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Medical Forum / Diseases and Disorders / Sinusitis / October 2006Singulair no better than Sudafed
http://www.eurekalert.org/pub_releases/2006-02/uocm-ode021606.php "This came as a genuine surprise," said Fuad Baroody, M.D., associate professor of surgery at the University of Chicago and director of the study. "Our hypothesis was that montelukast would have additional benefits and pseudoephedrine would interfere with sleep, but when we compared them head-to-head we found that for treatment of allergic rhinitis, these drugs at these doses were virtually identical." Susan > x-no-archive: yes > [quoted text clipped - 8 lines] > > Susan I wonder why that aticle that is not telling the full story did not even mention any of the blood pressure or cardiovascular side effects of taking either? >>x-no-archive: yes >> [quoted text clipped - 12 lines] > even mention any of the blood pressure or cardiovascular side effects > of taking either? The article obviously took the economic angle. Susan I took Sudafed ONCE many years ago and I thought I was going to die from a heart attack!I had palpitations,nausea.....I thought I was a goner!! Kindest personal regards, Ray The Travellin' Man.....Ray Armstrong your eyes and ears on the Tweed!! Let's Keep Music Liiiiiiiiiiiive!!!!!!! > x-no-archive: yes > [quoted text clipped - 18 lines] > > Susan >> > I wonder why that aticle that is not telling the full story did not >> > even mention any of the blood pressure or cardiovascular side effects >> > of taking either? Sudafed can definitely affect blood pressure, heart rate, etc., and is not supposed to be used regularly. I never heard of Singular having side effects like those though, and it is supposed to be used regularly, long-term. (I think it might not be recommended for people whose livers are not good, something like that, don't recall for sure.) ------------- The newer Sudafed (and generic equivalents) uses phenylephrine instead of pseudoephedrine (from which the name comes), due to the latter being used to make methamphetamine in home labs. (Versions with pseudoephedrine are still available behind the counter though.) Does anyone know--are the cardiovascular effects of phenylephrine the same as pseudoephedrine, or is the former a little more benign? Have there been tests comparing the efficacy of the two? Anyone reading who has used both, and care to comment on any difference they have noticed in efficacy, and/or side effects? My surprise wouldn't be that this study didn't show Singular as more effective than Sudafed, but that it showed it equal to it. I feel some symptomatic improvement from taking a sudafed. On the other hand, I have been taking Singular for years, and have not noticed any improvement from it at all. (Why do I continue to take it? One ENT told me that statistics show that there are lesser symptoms among those who take Singular regularly, than among a similar group who doesn't. So, although my symptoms are bad, the logic goes "maybe I would be still worse if I wasn't taking that". Of course, if I actually had to pay for it, rather than only a nominal co-pay (I have good RX insurance), I doubt I'd keep taking something for which I have noticed no benefit at all. Has anyone here actually definitively noticed an improvement in their symptoms due to taking Singular? Actually, I'm surprised they did a study comparing these two meds, as it is like comparing apples and oranges. Singular is meant to be taken regularly long-term, while Sudafed is only meant to be used for occasional symptomatic relief. For instance, if they compared the efficacy of two nasal sprays, a cortisone spray vs. an Afrin-type OTC spray with oxymetazoline, I'm sure that Afrin would win that contest hands down, that more patients would feel much more immediate symptomatic improvement from taking it. However, they are not to be so compared, as the cortisone spray is meant for long term regular use, and Afrin is only meant for occasional symptom relief, and in fact can be quite harmful to use regularly. > x-no-archive: yes > [quoted text clipped - 8 lines] > > Susan The newer OTC version of sudafed is shorter acting, less potent, and some migraine patients feel it has caused migraines. Pseudoephedrine, the behind the counter sudafed, actually can relieve migraines--many of which are mistakenly called "sinus headaches". I used to be on Entex LA when it was phenypropolalmine. Then it got yanked off the market for a correlation with hemorrhagic strokes in women: usually women who were using it for weight loss. Singulair is an anti-inflammatory leukotriene inhibitor. Sudafed is a vasoconstrictor based on some version of synthetic epinephrine. It causes high blood pressure, anxiety, racing heart. You just can't compare their effects on nasal stuffiness without comparing their side effect and saftey profile. I can't tolerate sudafed due to the racing heart and insomnia. I've taken singulair for years. Judy > My surprise wouldn't be that this study didn't show Singular as more > effective than Sudafed, but that it showed it equal to it. [quoted text clipped - 35 lines] > > > > Susan > The newer OTC version of sudafed is shorter acting, less potent, and > some migraine patients feel it has caused migraines. Pseudoephedrine, [quoted text clipped - 10 lines] > I can't tolerate sudafed due to the racing heart and insomnia. I've > taken singulair for years. I can't tolerate Singulair due to the hypertension it caused me along with a feeling of lability and agitation. I posted about it on askapatient.com, and found other posts about new behavior/mood problems in children and adults taking it with assurances it had no such effects. Susan Susan, That's interesting. It's felt to be a "clean" drug with minimal side effects. It can unmask a syndrome of eosinophilic vasculitis. Some patients have complained that it made them tired, or they felt flu-like. I'll bet post-marketing surveilliance of emotional side effects hasn't been done, or the association wasn't made. JUdy > x-no-archive: yes > [quoted text clipped - 19 lines] > > Susan > Susan, > That's interesting. It's felt to be a "clean" drug with minimal side > effects. Taht's a triumph of marketing over patient experience, which takes decades to trump marketing, if ever. > It can unmask a syndrome of eosinophilic vasculitis. Some > patients have complained that it made them tired, or they felt > flu-like. I'll bet post-marketing