FM/CFS/ME RESOURCES - Over-The-Counter (OTC) Medications


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Over-The-Counter (OTC) Medications OTC Medications

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.

The U.S. Food and Drug Administration (FDA) determines whether medicines are prescription or nonprescription. The term prescription (Rx) refers to medicines that are safe and effective when used under a doctor's care. Nonprescription or OTC drugs are medicines FDA decides are safe and effective for use without a doctor's prescription.

The FDA also has the authority to decide when a prescription drug is safe enough to be sold directly to consumers over the counter. This regulatory process allowing Americans to take a more active role in their health care is known as Rx-to-OTC switch. As a result of this process, more than 700 products sold over the counter today use ingredients or dosage strengths available only by prescription 30 years ago. Choose from the information below to learn more about OTC medications.

On The Label

You wouldn't ignore your doctor's instructions for using a prescription drug; so don't ignore the label when taking an OTC medicine. Here's what to look for:

  • Active Ingredients: The active ingredient is the chemical compound in the medicine that works to relieve your symptoms. It is always the first item on the label. There may be more than one active ingredient in a product. The label will clearly show this. Make sure the Active Ingredients aren't the same as those in other medicine already being used. If the medicine contains more than one Active Ingredient, read the Purposes of each active ingredient to make sure all of the active ingredients are needed for the problem(s) or symptom(s) to be treated.

  • Purpose: This is the product category (such as antihistamine, antacid, or cough suppressant)

  • Uses: This section lists the symptoms the medicine is meant to treat. The U.S. Food and Drug Administration (FDA) must approve these uses. Uses are sometimes referred to as "indications." Find medicine that treats only the problem(s) or symptom(s) to be treated.

  • Warnings: This safety information will tell you what other medicines, foods or situations (such as driving) to avoid while taking this medicine. Before taking a medication ask yourself is there any reason this medicine shouldn't be used? Is there any reason to talk to a doctor or pharmacist before using this medicine?

  • Directions: Information about how much medicine you should take and how often you should take it will be listed here. Before buying or taking a medication find the correct dose on the package. Make sure liquid medicine comes with a measuring tool (such as dosing or measuring cup). If not, ask for one at the pharmacy. Spoons made for eating and cooking may give the wrong dose and shouldn't be used.

  • Other Information: Any other important information, such as how to store the product, will be listed here.

  • Inactive Ingredients: An inactive ingredient is a chemical compound in the medicine that isn't meant to treat a symptom. Inactive ingredients can include preservatives, binding agents and food coloring. This section is especially important for people who know they have allergies to food coloring or other chemicals.

  • Questions or Comments: A toll-free number is provided to address any questions or comments you may have about the medicine.

If necessary, use your glasses or contact lenses when reading labels. Always remember to look for the statement describing the tamper-evident feature(s) before you buy the product and when you use it.

When it comes to medicines, more does not necessarily mean better. You should never misuse OTC medicines by taking them longer or in higher doses than the label recommends. Symptoms that persist are a clear signal it's time to see a doctor.

Be sure to read the label each time you purchase a product. Just because two or more products are from the same brand family doesn't mean they are meant to treat the same conditions or contain the same ingredients.

Remember, if you read the label and still have questions, talk to a doctor, nurse, or pharmacist.

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Drug Interactions

Although mild and relatively uncommon, interactions involving OTC drugs can produce unwanted results or make medicines less effective. It's especially important to know about drug interactions if you're taking prescription and OTC drugs at the same time.

Some drugs can also interact with foods and beverages, as well as with health conditions such as diabetes, kidney disease, and high blood pressure. Here are a few drug interaction cautions for some common OTC ingredients:

  • Avoid alcohol if you are taking antihistamines, cough-cold products with the ingredient dextromethorphan, or drugs that treat sleeplessness.

  • Do not use drugs that treat sleeplessness if you are taking prescription sedatives or tranquilizers.

  • Check with your doctor before taking products containing aspirin if you're taking a prescription blood thinner or if you have diabetes or gout.

