12 Medicine Cabinet Essentials (Home Pharmacy OTC Drugs)

Over-the-counter medications are available for purchase without a prescription.

What Are Over-the-Counter Medications?

• There are many over-the-counter (OTC) medications available without a prescription, which are used to treat the symptoms of many illnesses that don't usually require the help of a physician or health care practitioner.

What Conditions Can Be Treated Using Over-the-Counter Medicine?

• This article reviews a few of these medications that can help treat
  • minor aches and pains,
  • fever,
  • diarrhea,
  • cold symptoms,
  • sore throat, and
  • allergies.
• OTC medications have brand names as well as generic and store brand names (similar to prescription medications). Generic, store, and brand names contain the same active ingredients and are identical in their action on the body if the concentration of the active ingredients are the same.
• Because some OTC pills and liquids contain multiple medications, it is important to read the fine print on the label to know exactly what ingredients are in the product.

Can Over-the-Counter Drugs Be Dangerous?

• Even though they do not require a prescription, OTC medications may cause significant side effects. Some can interact with prescription medications and cause harm (for example, patients who take warfarin [Coumadin], a blood thinner, are at higher risk of bleeding from ulcers if they take OTC ibuprofen) while others products can cause organ damage if taken in amounts greater than recommended (for example, acetaminophen may cause liver failure; aspirin may cause lung and kidney damage).
• Before taking any OTC medication or dietary supplement, read the label, especially the dosage, frequency, and precautions sections.
• If you have any questions or concerns in regard the use of any OTC medication or dietary supplement, contact a medical health care practitioner or pharmacist for clarification.

There are three major medication categories available OTC to treat pain and fever;

1. acetaminophen,
2. nonsteroidal anti-inflammatory drugs (NSAIDs), and
3. aspirin.

Although the three major categories of drugs listed below are also used to treat the pain of minor trauma, rest, ice, compression, and elevation (RICE) are easy first steps in the treatment for minor injuries, especially the pain associated with sprains and strains.

Acetaminophen

Acetaminophen is the most commonly recommended OTC medication for fever. It works well for minor aches and pains, especially for people who cannot tolerate anti-inflammatory medications such as ibuprofen or aspirin. It is important to read the labels in regard to the recommended dosing of each medication to prevent accidental overdose. This is especially true with infants and children where the proper dosage depends upon the weight of the infant or child.

For an adult, the maximum dose of acetaminophen per day is 4 grams to prevent the complication of liver damage. Many cold medications contain acetaminophen as one of several other ingredients and it is important to read the labels carefully to prevent overdose. Because of the possibility of liver toxicity, acetaminophen should be avoided in patients with liver diseases such as cirrhosis and hepatitis.

There are several brand and generic names for acetaminophen. Common brand names include Tylenol, Panadol, and Tempra.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Many nonsteroidal anti-inflammatory drugs (NSAIDs) used to treat inflammation, fever, and pain are available over-the-counter. OTC ibuprofen (for example, Motrin, Advil) is often recommended by health care practitioners to decrease pain and inflammation from minor orthopedic injuries. It can also be used effectively as part of the treatment for kidney stones and gallstones, where inflammation is part of the process causing pain. Ibuprofen is also frequently recommended for the treatment of fever in all age groups.

Naproxen (for example, Naprosyn, Anaprox, and Aleve) is another NSAID available over-the-counter. The benefit of OTC naproxen is that it is longer lasting than ibuprofen and only needs to be taken twice a day instead of every 4 hours.

NSAIDs should not be taken by individuals with kidney disease, or those who have a history of bleeding from the stomach and bowels because NSAIDS are removed from the body by the kidneys and may increase bleeding in the stomach or bowels. These medications are relatively contraindicated in individuals taking blood thinners such as warfarin (Coumadin), clopidogrel (Plavix), and prasugrel (Effient) because the NSAIDS may increase the chance of inappropriate bleeding.

Salicylic Acid or Aspirin

Salicylic acid or aspirin is a well known medication that has been recommended for generations as a treatment pain, inflammation, and fever. It is also a first line treatment in the prevention of heart attack and stroke because of its anti-blood clotting properties by making platelets in the bloodstream less sticky.

Because of the many side effects associated with aspirin, other medications such as acetaminophen (Tylenol and others) or ibuprofen may be recommended instead of aspirin.

Aspirin may cause Reye's syndrome in infants and children, which can lead to fatal brain swelling. Therefore, aspirin should not be taken by children younger than 14 years of age.

Some individuals may need to take large amounts of aspirin to manage pain from arthritis, but high doses of aspirin can cause major complications such as tinnitus (ringing in the ears), pulmonary edema (fluid build up in the lungs) and kidney failure.

Aspirin can cause irritation of the stomach and may lead to ulcers and bleeding. Individuals with a history of ulcers or other stomach problems should not take aspirin, and those who take blood thinners should use caution when taking aspirin at the same time, as the probability for inappropriate bleeding is increased.

There are several brand and generic names for aspirin. Common brand names include Bayer aspirin, St. Joseph's aspirin, and Anacin.

