Q: I just bought some Sudafed® but it doesn’t seem to work for me any more. Is there anything else I can take that would work better?
If you purchased Sudafed® from the allergy and cold medicine section of your local pharmacy or grocery store, it’s not the same medicine. In fact, if you look closely, the box has Sudafed PE® on it.
Sudafed PE® is different than the Sudafed® you remember. The original formulation of Sudafed® contains pseudoephedrine. The newer version of it has phenylephrine, which is why the name on the package is Sudafed PE®. Both pseudoephedrine and phenylephrine are decongestants designed to relieve stuffy nose symptoms but their potency and effectiveness are different.
Phenylephrine is effective as the topical decongestant in Neo-Synephrine® nose spray but Sudafed PE® doesn’t work as well. For one thing, phenylephrine is not well absorbed into your body from your stomach. Some of the phenylephrine is left behind instead of getting into your bloodstream, where it needs to be to do its job.
The other reason Sudafed PE® doesn’t work as well as Sudafed® is because it is less potent. Phenylephrine and pseudoephedrine are both effective as nasal decongestants when taken as a 30mg dose. Phenylephrine has caused high blood pressure and stroke at that dose, so the Food and Drug Administration (FDA) has limited it to a 10mg dose, only 1/3 of the adult dose considered equivalent to pseudoephedrine. Sudafed PE® is unlikely to cause any serious side effects at this dose, but it’s also unlikely to give you much relief from your stuffy nose.
Why was an effective and popular non-prescription medicine replaced with a wimpy one? Pseudoephedrine became too popular for its own good by being a key ingredient in making methamphetamine. In 2005, the USA Patriot Act restricted the sale of key ingredients of methamphetamine, called precursors, in an attempt to combat meth production, trafficking and abuse.
The compounds identified as precursors are ephedrine, phenylpropanolamine, and pseudoephedrine. Beginning on September 30, 2006, products containing any of these were to be kept “behind the counter” in pharmacies or under lock and key by grocery stores or other vendors. Today, except in Oregon and Mississippi, you can still purchase the original formulation of Sudafed® if you ask for it, show your ID and sign for it. You cannot purchase more than 3.6 grams in a 24-hour period or 9 grams in a month.
My pharmacy moved our stock of cold medicines with pseudoephedrine behind our counter nearly a year before the restrictions took effect because we were getting ripped off. When we first noticed the problem we tried moving them to where they were in plain view of the pharmacist. Despite that, the shelf would be bare again within a day or two. Pretty brazen, shoplifting them right in front of the pharmacist!
Did these restrictions on pseudoephedrine work? Not according to a report published April 30, 2012 by the National Association of State Controlled Substances Authorities (NASCSA). Titled Impact of State Laws Regulating Pseudoephedrine on Methamphetamine Trafficking and Abuse, the report describes how “smurfing” – the practice of buying pseudoephedrine frequently by using various fake IDs at multiple locations, has circumvented the federally mandated restrictions and recommends a different approach.
The state of Oregon took the Patriot Act restrictions on methamphetamine precursors even farther and changed pseudoephedrine into a prescription-only controlled substance with restrictions and monitoring just like the narcotic pain reliever Vicodin®. Oregon is one of the only states to experience a consistent and dramatic decline in meth lab incidents and trafficking since 2006 and NASCSA is now petitioning the Drug Enforcement Administration (DEA) to follow Oregon’s example and reclassify pseudoephedrine as a controlled substance.
If Sudafed® becomes a prescription-only medicine it would be more expensive and require a clinic visit, driving an inexpensive and effective systemic nasal decongestant out of reach of many Americans.
For now, except in Oregon and Mississippi you can buy the old formulation of Sudafed® or generic pseudoephedrine by stopping by a pharmacy, showing your ID and signing for it.
Dr. Louise Achey, Doctor of Pharmacy is a 30-year veteran of pharmacology. Please send your questions and comments to www.AskDrLouise.com.
©2012 Louise Achey
Dr. Louise,
As a registered nurse and nurse educator I wholeheartedly agree with you! It is ridiculous that we have to worry about the hazards of meth labs popping up in our communities, but making pseudoephedrine a prescription would be unreasonable. Like many Americans I have health insurance, but what it covers even with being part of a group plan with a big company isn’t enough. My husband and I avoid going to the doctor’s at all costs whenever we can so we don’t incur more medical bills as we are already deeply in debt paying on two surgeries I required a few years back. I cannot imagine the costs of the doctor’s visits and what not that would incur just to get a little bit of relief from a stuffy nose every time any member in my family catches a cold or has allergies. Imagine also all the patients that would be coming in needlessly infecting other patients and staff with their colds to come in person to get said controlled substance. With it being over the counter at least a healthy family member can come in and pick up the medicine, or it is already on hand in the home. Pseudoephedrine in league with opiates, really?! I am glad that I don’t live in Oregon or Mississippi, and hopefully common sense will prevail to keep all states from passing the same legislation.
