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Stocking Your Medicine Cabinet - What to have and why

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Stocking Your Medicine Cabinet - What to have and why Powered By Docstoc
					    H ealth H ints                                                                              October/November 2009
 Editor: Janet M. Pollard, MPH
                                                                                                      Vol. 13, No. 10/11


Stocking Your Medicine Cabinet
What to have and why
Fall has arrived, and with it              people out to the field – and
comes another season of cold               muscle pain issues along with it.
and influenza (“flu”) viruses. It                                                               Over-the-counter (OTC)
                                           No matter what the time of year,
is believed that these viruses are
                                           most all of us will experience
                                                                                               medicines are those
more easily spread in the fall and                                                            you can get without a
                                           discomfort of some sort at some
winter months because we begin
to spend more time indoors and
                                           time that may not be severe                        prescription from your
                                           enough to require immediate                        doctor; however, this
in close proximity to one another,
                                           attention from a doctor, but it
thus, making the spread of the
                                           could use some self-care at home.
                                                                                               does not mean they
illness more prevalent.                                                                        cannot be harmful.
                                           In spite of our best efforts to
Cold and flu may not be the only            prevent the transfer of viruses
thing peaking where you live.              to one another, sometimes we
For some people, allergies are in          end up sick. And, in spite of                 and non-medicine options for self-
high gear as the seasons change,           our efforts to prevent injuries                care so you can care for pain and
blowing in new allergens that              and accidents, they sometimes                 discomfort appropriately at home
may not have been present in the           happen. For some individuals,                 when needed.
months before. And, although               pain due to chronic conditions like
there is conflicting evidence, many         orthopedic impairments, arthritis,            This issue of HealthHints will act as
people with arthritic-type pain say        fibromyalgia, or other rheumatic               a guide to what over-the-counter
it peaks when the weather changes          conditions2 is part of everyday life.         (OTC) medicines are commonly
to cold, rainy days.1 Fall sports and      In fact, almost half of all Americans         available and how to use them
exercise are also in gear, bringing        (about 133 million) live with                 safely, as well as non-medicine
                                           at least one chronic condition.3              options that may work just as well
                                           Knowing how to handle these                   for particular ailments/symptoms.
                                           conditions at home can improve
                                           life quality.                                 Choosing & Using
                                           If you are experiencing pain or               OTC Medicines
                                           discomfort due to illness or injury,          Know what you’re taking
                                           the best thing to do is to call your          Over-the-counter medicines
                                           doctor to ensure the best course              are those you can get without a
                                           of treatment can be started early.4           prescription from your doctor;
                                           “Usually, colds and flu simply                 however, this does not mean they
                                           have to run their course.”4 These             cannot be harmful. It is important
                                           illnesses are viral in nature (caused         to use only the medicine you need,
                                           by viruses not bacteria); they                in the amount (dose) you need, for
                                           can’t be fought with antibiotics              the appropriate time period to be
                                           – only bacterial infections can be            safe and effective. It is common
                                           fought off with antibiotics. It is             for people to think that OTC
                                           helpful to know your medicine                 medicines are safe at any dose

