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Sudafed Not the Solution For Some Doctors



If some state lawmakers have their way, buying a package of Sudafed for a stuffy nose could soon be a lot more difficult.

But according to some local doctors, pseudoephedrine might not be the best choice for what ails you, anyway.

Gov. Earl Ray Tomblin last week proposed a new, real-time tracking system for pseudoephedrine- based medications. The drugs are used in clandestine labs to make methamphetamine. The tracking system would, in theory, allow law enforcement to pinpoint meth makers by identifying those who buy large amounts of cold medicine.

Meanwhile, legislators like Delegate Don Perdue, D-Wayne, want to choke off the labs’ pseudoephedrine supply by making the drugs available by prescription only. 

Either way, it’s no skin off Dr. David Phillips’ ear, nose or throat. 

Phillips, an ear, nose and throat specialist at Eye and Ear Clinic Physicians of Charleston, said he rarely suggests patients take pseudoephedrine. 

“It’s just not a great medicine when you look at your risks and benefits,” he said. “We believe it really has a limited use. It might provide some decongestion and temporary relief, but it’s also got side effects.” 

Phillips said pseudoephedrine is a stimulant and can leave some patients feeling jittery and unable to sleep. It also can raise blood pressure and cause men with prostate problems to have difficulty urinating. 

Until the last decade, doctors recommended pseudoephedrine for children with ear infections and congestion. 

“We stopped recommending it for use in pediatric patients because we couldn’t show any clear benefit,” Phillips said. 

Dr. Malcolm Chaney, a general practice physician at Charleston Family Practice Group, said he doesn’t recommend patients use pseudoephedrine because it’s sometimes a hassle to purchase. “I tend to say just get a combination product, like Dimetapp. It has a combination that will probably work just as well. No one’s got a great help for colds,” he said. 

Dr. Charles Crigger, of Crigger and Associates Ear, Nose and Throat Associates, said most of his patients who take pseudoephedrine take the drug in a combination form. 

Allergy drugs like Claritin and Alavert combine pseudoephedrine with loratadine. Zyrtec combines the drug with cetirizine. 

Crigger said he writes prescriptions for traditional pseudoephedrine drugs when patients don’t have success with the combination medicines. 

If patients must use pseudoephedrine, Phillips said he recommends it in a nasal spray formula. It relieves congestion without the usual side effects. Otherwise, he recommends patients with upper respiratory infections use a saline rinse to clear mucus from their noses. For allergy sufferers, he recommends a nasal steroid spray like Flonase or Nasonex to relieve congestion. 

“It would be no great inconvenience. I don’t know that it would have much effect on a patient,” Phillips said. 

Still, he said he’s skeptical removing the drug from store shelves will impede meth production. 

“When they want it, they’ll get it,” Phillips said. 

The doctors said they already try to guard against pseudoephedrine misuse. 

“We have to make sure, to the best of our ability, you’re not abusing the drug. In a way it is a way of protecting ourselves,” Crigger said. 

“I’m in a position where I’m supposed to be a guardian of society’s interests and the patients,” Chaney said. 

Chaney said a doctor would be “foolish” to prescribe more than seven days’ worth of pseudoephedrine pills. If he’s concerned a patient is selling their pseudoephedrine or making meth with it, he just suggests they purchase one of the many combination drugs available. 

The combination drugs don’t work for meth.