catching the run away nose

Everyone seems to down with cold recently and the first thing they complained, that they have tried phenylephrine and it does not work for them and everything containing pseudoephedrine is now stored at the dispensary at my new work place, thus more work has to be done retrieving the different products, proceed to explain the different single or combination products available. I believe in giving the patient the choice to choose the best product, one that is most suitable.

Why pay more or even pay anything for a less effective product? I asked the pharmacy assistant who has years of experience in a retail setting when she decided to price the less effective decongestant product a dollar cheaper than the golden standard decongestant at my old pharmacy, considering the good markup even before hiking the price or rather standardizing the price among similar products. There is no way I am going to fork out a similar amount for something that is unlikely going to work, can I just have the pseudoephedrine?

The controversial decongestant phenylephrine is less effective and is associated with offering nothing more than just placebo effect compared to the one who does the job – pseudoephedrine and I do not know what is worse, the ever popular day and night cold formulation containing phenylephrine is at sub-therapeutic dose, the 5mg instead of 10mg. Correction – the dose is to take 2 tablets thus achieving 10 mg of phenylephrine, two of the pseudoephedrine tablets adds up to the standard 60mg; all these while I thought I was selling sub-therapeutic products. Why the manufacturer did not just combine the intended dose into a single tablet then?

Still, it does not change the fact that I want to sell only pseudoephedrine/ oxymetazoline/saline but sometimes the extra work I have to do for products containing pseudoephedrine put me off. I will have to ask for a photo id, normally driver license of the customer and record their details using project STOP (web-based tool developed aimed at preventing the use of pseudoephedrine based products to manufacture methamphetamine), I will then briefly go though the rationale behind inclusion of each active ingredient in the product – paracetamol, codeine, pseudoephedrine/ phenylephrine and the sedating antihistamine, I will have to at least TRY to WWHAM all five must-ask questions, the Who, What, How, Actions, Medications, and lastly telling them the dose and ask if they have any query.

That is exactly how I complete the sales provided they did not question me the difference between phenylephrine and pseudoephedrine or the difference between the different brands only to have me attempt to convince them that they contain the same active ingredients. Oh, I forget that most of time time, I will have to make clear the dissimilarity between the products we hid behind and the ones on display.

All the little things could add up to a good few minutes and try comparing that to the easy way out, grab a box of product containing phenylephrine and tell the customer to take 2 tablets up to four times a day and end with have a nice day and I will see you again, because most of the time they will have to come back to get the pseudoephedrine.

One of the customer I had on Tuesday told me that she wanted the flu formulation as I was approaching to close the sale. I just try to tell her that cold and flu are marketed together and she has to tell me every symptom she is having and I will recommend a few of the "best" combination products and she can decide. Flu formulation is just the same as cold formulation unless you are having the real flu, and in that case, you are bed-ridden anyway. I would love to be asked to enlighten her on the distinctness of cold and flu, I am being sarcastic.

Phenylephrine was not significantly different from placebo in the primary end point, mean change in nasal congestion score at more than 6 hours (P = .56), whereas pseudoephedrine was significantly more effective than both placebo (P < .01) and phenylephrine (P = .01). During a 6-hour observation period, a single dose of pseudoephedrine but not phenylephrine resulted in significant improvement in measures of nasal congestion.

Horak, F; Zieglmayer, P; Zieglmayer, R; Lemell, P; Yao, R; Staudinger, H; Danzig, M (Feb 2009). "A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber". Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology 102 (2): 116–20.

There is insufficient evidence that oral phenylephrine is effective for nonprescription use as a decongestant. The Food and Drug Administration should require additional studies to show the safety and efficacy of phenylephrine.

Randy C Hatton, Almut G Winterstein, Russell P McKelvey, Jonathan Shuster, and Leslie Hendeles. Efficacy and Safety of Oral Phenylephrine: Systematic Review and Meta-Analysis. Articles Ahead of Print published on 1 March 2007, DOI 10.1345/aph.1H679.Ann Pharmacother ;41:381-390.

UF researchers question effectiveness of decongestant- source here.