        For information on other health topics, visit Extension’s Family & Consumer Sciences website: http://fcs.tamu.edu.
and in any combination, simply                important part of self-care with        sedating effect). And, of course,
because they are sold without a               OTC medicines.”5 Read the label         it tells you to keep medicines
prescription. People often think              every time – even if you have           away from children.9
“more is better” or “an adult dose            taken or given the medicine before
                                                                                    • Directions. This section tells
cut in half is about the amount               – to make sure there have been
                                                                                      you how to safely use the
appropriate for a child.” None of             no changes and you are giving
                                                                                      medication – how much to use,
these statements could be further             or taking the medicine safely and
                                                                                      how often to use it, and for how
from the truth.                               appropriately. The Drug Facts label
                                                                                      long you can use it.9 Be very
                                              contains the following items:
“The U.S. Food and Drug                                                               careful when giving medicines
Administration (FDA) determines               • Active Ingredient. Know the           to children. When possible, use
whether medicines are                           “active ingredient.” It is what       the child’s weight rather than
prescription or nonprescription.                makes the medicine work               age for dosing purposes. Never
The term prescription (Rx) refers               and is listed at the top of the       guess how much to give a child.
to medicines that are safe and                  Drug Facts label. Sometimes           Note that “infant” drops are
effective when used under a                      an active ingredient can be           often significantly stronger than
doctor’s care. Nonprescription or               used to treat more than one           the “children’s” version of the
OTC drugs are medicines FDA                     medical condition. For example,       same medicine – so do not give
decides are safe and effective for               an active ingredient used to          a larger dose of infant medicine
use without a doctor’s prescription.            treat headache may also be            to young children.10 Never try
                                                used in cold medicines.7 “Two         to cut adult strength medicines
FDA also has the authority to
                                                medicines with the same active        in half or estimate a child’s
decide when a prescription drug
                                                ingredient should NOT be used         dose from an adult product.11
is safe enough to be sold directly
                                                at the same time.”8 Doing so can      Know your measurements – a
to consumers over the counter.
                                                result in an overdose.                tablespoon is abbreviated tbsp.
This regulatory process allowing
                                                                                      and a teaspoon is abbreviated
Americans to take a more active               • Uses. This section of the label
                                                                                      tsp. A tablespoon holds three
role in their health care is known              tells you about the problems
                                                                                      times as much as a teaspoon.
as Rx-to-OTC switch. As a result                the medicine will treat. Look for
                                                                                      A teaspoon is equal to “5 cc”
of this process, more than 700                  a product that will treat only
                                                                                      or “5 ml.” Use the dosing tool
products sold over the counter                  the symptom(s) you have.9 For
                                                                                      provided with the medicine.
today use ingredients or dosage                 example, if you have a runny
                                                                                      If one is not provided, ask
strengths available only by                     nose, don’t choose a product
                                                                                      your local pharmacist for one,
prescription 30 years ago.”5                    that also treats coughs and
                                                                                      or purchase one at your local
                                                headaches.6 There is no point in
Here are some important                                                               drug store. Never use a kitchen
                                                taking extra medicines that you
guidelines to follow when                                                             measuring spoon, which could
                                                don’t need.
purchasing and taking (or giving)                                                     provide an inaccurate dose.7
OTC medicines.                                • Warnings. This section tells
                                                                                    • Other Information. This section
                                                you when you should talk to
Before you take an OTC medicine,                                                      tells you how to store your
                                                your doctor first and when you
read and thoroughly understand                                                        medicine when you aren’t using
                                                shouldn’t use the medicine
the information on the “Drug                                                          it (e.g., at what temperature,
                                                (such as when pregnant or
Facts” label.6                                                                        away from moisture or direct
                                                breast-feeding, when you have
Reading this                                                                          sunlight).9
                                                a chronic health condition,
information
                                                or when you are taking other        • Inactive Ingredients. The
may be
                                                drugs that might negatively           inactive ingredients are mixed
overwhelming
                                                interact with this one). The          with the active ingredients
considering
                                                warnings section also tells you       to form a pill, add color or
the number
                                                about possible side effects,           flavor, or help the medicine
of OTC drugs
                                                when you should stop taking           last longer.9 The inactive
available,
                                                the medicine, and things you          ingredients do not help to treat
but take the
                                                shouldn’t do while using the          the symptoms, but you should
time. “Next
                                                medicine (e.g., eating certain        be aware of them if you or
to the medicine itself, label
                                                foods, driving or operating           someone in your care is allergic
comprehension is the most
                                                machinery if the medicine has a       to such ingredients.
HealthHints: Stocking Your Medicine Cabinet                    2                            Texas AgriLife Extension Service
You will also want to note the             same active ingredient as pain             6 years old.13 Cold and influenza
expiration date. This date is not          relievers, it is possible to take          (“flu”) are caused by viruses that
found on the Drugs Fact label, but         (give) two different products that          usually have to run their course and
should be imprinted elsewhere on           contain the same active ingredient         cannot be treated with antibiotics
the label. It lets you know the date       without realizing it.11 In fact, there     (which only fight bacterial
after which you shouldn’t use the          are over 600 products that contain         infections – not viruses). In many
medicine. It is important to dispose       acetaminophen.12 Consider the              cases, there are non-medicine, self-
of medicines after their expiration        possibilities, and be sure to double       care measures you can take that
date since they may have lost their        check the Drug Facts label.                may be just as effective at relieving
effectiveness or become harmful in                                                     symptoms as OTC medications.
                                           Duplicate usage. Check that you
some way. For information on the                                                      Here are some non-medicine
                                           aren’t using two medicines to treat
safe and proper disposal of your                                                      options that may be effective:
                                           the same symptom. For example,
medicines, see How to Dispose of
                                           two cold medicines could contain           • Rest. Stay home and rest,
Unused Medicines.
                                           different active ingredients, but             especially if you have a fever.14
Don’t forget to check the packaging        both of those ingredients act as             Getting more sleep helps your
and contents when you purchase             fever reducers. That’s duplicate             immune system fight infection.
medicines. “First, check the outside       usage and should be avoided.11               Rest is also often prescribed for
packaging for such things as cuts,                                                      minor injury to muscles and
                                           Don’t hesitate to ask your doctor if
slices, or tears. Second, once you                                                      joints.
                                           you have questions or need advice
are at home, check the label on the
                                           on product selection.11                    • Fluids. Drink plenty of liquids
inside package to be sure you have
                                                                                        such as water, juice, and warm
the right medicine. Make sure the          Always talk with your doctor
                                                                                        soups to prevent dehydration
lid and seal are not broken. Third,        before
                                                                                        during the loss of bodily fluids
check the color, shape, size, and          starting
                                                                                        from diarrhea, vomiting,
smell of the medicine. If you notice       any OTC
                                                                                        perspiration, and nasal
anything different or unusual,              medicines
                                                                                        secretions.15 Note, however, that
talk to a pharmacist or another            if you are
                                                                                        infants and children in particular
healthcare professional.”7                 already
                                                                                        may need oral rehydration
                                           taking
Store medicines away from heat,                                                         solutions rather than plain water
                                           prescription
moisture, and sunlight in a place                                                       or other fluids.16, 17
                                           medicines.
out of reach of children. If, for
                                           Drug                                       • Chicken soup. Chicken soup
any reason, you suspect overdose,
                                           interactions                                 really can help illness by
contact the Poison Control Hotline
                                           can cause severe negative side               breaking up congestion.18
at 1-800-222-1222 (open 24 hours a
                                           effects. Always let your doctor
day, 7 days a week), or call 9-1-1.                                                   • Gargle. Gargle with warm
                                           know about any medications,
                                                                                        salt water a few times a day to
                                           vitamins, or herbal supplements
Using Multiple Medications                                                              relieve a sore throat.14
                                           you are taking to avoid negative
Safety & effectiveness                     drug interactions.                         • Saltwater (saline) drops.
Sometimes you need more than                                                            Use these drops a few times
one medicine when treating an              Know Your Non-                               a day in the nostrils to thin
illness or injury. In these cases, it is                                                nasal discharge and relieve
                                           Medicine Options                             nasal congestion.14, 19 They
important to watch for:
                                           What you can do                              can be purchased OTC at any
• duplicate ingredients and                                                             pharmacy. For infants, you will
                                           without medicine
• duplicate usage.                         Many medicines are used simply               need to use the saline solution
                                           to treat symptoms, and although              and a suctioning bulb to help
Duplicate ingredients. Check the
                                           they may make you feel better for            relieve the nasal passages.
active ingredient(s) in each OTC
medicine to make sure you are              a time, they will not “cure” your          • Cool-mist humidifier. Use a
not taking (or giving) more than           illness or injury. Cough and cold            cool-mist humidifier to keep
one product with the same active           medicines, especially, have come             moisture in the air to loosen
ingredient. Because many cough             under scrutiny as to their safety            congestion.13, 15
and cold preparations contain the          and effectiveness for children under


