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Medical Forum / General / Pharmacy / October 2003

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Decongestants other than pseudoephedrine; non-perfumed nasal steroids.

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- 30 Jul 2003 16:07 GMT
My allergy season is coming up, as it does every fall. (Oak pollen.)

I can't use pseudoephedrine: it gives me severe insomnia (not to mention
irritability, etc.). Even tried Zyrtec-D once, when I was desperate, and
the cetirizine knocked me out for 2 hours, after which the PSE kept me
awake the rest of the night.

Phenylpropanolamine appears not to do this; I can take it at bedtime and
it doesn't keep me awake. Unfortunately I'm down to my last 20 tablets
of Propagest, and when that's gone I'm stuck. If I could get my hands on
some PPA in powder form, I'd punch capsules (I used to be really good at
that: when I was working in another city, we had one doctor who had his
own proprietary sedative/hypnotic mixture, which turned out to be 50mg
Vistaril and 2mg melatonin, and we had to compound these for him) but
none of my wholesalers have it in stock even in that form anymore.
Probably could get some from Sigma/Aldrich or similar, but that would
probably draw unwanted attention from various regulatory authorities
(not to mention the accountants at the chain I work for, who would be
wondering why I'm ordering it). Web searches on PPA have mostly turned
up ambulance-chasers soliciting clients for product liability lawsuits,
along with a few suppliers of PPA for veterinary use only.

I've noticed that Entex-LA has been reformulated with phenylephrine
rather than PPA, but I don't see that oral phenylephrine is available as
a single entity (and I don't particularly need an expectorant anyway). I
suppose I could do some compounding beginning with Neo-Synephrine or
something and wind up with some kind of oral dosage form, but I've no
idea whether it would behave more like PPA or PSE as far as CNS
stimulation is concerned (in my particular case).

USD XXVI had a bunch of other decongestants listed, but none of those
are available as oral dosage forms anymore (that book is 36 years old).
Paredrine is ophthalmic only, methoxamine is used only as a pressor
agent, etc.

So, does anyone here know of other orally-active decongestants than the
ones I've already mentioned, that are legally available in the USA?

And while I'm on the subject, which intranasal steroids don't stink? I
don't happen to like the smell of lilacs... once I received a shipment
that had gotten some rough handling, and a bottle of Flonase had gotten
cracked: the entire tote reeked of it. Eugh. I remember that this was
one of the selling points of the original Rhinocort pockethalers, but
those seem to be discontinued.

Signature

Shalom

Brad - 30 Jul 2003 20:32 GMT
> I've noticed that Entex-LA has been reformulated with phenylephrine
> rather than PPA, but I don't see that oral phenylephrine is available as
[quoted text clipped - 6 lines]
> So, does anyone here know of other orally-active decongestants than the
> ones I've already mentioned, that are legally available in the USA?

AH-Chew D 10mg chewable

> And while I'm on the subject, which intranasal steroids don't stink? I
> don't happen to like the smell of lilacs... once I received a shipment
> that had gotten some rough handling, and a bottle of Flonase had gotten
> cracked: the entire tote reeked of it. Eugh. I remember that this was
> one of the selling points of the original Rhinocort pockethalers, but
> those seem to be discontinued.

Most compounding pharmacies can compound steroid nasal sprays that contain
no fragrance.
Some folks at "The Powers That Be" have decided that all those cfcs in the
aerosol inhalers must be causing a hole in the ozone so Rhinocort was
replaced by an AQ pump.
BTW, most of my patients prefer the new AQ over the aerosol in both Rhino
and Nasa.
And now pharmacist get to actually see the device - it used to be hidden in
the foil pouch.

> Shalom

Back atcha pardner

Brad
J. Alan Septimus (Shalom) - 01 Aug 2003 20:31 GMT
>AH-Chew D 10mg chewable

Cool, thanks. I'd never heard of it, certainly never dispensed it. I
just checked, and Bergen even has it in stock.

Only problem is, that's a legend drug. Now I'll have to convince my MD
to write me a script for it......

Shalom
Brandy?Alexandre - 04 Oct 2003 07:35 GMT
<druggist@p0b0x.c0m> wrote in sci.med.pharmacy:

> So, does anyone here know of other orally-active decongestants
> than the ones I've already mentioned, that are legally available
> in the USA?

There's a veterinary drug for dogs with bladder control issues that
contains PPA.  It comes in a nice liver flavor chew tab.  ;)

Don't think I haven't thought about it...
 
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