A cold is an upper respiratory tract infection (URI's) caused by a virus. Since most people with a viral illness (viral upper respiratory infection) generally recover in approximately 7 to 14 days, treatment is focused on symptom control. Symptoms of a cold are:

• runny nose,
• stuffiness,
• possibly a sore throat, and
• hoarseness.

The symptoms the flu (influenza) are different. Influenza (flu) has more systemic symptoms such as fever, chills, coughs, and muscle/body aches.

OTC medications including herbal remedies may be of benefit in controlling symptoms but cannot cure a cold; instead they can potentially minimize the symptoms that cause people to suffer. Herbs have been used for centuries to help relieve cold symptoms but scientific studies have not yet proven their effectiveness. While herbal remedies may be of benefit to some people, it is important to remember that they are not harmless and may interact with prescription medications. Your pharmacist or health care practitioner can give advice as to the safety of a specific treatment plan. Drugstore and grocery shelves are lined with numerous types of drugs used to treat the symptoms of a cold; listed below are some of the treatments for cold symptoms and precautions about their use.

OTC cold medication and other cold preparations are not recommended for children under the age of 2, and are not effective for children younger than 6 years of age, according the American Academy of Pediatrics. Symptomatic treatment with humidified air and cough drops may be most effective, although cough drops can be a choking hazard in young children.

OTC cough preparations are not always recommended for adults, and may not work well according to some studies. However, many people are convinced that cough preparations are helpful, so listed below are some of the most widely used preparations. Menthol is the active ingredient in many cough drops. Their effect is temporary and wears off when the cough drop has dissolved.

• Dextromethorphan (Delysm, Pedicare, Robitussin, Scot-Tussin, St. Joseph, Theraflu, Triaminic, Vicks 44, and many others) is an over-the-counter product used to control cough. It is usually found as one of many ingredients in cough syrups and cold medications (those that have the DM in their names such as Robitussin DM or store brands). Dextromethorphan should not be taken by individuals who are taking CNS depressive drugs, opiates, and other psychoactive drugs, or children under 4 years of age.
• Guaifenesin (Robitussin, Mucinex among many others) is an expectorant (it loosens mucus in the bronchi or large breathing tubes). It may initially cause more coughing to remove the mucus but will then decrease the cough intensity and frequency as the mucus is cleared out. Adequate hydration will augment the effect of guaifenesin.

• Oral decongestants come in either pill or liquid form and act by shrinking engorged blood vessels in the nasal and sinus passages. It is important to read the ingredient list since many preparations contain multiple medications. These medications often contain an active ingredient such as pseudoephedrine (Sudafed) which is an adrenaline like drug. It should not be taken by individuals who have high blood pressure or who have palpitations or rapid heartbeat. These over the counter medications have warning labels that discuss their side effects. They may require special provision by the pharmacist at certain stores.
• Nasal spray decongestants act similarly to oral decongestants but have the advantage of acting only in the area applied, usually without the stimulant side effects. The most common active ingredient in nasal sprays is oxymetazoline (for example, oxymetazoline [Afrin], Dristan Nasal Spray, phenylephrine [Neo-Synephrine]). Nasal sprays can cause a "rebound" effect where nasal symptoms can return if they are used for more than 3 days and then discontinued. It is important to read and follow the package label instructions. People with heart disease, hypertension (high blood pressure), diabetes, or urinary retention due to an enlarged prostate should not use these medications.
• Humidified air and salt water nasal sprays are effective alternatives to OTC medicated sprays and oral decongestants.

• Many sore throats are caused by viruses but others may be due to a strep or other bacterial infection. It is reasonable to treat the symptoms of a sore throat for a few days but if symptoms don't resolve, a strep screen or throat swab may be necessary to determine if antibiotics are needed.
• Acetaminophen and ibuprofen are helpful in treating the pain associated with cold and influenza.
• Benzocaine (Cepacol) is the active ingredient in cough drops and sprays that helps to control the symptoms of a sore throat. It is also available as an eardrop antipyrine (A/B Otic, Aurodex, Rx-Otic), benzocaine (Oticaine); as a dehydrated glycerin (Auralgan) for temporary relief of ear pain; and as a pain reliever for oral ulcers toothache pain (Anbesol).

• Diphenhydramine (Benadryl) is an antihistamine used to treat the symptoms of sneezing, runny nose, and watery eyes. Its major side effect is drowsiness or sleepiness, so it also is the active ingredient in many OTC sleeping pills. Other nonsedating antihistamines are available for symptom control, including loratadine (Claritin), cetirizine (Zyrtec), and fexofenadine (Allegra).

Classic heartburn is described as a burning sensation in the upper abdomen that may radiate to the upper chest and may be associated with a bad taste in the back of the throat. It is important to note that many of these symptoms also are associated with heart attack or angina. Unless the diagnosis of heartburn is well established, individuals with chest pain should consider seeking emergent medical care. This is especially true in those with significant risk factors for heart disease including smoking, high blood pressure, high cholesterol, diabetes, and a family history of heart disease or stroke.

