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Background:
In 2002 the FDA made a ruling that changed the guaifenesin protocol substantially. The many brands of (generic) prescription long acting guaifenesin were taken off the market. A more expensive (but over the counter) product, Mucinex was approved in their place. Although Mucinex is considered a replacement for what had been on the market for so long it really isn’t quite the same. Mucinex is actually a bi-layered tablet with a short acting layer as well as a timed release component. Mucinex is currently enjoying the marketplace unchallenged until its patent expires in about five years.
We were suddenly faced with a dual challenge: trying to figure out how this new delivery system might be different from what we’d been using, and what to do for the people for whom this higher price was a real hardship. Many of Dr. St. Amand’s patients were able to stock up on the older prescription brands. But now those supplies are long gone, and countless new and old patients have helped us learn what follows:
We’re finding it’s no longer necessary to use the high doses of guaifenesin we often utilized in the past. To our surprise, short acting guaifenesin when added to long acting has proven a very effective delivery system. We believe this is due to the action of the cytochrome system.
We start our patients out on 300 mg twice a day of guaifenesin. This should NOT be a short acting (or quick release) product. Use Mucinex (or the Pro Health 600 mg. product) or a compounded guaifenesin that is reliably longer acting. Only 20 percent of patients respond at 300 mg. twice a day. We do not use lower doses than 600 mg. a day.
Patients remain at 300 mg. twice a day for ONE WEEK. If he or she doesn't feel worse, we ask him or her to increase the dose to 600 mg twice a day. 600 mg. twice a day is the correct dose for the next one month. Feeling worse should be distinct: like a bad flare of any/all symptoms.
If the patient's left thigh has not cleared to palpation after one month, or if a patient notices no change in symptoms, the dose needs to be raised again. If a patient is taking Mucinex or Pro Health, he or she should go to 3 tablets a day. (can be taken as 1 in the a.m. --2 in the p.m. or 1 1/2 twice a day.)
If the patient is taking a compounded longer acting guaifenesin the dose can be raised by adding a 400 mg. short acting twice a day to the 600 mg. or by adding another 600 mg. tablet.
When a higher dose is needed we now use short and long acting (2 each, twice a day). This combination is working very well and seems to be handling between 90-95% of our patients. If money is not an issue, 2400 mg. of Mucinex with its two layers accomplishes the same thing.
Available Guaifenesin:
MUCINEX
600 mg or 1200 mg bi-layered tablets
PROHEALTH (Mucinex) 600 mg. guaifenesin tablets.
GUAIFENESIN—DYE FREE 600 mg
(www.fibropharmacy.com)
FAST-ACTING- FIBROPHARMACY GUAI 400 mg
(www.fibropharmacy.com)
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FOR THOSE FORMERLY USING HUMIBID--this product has been renamed as Mucinex Maximum Strength (1200 mg.) One tablet is equivalent to 2 of the 600 mg. Mucinex. It has a long acting and a short acting layer. The two boxes are below. The box with blue on the top is 600 mg. and the box with the blue on the bottom is the 1200 mg. maximum strength.
FROM CLEURE:
Only Cleure guaifenesin sales benefit The Fibromyalgia Treatment Center. Order with the link below or on the homepage. If ordering by telephone mention The Treatment Center. 888-883-4276. Cleure also carries salicylate free dental products, personal care items, make up, etc.
SOLO GUAI FAST ACTING —
400 mg guaifenesin calcium phosphate dibasic, magnesium sterate, microcrystalline cellulose, Poridene K-30, prosolv, stearic acid.(www.cleure.com/ftc)
Cleure guaifenesin is latex exposure free.
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LIQUID GUAIFENESIN: These two formulas do not contain mint or menthol. If using any other liquid guaifenesin be sure to check ingredients to make sure there is no menthol listed or as an ingredient in the flavor:
Children’s Mucinex Grape Flavor. 1 tsp contains 100 mg of guaifenesin. Alcohol free. Inactive ingredients: citric acid anhydrous, dextrose, FD&C Blue #1, FD&C red #40, flavor, glycerin, methylparaben, potassium sorbate, propylene glycol, propyl paraben, saccharin sodium, sodium hydroxide, sucralose, xanthan gum, water. Salicylate free
Marina del Rey Pharmacy also carries a liquid guaifenesin. For information please contact them directly: (www.fibropharmacy.com )
For those with stomach upset, Marina del Rey pharmacy carries a gelatin capsule that will fit around their compounded guaifenesin tablet.
JUNIOR STRENGTH Mucinex Mini-Melts (for older kids) –fast acting. Take every four hours
Mucinex Grape Mini Melts: 50 mg of guaifenesin per packet. Inactive ingredients: aspartame, butylated methacrylate copolymer, carbomer, carboxymethylcellulose sodium, grape flavor, magnesium stearate, microcrystalline cellulose, povidone, raspberry flavor, sodium bicarbonate, sorbitol, stearic acid, talc, triethyl citrate. Salicylate free.
Mucinex Bubble Gum Flavor Mini Melts: 100 mg. of guaifenesin per packet. Inactive Ingredients: aspartame, banana flavor, butylated methacrylate copolymer, carbomer, carboxymethylcellulose, sodium, magnesium stearate, microcrystalline cellulose, povidone, sodium bicarbonate, sorbitol, stearic acid, talc, triethyl citrate, tutti frutti flavor. (Salicylate free)
NOTE: Children’s Mucinex Cough (Cherry) is not plain guaifenesin --contains dextromethorthan.
WARNING: GUAI-AID
600 mg (and other strengths)
is NOT long acting
guaifenesin. We do not
suggest this as a stand
alone guaifenesin although
it can be used as an add-on
to a longer acting product.
The advertising for this
product is consistently
misleading and we advise
patients to avoid it for
that reason.
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