Texas AgriLife Extension Service                             3                      HealthHints: Stocking Your Medicine Cabinet
• Petroleum jelly. Use on the                                 less stiffness, greater flexibility,                     Knowing Your
  skin under the nose to relieve                              and less pain.21, 22
                                                                                                                     Medicine Options
  rawness.
                                                          • Chest physical therapy. This                             What’s in your cabinet?
• Steam. Use steam from a                                   type of therapy can loosen                               “American medicine cabinets
  shower for congestion to help                             mucus and may help infants                               contain a growing choice of
  you breath more easily and to                             and young children to cough                              nonprescription, over-the-counter
  relieve sinus pain. You can also                          it out. Lay your child across                            medicines to treat an expanding
  drape a towel over your head                              your knees, face down; cup                               range of ailments. OTC medicines
  and breath steam in from a                                your hand, and gently tap your                           often do more than relieve aches,
  bowl of hot water.19, 20                                  child’s back. Or sit your child on                       pains, and itches. Some can
                                                            your lap; lean her body forward                          prevent diseases like tooth decay,
• Warm compresses. Place warm,
                                                            about 30 degrees; cup your                               cure diseases like athlete’s foot
  damp towels around your nose,
                                                            hand, and gently tap her back.13                         and, with a doctor’s guidance, help
  cheeks, and eyes to ease facial
  pain from sinuses.20                                    • Honey. To relieve a cough, try                           manage recurring conditions like
                                                            half a teaspoon of honey for                             vaginal yeast infection, migraine,
• Warm bath or heating pad.                                                                                          and minor pain in arthritis.”5
                                                            children aged 2 to 5 years; 1
  Take a
                                                            teaspoon for children aged 6 to                          There are some options available
  warm
                                                            11 years; and 2 teaspoons for                            in OTC medicines to help you
  bath or
                                                            children 12 years and older. If                          decide what you need in your
  use a
                                                            honey is given at bedtime, make                          home pharmacy. We have created
  heating
                                                            sure you brush your child’s                              a short handout of common OTC
  pad to
                                                            teeth afterward. Remember,                               options – types available, updates,
  soothe
                                                            it’s not safe to give honey to                           and changes, as well as potential
  aches
                                                            babies younger than 1 year13                             concerns, side effects, and risks.
  and
                                                            due to risks for infant botulism,                        We hope you will find this helpful
  pains
                                                            a rare and serious form of food                          as you stock your medicine
  during a cold or flu.19 Note: If
                                                            poisoning.23                                             cabinet: OTC Medicines: Deciding
  you or your child has fever,
  extra heat will only complicate                         “Researchers aren’t sure whether                           what you need.
  the problem. Try a tepid bath or                        taking extra zinc or vitamin C can
  cool cloth to reduce fever.                             limit how long cold symptoms
                                                          last or how severe they become,
• Cold or heat therapy for minor
                                                          but large doses taken every day
  muscle or joint pain. An ice
                                                          can cause negative side effects.
  pack or frozen beans wrapped
                                                          The results of most studies on the
  in a towel may help relieve
                                                          value of herbal remedies, such as
  minor aches and pains from
                                                          echinacea, are either negative or
  joints and muscles. The cold
                                                          inconclusive, and few properly
  can help reduce swelling and
                                                          designed scientific studies of these
  inflammation by constricting
                                                          treatments have been done in
  blood vessels. For some
                                                          kids.”19
  individuals, heat from a warm
  bath or heating pad may work.                           Talk to your doctor before you
  Heat therapy increases blood                            decide to take or give your child
  circulation, which can aid the                          any herbal remedy or more
  healing of damaged tissues.                             than the recommended daily
  Heat also allows tissues to                             allowance (RDA) of any vitamin or
  stretch more easily, resulting in                       supplement.19
                                                                                                                       To view the references used in
                                                                                                                       this newsletter, go to:
This document is meant for educational purposes only and is not intended to                                            http://fcs.tamu.edu/health/
replace the advice of your doctor or other health care provider.                                                       healthhints/2009/nov/ref.php

   Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.
                  The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating

HealthHints: Stocking Your Medicine Cabinet                                          4                                             Texas AgriLife Extension Service
    H ealth H ints
Cold & Influenza (“Flu”) Viruses

