksi and had to take a standard open window bus for one hour. This would normally ensure a day of sneezing, pain, and headaches but it didn't happen.

Early days, but I really hope this is due to the above. Fingers crossed.

[Sheryl]

Actually there is some discussion now of reversing the ban and allowing pharmacies to sell in limited quantitites. (The rationale for making it hospital only kind of fell apart when it was discovered that it was the hospitals who were selling massive quantities of the stuff to drug gangs).

But not decided yet.

While pseudoephedrine is not the answer for people with chronic sinus issues, allergies etc, it is fine for short-term relief of common colds. And pretty hard to go without, as the cold I just came down with has reminded me.

[japkoo]

Even less than 5 grams will get you 1-5 years in jail.

Do these guys have any morals? Making harmless medicine which is perfectly legal in the US into a crime equal to manslaughter? Hurting millions of innocent allergy sufferers in order to slightly inconvenience a handful of evil people.

Cabinet acknowledges new regulations on pseudoephedrine control

BANGKOK, 11 April 2012 (NNT) - Acting Spokesman of the Prime Minister’s Office Mr. Anusorn Iamsa-ard said the Cabinet has acknowledged the issuance of two ministerial announcements made by the Ministry of Public Health to deal with pseudoephedrine abuse.

Mr. Anusorn said the two Public Health Ministry announcements have been issued to keep the use of pseudoephedrine under control. The first one states that the chemical has now been recognized as the second type of psychotropic substances and shall not be sold, contributed or imported by any means.

Possession of pseudoephedrine-containing medication at any health services or chemists is now prohibited and the medicines shall be returned to manufacturers or importers accordingly. Under the second announcement, any individuals or organizations found to have been in possession of psychotropic substances of Types 1 and 2, will be prosecuted according to law.

They could face a jail term of 1-5 years and a fine of 20,000-100,000 baht if less than 5 grams of pseudoephedrine were found. However, any amount higher than that could send an owner to a jail term of 5-20 years and a maximum fine of 400,000 baht.

Mr. Anusorn added that the Public Health Ministry has coordinated with enforcement authorities in investigating and tracking down those involved in the recent smuggling of pseudoephedrine out of the national drug system.

http://thainews.prd....id=255504110031

[japkoo]

The law would mean that 2 boxes of cold medicine could get tourists who weren't aware of stupid laws thrown in jail for 20 years.

1 box contains 3.6 grams

http://www.drugstore.com/claritin-d-24-hour-allergy-and-congestion-tablets/qxp78906

[TallGuyJohninBKK]

The article you've posted above appears to be a day before, and prior to, the subsequent news yesterday about the bans being revoked... This is getting a bit confusing... but I think they're now going the other way.

Posted Yesterday, 06:51

COLD PILLS

Govt ban on prescription revoked

THE NATION

BANGKOK: -- State and private hospitals will be allowed to prescribe pseudoephedrine-based medication after Dr Paijit Warachit, permanent secretary of the Public Health Ministry, signed a directive revoking the ban yesterday.