Doctors: Drugs besides pseudoephedrine also work for sinus, allergies

Wednesday, December 8, 2010
In this Tuesday, Oct. 13, 2009 photo, Pharmacist Les Logan holds up common cold medicines at Rinderer's drug store containing pseudoephedrine, in Union, Mo. The small eastern Missouri town is now forcing consumers to get a doctor's prescription for the common over-the-counter cold medicines, which contain a key ingredient used in the making of meth. (AP Photo/Jeff Roberson)

Although Cape Girardeau physicians may see an uptick in visits from residents seeking relief from a seasonal cold or allergy via a pseudoephedrine prescription, a few area doctors say they're understanding of the city's decision to limit access to the methamphetamine precursor.

In a split vote Monday, the Cape Girardeau City Council approved 4-3 a new ordinance regulating the sale of products containing pseudoephedrine. Ordinance language gives no distinction between pseudoephedrine in liquid, tablet or gel cap form -- just anything containing the precursor -- and authorizes the sale of the drug only with a doctor's written prescription.

Mayor Harry Rediger, councilwomen Debra Tracy, Kathy Swan and Loretta Schneider voted in favor of the measure, while Mark Lanzotti, John Voss and Meg Davis Proffer voted against its passage.

The ordinance goes into effect 10 days after the council's vote, or Dec. 16.

"I don't think it burdens people at all. I don't think we're micromanaging medicine," said Dr. Robert Sacha, a retired pharmacist and allergist, who treated nasal diseases for more than 20 years. "I think it's clear cut here that we have a significant problem in the state."

Dr. Bernie Ranchero, who practices at Doctors Express on Mount Auburn Road, said the drug does have a proper place in treating congestion, because it clears the nasal passages, offering relief to a sinus cold. It's also effective in controlling some allergies, but it can come with side effects to the user.

"It works if there's no hypertension or cardiac risk factors," he said. "Pseudoephedrine dries out secretions, but it's also a stimulant and that's why its used for methamphetamine synthesis."

Ranchero added that although he didn't have a point of view on the issue before the vote, he said Tuesday pseudoephedrine sales are better controlled.

"I understand the risks associated with it," he said.

Sacha listed additional side effects of the drug before the council Monday night, saying pseudoephedrine use can also trigger an increased heart rate and a heightened blood pressure. By mandating residents obtain a prescription before having access to the medication, the city is ensuring people are aware of the side effects, he told the panel.

"By going to a physician once a year you can at least monitor the person's blood pressure ... a doctor can monitor those side effects," Sacha said.

Still, depending on a patient's symptoms, pseudoephedrine may not even be the appropriate treatment, according to Ranchero and Southeast Health Dr. Mourad Nessim, who specializes in internal medicine.

"If it's allergies, I think a nasal steroid would help quite a bit," Nessim said.

Ranchero said pseudoephedrine is typically not his first choice for a patient, sometimes not even the second.

"Definitely, if they come in, I'll likely prescribe a nasal steroid. It actually treats and prevents," he said.

Costs per doctor visit for uninsured patients varied among the three physicians.

Ranchero said a visit, where he writes a prescription, at his office would cost an uninsured person up to $100. The visit alone, without Ranchero writing the patient a doctor's note, would cost someone $68. Nessim guessed it would cost someone without insurance around $50 to see him, and Sacha said it could be as a little as $40 and he could write the person a prescription good for a year.

"We don't do that, not for an entire year," Ranchero said. "I'd do a one month's supply."

Nessim said he'd most likely fill a patient's prescription so it's good for two weeks.

No physician at Saint Francis Medical Center would comment on pseudoephedrine regulation, according to Emily Sikes, who does marketing and referral services for the hospital.

ehevern@semissourian.com

388-3635

Pertinent Addresses:

465 Mount Auburn Road, Cape Girardeau, MO

817 S. Mount Auburn Road, Cape Girardeau, MO

710 Broadway, Cape Girardeau, MO

Map of pertinent addresses

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