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Aurornis 2 hours ago

This article uses the trick where you pick studies that support your argument and ignore all of the studies that disagree with it.

There are other studies where Dextromethorphan improves both objective and subjective measures of coughing: https://pubmed.ncbi.nlm.nih.gov/37232330/

They also picked a study that shows honey outperforming Dextromethorphan but ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.

There are so many studies and papers published now that you can find both positive and negative results for just about anything. When someone starts pulling up singular random links to papers you should be suspicious. Be even more suspicious when someone is calling for bans or regulations based on those individually selected papers

projektfu 20 minutes ago | parent | next [-]

And, all of this, to avoid selling a little bit of the narcotic codeine. Which was technically permitted to be sold "behind the counter" without prescription, but was made Schedule II as part of cough syrup in the US not long ago. (It used to be Schedule III or IV when combined with homoatropine or promethazine).

Modified3019 38 minutes ago | parent | prev | next [-]

I work for a large agricultural company, in my part of it we sell fertilizer, chemical, and agronomic services. As part of this, we end up putting out a lot of trials so we can actually say something true instead of “buy our stuff it’s great I promise ;)”

One of my favorite slides is when we compiled dozens of trials on something that’s basically a nitrogen fertilizer. When compared in a graph most of the trials show an overwhelming effect on increasing yield over an untreated check, however there’s always a portion of the trials where the yield decreases compared the check.

Real life is extremely noisy for a multitude of circumstantial reasons that are either not practical or possible to control for, so a single trial is generally worth fuckall. It takes a lot of testing to see a consistent trend across them.

robmccoll 2 hours ago | parent | prev | next [-]

DXM may or may not suppress coughing relative to placebo - the study cited here appears to be have been written entirely by authors from drug companies, so perhaps there is some bias. Here's a meta analysis that favors honey over DXM https://pubmed.ncbi.nlm.nih.gov/32817011/, the original study that kicked off this idea that also favors honey https://pubmed.ncbi.nlm.nih.gov/18056558/, and a different meta analysis https://pmc.ncbi.nlm.nih.gov/articles/PMC6513626/ which found little or no difference between honey and DXM. Whether its effective or not, to me there doesn't seem to be compelling evidence that it is more effective than honey.

asveikau an hour ago | parent [-]

It's funny that TFA seems to use the comparison to honey as disparagement, rather than interpret the same information as an endorsement of the helpfulness of honey.

tclancy an hour ago | parent [-]

I think the point is honey is known as a home remedy, may already be in your house and is available at a much lower price (farmer’s markets and woo merchants possibly excepted).

jmalicki 2 hours ago | parent | prev | next [-]

An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself, and similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.

Aurornis 2 hours ago | parent | next [-]

> An interesting new drug is Auvelity, where Dextromethorphan is proposed to help stimulate neurotropic growth factor to help the brain repair itself,

Auvelity is interesting, but the exact mechanism of action is not very clear.

Auvelity is a combination of two drugs: Dextromethorphan and Bupropion. Bupropion, aka Wellbutrin, is an antidepressant by itself. In Auvelity it helps alter how Dextromethorphan is processed by the body, but we can't rule out that it contributes to the antidpressant effect. I mean it's literally an antidepressant.

Dextromethorphan has a lot of interactions and gets a lot of comparisons to ketamine because it has NMDA affinity, but if you look at the table of receptors it interacts with the serotonin receptor is one of the strongest interactions. It is a potent serotonin reuptake inhibitor, which is also known to have antidepressant effects. It also has some sigma receptor interactions which might be doing something significant.

The NMDA interactions get all of the attention because if you put "ketamine" in the headline you get a lot more attention, but NMDA may be much lower on the list or even negligible for this combo.

gumby an hour ago | parent | prev | next [-]

> … similar related drugs like dextromethorphan and ketamine and other NMDA receptor antagonists are innovative drugs to help prevent Alzheimer's.

Should read “NMDA receptor antagonists _may_ give rise to treatments that _may help prevent or ameliorate the symptoms_ of Alzheimer’s.

Nobody even knows how Alzheimer’s works at all — like most diseases it’s a description of some detectable symptoms, some of which could even turn out to be the body defending itself.

Thus compounds that may have a mechanism of action that affects some concomitant, visible symptoms might potentially be useful.

The use of definitive sentences about unknown results is how we end up with wellness and some “biohacking” nonsense.

Melatonic an hour ago | parent | prev | next [-]

Haven't heard of Alzheimer's. What kind of use is necessary ? I would assume something like an ultra low dose but daily thing ?

gavinray 2 hours ago | parent | prev [-]

This is straying a bit from the original post, but agreed, NMDA antagonists and related compounds effecting glutaminergic tone are showing promising directions.

N=1, I've had very positive experiences with DIY Auvelity, using 150mg Buproprion XR that I'm RX'ed with 60mg OTC DXM-only tablets.

vlovich123 2 hours ago | parent | prev | next [-]

> There are so many studies and papers published now that you can find both positive and negative results for just about anything.

Doesn’t that suggest that the effect overall is neutral?

Aurornis 2 hours ago | parent | next [-]

You can find positive and negative results for everything.

If that implies the effect is neutral, then by extension that means nothing works at all.

eli an hour ago | parent | prev [-]

No, you can't just "average" different studies and I'm not sure what "neutral" means in the context of some studies showing a benefit and others not showing a benefit.

hadlock 2 hours ago | parent | prev | next [-]

In my subjective experience, Dextromethorphan (DXM, as the robo-trippers call it) does almost nothing for me, in the 1-5% range

The only cold and cough medicine that really truly works is the over-the-counter stuff, pseudoephedrine, works amazing for me. I usually pick up a box of the stuff when school starts in the fall and I go through half a box of it by the following summer.

esperent 2 hours ago | parent | prev | next [-]

> ignored all the studies that show honey performing similarly or slightly worse than Dextromethorphan, or studies where honey showed no measurable effect.

To be fair, you're doing pretty much the same by claiming these studies exist without proof.

tptacek an hour ago | parent | prev | next [-]

Are you sure you posted the right paper? That paper appears to present a clinically insignificant outcome for DXM in children.

I think it's perfectly reasonable to contest the research summary this article is providing. All science-based articles on interesting topics are going to be like that. But you're writing your comment as if they took a flyer on DXM, and the research consensus is in fact that DXM is not effective. It's not as bad as phenylephrine (it has detectable, if immaterial, impact in adults), but it's pretty bad.

The point of the article, of course, isn't that Dayquil should be illegal because it's dangerous; it's that it doesn't work. Having spent an unreasonable amount of time in HN pseudoephedrine threads, I think the broad consensus of this site is that phenylephrine should be taken off the shelves.

Melatonic an hour ago | parent [-]

Phenylephrine was the replacement that doesn't really work but is non (or less) stimulating right ?

From what I remember it was actually quite effective topically but not through pill form. Could be wrong.

Also makes me wonder if there's an alternative function to DXM for people with colds (maybe it makes them feel better in other ways). Or it's just good marketing and associated with NyQuil having other drugs and people assuming DayQuil works

tptacek 28 minutes ago | parent [-]

It's not that it's less stimulating, it's that pseudoephedrine basically is methamphetamine (the chemistry to reduce it to meth is truck-stop straightforward). But oral phenylephrine doesn't work at all.

The case against DXM is nowhere nearly as good as the case against phenylephrine; phenylephrine is a scam, and DXM is a drug everyone thought was the gold standard cough suppressant, but then serious studies knocked down its effectiveness.

the_real_cher 15 minutes ago | parent | prev [-]

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