The Cold Medicine Scam

Typical cold/flu remedies all have pretty much the same stuff in them: an analgesic, a decongestant, an anti-cough drug, and (in the case of night-time formulations) an antihistamine. The analgesic tends to be acetaminophen (Tylenol) or ibuprofen (Advil), the anti-cough drug tends to be dextromethorphan (Robitussin DM), the antihistamine is usually diphenhydramine (Benadryl) or doxylamine succinate (Unisom), and -- until recently -- the decongestant was pseudoephedine (Sudafed).

The point of enumerating these ingredients is twofold; for one, it's worth noting that despite over a dozen brand names of cold medicine (Tylenol Cold, Advil Cold, NyQuil, etc.), they all pretty much have the same stuff, and it's pretty prosaic stuff overall. The moral here is to buy generic over-the-counter medications whenever possible; they have the same ingredients at a lower cost.

But the second point is that in the past few years, cold remedy formulations have switched to a decongestant called phenylephrine in place of pseudoephedrine. Though it's still possible to obtain pseudoephedrine by asking a pharmacist, few consumers do. The reason for the change is simple -- it is purported to reduce methamphetamine abuse, as meth can be synthesized from pseudoephedrine.

I won't dwell on the complete failure of the American anti-drug effort or the vast array of research showing that the program to take pseudoephedrine off of pharmacy shelves has failed to reduce meth abuse. But I will point out that phenylephrine, now the decongestant in essentially every cold remedy on store shelves, is completely ineffective at reducing cold symptoms.

That's right, this purported decongestant does nothing. (1) Human subjects suffering from the common cold were observed for six hours. Those who took pseudoephedrine (Sudafed) experienced a reduction in cold symptoms. Those who took phenylephrine showed no reduction, as did the placebo subjects. This is not an isolated result, either; articles have now been written decrying the use of phenylephrine in lieu of pseudoephedrine. (2)

Instead of waxing on for another few pages about the idiocy of this medication switch, I'll sum this up. Next time you go to buy cold medicine, go to the pharmacist and ask for one with pseudoephedrine in it. It won't be any more expensive than the stuff you see on the shelves, but, in contrast, it will actually work.

(1) Horak F, et al., A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber, 2009.

(2) Eccles, R, Substitution of phenylephrine for pseudoephedrine as a nasal decongeststant. An illogical way to control methamphetamine abuse, 2007.