GUAIFENESIN - Frequently asked questions
What is guaifenesin?
Guaifenesin (or glyceryl guaiacolate) is an old medication, a synthetic version of the active compound in a tree-bark that has been used to liquefy mucus. It has been used for conditions such as bronchial infections, colds, sinus infections and allergies, and in patients with some chronic lung conditions.
The 1955 edition of the Textbook of Pharmacognosy states: "Guaiacum has a local stimulant action which is sometimes useful in sore throat. The resin is used in chronic gout and rheumatism, whilst the wood is an ingredient in the compound concentrated solution of sarsaparilla, which was formerly much used as an alternative in syphilis." Other books mention it as a treatment for growing pains and menstrual cramps.
Guaifenesin was approved by the FDA in 1952 and was available as a prescription pill but over the counter in various cough and cold mixtures due to those being a lower strength.
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 white short acting layer (100mg) as well as a timed release blue portion.(500 mg) This product was manufactured by Adams, but now is owned by Reckitt Benckiser.
So in 2002 we were faced with a dual challenge: trying to figure out how this new delivery system might be different from what we had been using, and what to do for the people for whom this higher price was a real hardship.
At this point Marina del Rey Pharmacy (fibropharmacy.com) developed a capsule (previously tablet) guaifenesin for use with the protocol. It is currently available over the counter and is also sold by mail order. This product does NOT have a short-acting part to it which is helpful to low dose patients. This is because the short acting layer can produce more symptoms as it reverse the fibro.
In 2013, the generic house Perrigo brought to market an extended release guaifenesin tablet which is 600 mg. of straight long-acting. This product is white (no dye) but does contain compressed sugar as an additive to mask the bitter natural taste of guaifenesin. This is marketed as a generic product, usually in a blue and white box with red, bearing the brand name of the pharmacy where it is sold. For example the Rite Aid product is called Mucus Relief and the Kroger brand is Mucus-ER 12 hour. The boxes contain the tagline “Compare to Mucinex.”
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 which is designed to protect the body by destroying foreign substances.
We still start our patients out on 300 mg twice a day of long-acting guaifenesin. This should NOT be a short acting (or quick release) product. Use Mucinex 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. If you are starting with Mucinex we advise staring with 900 mg. a day (1/2 in the a.m. and a full pill at night) so that you will be getting at least 600 mg. of long acting in a 24 hour period.
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 you are taking Mucinex you should go to 600 mg. morning and night OR one full pill in the a.m. and 1 full pill in the p.m.
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, 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 twice a day 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.
The 1955 edition of the Textbook of Pharmacognosy states: "Guaiacum has a local stimulant action which is sometimes useful in sore throat. The resin is used in chronic gout and rheumatism, whilst the wood is an ingredient in the compound concentrated solution of sarsaparilla, which was formerly much used as an alternative in syphilis." Other books mention it as a treatment for growing pains and menstrual cramps.
Guaifenesin was approved by the FDA in 1952 and was available as a prescription pill but over the counter in various cough and cold mixtures due to those being a lower strength.
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 white short acting layer (100mg) as well as a timed release blue portion.(500 mg) This product was manufactured by Adams, but now is owned by Reckitt Benckiser.
So in 2002 we were faced with a dual challenge: trying to figure out how this new delivery system might be different from what we had been using, and what to do for the people for whom this higher price was a real hardship.
At this point Marina del Rey Pharmacy (fibropharmacy.com) developed a capsule (previously tablet) guaifenesin for use with the protocol. It is currently available over the counter and is also sold by mail order. This product does NOT have a short-acting part to it which is helpful to low dose patients. This is because the short acting layer can produce more symptoms as it reverse the fibro.
In 2013, the generic house Perrigo brought to market an extended release guaifenesin tablet which is 600 mg. of straight long-acting. This product is white (no dye) but does contain compressed sugar as an additive to mask the bitter natural taste of guaifenesin. This is marketed as a generic product, usually in a blue and white box with red, bearing the brand name of the pharmacy where it is sold. For example the Rite Aid product is called Mucus Relief and the Kroger brand is Mucus-ER 12 hour. The boxes contain the tagline “Compare to Mucinex.”
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 which is designed to protect the body by destroying foreign substances.