Although I’m sure what you are saying is true, I don’t think it is the case for everyone.
I just purchased a box of Sudafed that uses Pseudoephedrine (from the pharmacist directly) that doesn’t seem to work (which is why I stumbled across your article). I have taken the recommended amount on several occasions and I get no noticeable relief.
I don’t get sick often, but when I do, the only thing that clears up my nasal and sinus congestion is nasal spray.
The doctor convinced me to give Sudafed another shot because nasel sprays can cause a dependence. I tried it. It still doesn’t work.
As I explain in my book Why Dogs Can’t Eat Chocolate: How Medicines Work and How YOU Can Take Them Safely, no drug works in everyone and no drug works the same in everyone. Sudafed® acts differently with me too. I can take the short acting pills just fine but the long-acting capsules give me a nasty case of the jitters and an acid stomach to boot!
If you have to use nasal spray for relief of your congestion, I recommend using Afrin® nasal spray (or its generic, oxymetazoline nasal spray) and being careful to use it ONLY as directed on the bottle. Using it more frequently or for more than 3-5 days will cause it to stop working for you and set you up for a dramatic return of your stuffiness, called rebound congestion.
Good luck!
> we tried moving them to where they were in plain view
> of the pharmacist. Despite that, the shelf would be
> bare again within a day or two. Pretty brazen,
> shoplifting them right in front of the pharmacist!
Not at all—the mistake you’re making is unconsciously assuming that the location where the product is located is also where/when the goods get “stashed”, as in, made to disappear. This is rarely if ever the case, and honestly, in my opinion the person would have to be either a child or mentally feeble to do such a thing, with any product, not just these.
I used to work in loss prevention for a large chain of corner stores in my area and would often offer general info and tips to, for example, newly promoted or recently hired store managers and assistant managers. If I was looking to steal ONLY this one product and nothing else, I would:
(1) Plan on doing it only when I had other things I needed to get from that store as well, things I will be paying for. Let’s say 6 things (soap, toothpaste, whatever) altogether.
(2) Upon entering I would start by getting maybe 2 of those things, taking about 2 min to select each, all very relaxed. Then I would add the pseudoephedrine to my basket, then the other 3 things. All together in the store about 12 minutes, having selected 6 items, all very relaxed like I said.
(3) Then I would head for the cash. I would be friendly with the cashier as s/he totals it up, pay for it, and leave.
Some criminal, huh? Only I left out that there were only 5 items rung up at the cash and paid for, because at some point during the 6–7 minutes that began when I added the pseudoephedrine to my basket and the time I started heading for the cash to pay, the pseudoephedrine was removed from its packaging, stashed, and the packaging gotten rid of.
What difference does it make then, if you stock it in the aisles or a few inches in front of the pharmacist’s nose? Exactly. Moreover, further advantages of doing it this way are:
Store security cannot stop someone unless they were able to follow a *complete* path, with their own eyes or camera, from the moment they (pay attention now) saw you lift the item off the store’s shelves, stash it, and leave the store with the item unpaid. The *entire trail* must be witnessed. This is the reason I would take my time as I described, because (a) very, very few security personel will keep eyes locked on you for all those minutes because they know they are letting other theft go completely unwitnessed and (b) if it’s a store detective, an experienced shoplifter will be looking to see if he’s being followed by someone over that length of time, and if so he will dump the item(s) before getting to the cash. He knows the store detective will not approach him even if he is seen blatantly getting rid of the merchandise, because there has been no crime and the store detective knows it, and more importantly, he knows *you* know it.
Lastly, the fact he has to follow the complete trail from beginning to end is also the reason I wouldn’t go straight for the item upon entering the store. All it takes is for one security guy in his office watching the monitors in a store with 100% camera floor coverage, who decides he doesn’t like my face as I enter, to keep following me by camera to the first item to see what I do, and I’ve snookered myself. That’s why I would take a couple minutes to pick out my first to-be-paid-for items, another couple minutes for the second item, and only by the 3rd or 4th item will I add “the” item to my basket.
I could write 10× this much, and have in the past (lol), but my point is, in all seriousness, with no sarcasm intended, to just go ahead and stock your items where they make the most sense to stock, because if moving something within direct eye view of an employee discourages anyone, it will *not* be anyone from within the group of those individuals who are costing you the most in losses. Honestly, if I had to leave you with one single tip to help cut your losses? I would tell you to watch your employees. CLOSELY. You do that, you’ll see a big decrease in losses, probably bigger than you’re expecting.