Cold and influenza (“flu”) viruses are spread through                                   help relieve symptoms. There are also prescription
the air when an infected individual coughs or sneezes                                 (i.e., you must see your doctor for these medicines)
on you or transfers the virus to something you touch.                                 antiviral medicines for the flu. If treated within the
For instance, if a person coughs, sneezes, or wipes his                               first few days after the virus is contracted, these
nose with his hands, the virus could be transferred                                   prescription medicines can reduce the number of days
to anything he touches. That’s why hand washing                                       you have the flu.
is so important. Or, if a person blows her nose in a
tissue and leaves it on a desk or table, the virus can be                             Sources
transferred to the desk or table (as well as the tissue,                              1. Centers for Disease Control (2004). Stopping germs
of course). That’s why it is important to always throw                                   at home, work, and school [on-line]. Retrieved
used tissues in the trash and to use disposable tissue                                   August 3, 2009. From http://cdc.gov/germstopper/
and paper towels when possible. It is also wise to                                       home_work_school.htm.
use individual hand and bath towels during times of
                                                                                      2. U.S. Food and Drug Administration (2008). Get
illness, rather than sharing them.
                                                                                         set for winter illness season [on-line]. Retrieved
Viruses are more easily transferred/transmitted                                          September 10, 2009. From http://www.fda.gov/
through mucous membranes (the wet/moist parts of                                         downloads/ForConsumers/ConsumerUpdates/
the body), so it is important to keep your hands clean                                   UCM143453.pdf.
and away from your eyes, nose, and mouth as much
as possible. Additionally, some viruses can live from
20 minutes to 2 hours or more on surfaces (e.g., tables,
desks, doorknobs, toys).1 It is a good idea to clean
and disinfect door knobs, light switches, telephone
receivers, and other commonly shared objects. And,
of course, one of the best ways to prevent the flu virus
is to get the seasonal flu shot or flu mist each year. It
builds up your body’s immunity to the flu without
actually having to get the flu!
Call your doctor to ensure the best course of
treatment can be started early. Get plenty of rest. Stay
hydrated with lots of clear fluids. Wash your hands
with warm, soapy water after coughing, sneezing,
or blowing your nose, or use an antibacterial hand
sanitizer if soap and water are unavailable. Place
used tissues in the trash. Limit your exposure to other
people. Know your medicine options.2
There is no “cure” for cold and flu viruses, but
there are over-the-counter (OTC) medicines that can



  Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.
                 The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating


Stocking Your Medicine Cabinet—What to Have and Why                                                            October/November 2009 – Vol. 13, No. 10/11
    H ealth H ints
OTC Medicines
Deciding what you need
“American medicine cabinets contain a growing choice of nonprescription, over-the-counter (OTC) medicines
to treat an expanding range of ailments. OTC medicines often do more than relieve aches, pains, and itches.
Some can prevent diseases like tooth decay, cure diseases like athlete’s foot and, with a doctor’s guidance, help
manage recurring conditions like vaginal yeast infection, migraine, and minor pain in arthritis.”1

Scroll down or click on the links below to decide what you need to treat your family and have stored in your
medicine cabinet.*
Pain Relievers
Antihistamines
Decongestants
Cough Medicines
Stomach & Intestinal Problem Medicines
   •   Antidiarrheals
   •   Laxatives
   •   Antacids & Acid Reducers
   •   Antiemetics
Topical Products
   •   Antibiotic Ointment and Antiseptics
   •   Anti-fungal Creams
   •   Anti-itch Creams

   •   Muscle-ache Creams


*Mention of brand names is in no way an
endorsement of any particular product. Brand
names are used within this document to help
you identify common products.




This document is meant for educational purposes only and is not intended to replace the advice of your doctor or
other health care provider.


Stocking Your Medicine Cabinet—What to Have and Why      1                 October/November 2009 – Vol. 13, No. 10/11
Pain Relievers                                                 “Aspirin and NSAIDs relieve pain by stopping the
Two classes of commonly used drugs are effective in             production of prostaglandins, which are natural
reducing fevers and relieving minor aches and pain:2           chemicals in the body. Prostaglandins irritate nerve
                                                               endings, triggering the sensation of pain.”7
• acetaminophen (e.g., Tylenol, Tempra) and
                                                               It is not completely understood how acetaminophen
• non-steroidal anti-inflammatory drugs (NSAIDs),               relieves pain and reduces fever. “We do know that
  which include aspirin (e.g., Bayer, Bufferin,                 unlike aspirin and NSAIDs (which work in the skin,
  Ecotrin), ibuprophen (e.g., Advil, Motrin), and              muscles and joints), acetaminophen blocks painful
  naproxen (e.g., Aleve).3                                     sensation in the brain and the spinal cord.”7
There are also combination products, which
include both classes of pain relievers, such as the            Should I take pain relievers?
acetaminophen, aspirin, caffeine combination that is            Taking these pain relievers is generally considered
found in Excedrin.3                                            safe; however, taking too much of the active
                                                               ingredient in acetaminophen can lead to liver
Note: Aspirin and/or
                                                               damage. The risk for liver damage increases if you
aspirin-containing
                                                               drink three or more alcoholic drinks while using
products (which come
                                                               acetaminophen-containing medicines.8
from the salicylate
family) should never                                           For some individuals, NSAIDS can cause stomach
be given to children                                           bleeding. Although it is rare for these events to occur
or teenagers because                                           when using OTC doses for short periods of time,
it puts them at risk for                                       some people develop bleeding. You have an increased
a serious disease that                                         risk if you:
can affect the brain and                                        • are over age 60,
liver known, as Reye’s
Syndrome.4 Check the                                           • take prescription blood thinners,
Drug Facts label of                                            • drink three or more alcoholic drinks a day,
medications for those
containing aspirin.                                            • have previous stomach ulcers,
Some medicine labels may refer to aspirin as salicylate        • take steroid medicines or take other NSAID
or salicylic acid,5 which you may find in unexpected              medicines,
places like muscle ache creams (methyl salicilate)6
for your athletes or in some anti-diarrheals like Pepto        • have other bleeding problems, or
Bismol3 as well as in combination medicines that treat         • have a previous history of stomach bleeding.
more than one symptom, like Excedrin.3 Be sure to
                                                               If you have any of these factors, talk with your
read labels carefully. Aspirin is also used for purposes
                                                               doctor before using NSAIDs.8, 9 NSAIDs can also
beyond pain relief to prevent or reduce the risk for
                                                               cause damage to the kidneys (although the damage
stroke, heart attack, and other coronary conditions,
                                                               is usually reversible if you stop taking the medicine).
as well as rheumatic conditions. Never take aspirin
                                                               The risk of kidney damage may increase in:
for these purposes without direct dosage prescription
and supervision of a doctor. For more on aspirin               • people who are over 60;
for these purposes, see the Aspirin: Questions and
                                                               • people who have high blood pressure, heart
Answers and Safe Daily Use of Aspirin articles from
                                                                  disease, or pre-existing kidney disease; and
the U.S. Food and Drug Administration (FDA).
                                                               • people who are taking a diuretic.8




