Limited choices for those who use pseudoephedrine

medical matters

October 27, 2006|By Judy Foreman

Now that it's harder to get decongestants containing pseudoephedrine, will cold and allergy sufferers have to make do with weaker over-the-counter drugs?

That depends. As of Sept. 30, the effective date of an amendment to the U.S. Patriot Act, nasal products containing pseudoephedrine must be sold "behind the counter," which means the purchaser has to show a photo ID and sign a log book to get them.

The idea is to make it harder for illegal drug suppliers to make methamphetamine from pseudoephedrine, though whether the new law will do so is an open question.

For those of us who want pseudoephedrine-type drugs, there are now two choices. Go through the hassle of signing the log book to get pseudoephedrine or switch to decongestants such as Sudafed-PE containing a similar, but less powerful ingredient, phenylephrine.

Dr. Leslie Hendeles, a professor of pharmacy and pediatrics at the University of Florida who co-authored a recent, peer-reviewed letter in the Journal of Allergy and Clinical Immunology, says that phenylephrine at the approved 10 milligram dose is "unlikely to be effective in relieving a stuffy nose because it is inactivated by [digestive] enzymes" before it enters the bloodstream.

You could take a higher dose -- 2 1/2 phenylephrine tablets, to get 25 milligrams, which some studies show to be safe and effective, but this dose has not been approved by the Food and Drug Administration.

There are other alternatives.

"For those with allergic symptoms, antihistamines alone suffice. They are, however, not very effective for colds," said Dr. Frank Twarog, an allergy specialist and clinical professor at Harvard Medical School.

There are also good steroid nasal sprays such as Flonase, Nasonex and Rhinocort, all available by prescription. Nonsteroid nasal sprays such as Afrin can also help, but they tend to cause rebound congestion if used for more than a few days.

What are varicose veins and how can you prevent them?

Varicose veins, those bumpy, enlarged blood vessels, usually in the legs, occur when the valves inside the veins fail. The valves are there to keep blood from flowing backward, so when they break down, blood pools lower and lower in the leg, causing the vein to "pop" up toward the surface of the skin. Each time one valve fails, that puts more pressure on the valve below it.

"It's like a domino effect," said Dr. Robert Weiss, a dermatologist and director of the Maryland Laser, Skin, and Vein Institute in Baltimore. The result of the pooling blood is a less-than-optimal cosmetic appearance and an achy, fatiguelike feeling in the legs, especially in people who stand for long periods.

In some cases, varicose veins can also be caused by blood clots, so if you have large, painful veins, you should have an ultrasound exam to rule out clots, said Dr. Michael Jaff, director of vascular medicine at Massachusetts General Hospital.

In one sense, there's not much you can do to prevent varicose veins. The tendency to get them runs in families, and women, perhaps because of the pressure of pregnancy on leg veins, get them more than men.

But aerobic exercise, such as running, swimming or cycling, can help, in part by building strong calf muscles that help squeeze blood back up toward the heart. Weightlifting is a no-no because the increased pressure with all that straining can make varicose veins worse.

If your varicose vein problems are mild, compression stockings -- the over-the-counter kind or thicker, stronger ones available by prescription -- can help keep blood from pooling at the ankles.

Historically, doctors used to recommend surgery to "strip" or remove the veins in severe cases. Now, the preferred treatment is endovascular laser therapy, in which a laser is used to burn the inside of veins, causing the sides to stick together; an even newer approach, using radio frequency, is also in the works. Over time, the body absorbs the vein and other blood vessels take over the circulatory function.

Smaller varicose veins called spider veins can be treated with sclerotherapy -- the injection of a medication into the vein to make it collapse and disappear.

Send your questions to foreman@baltsun.com.

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