Intended for healthcare professionals

Rapid response to:

News Roundup [abridged Versions Appear In The Paper Journal]

Methamphetamine epidemic hits middle America

BMJ 2006; 332 doi: (Published 16 February 2006) Cite this as: BMJ 2006;332:382

Rapid Response:

Phenylephrine an ineffective replacement for pseudoephedrine in response to the methamphetamine problem in the USA

Pseudoephedrine is currently being replaced by phenylephrine as the
ingredient in most oral decongestant medicines in the USA. This move by
pharmaceutical industry is in response to legislation that will be
from September 30th 2006. The ‘Combat Methamphetamine Epidemic Act of
2005 has been incorporated into the ‘Patriot Act’ signed by President Bush
March 9th 2006. The act bans over-the-counter (OTC) sales of colds
medicines that contain pseudoephedrine. Sale of pseudoephedrine will be
limited to ‘behind the counter’ and individuals will be required to
present a
photo identification to purchase any products that contain

The amount that an individual can purchase each month is limited and the
buyer will be required to provide personal information about purchases in
log which will be kept by the seller for at least two years. These
and restrictive measures have been brought in to force to curb what is
described as an ‘epidemic’ of methamphetamine abuse in the USA[1] , with
claims that up to half a million Americans use methamphetamine every week
[2]. The loser in this war against methamphetamine abuse will be the
American public as it is doubtful if the legal restrictions on the sale of

pseudoephedrine to the public will reduce the availability of
methamphetamine, as there is little evidence that medicines containing
pseudoephedrine are used by large scale producers[3]. The American public
will be deprived of access to an effective nasal decongestant
pseudoephedrine as pharmaceutical companies switch to an ineffective
decongestant phenylephrine as the only alternative available open to them.

There is little if any clinical support for the efficacy of phenylephrine
as a
nasal decongestant[4] and since the medicine is subject to gut wall
metabolism its absorption is erratic [5]. In contrast the efficacy of
pseudoephedrine as a nasal decongestant is much stronger and its
absorption from the gut is uncomplicated [6]. It is to be hoped that the
regulatory authorities do not follow the US example and restrict the sale
pseudoephedrine as it is the larger scale illicit laboratories that need
to be
targeted rather than the public sale of pseudoephedrine [3].

[1] Tanne JH. Methamphetamine epidemic hits middle America. BMJ.

[2] Roehr B. Half a million Americans use methamphetamine every week.
BMJ. 2005;331(7515):476.

[3] Cunningham JK, Liu LM. Impacts of federal ephedrine and
pseudoephedrine regulations on methamphetamine-related hospital
admissions. Addiction. 2003 SEP;98(9):1229-37.

[4] Eccles R. Nasal airflow and decongestants. In: Naclerio RM, Durham SR,

Mygind N, eds. Rhinitis Mechanisms and management. New York: Marcel
Dekker 1999:291-312.

[5] Kanfer I, Dowse R, Vuma V. Pharmacokinetics of oral decongestants.
Pharmacotherapy. 1993;6:116S-28S.

[6] Eccles R, Jawad MS, Jawad SS, Angello JT, Druce HM. Efficacy and
of single and multiple doses of pseudoephedrine in the treatment of nasal
congestion associated with common cold. Am J Rhinol. 2005 Jan-Feb;19(1):

Competing interests:
Act as an occasional consultant to
pharmaceutical companies but am
not involved in any current
consultancy work on nasal

Competing interests: No competing interests

22 May 2006
Ronald Eccles
Professor and Director
Common Cold Centre, Cardiff University, Cardiff CF10 3US