October/November 2009 – Vol. 13, No. 10/11                 2         Stocking Your Medicine Cabinet—What to Have and Why
Antihistamines                                                decongestants. Many of the brand names [listed]
“Antihistamines work by blocking the receptors that           above are for these combination medicines, which are
trigger itching, nasal irritation, sneezing, and mucus        meant to treat many symptoms at once.”12
production.”7 Therefore, they can help you feel better        “First-generation antihistamines can make you feel
when you have a runny nose, itchy eyes or sneezing            very sleepy. This can affect your ability to drive or
due to allergies. They can also relieve itching from          operate machines. It can also make it hard for you to
chickenpox or insect bites, as well as control hives or       think clearly. Antihistamines can cause your mouth
other allergic reactions.10 Sometimes they are used           and eyes to feel dry. Second-generation antihistamines
to help relieve symptoms of the common cold, such             are not as likely to cause these side effects.”12
as sneezing and runny nose.11 Two types of OTC
antihistamines are available:                                 Should I take antihistamines?
• First-generation OTC antihistamines        12, 13           “Talk to your doctor before using a first-generation
                                                              antihistamine if you have any of the following health
      brompheniramine (e.g., Dimetapp Cold &                  problems:
      Allergy Elixir, Bromphen, Dimetane, Nasahist,
      Robitussin Allergy & Cold Liquid)                       • glaucoma;

      chlorpheniramine (e.g., Chlor-Trimeton, Singlet)        • trouble urinating (from an enlarged prostate
                                                                 gland);
      clemastine (e.g., Allerhist, Tavist)
                                                              • breathing problems, such as asthma, emphysema,
      dimenhydrinate (e.g., Dramamine original)                  or chronic bronchitis;
      diphenhydramine (e.g., Benadryl, Nytol,                 • thyroid disease;
      Sominex)
                                                              • heart disease; or
      Doxylamine (e.g., Vicks Nyquil, Alka-Seltzer
      Plus Night-time Cold Medicine)                          • high blood pressure.

• Second-generation OTC antihistamines12, 13                  Before taking a second-generation antihistamine,
                                                              tell your doctor if you’ve ever had kidney or liver
      Loratadine (e.g., Alavert, Claritin).                   disease.”12
“Note: Both types of antihistamines often are
mixed with other drugs, such as pain relievers or




Stocking Your Medicine Cabinet—What to Have and Why       3                  October/November 2009 – Vol. 13, No. 10/11
Decongestants                                                Some drug companies have reformulated these
“Decongestants work by narrowing blood vessels in            products replacing pseudoephedrine with
the lining of the nose. This reduces how much blood          phenylephrine. Many times, the label has not
flows through the area so that swollen tissue inside          changed, so it is important to make the distinction
the nose shrinks and air can pass through more easily.       as a consumer – knowing that those containing
Decongestants can help relieve a stopped-up nose             pseudoephedrine would have to be purchased
caused by a cold, or the flu (influenza), sinusitis, or        from the pharmacy (though they do not require a
allergies.”14                                                prescription) and those containing phenylephrine
                                                             are simply available on the store shelves. There is
Decongestants come in oral form and decongestant             also some controversy as to whether phenylephrine
nasal sprays:                                                is as effective as pseudoephedrine.16, 17, 18 Consult
• Oral decongestants: pseudoephedrine (e.g.,                 your doctor or pharmacist about which product he
  Sudafed) and phenylephrine (e.g., Sudafed PE)              recommends for your symptoms.
• Decongestant nasal sprays: oxymetazoline (e.g.,
                                                             Should I take a decongestant?
  Afrin, Neo-Synephrine, Sinex) and phenylephrine
                                                             Because decongestants produce a narrowing of the
  (Neo-Synephrine, Sinex). “Note: Decongestant
                                                             blood vessels, this effect may also increase blood
  nasal sprays may work more quickly but have a
                                                             pressure in patients who have high blood pressure.11
  rebound effect if you use them more than 3-5 days.
                                                             “If you have any of the conditions below, talk to your
  They are best for short-lived colds and not for
                                                             doctor before taking a decongestant:
  persistent allergies.”3
                                                             • heart disease,
“Until recently, pseudoephedrine has been the more
commonly used decongestant and the main active               • high blood pressure,
ingredient in many popular nonprescription cold and          • kidney disease,
allergy medications. Unfortunately, pseudoephedrine
is also a key ingredient in the production of                • glaucoma,
methamphetamine, a highly addictive illegal                  • thyroid disease,
stimulant. In an effort to combat methamphetamine
production, federal law has recently required                • diabetes,
that all nonprescription medications containing              • trouble urinating from an enlarged prostate
pseudoephedrine be taken off drugstore shelves                   gland.”14
and be stored behind the counter in the pharmacy.
To purchase these medications, you must go to the
pharmacy, show some form of government-issued
identification, and sign a logbook.”15




