According to a recent study out of the University of Florida, it appears that phenylephrine—an active ingredient in many over-the-counter cold & flu remedies is no more effective for nasal congestion than a placebo.   This was not an isolated study; it was the third in a series showing that phenylephrine is totally ineffective in treating nasal congestion.

Yet there are dozens and dozens of OTC products sitting on most pharmacy shelves containing phenylephrine, especially hot-beverage treatments.

Decongestants such as phenylephrine constrict blood vessels and relieve congestion, but only when used as a nasal spray applied directly into the sinuses.  Taken orally, phenylephrine constricts all blood vessels throughout the body and is therefore largely ineffective.

This is basic stuff, and a column on this subject was published this week in the Globe and Mail detailing the ineffectiveness of all oral OTCs containing phenylephrine.

Here is the acid test for pharmacists, (or the moment of truth if you like).  When patients, (hundreds of them) approach you asking for relief from nasal congestion, often with a box of Neocitran already in their hand, (“I saw it on TV”), what do you do?

The great dilemma that pharmacists constantly suffer from is that as custodians of patients’ health, and as self-described “medication experts”, they are constantly operating under a conflict of interest.

The proper response is: “Put that box of garbage back on the shelf.  Here is some inexpensive generic acetaminophen (not expensive brand Tylenol).  Take one or two tablets three time a day if you feel feverish.  Make a mild tea with a teaspoon of honey and some lemon juice and ride it out; it’s probably a virus and will resolve itself in a few days.  Oh yes, and by the way, put that box of candy back on the shelf.  As a diabetic you should not be consuming needless sugar”

But then you look around the mountains of OTC decongestants which the mass merchandiser/box store you are working for has shipped in, and is heavily promoting in one of its endless flyers.  Then you take a second look around to ensure that the store manager, or worse the district manager/retail sales enforcer is not in within ear shot.

The constant theme in pharmacy today is that pharmacists are no longer in control of their profession.  Indeed the profession is in the firm grip of Big Pharmacy Retail (BPR).

But the fact of the matter is that this does not always have to be true.  Pharmacists are often their own worst enemies.  Conciliators, non-confrontational and reluctant to challenge authority, pharmacists often make their own beds.

Here is where pharmacists can make a difference in the face of the large forces which shove them around every day.  Simply, “do the right thing” and tell the patient the truth.  Give proper advice and let the chips fall where they may.  At least then you can sleep peacefully at night.


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