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Comment by dbbolton | Hacker News Reader

I'm a physician- although I don't disagree with the spirit of the article the headline is exceptionally misleading.

Phenylephrine is useless as an oral decongestant. It is still quite useful for other indications, including as a vasopressor (given IV to increase blood pressure such as in hypotensive shock). I believe it is actually the only commonly available vasopressor in the US that is a pure alpha-1 agonist which in certain scenarios is desirable.

It is also indicated for treatment of priapism.

The real kicker is that phenylephrine actually does work as a nasal decongestant when it is used as an intranasal spray, which has the added benefit of fewer systemic side effects compared with oral decongestants.

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> The real kicker is that phenylephrine actually does work as a nasal decongestant when it is used as an intranasal spray

humm, so, crush and and snort it?

You can buy it in nasal spray form already. I would skip it and use oxymetazoline, though. (Do be aware of "rebound congestion" with any of these decongestant sprays. If you're always stopped up, ask your doctor about the steroid sprays. They're over the counter as well, but I feel bad recommending steroids to random people on the Internet.)

What about when it does work for people as an oral decongestant though? Are you suggesting that's just randomness? Or perhaps the placebo effect? I guess I'm not entirely convinced it's really useless for that purpose, but I'm just a layman.

The original article doesn't just suggest it, it claims it outright, and links a study to back up that claim: https://www.annallergy.org/article/S1081-1206(10)60240-2/ful...

Here's my theory: you know that pseudoephedrine works, so taking this thing that's supposed to be a replacement for it, and sounds pretty similar, will convince your brain that phenylephrine will also work. So yes, placebo, but with foreknowledge of the effectiveness of pseudoephedrine. I'm curious if there have been placebo-controlled studies on phenylephrine where the participants were told they were receiving pseudoephedrine

He did mention it's usefulness for raising blood pressure and it's use in anesthesia.

It's also the active ingredient in Preparation H as a vasopressor

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