October/November 2009 – Vol. 13, No. 10/11               4         Stocking Your Medicine Cabinet—What to Have and Why
Cough Medicines                                             used in children aged less than 6 years. The FDA’s
Cough medicines are grouped into two types:                 Nonprescription Drugs Committee and Pediatric
                                                            Advisory Committee have since unanimously
• antitussives (cough suppressants), which act              recommended that these agents not be used in
  directly on the cough center in the brain to block        children aged less than 2 years and by majority vote
  the cough reflex; and                                      that they not be used in children aged less than 6
• expectorants, which work by loosening or thinning         years based on lack of evidence of effectiveness and
  the mucus or phlegm in the lungs and make                 increased risk of harm.
  coughing more productive to clear the mucus from          The Consumer Healthcare Products Association,
  the airway.7, 11                                          which represents manufacturers of OTC medications,
The most common cough suppressant medicine is               has issued a voluntary market recall of OTC cough
dextromethorphan, which can be found in products            and cold medications labeled for use in infants but
like Delsym, Drixoral, Robitussin DM, Simply Cough,         has also issued a position statement that cautioned
and Vicks 44.3, 7                                           against the recommendation to make cough and cold
                                                            medications unavailable to children aged 2 to 6 years.
Guaifenesin is the only expectorant used in OTC
                                                            The FDA has not yet ruled on these issues.”20
products such as Mucinex, Robitussin.3, 7, 19
                                                            As a complete consensus has not been fully reached,
Should I treat a cough?                                     the modified product labels of OTC cough and cold
“Most of the time, a cough doesn’t require treatment.       medicines to date state, “do not use in children under
It will go away on its own. Cough medicines may             4 years of age.”21 (Note that the old products may
be helpful if your cough is caused by a cold or the         not have been removed from the store shelves, and
flu (influenza). Some types of cough should not be            many of the products may currently state, “do not
treated with cough medicines because the cough is           use in children under 2 years of age.”21) Concerning
helping to keep the lungs clear so you can breathe.         combination cough and cold medicines, the U.S.
Examples include cough from smoking, emphysema,             National Library of Medicine’s Home Pharmacy
asthma, or chronic                                          document recommends “avoid combination cough
bronchitis.”19                                              and cold preparations in children under age 6 because
                                                            they have sometimes caused over-sedation and death.
Recently, attention
                                                            Above all, be sure that the medications you use do not
has focused on the
                                                            contain the same ingredients, which could lead to an
potential harmful
                                                            overdose.”3
effects of cough
and cold medicines                                          Obviously, some controversy still exists concerning
among children.                                             the safety and effectiveness of cough and cold
“Because of reports                                         medications in children ages 4-6 years.22 DO NOT
of unintentional                                            give OTC cough and cold medicine to a baby or child
overdoses of                                                under 4 years of age. Using these medicines in very
cough and cold                                              young children might cause serious or possibly life-
medications and                                             threatening side effects. When considering use in
links between these                                         older children, “understand that using OTC cough
medications and                                             and cold medicines does not cure the cold or cough.
infant deaths, a                                            These medicines only treat your child’s symptoms,
number of national                                          such as runny nose, congestion, fever, and aches.
pediatric experts                                           They do not shorten the length of time your child is
petitioned the U.S. Food and Drug Administration            sick.”21 Consider non-medicine options to relieve your
(FDA) to advise that these medications not be               young child’s symptoms, as well as your own. Talk
                                                            with your doctor about his/her recommendations.




Stocking Your Medicine Cabinet—What to Have and Why     5                  October/November 2009 – Vol. 13, No. 10/11
Stomach and Intestinal Problem Medicines                        daily for them to work. Start slowly, and drink
Four of the most common symptoms for which you                  plenty of fluids. Gradually increase how much you
may want stomach or intestinal medications are:                 use to reduce the chance of having any side effects.
• diarrhea,                                                  • Lubricant laxatives work by coating the surface of
                                                               the stools. This helps the stools to hold in water so
• constipation,                                                they move out of the body more easily. Glycerin
• heartburn, and                                               suppositories lubricate the inside of the anus (the
                                                               outside opening to the intestine) to make it easier
• nausea/vomiting.
                                                               to pass hard stools.
Antidiarrheals                                               • Stool softeners help mix fluid into stools to soften
Antidiarrheals are medicines that treat diarrhea.              them. This makes stools easier to pass out of the
There are two types of antidiarrheals available OTC.           body.
• Loperamide (e.g., Imodium) works by slowing                • Saline laxatives draw fluid into the bowel from
  down the speed of fluids moving through your                  nearby tissue. This softens stools and helps the
  bowels.3, 23                                                 bowel move them out.
• Bismuth subsalicylate (e.g., Kaopectate, Pepto-            • Stimulant laxatives (e.g., Ex-lax, Senokot25) are
  Bismol) works by balancing the way fluid moves                the harshest laxatives. They cause the bowel
  through your bowels. It also binds toxins (poisons)          to squeeze or contract to move the stools out.
  from bacteria so that they are not harmful and               Stimulant laxatives should generally be used only
  helps kill germs.3, 23                                       when your doctor recommends them, such as if
                                                               you’re preparing for a bowel exam or if you’ve just
Should I treat diarrhea?                                       had surgery and shouldn’t strain to have a bowel
Most of the time,                                              movement.26
diarrhea doesn’t
require treatment.                                           Should I use laxatives/treat constipation?
Most often, it lasts                                         “Most of the time, constipation doesn’t require
only a couple of days                                        treatment with laxatives. It will go away on its own
whether you treat it                                         or if you make changes in your diet and other habits.
or not. Sometimes                                            For example, you can treat constipation by eating
medicine can help                                            enough fiber, drinking enough fluids, and getting
you feel better,                                             enough exercise.”26 “Just because laxatives are
especially if you                                            available without a prescription doesn’t mean that
also have cramping.                                          they’re without risk. Laxative use can be dangerous if
However, don’t use                                           constipation is caused by a serious condition, such as
loperamide if you                                            appendicitis or a bowel obstruction. If you frequently
have bloody or black                                         use certain laxatives over a period of weeks or
stools, which may                                            months, they can decrease your colon’s natural
be signs of a more                                           ability to contract and actually worsen constipation.
serious problem; talk                                        In severe cases, overuse of laxatives can damage
to your doctor. Also, don’t give bismuth subsalicylate       nerves, muscles, and tissues of your large intestine.”25
to children who may have the flu or chickenpox                Don’t use laxatives in children under age 6 or if you
because they will have a higher risk of Reye’s               are pregnant unless under the specific direction of a
Syndrome.23                                                  doctor.25
                                                             “Talk to your doctor before using laxatives if you have
Laxatives                                                    the following:
Laxatives treat constipation. There are five different
kinds of laxatives:                                          • kidney disease;