• Bismuth subsalicylate (Pepto-Bismol) is an OTC liquid medication recommended by many for the treatment of indigestion, nausea, and diarrhea. The bismuth often will cause black stools (usually this is not a concern). The compound has anti-secretory, antibacterial, and anti-acid properties, but should not be used in infants, young children, or women who are breastfeeding to avoid the chance of causing Reye syndrome. Bicarbonate tablets (for example, Alka-Seltzer, Bromo-Seltzer) are recommended to relieve heartburn and indigestion because they reduce stomach acidity.
• Simethicone (Gas-X, Phazyme) is an OTC medication used to reduce/relieve gas and the feeling of stomach bloating.
• Dimenhydrinate (Dramamine) may be taken to control nausea and vomiting. It is also recommended for motion sickness and dizziness. It should not be used with sedatives as it may increase drowsiness.
• Emetrol is an OTC medication that relieves nausea and vomiting. It is a mixture of carbohydrate-rich sugars that is also relatively safe for children and pregnant women (with a doctor's approval). People with diabetes should not use this medication because of the high sugar content. Continued nausea and vomiting may result in dehydration, and these symptoms may signal a more serious illness. If the symptoms persist, it is reasonable to contact you health care practitioner.
• A variety of OTC medications are now available to help treat indigestion. They include H2 blockers (a type of antihistamine that helps control acid secretion in the stomach) such as cimetidine (Tagamet) and ranitidine (Zantac). Proton pump inhibitors (PPIs) decrease acid production through a different pathway and include medications such as omeprazole (Prilosec) and lansoprazole (Prevacid).
• Calcium carbonate (for example, Caltrate 600, Os-Cal 500, Rolaids, Tums), aluminum hydroxide (for example, ALternaGEL, Dialume), and magnesium hydroxide (Phillips Milk of Magnesia) are antacids that work immediately to relieve acid indigestion and heartburn. They are available in both chewable tablets and liquid forms. Aluminum based antacids may cause constipation, and the magnesium based products may cause diarrhea. Maalox is a combination of the two types of antacids.

People normally have bowel movements once a day, more than once a day, or only every few days. So constipation for one person may not be a concern to another person. Constipation can be defined as hard feces that make it difficult to have a bowel movement. Abdominal pain and cramping may be associated symptoms.

Adequate hydration and increased roughage in the diet (leafy vegetables, fiber, whole grains, bran) are the mainstays of preventing constipation and are the first line treatment should constipation occur.

OTC medications to relieve constipation include glycerin suppositories as well as medications that help bulk-up and lubricate the stool. Bisacodyl (Correctol, Dulcolax), calcium docusate (Colace, Surfak), and Senna (Ex-lax, Senokot) are the most commonly available medicine. Laxative dependence is a problem that may occur with laxative use; use of these drugs continually over one week indicates the individual should seek medical advice.

Constipation may be a symptom of a more serious medical condition, especially if it is associated with chronic abdominal pain, bloating, fever, or bleeding from the rectum, and it is appropriate to seek medical care when these symptoms are present.

• Attapulgite (Kaopectate, Donnagel, Diatrol, and others) is an OTC medication that helps control diarrhea. Attapulgite should not be used for more than 2 days unless directed by your health care practitioner.
• Loperamide (Imodium A-D) is often recommended as an OTC medication for the treatment of diarrhea. However, if constipation, ileus (constipation, abdominal distension, nausea, and vomiting), fever, or bloating occur, the medication should be stopped.
• Bismuth subsalicylate (Pepto-Bismol) is a good first-line treatment for intestinal problems and is effective for mild diarrhea. It also helps relieve nausea and indigestion. Remember that the bismuth will turn the stool a black color, and should not be used in infants or children because of the possible development of Reye syndrome.

Diphenhydramine (for example, Benadryl, Sominex, Compoz) is a sedating antihistamine. It is primarily recommended for the treatment of allergic reactions or stuffiness due to a cold. Drowsiness is one of the side effects of diphenhydramine and therefore it is used as a sleep aid; individuals should be ready to attempt sleep before taking any sleep aid and should not attempt to drive or do any activity that would compromise their safety if they become sleepy. Melatonin may be effective in some individuals for treating insomnia. Studies regarding its benefits have been inconclusive; however, melatonin has few side effects.

Allergic reactions limited to the skin including itching and hives (urticaria) usually are not life-threatening. However, difficulty breathing, wheezing, hoarseness, or difficulty swallowing may be signs of a life-threatening allergic reaction called anaphylactic shock and emergency medical services should be activated (call 911 if available) if these symptoms develop.

• Diphenhydramine (Benadryl) is an antihistamine that treats allergic reactions and itch. It is effective but a significant side effect in drowsiness. Individuals taking diphenhydramine should not drive a car, operate heavy machinery, or drink alcohol. Nonsedating antihistamines include loratadine (Claritin), cetirizine (Zyrtec) and fexofenadine (Allegra).
• Cromolyn sodium (Nasalcrom) is a nasal spray used to treat nasal allergies.