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Why
Guaifenesin? There are
many approaches to treating the various nonplus conditions, but after over
twenty years of dealing with these conditions, I have found only one
approach that gives long term results and can eliminate all associated
symptoms in a majority of people. Every other treatment that I have used on
my patients has had only minimal or temporary results.
Most people will be surprised to learn
that guaifenesin’s herbal cousin, guaiac, was used as early as the 1530’s
for the symptoms of rheumatism. By the 1700’s it was one of the four most
common remedies used for rheumatic type pains according to The Textbook
of Rheumatic Diseases.(1) Each of the four treatments referred to by
this book, (quinine, colchicum, sulfur, guaiac), can be directly associated
with four of the most common rheumatic conditions, rheumatoid arthritis,
gout, osteoarthritis and fibromyalgia. Surprisingly, treatments for the most
common rheumatic conditions of today have their basis in treatments that
were used over three hundred years ago. Plaquenil, one of the most important
drugs for the treatment of rheumatoid arthritis came from quinine.
Colchicine is a medication used to treat acute gout comes from the plant
colchicum, also known as meadow saffron. Sulfur has only recently been
rediscovered as a treatment for osteoarthritis in the form of glucosamine
sulfate, chondroitin sulfate and methylsulfonylmethane (MSM). Only guaiac
and now guaifenesin has been associated with fibromyalgia.
Today, thousands of people have found
guaifenesin to give long term relief to a wide range of symptoms caused by
the nonplus conditions. Guaifenesin is a safe and inexpensive
nonprescription medication. Although it should be taken in accordance with
label directions, no toxic dose has been found in animal studies.(2) Unlike
many other medications, the dose of guaifenesin does not need to be
continually raised to remain effective. Over time the therapeutic dose
usually remains consistent and if it does need to be changed it is as likely
to be lowered as it is to be raised. The primary down side to using
guaifenesin is that it requires great care and patience in its use. This may
be why guaiac and later guaifenesin were largely forgotten for most of the
nineteenth and twentieth centuries.
As of this time, no treatment for the
nonplus conditions, including guaifenesin, has been proven effective for
long term relief of all symptoms. There are many reasons for this with the
primary one being that the no study has been done which tests guaifenesin as
a treatment for all of the complex and various symptoms associated with the
nonplus conditions. In addition, it is difficult to perform controlled
trials on health problems that present no clinical marker, (that is no test
exists that can positively identify nonplus conditions) and where symptoms
can vary greatly from week to week, even day to day. These problems are
compounded by the fact that guaifenesin is a generic compound, no drug
company will spend the considerable sum of money that it costs to perform a
randomized controlled trial.
But, this does not mean that someone with
a nonplus condition should just give up and live with his or her health
problems. There is almost no down side to trying guaifenesin due to its
safety record and low cost. I have never met anyone who has one of these
conditions who is doing nothing to try to alleviate their symptoms either
through exercise, diet, medication, adjustments, rest, etc. All of these
approaches may help some symptoms but in most instances people find that the
majority of their symptoms remain unchanged unless guaifenesin is used.
1. W. S. C. Copeman, Textbook Of The
Rheumatic Diseases, (Edinburough: E. & S. Livingstone., 1964)
2. Drug Facts and Comparisons (St. Louis: Wolters Kluwer
Health, Inc., 2004)
Different Types of Guaifenesin and its Recently Changed Status with the FDA
Single-ingredient guaifenesin refers to a product where
guaifenesin is the only active ingredient. This is the only guaifenesin
recommend for the nonplus conditions. Guaifenesin that is combined with
other ingredients whether in cough syrups or in pill form is not generally
considered appropriate for our purposes.
Guaifenesin comes in
two types, both of which are non-prescription, immediate-release, IR, and
extended-release, ER guaifenesin. Immediate-release guaifenesin is also
called QA, meaning quick acting and FA, fast acting. Immediate-release
guaifenesin is also available as a liquid and is found in most grocery and
drug stores. The liquid form frequently contains food coloring and
sweeteners and is not recommended due to these additives. Guaifenesin
contained in liquid cough and cold medications is not considered appropriate
for treating the nonplus conditions due to the other ingredients.
Extended-release guaifenesin is sometimes known by several other names:
long-acting, LA, sustained-release, SR, and bi-layered.
The two different types of guaifenesin currently sold
both work well when used for treating the nonplus conditions. However, if a
person changes the type of guaifenesin they are using (from immediate
release to extended release or vice versa) an adjustment in dose may be
necessary to achieve the same level of symptomatic change. It is not unusual
to require a slightly lower daily dose if one is using immediate-release
when compared to extended-release. This means that if a
person switches from extended-release to immediate-release the dose may need
to be lowered. Conversely, an increased dose may be necessary if switching
from immediate-release to extended-release. The difference in dose between
the two often ranges from 20 % to 70%. However, a change in dose is not
always required. If you change from one type to another, pay attention to
your symptom changes and be prepared to alter your dose to achieve the ideal
amount of symptomatic change as discussed in The Guaifenesin Guide,
Chapter 8, Finding Your Dose.
Because of problems with the release rate of many
brands of extended-release guaifenesin, the FDA has stopped all companies
except one from selling extended-release guaifenesin. As of December 2003
the only single-ingredient extended-release guaifenesin available is a
bi-layered guaifenesin that contains some immediate release guaifenesin
also. This product is labeled as an
extended-release guaifenesin and the above suggestions for extended-release
still apply.
Even though all brands of guaifenesin currently
available work consistently well, whether extended-release or
immediate-release, you should be aware that many brands of extended-release
guaifenesin sold prior to December of 2003 may not be effective. (1) This unfortunate problem has no doubt resulted in many
people and physicians failing to get results when using it as a treatment
for the nonplus conditions. If you were one of the people who used ER, SR
or LA guaifenesin before December of 2003 and did not get the results you
expected, I encourage you to give guaifenesin another try.
All legally manufactured single-ingredient guaifenesin
now sold, whether immediate-release or extended-release is FDA approved. No
approval has a higher status than another with regards to guaifenesin.(2)
- U. S. Food and Drug Administration News,
10-17-2003, ‘FDA Proposes Steps to Assure the Safety and Efficacy of
Certain Currently Unapproved Medicines.’
www.fda.gov/bbs/topics/NEWS/2003/NEW00962.html Accessed 2004 July
20.
- Food and Drug Administration Center for Drug
Evaluation and Research, Letter to Author, 8-27-04.
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