Remixed cold meds pack less punch

Consumers could face a challenge this coming cold and flu season as restrictions aimed at curbing methamphetamine abuse make it more difficult to stock up on popular over-the-counter remedies.

But even as Congress considers legislation that would require prescriptions for some cold medications, and California already limits the purchase of such items, drug makers are scurrying to get reformulated remedies onto pharmacy and store shelves.

The newer cold medications -- expected to hit the market this fall -- are slightly less effective than most products now available. Over time, however, the new products could replace many of the medications consumers have used for decades because their ingredients can’t easily be used to make methamphetamines.

One product, Sudafed PE, is already available, and as many as half a dozen other reformulated medications are expected soon. They will not contain pseudoephedrine, a popular decongestant that has been used in many cold and allergy medications such as NyQuil, Tylenol Flu and Claritin-D. Pseudoephedrine is a key ingredient in producing methamphetamines when it’s boiled and mixed with household ingredients.

Some drug companies such as Pfizer Inc., which manufactures Sudafed, plan to continue offering both versions of their products indefinitely while others, including Procter & Gamble Co., which makes NyQuil and DayQuil, said they would phase out all medications containing pseudoephedrine later this year.

As abuse of methamphetamines has grown in recent years, at least 44 states have enacted laws or are considering legislation to restrict products that contain pseudoephedrine. California now limits people from buying more than three packages of cold or allergy pills during each visit, and Oregon will require consumers to get a prescription from a doctor before they can buy over-the-counter cold medications next year.

Congress is also considering legislation co-sponsored by Sen. Dianne Feinstein (D-Calif.) requiring retailers to put all cold medications containing the decongestant behind the counter and have customers sign an inventory log and show a photo ID. Under the bill, pseudoephedrine would be listed as a Schedule 5 narcotic and could only be sold by a pharmacist.

Critics of strict restrictions on the sale of cold medications say they are an overreaction to the methamphetamine problem. Several drugstore chains have complained that the barriers are unfair to law-abiding customers and retailers. They also point out that many users can find ways around the laws. In states with daily limits such as California, they say, methamphetamine users can leave one store and buy more at another, a tactic known as “smurfing.” Medications without pseudoephedrine are exempt from such restrictions, but the laws will affect those products that continue to include the decongestant.

Mary Ann Wagner, spokeswoman for the National Assn. of Chain Drug Stores in Alexandria, Va., said the group supported a national standard like the one Congress is considering but fears requiring customers to fill out a log would lead to longer lines and more work for pharmacists. The group stresses other solutions.

“We need to get at the bigger issue of methamphetamine addiction and how to treat it,” she said.

Newer medications use a different decongestant, phenylephrine, which is considerably more difficult and expensive to convert into methamphetamines. The drawback for consumers is that the medications are slightly less effective in treating colds and allergies in some people, according to several manufacturers and doctors.

Although the decongestant has been used in a small number of products such as Alka-Seltzer cold medicine for years and is considered safe, it hasn’t been very popular because it works for only about four hours.

Phenylephrine also has different side effects. It “can slightly increase people’s blood pressure or a feeling of jumpiness more than other medications,” said Dr. Robert Eitches, a Los Angeles otolaryngologist. Eitches said people who frequently use cold and allergy medications should discuss the products with their doctor before switching.

Another concern about cold medications containing phenylephrine is that people may take more than the recommended dosage for a stronger effect. Eitches has cautioned patients against doing so.

“There is a reason we ask people to follow the instructions on the label,” he said. “People who take more can have serious side effects.”