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Discontinuing GuaifenesinThere are a number of factors to consider in deciding whether to start or discontinue the use of guaifenesin. Guaifenesin's Safety
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Guaifenesin's SafetyWhen doctors talk about a drug being safe, or having "few" side
effects they are always talking in RELATIVE terms. Compared to a
lot of other drugs with severe side effects guaifenesin is "safe".
However, there is no such thing as a totally "safe" pharmaceutical.
If it were totally safe, it would not be a "drug" and would not
be a classified as a prescription drug in some countries. |
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Most of guaifenesin's assumed safety is built on the fact that
it has never been tested for safety because it is such an old drug.
Aspirin was accepted as being harmless on the same basis for many
years. Now that more research has been done it is implicated in
contributing to several medical problems. |
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The side effects of guaifenesin that are known are based on recommended dosages and the drug being taken intermittently. The maximum recommended dose for guaifenesin is 400mg every four to six hours. Known side effects are nausea and vomiting, and less commonly dizziness, headache, and rashes (including urticaria or hives). |
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Guaifenesin's ActionThere is no such thing as a pharmaceutical that works in a mechanical
manner. Guaifenesin is a chemical and works by chemical reactions. |
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There are very few pharmaceuticals that act specifically. Most
have more wide-ranging action than they are designed for. They set
into motion an unintended cascade of physiological events. That
is why every systemic drug like guaifenesin has side effects, whether
they are obvious enough to be felt or not. |
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Guaifenesin works systemically, which means it affects whole body systems, not just the kidneys. It is metabolized in the liver before it goes to the kidneys. One of the side effects of guaifenesin is nausea. People who report "cycling" IBS, which they did not have before taking guaifenesin, may be experiencing guaifenesin's side effects. Diarrhea can be the body's response to foreign unhealthy substances. Guaifenesin's side effects also need to be taken into account when some people report rashes, dizziness and headaches, where these have not been a problem previously. |
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Physiological AdaptationIf one takes most of the "safe" drugs for short periods of time, the body can recover from discontinuing them abruptly without too much trouble. For acute care, the value of many pharmaceuticals is unquestionable. For long term use, drugs are always a tradeoff. Any drug, taken over a long period of time, reduces the body's response capabilities in the area the drug is designed to support. The body incorporates or adapts to the new chemical as it is always present and it becomes part of a new functional balance. Then the chemical process of the pharmaceutical effects enzymes, hormones etc. that the body used to produce, and the body "gets lazy". (Think antidepressants, which need to be reduced gradually, or birth control pills - after stopping them doctors suggest at least three months for the body to "get back to normal" before attempting pregnancy). This does not mean the body cannot recoup - it just needs time to gear up again. |
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Detoxing GuaifenesinThe two major "cleanup" organs are the kidney and liver. Most pharmaceuticals
exiting the body have to be processed by the liver to get out of
the body. Detoxing too quickly can overload the liver. Liver overload
can produce symptoms of pain, irritability, depression, fatigue,
lethargy, discouragement and headaches. Disturbed sleeping patterns
in which one wakes around 1 o'clock and/or around 4 o'clock can
also be a sign of liver stress. |
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As well, the body needs time to reestablish the chemical reactions and pathways that it relinquished in its adaptation to guaifenesin. |
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Phosphates In, Phosphates OutSome attribute the pain, headaches, continued "cycling" and other
symptoms people feel when they discontinue guaifenesin abruptly
to phosphates "going back into the cells". They believe that phosphates
"hurt going in and hurt coming out". This is not biologically sound.
Phosphates move throughout the body continuously, in the bodies
of both healthy people and people with FM/CFS. This is a natural
physiological process that does not hurt. If this process were to
hurt, every human being would be in pain continually. |
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While Dr. P. St. Amand presents a very plausible explanation for the pain guaifenesin causes when it releases phosphates (due to water utilized and consequent swelling), there is no explanation available for the continuation of pain some people experience when they discontinue guaifenesin abruptly. |
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Phosphate Re-accumulationOthers suggest that the pain from discontinuing guaifenesin abruptly is caused by phosphates re-accumulating in the tissues. However, if someone has spent three years clearing a significant amount of phosphates out of their tissues, a few weeks or months of minute quantities of phosphate building up again should not come close to producing the critical mass of phosphate accumulation that caused the original pain. |
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Continued CyclingThere are numerous posting on the guai support line* describing the muscle pain and headaches that occur when people abruptly discontinued guaifenesin. We, unfortunately, are in touch with a number of people who discontinued their guaifenesin abruptly and triggered harsh and prolonged cycling. Mentors on the guai support line recognize this happens and have no explanation for it. It is just not worth the risk when it can be easily avoided by decreasing guaifenesin slowly. *GuaiSupport@maelstrom.stjohns.edu - check for "guai vacation" especially August 7 & 8, 2002. |
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Discontinuing Guaifenesin SlowlyFor the foregoing reasons, one should consider reducing guaifenesin
gradually. Postings on support groups indicate people sometimes
feel good for a day or two, sometimes not even that, and then symptoms
caused by discontinuing guaifenesin can set in, in the form of pain,
continued cycling, depression, irritability, and headaches when
guaifenesin is discontinued abruptly. |
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One schedule for low dose users to begin tapering off use is to
reduce the dosage at the rate of 50mg each week. High dose users
may want to reduce by 100 to 150 mg/week. This will require some
pulverizing of tablets if the guaifenesin is in tablet form, and
approximation of smaller portions. |
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This is only a generalized suggestion to indicate a possible schedule for discontinuing guaifenesin while minimizing the risk of significant pain and stress to the body. For a schedule pertaining to your particular needs, consult your doctor. |
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Nutritional SupportWhen discontinuing guaifenesin use, it is a good idea to support the liver. This can be done by increasing Essential Fatty Acid (EFA) intake through taking fish oils. We suggest people wait to begin tapering off their guaifenesin until they are well established on the #2 kidney remedy and have increased their EFA intake up to the levels discussed in "Nutritional Support". As well, drinking water with fresh lemon juice added, just enough to make it pleasant without adding sweetener, is also supportive of the liver. |
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