• Bulk-forming laxatives (e.g., Metamucil, Citrucel24)       • heart disease or high blood pressure;
  add bulk and water to your stools. The larger              • stomach pain, nausea, vomiting, or rectal bleeding.
  stools help trigger the bowel to contract and move
  the stools out. You must use bulk-forming laxatives        Call your doctor if you’re taking laxatives and have
                                                             these symptoms:

October/November 2009 – Vol. 13, No. 10/11               6         Stocking Your Medicine Cabinet—What to Have and Why
• bloody stools or                                         diarrhea. These are usually temporary and will likely
                                                           go away on their own.
• constipation doesn’t improve after a week of
   laxative use.                                           When combined with lifestyle changes, these over-
                                                           the-counter remedies relieve symptoms in about
If you’re dependent on laxatives, ask your doctor for
                                                           25 percent of heartburn sufferers. People who have
advice on how to gradually withdraw from them and
                                                           more severe heartburn symptoms that aren’t relieved
restore your colon’s natural ability to contract.”25
                                                           with these medications or who have been using these
                                                           drugs for more than two weeks should contact their
Antacids or Acid Reducers
                                                           physician.”27
Antacids or acid reducers can relieve heartburn.
“Antacids neutralize excess stomach acid to relieve        Should I take an antacid?
heartburn, sour stomach, acid indigestion, and             “Before taking an antacid or acid reducer, talk to your
stomach upset. They are also occasionally prescribed       doctor if you have any of the following symptoms:
to help relieve the pain of ulcers. Some antacids
                                                           • trouble or pain when you swallow;
also contain simethicone, an ingredient that helps
eliminate                                                  • bloody vomit;
excess gas.
                                                           • bloody or black stools;
Examples
of antacids                                                • ongoing stomach pain;
include                                                    • lightheaded, dizzy, or sweaty feeling;
Tums,
Rolaids, and                                               • chest pain, shoulder pain, or pain that spreads to
Maalox.                                                       your arms, neck, or shoulders with shortness of
                                                              breath;
You should
take                                                       • weight loss for no reason;
antacids                                                   • nausea or vomiting;
exactly as directed by your doctor, or according to the
manufacturer’s directions. If you are using the tablets,   • wheezing (you’ll hear a squeaky or musical sound
chew them well before swallowing for faster relief.           in your chest);

Some antacids contain magnesium or sodium                  • heartburn that has lasted more than 3 months.
bicarbonate, ingredients that may have a laxative          You should stop using antacids or acid reducers and
effect.                                                     call your doctor if any of the following are true:
Side effects include constipation, diarrhea, white or       • Your stomach pain doesn’t get better when you use
pale bowel movements, and stomach cramps. Serious             the medicine, or it gets worse.
side effects can occur with an overdose or overuse of
antacids.                                                  • You need to take the medicine for more than 14
                                                              days.
Acid blockers. Pepcid AC, Tagamet HB, Zantac
75 (ranitidine), and Axid AR are H2 blockers or            • You’re taking Omeprazole (brand name: Prilosec)
acid-blocking drugs that are available without a              and feel like you need to take more than 1 course
prescription (over-the-counter). These products               in 4 months.
are for relief of heartburn, acid indigestion, and         Don’t try to treat yourself if you have any of these
sour stomach. Acid blockers work by reducing the           symptoms. They may be signs that you have an ulcer
production of stomach acid.                                or a more serious problem that needs to be checked
Take these medications according to the directions on      by your doctor.”28
the package or as advised by your doctor.
                                                           Antiemetics
Possible serious side effects that need to be reported      Antiemetic drugs are medicines that can help relieve
to your doctor right away include confusion, chest         nausea, vomiting, and motion sickness. Several OTC
tightness, bleeding, sore throat, fever, irregular         drugs are used as antiemetics.
heartbeat, weakness, and unusual fatigue. Other, less
serious, side effects include headache, dizziness, and      • “Bismuth subsalicylate (brand names: Kaopectate,
                                                             Pepto-Bismol) may help treat some types of
   nausea and vomiting, such as from the flu                   Should I take antiemetic drugs?
   (influenza). It’s also used for upset stomach and           As with any drug from the salicylate family (like
   as an antidiarrheal (medicine to treat diarrhea).”29       aspirin), don’t give this medicine to children or teens
   “Bismuth subsalicylate works by                            because of the risk for Reye’s Syndrome – a disease
   coating the stomach lining.”29                             affecting the brain and liver. Also, before taking an
                                                              antihistamine, talk with your doctor if you have any
• “Certain antihistamines may help
                                                              of the following problems:
  prevent nausea and vomiting
  caused by motion sickness. These                            • glaucoma;
  include dimenhydrinate (one
                                                              • trouble urinating (from an enlarged prostate
  brand name: Dramamine) and
                                                                 gland);
  meclizine hydrochloride (one
  brand name: Dramamine Less                                  • breathing problems, such as asthma, emphysema,
  Drowsy).”29 “Antihistamines                                    or chronic bronchitis;
  appear to dull how the inner                                • thyroid disease;
  ear senses motion. They ‘block’
  messages to the part of the brain that controls             • heart disease; or
  nausea and vomiting. This is why they work best if          • high blood pressure.29
  you take them before you think you might have a
  problem with motion sickness.”29