surveilliance of emotional side > effects hasn't been done, or the association wasn't made. I'm sure that's true, but go take a look at the website I mentioned. Singulair made me feel like jumping out of my skin. :-/ Susan On 10/25/06 8:45 AM, in article 4q9f51Flh3apU1@individual.net, "Susan" <nevermind@nomail.com> wrote: > I'm sure that's true, but go take a look at the website I mentioned. > Singulair made me feel like jumping out of my skin. :-/ I wonder if it was the Singular? In the hundreds of patients we have given it to, we just haven't seen any side effects. Its been great for serious allergy, for reducing allergy symptoms and medications, but it is not a sudafed and doesn't fo what sudafed does. Murray Grossan, M.D. Www.grossan.com > I wonder if it was the Singular? I did, too. So I tested it by going off, on, off on. Reproducible bp spikes and that agitated feeling. In the hundreds of patients we have given > it to, we just haven't seen any side effects. Its been great for serious > allergy, for reducing allergy symptoms and medications, but it is not a > sudafed and doesn't fo what sudafed does. Many folks on askapatient.com report terrific benefits from Singulair, especially in managing their ashtma. Quite a few have also reported agitated, disturbing dreams, mood and behavior problems on the drug. I'm quite sure the Singulair caused the adverse reactions I share with other patients, some of whose children were Jekyll/Hydes on the drug. Getting one's drug info strictly from pharmaceutical reps or publications is very bad medicine, IMO. Susan > x-no-archive: yes > [quoted text clipped - 11 lines] > Many folks on askapatient.com report terrific benefits from Singulair, > especially in managing their ashtma. Uh, athsma. Susan > but it is not a > sudafed and doesn't fo what sudafed does. > > Murray Grossan, M.D. Agreed. That's why I wrote that I find it strange that someone conducted a medical study comparing Singular and Sudafed. Although they may be prescribed for the same symptoms, they are entirely different, and not really comparable. I completely agree: a vasoconstrictor with anti-cholinergic effects compared to a leukotriene inhibitor. Apples and oranges. Why didn't they look at nasal steroids if the end point was relief of nasal stuffiness? Judy > > but it is not a > > sudafed and doesn't fo what sudafed does. [quoted text clipped - 5 lines] > prescribed for the same symptoms, they are entirely different, and not > really comparable. On 10/29/06 7:11 AM, in article 1162134696.048246.74490@f16g2000cwb.googlegroups.com, "judy.n" > I completely agree: a vasoconstrictor with anti-cholinergic effects > compared to a leukotriene inhibitor. [quoted text clipped - 11 lines] >> prescribed for the same symptoms, they are entirely different, and not >> really comparable. Again, Singular is not meant to act like Sudafed or an antihistoamine. Its primary use is in reducing serious allergy symptoms - by reducing the amounts of medication. Singular won't stop an asthma attack, but persons that take it usually get fewer attacks. But strangely, some persons on singular have been able to stop their claritin or other medication for nasal allergy. > Its been great for serious > allergy, for reducing allergy symptoms and medications, ......... > Murray Grossan, M.D. I'm glad someone benefits from it. As I mentioned, I've been taking it for years, and have not noticed any improvement from it. Are there others here who think that Singular improves their rhinitis symptoms? (Judy? It sounds like you have also been taking it for years. Has it helped you?) >> Its been great for serious >> allergy, for reducing allergy symptoms and medications, ......... [quoted text clipped - 6 lines] >symptoms? (Judy? It sounds like you have also been taking it for years. Has >it helped you?) I took it for awhile, and then decided not to get it refilled. I haven't noticed a difference one way or another. Rick I take singulair and allegra every day. I believe it's helped me. We were just discussing it at my office, and again, we discussed what a safe drug it is. I find it very useful in asthma patients: so many patients get confused by their inhalers: maintenance anti-inflammtory inhalers, rescue inhalers--and they don't understand when to step-up and step-down therapy, even with an "asthma action plan". However, taking a pill every evening is so simple. Study after study shows that singulair is less effective than inhaled steroids for asthma, but doesn't have the side effects (decreased growth, cataracts, bone thinning.) There was some belief, and one observational study showed that it was effective in migraine prevention, but a second study (randomized, controlled, double blinded) didn't show benefit. So much disease is caused by inflammation. Singulair is a leukotriene blocker and decreases inflammation. So, I know Susan didn't like it, and it often produces subtle improvement in rhinits and asthma---it's really good for rhinitis if used with an anti-histamine--but I think it's a safe and reasonably effective drug. Judy > > Its been great for serious > > allergy, for reducing allergy symptoms and medications, ......... [quoted text clipped - 6 lines] > symptoms? (Judy? It sounds like you have also been taking it for years. Has > it helped you?) > I take singulair and allegra every day. I believe it's helped me. We > were just discussing it at my office, and again, we discussed what a [quoted text clipped - 15 lines] > used with an anti-histamine--but I think it's a safe and reasonably > effective drug. I have no argument with any of what you write. I do think, though, that too often physicians think a safe drug can't possibly cause a problem for *any* patient, and therefore miss opportunities to help those few folks who do experience adverse reactions and report them. I think antidepressants and accutane are "safe drugs" for most people, but that hasn't stopped them from causing suicidal, homicidal reactions in some users. Doctors and patients can be watchful if informed about the possible risks. Susan I have to agree with Dr. Grossan, I use it a lot and patients tolerate it very well: the only reason they stop it is perceived lack of benefit. No one has reported side effects. Judy > On 10/25/06 8:45 AM, in article 4q9f51Flh3apU1@individual.net, "Susan" > <nevermind@nomail.com> wrote: [quoted text clipped - 9 lines] > Murray Grossan, M.D. > Www.grossan.com
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