Over The Counter (OTC) Medications: The Basics
I am frequently asked about over the counter (OTC) medications and what to use in certain situations. Below is a list of some of the most popular over the counter medications and some key points about their use. Each person and situation is unique and some of these may work better than others. If you ever have questions, I am always happy to review with you.
FOR UPPER RESPIRATORY SYMPTOMS
Fluticasone [brand name Flonase]:
-A topical nasal steroid spray, which decreases swelling of the nasal mucosa and sinuses and hopefully helps to decrease that drippy nose feeling
-Important points
· Does not work right away-needs to build up over several days to a week to give the full effect
· Avoid pointing the nozzle at the nasal septum as that can increase risk of nose bleeds if used chronically
Pseudoephedrine [brand name Sudafed]:
-A strong decongestant, which helps decrease the pressure in the sinuses and dries out the nose, sinuses, and mouth.
-It works by constricting blood vessels to decrease swelling and limit runny nose.
-Important points:
· It can increase blood pressure because it constricts blood vessels everywhere, so I avoid use in patients with hypertension, heart disease, or abnormal heart rhythms
· It can also increase heart rate, cause an anxious feeling, and cause difficulty with sleep
· I suggest patients take it in the morning and see how it affects them
Antihistamines: so many options!
-Cetirizine/Zyrtec, loratadine/Claritin, fexofenadine/Allegra, just to name a few
-These decrease histamine release and histamine can cause blood vessels to dilate and thus lead to congestion and drippy nose
-Antihistamines work the best for nasal congestion and runny nose caused by allergies since allergens trigger histamine release
Dextromethorphan [brand name Delsym]:
-Cough suppressant
-Many people will experience a dry cough that may last for weeks after an upper respiratory infection
-Dextromethorphan can help suppress a cough that is triggered by that tickle at the back of the throat
Guaifenesin [brand name Mucinex]:
-This medication is meant to help thin secretions/mucus.
-In studies, effect is similar to just drinking a lot of water, but it may be helpful to those who are not big water drinkers.
I’m not a big fan of combination medications (for example, DayQuil) as you may not need all the ingredients. If you have a side effect, it is difficult to determine which medication is the cause. Try some of these solitary medication options and learn what works best for you.
FOR PAIN OR FEVER
Acetaminophen [brand name Tylenol]:
-Acetaminophen has several dosing options (1000mg every 8 hours, 500mg every 4 hours, 650mg every 6 hours), but the goal is not to exceed 3000mg per day to avoid irritation to the liver
-Acetaminophen can be very helpful for fever reduction and it can also give some people pain relief
Ibuprofen [brand name Advil]:
-Usually dosed 400-600mg every 6 hours.
-This is one of a large class of medications called NSAIDs (non-steroidal anti-inflammatory drugs)
-NSAIDs are very helpful to reduce inflammation and can help pain related to repetitive use injuries (like tennis elbow, rotator cuff irritation, runners’ knee), but they do have a few downsides
· NSAIDs as a class can disrupt the protective mucus lining of the stomach and thus increase your chance for heartburn, upset stomach, and potentially even stomach bleeding
· At high doses, they can also irritate the liver and potentially damage the kidneys
· They also can cause fluid retention and increase blood pressures
· We encourage taking NSAIDs with food and avoid use if you are currently on a blood thinner such as warfarin or Eliquis.
Naproxen [brand name Aleve]:
-Dosed 220mg oral twice daily
-Also an NSAID like ibuprofen, but has a longer duration of action, so it can be dosed twice daily
-The benefits and risks are similar to ibuprofen.
FOR HEARTBURN
Calcium carbonate [brand name Tums]:
-This is a good option for brief episodes of unexpected heartburn as it helps neutralize the acid of the stomach
-Some people do feel more constipated if they take this regularly
Famotidine [brand name Pepcid]:
-Can be dosed chronically twice daily, but in the over-the-counter form, most people take it as needed when they know they are going to be eating something that often causes heartburn (ie spicy foods)
- Famotidine helps lower the amount of acid pumped into the stomach but does not shut down the acid pumps completely
-Quicker acting than omeprazole but less robust in lowering stomach acid levels
Omeprazole [brand name Prilosec]:
-Part of a class of medications called PPIs (proton pump inhibitors) which works by shutting down the acid pumps of the stomach
-Helpful for ongoing heartburn/reflux
-Not as quick acting as famotidine or Tums but if used daily for several weeks, it can help heal irritated esophagus or stomach lining
-The over the counter version is usually a 10 or 20mg dose and can be used for a short term trial (around 2 weeks)
-We do use omeprazole at higher dosages for longer durations in some instances, however, it does have downsides when used chronically
· It may increase the risk for certain types of infections (C diff), decrease the absorption of calcium, and has had some associations with lowered kidney function
· Stopping abruptly after using it for several weeks can cause a rebound in heartburn, so often we suggest patients taper off this medication or use famotidine to step-down therapy
FOR CONSTIPATION
Magnesium:
-Magnesium oxide 500mg supplement is a fairly mild way to help treat constipation
-Magnesium in a daily fashion can also help prevent migraines and some people find it helps relax them for sleep
Polyethylene Glycol [brand name Miralax/Clearlax]:
-Osmotic laxative
-Generally, it is an odorless/tasteless powder mixed in a liquid (usually water)
-It works by bringing fluid into the colon to help treat constipation
-Not as quick acting as a stimulant laxative, but it may not cause the cramping of a stimulant laxative
-Some people do get bloating with it and it can take a bit of trial and error to get the right amount.
Senna:
-Stimulant laxative
-Quicker acting than osmotic laxatives, but can cause cramping as it stimulates the colon
Bisacodyl:
-Stimulant laxative
-Quicker acting than osmotic laxatives, but can cause cramping as it stimulates the colon
Psyllium fiber [brand name Metamucil]:
-Works by pulling water into the colon
-If not a good water drinker, however, this is not a great idea as it can make the stools more firm and difficult to pass
Docusate [brand name Colace]:
-Softens stools, but is not a true laxative
-Often taken 100mg twice daily and can be used in a chronic fashion
