First-generation antihistamines (chlorpheniramine, clemastine, diphenhydramine) may cause excitability in children.
Second-generation antihistamines (cetirizine, fexofenadine, levocetirizine, loratadine) have minimal anticholinergic effects and are associated with lower chances of sedation.
TABLE 63–2 Ingredients of known efficacy for selected over-the-counter (OTC) classes. (Continued)
Temporary relief of upset stomach with heartburn, acid indigestion, and sour stomach. Products containing simethicone are used for relief of bloating, pressure, or gas symptoms.
To control symptoms of diarrhea (including traveler’s diarrhea). Bismuth-containing products are also used to relieve upset stomach symptoms (indigestion, heartburn, nausea, gas, belching).
Avoid use in patients with: severe renal impairment (aluminumand sodium-containing products); heart failure or high blood pressure (sodium-containing products).
Adverse effects include: diarrhea (magnesium preparations) and constipation (aluminum preparations).
Avoid use in patients: taking salicylate products; with allergies to aspirin; with bleeding disorders; with peptic ulcer disease; with bloody or black stool; in children or teenagers with chickenpox or flu-like symptoms due to an increased risk of Reye’s syndrome.
Combinations of magnesium and aluminum hydroxide are less likely to cause constipation or diarrhea and offer high neutralizing capacity.
With prolonged use, antacids may cause “acid rebound” (paradoxical acid hyper-secretory state associated with increased gastrin levels).
Antacids can significantly reduce the absorption of many prescription drugs.
Antidiarrheal agents should not be used if diarrhea occurs with fever >100°F or if blood or mucus present in stool.
Bismuth-containing products may be used as part of combination therapy for Helicobacter pylori eradication therapy.
Loperamide, a synthetic opioid, is not considered a controlled substance but is sometimes abused in high doses for euphoric opioid-like effects.
TABLE 63–2 Ingredients of known efficacy for selected over-the-counter (OTC) classes. (Continued)
Miconazole (Desenex, Lotrimin AF)
Miconazole (Monistat-1, Monistat-3, Monistat-7, Vagistat-3)
Tioconazole (Monistat-1 1-Day, Vagistat-1)
Dextromethorphan (Delsym, Robitussin Cough, Vicks 44)
Relieves itching, burning, scaling, chafing, and discomfort associated with tinea pedis (athlete’s foot), tinea cruris (jock itch), and tinea corporis (ringworm).
Treatment of vaginal yeast (candidiasis) infections and for the relief of external vulvar itching and irritation associated with vaginal yeast infections.
Temporary relief of cough due to minor throat and bronchial irritation with the common cold or inhaled irritants.
For external use only. Avoid contact with eyes, nose, mouth, or other mucous membranes. Avoid use: in children <2 years of age (clotrimazole, miconazole, tolnaftate) or children <12 years of age (butenafine, terbinafine).
Adverse effects include: erythema, irritation, itching, and burning.
For vaginal use only. Avoid use: in children <12 years of age; if patient has lower abdominal, back, or shoulder pain, or fever, chills, nausea, vomiting, or foul-smelling vaginal discharge; in combination with tampons, douches, spermicides, or other vaginal products.