Consumers and providers should carefully read the “Drug Facts” label (Figure 63–1) to determine which ingredients are appropriate based on the patient’s symptoms, underlying health conditions, and whatever is known about the medications the patient is already taking. Many products with the same brand name contain different ingredients that are labeled for different uses. For example, multiple products (with different active ingredients) carry the Allegra name, including Allegra Allergy (fexofenadine), Allegra-D (fexofenadine and pseudoephedrine), and Allegra Anti-Itch Cream (allantoin and diphenhydramine).
4.
Recommend a generic product if one is available.
5.
Be wary of claims of specific superiority over similar products.
6.
For children, the dose, dosage form, and palatability of the product are prime considerations.
Certain ingredients in OTC products should be avoided or used with caution in selected patients because they may exacerbate existing medical problems or interact with other medications the patient is taking. The presence of many of the more potent OTC ingredients may be unexpectedly hidden in products (Table 63–3). Although OTC medications have standardized label formatting and content requirements (Figure 63–1), many consumers do not carefully read or comprehend this information. Lack of awareness of the ingredients in OTC products and the belief by many patients and providers that OTC products are ineffective and harmless may cause diagnostic confusion and compromise therapeutic management. For example, innumerable OTC products, including analgesics and allergy, cough, and cold preparations, contain sympathomimetics. These agents should be avoided or used cautiously by patients with type 1 diabetes and patients with hypertension, angina, or hyperthyroidism. Aspirin should not be used in children and adolescents for viral infections (with or without fever) because of an increased risk of Reye’s syndrome. Aspirin and other NSAIDs should be avoided by individuals with active peptic ulcer disease, certain platelet disorders and patients taking oral anticoagulants. Cimetidine, an H2 antagonist, is a well-known inhibitor of hepatic drug metabolism and can increase the blood levels and toxicity of agents such as phenytoin, theophylline, and warfarin.
Overuse or misuse of OTC products may cause significant medical problems. A prime example is rhinitis medicamentosa or “rebound rhinitis,” a condition that manifests as nasal congestion without rhinorrhea, associated with the regular use of topical decongestant nasal sprays for more than 3 days. The improper and long-term use of some antacids (eg, aluminum hydroxide) may cause constipation and even impaction in the elderly, as well as hypophosphatemia. Long-term laxative use can result in abdominal cramping and fluid and electrolyte disturbances. A condition known as laxative abuse syndrome is often observed in women with anorexia nervosa. Insomnia, nervousness, and restlessness can result from the use of sympathomimetics or caffeine present in many OTC products (Table 63–3). The long-term use of analgesics containing caffeine may trigger rebound headaches upon discontinuation. OTC products containing aspirin, other salicylates, acetaminophen, ibuprofen, or naproxen may increase the risk of hepatotoxicity and gastrointestinal hemorrhage in individuals who consume three or more alcoholic drinks daily, and long-term use of these products has been associated with interstitial nephritis. Acute ingestion of large amounts of
Chlorpheniramine maleate 2 mg . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Antihistamine
Uses temporarily relieves these symptoms due to hay fever or other upper respiratory allergies: Sneezing
Runny nose Itchy, watery eyes Itchy throat