October/November 2009 – Vol. 13, No. 10/11                8         Stocking Your Medicine Cabinet—What to Have and Why
Topical Products                                         should not be used repeatedly, as it does not promote
“Topical products are those that can be applied to       healing.31
areas of the skin.”6 OTC topical products can be
effective in preventing and curing infection as well      Anti-fungal Creams
as relieving itching and aching, but it is important     Anti-fungal creams are commonly used to treat
to remember that medical creams and ointments            athlete’s foot (e.g., terbinafine [Lamisil], clotrimazole
available OTC for these conditions are not like          [Lotrimin], miconazole [Monistat-Derm]) or jock
moisturizing lotions and creams – they are medicines     itch (terbinafine [Lamisil AT], naftifine [Naftin],
that can “sometimes penetrate the skin and enter the     miconazole [Micatin, Monistat-Derm], clotrimazole
blood stream.”6                                          [Lotrimin AF]).32, 33 Your doctor can confirm if you
                                                         have one of these conditions. You may only need to
Antibiotic Ointment & Antiseptics                        put an antifungal cream on the rash for a few weeks.
Antibiotic ointments and antiseptics can be helpful in   This is especially true for jock itch. If the condition
preventing infection.                                    does not clear up, you may need a prescription
                                                         medication that can be taken by mouth for a longer
“Antibiotic ointments                                    period of time.34
(such as Bacitracin,
Neosporin,                                               Anti-fungal creams and suppositories are also
Polysporin3) help                                        available OTC to treat yeast infections. Some
healing by keeping                                       examples include miconazole (Monistat), clotrimazole
out infection and by                                     (Gyne-Lotrimin), and tioconazole (Vagistat). “Yeast
keeping the wound                                        infections may also be treated with an oral antifungal
clean and moist. A                                       medication, such as fluconazole (Diflucan). The
bandage does pretty                                      advantages of over-the-counter treatment for a yeast
much the same thing.                                     infection are convenience, cost, and not having to wait
If you have stitches,                                    to see your doctor. The catch is you may be treating
your doctor will tell                                    something other than a yeast infection. It’s possible to
you whether he or she                                    mistake a yeast infection for other types of vaginitis or
wants you to use an                                      other conditions that need different treatment. Using
antibiotic ointment.                                     the wrong medicine may delay a proper diagnosis
Most minor cuts and                                      and the most appropriate treatment, and can lead to
scrapes will heal just                                   complications.”35 It is important to see your doctor,
fine without antibiotic                                   especially the first time you suspect a yeast infection,
ointment, but it can speed healing and help reduce       so that you can know how to identify it correctly. Talk
scarring.”30 Be sure to first wash the area with cool     with your doctor about whether or not OTC yeast
water. You can hold the wound under running water        infection medicines are right for you.
or fill a tub with cool water and pour it from a cup
over the wound. For cuts, scrapes, and wounds,           Anti-itch Creams (e.g., Cortisone/hydrocortisone
irrigation with cool running water is usually best.      creams)
You can hold the wound under running water or fill        “If you develop redness, heat, swelling, and pain
a tub with cool water and pour it from a cup over the    on your skin when you come in contact with certain
wound.30 Use soap and a soft washcloth to clean the      substances, you may have what is known as ‘contact
skin around the wound. Try to keep soap out of the       dermatitis.’ Contact dermatitis is caused either by
wound itself because soap can cause irritation. Use      an allergy or a sensitivity (a non-allergic response)
tweezers that have been cleaned in isopropyl alcohol     to common substances.”36 Some common culprits
to remove any dirt that remains in the wound after       are poison ivy, detergents, or fragrances. You can
washing.30                                               treat mild cases of contact dermatitis yourself. Over-
                                                         the-counter medications such as calamine lotion,
Even though it may seem that you should use a            antihistamines, or cortisone creams and ointments
stronger cleansing solution (such as hydrogen            usually will relieve your discomfort. Talk with the
peroxide or an antiseptic), these things may irritate    pharmacist about recommended products.36
wounds. Ask your family doctor if you feel you
must use something other than water.30 An initial        “If you have frequent and/or severe outbreaks of
cleansing of a wound with antiseptic (e.g., hydrogen     contact dermatitis, consult a physician. A proper
peroxide) may be appropriate to reduce infection, but    diagnosis along with identification of key allergens
and stronger prescription medications will help you                                      “…Products with methyl salicylate should not be
manage your skin allergy effectively.”36                                                  used for more than seven days and should not be
                                                                                         applied to wounds or damaged skin. They should not
Muscle-ache Creams                                                                       be used under a tight bandage, and contact with eyes
“Many athletes use muscle-ache creams that contain                                       should be avoided.
methyl salicylate. Also known as oil of wintergreen,
methyl salicylate is an aspirin-type ingredient                                          FDA requires the labeling of any drug containing
of many topical creams that relieves pain. Used                                          more than 5 percent methyl salicylate to include
correctly, creams containing methyl salicylate can                                       warnings that cover such precautions as keeping the
provide temporary relief from minor aches and                                            product out of children’s reach and using the product
pains of muscles and joints associated with simple                                       as directed.”6 Remember that salicylates are part of
backache, arthritis, strains, bruises, and sprains.                                      the aspirin family, which should not be used in young
                                                                                         children and teens due to the risk of Reye’s Syndrome.
As with all medications, misuse of these products can                                    Talk with your doctor about muscle-ache cream use
cause harm.”6                                                                            for your child.




                                                 To view the references used in this document,
                                                 go to: http://fcs.tamu.edu/health/
                                                 healthhints/2009/nov/otc-medicines-ref.php.


   Educational programs of the Texas AgriLife Extension Service are open to all people without regard to race, color, sex, disability, religion, age, or national origin.
                  The Texas A&M University System, U.S. Department of Agriculture, and the County Commissioners Courts of Texas Cooperating


October/November 2009 – Vol. 13, No. 10/11                                          10           Stocking Your Medicine Cabinet—What to Have and Why

				
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