We still start our patients out on 300 mg twice a day of long-acting guaifenesin. This should NOT be a short acting (or quick release) product. Use Mucinex 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. If you are starting with Mucinex we advise staring with 900 mg. a day (1/2 in the a.m. and a full pill at night) so that you will be getting at least 600 mg. of long acting in a 24 hour period.
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 you are taking Mucinex you should go to 600 mg. morning and night OR one full pill in the a.m. and 1 full pill in the p.m.
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, 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 twice a day 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.
Where can I get Guaifenesin?
1. Mucinex™ is the FDA approved time-released guaifenesin 600 mg. This can be purchased at any pharmacy. It is a bi-layered tablet containing both long and short acting guaifenesin. Our suggestion is that when using Mucinex begin at a full tablet twice daily to insure enough long-acting. If reversal symptoms are too severe then switch to the Marina del Rey 300 mg. capsules.
Coupons for discounts can be found on various websites, so check around. Also can be purchased from discount stores such as Walmart and Costco, on amazon.com or on Ebay.
2. Compounded Guaifenesin from Marina del Rey Pharmacy (www.fibropharmacy.com or 310-823-5311). Capsules.
There are two strengths of this product available: 300 and 600 mg. Patients should start with the 300 mg. strength (twice a day) and double that after one week if no change is noticed. If the 300 mg. twice a day does not cause a flare of your symptoms, you double that dose to 600 mg. twice a day and can switch to the 600 mg. strength.
If you live outside the US you will pay less import duty if you purchase it with a prescription. The prescription should read Guaifenesin 600 mg. dye free. Research what your country will let you import in one shipment, usually a 90 day supply. For details contact Marina del Rey Pharmacy 310-823-5311 but first be sure to check your local laws. (www.fibropharmacy.com)
3. Extended Release Guaifenesin 600 mg. tablets
This product is manufactured by Perrigo and is sold in pharmacies as a generic brand. (Called things like Mucus Relief, etc.) It must say EXTENDED RELEASE. Currently not being manufactured because of a supply issue it can still be found by shopping around. Some pharmacies currently have it on sale: stock up if you like this product. Also ask a manager to order some for you.
Start this product by cutting it in half, 300 mg. twice daily. If no change you would increase the dose by taking a full pill twice a day. After a month the dose would be raised (if no change) to one in the morning and two at night.
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.
Coupons for discounts can be found on various websites, so check around. Also can be purchased from discount stores such as Walmart and Costco, on amazon.com or on Ebay.
2. Compounded Guaifenesin from Marina del Rey Pharmacy (www.fibropharmacy.com or 310-823-5311). Capsules.
There are two strengths of this product available: 300 and 600 mg. Patients should start with the 300 mg. strength (twice a day) and double that after one week if no change is noticed. If the 300 mg. twice a day does not cause a flare of your symptoms, you double that dose to 600 mg. twice a day and can switch to the 600 mg. strength.
If you live outside the US you will pay less import duty if you purchase it with a prescription. The prescription should read Guaifenesin 600 mg. dye free. Research what your country will let you import in one shipment, usually a 90 day supply. For details contact Marina del Rey Pharmacy 310-823-5311 but first be sure to check your local laws. (www.fibropharmacy.com)
3. Extended Release Guaifenesin 600 mg. tablets
This product is manufactured by Perrigo and is sold in pharmacies as a generic brand. (Called things like Mucus Relief, etc.) It must say EXTENDED RELEASE. Currently not being manufactured because of a supply issue it can still be found by shopping around. Some pharmacies currently have it on sale: stock up if you like this product. Also ask a manager to order some for you.
Start this product by cutting it in half, 300 mg. twice daily. If no change you would increase the dose by taking a full pill twice a day. After a month the dose would be raised (if no change) to one in the morning and two at night.
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.
WILL MUCINEX WORK WHEN I START THE PROTOCOL?
Mucinex will work if you are taking the right dose.
The problem is that when you are starting out, you must remember that one Mucinex tablet is not 600 mg. of long acting. For a very tiny number of people this won't matter because the amount they need to clear is less than 600 mg.a day. However, this is not the case for most people. We believe that 99.9% of fibromyalgics need at least 600 mg of long acting a day to clear. Since each Mucinex tablet is 100 mg of short acting and 500 mg. of long acting, for most this isn't enough long acting. When people switch between brands--say the Perrigo which is all long acting, they are taking less long acting when they take Mucinex.
The second part of of this is that short acting guai has a kick. Pulls a punch. So what happens is that when people who start on Mucinex 1/2 tablet twice a day, they feel the short acting. They hurt more so they assume they have found the correct dose. But they do not have enough of the long acting to continue the clearing and so they hurt but they are not clearing.
We believe it is best for newbies to start on the FibroPharmacy 300 mg capsules, one twice a day, or the Perrigo 600mg extended release one half-twice a day. This way, without any short acting to confuse the issue, it is easier to find your dose.
If you start on Mucinex you can take 1/2 pill in the morning and a full pill at night. That puts you just over the magic 600mg a day of extended release that low dose people generally need to clear.
The problem is that when you are starting out, you must remember that one Mucinex tablet is not 600 mg. of long acting. For a very tiny number of people this won't matter because the amount they need to clear is less than 600 mg.a day. However, this is not the case for most people. We believe that 99.9% of fibromyalgics need at least 600 mg of long acting a day to clear. Since each Mucinex tablet is 100 mg of short acting and 500 mg. of long acting, for most this isn't enough long acting. When people switch between brands--say the Perrigo which is all long acting, they are taking less long acting when they take Mucinex.
The second part of of this is that short acting guai has a kick. Pulls a punch. So what happens is that when people who start on Mucinex 1/2 tablet twice a day, they feel the short acting. They hurt more so they assume they have found the correct dose. But they do not have enough of the long acting to continue the clearing and so they hurt but they are not clearing.
We believe it is best for newbies to start on the FibroPharmacy 300 mg capsules, one twice a day, or the Perrigo 600mg extended release one half-twice a day. This way, without any short acting to confuse the issue, it is easier to find your dose.
If you start on Mucinex you can take 1/2 pill in the morning and a full pill at night. That puts you just over the magic 600mg a day of extended release that low dose people generally need to clear.
what is Short Acting Guaifenesin? Do I want it?
This guaifenesin called short acting or immediate release guaifenesin is available in 200 and 400 mg strengths. It is sold as a store brand generic and also available from Marina del Rey pharmacy:www.fibropharmacy.com.
For those requiring higher doses than 1200 mg a day of long acting, you may add short acting to save money. A long-short acting combination is very effective: for example two long and two short twice a day seems to work for all but extremely high dose patients.
Once you have found your dose you can add short acting as per your own tolerance to speed up clearing.
WE REGRET HAVING TO POST WHAT FOLLOWS BUT DUE TO UNSCRUPULOUS MARKETING TECHNIQUES WE MUST:
DO NOT USE GUAI-AID PRODUCTS IN PLACE OF MUCINEX OR COMPOUNDED GUAIFENESIN. FOR MOST PATIENTS IT WILL NOT BE EFFECTIVE AS A STAND ALONE PRODUCT.
YOU MAY USE IT TO INCREASE YOUR DOSE BUT DO NOT TAKE ONLY GUAI-AID NO MATTER WHAT YOU ARE TOLD BY THEIR OWNER/SALES TEAM. IF YOU HAVE ANY QUESTIONS PLEASE CONTACT [email protected]
For those requiring higher doses than 1200 mg a day of long acting, you may add short acting to save money. A long-short acting combination is very effective: for example two long and two short twice a day seems to work for all but extremely high dose patients.
Once you have found your dose you can add short acting as per your own tolerance to speed up clearing.
WE REGRET HAVING TO POST WHAT FOLLOWS BUT DUE TO UNSCRUPULOUS MARKETING TECHNIQUES WE MUST:
DO NOT USE GUAI-AID PRODUCTS IN PLACE OF MUCINEX OR COMPOUNDED GUAIFENESIN. FOR MOST PATIENTS IT WILL NOT BE EFFECTIVE AS A STAND ALONE PRODUCT.
YOU MAY USE IT TO INCREASE YOUR DOSE BUT DO NOT TAKE ONLY GUAI-AID NO MATTER WHAT YOU ARE TOLD BY THEIR OWNER/SALES TEAM. IF YOU HAVE ANY QUESTIONS PLEASE CONTACT [email protected]