  • Do not use laxatives when you have stomach pain, nausea, or vomiting.

  • Unless directed by a doctor, do not use a nasal decongestant if you are taking a prescription drug for high blood pressure or depression, or if you have heart or thyroid disease, diabetes, or prostate problems.

This is not a complete list. Read the label! Drug labels change as new information becomes available. That's why it's important to read the label each time you take medicine.

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Potential Side Effects

While OTC medicines have a low risk of side effects when used occasionally by healthy adults, they can pose risks for very young children, the elderly, people with kidney problems and people taking more than one medicine. These people have an increased risk of side effects when they take OTC medicines. Potential side effects are described below.

Aspirin and NSAIDs
The main side effect associated with aspirin and other NSAIDs is gastrointestinal (GI) problems. These problems can range from upset stomach to GI bleeding, a serious event that is most likely to occur in older people. The chances of experiencing GI problems from NSAIDs or aspirin increase the larger the dose you take and the longer you take them.

NSAIDs can cause a variety of side effects related to kidney function. These side effects range from reversible inflammation to permanent kidney damage. Aspirin and NSAIDs may make high blood pressure worse or interfere with blood pressure medicines. High doses of aspirin pose a risk of liver damage for people who have liver disease, juvenile arthritis or rheumatic fever.

Although safe in the majority of users, long-term use of high doses of acetaminophen, especially in products that also contain caffeine (such as Excedrin®) or codeine (such as Tylenol® with Codeine), has been shown to cause a form of kidney disease called analgesic nephropathy. This serious condition may develop after years or decades of daily use.

Antihistamines can cause sedation or drowsiness and, therefore, can significantly impair a person's ability to drive or operate machinery. The sedative effects of antihistamines may increase the risk of falling. Antihistamines can also cause temporary dry mouth or eyes.

Pseudoephedrine can temporarily cause nervousness, dizziness and sleeplessness. It can make you lose your appetite or retain urine. It can also cause heart palpitations, high blood pressure or high blood sugar levels.

Cough Medicines
Codeine, when used as a cough suppressant, can temporarily cause nausea, sedation and constipation. Dextromethorphan, the medicine in Drixoral®, Pertussin CS® and Robitussin®, has a lower risk of sedation and GI side effects. It can, however, cause feelings of confusion, agitation, nervousness or irritability.

Drug-Drug Interactions
The body processes (metabolizes) every drug differently. If drugs are used together, their metabolism and effect on the body can change. When this happens, the chance that you will have side effects for each drug may become greater.

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Medicine Cabinet Checkup

Many of us with a chronic medical condition such as FM or CFS/ME take medication on a daily basis. There are always a host of medications, both prescription and OTC, that reside in our medicine cabinets. It's important to check your medicine supply at least once a year. Here are a few things you should look for:

  • To make sure no one takes the wrong medicine, be sure to keep all medicines in their original containers.

  • Throw away any medicines that are past the expiration date. This includes vitamins, pain relievers, antacids, etc.

  • Remember to always store medicines in a cool, dry place. The bathroom, despite its popularity, is one of the worst places to keep certain medicines because a warm, humid atmosphere may reduce their effectiveness. Consider creating a drug drawer in your bedroom night stand, or purchasing an inexpensive fishing tackle box in which to store your medications.

  • Keep Tubes Of Ointment Or Creams Away From Your Toothpaste. Tubes can feel very similar when making a quick grab on a rushed morning. The results can leave more that just a bad taste in your mouth.

  • Keep Drugs Out Of Reach Of Children And Pets. If you have children, or children come to your home, make sure that child safety caps are always secured.

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Pregnancy and Breast-Feeding

Drugs can pass from a pregnant woman to her unborn baby. A safe amount of medicine for the mother may be too much for the unborn baby. If you're pregnant, always talk with your doctor before taking any drugs, Rx or OTC.

Although most drugs pass into breast milk in concentrations too low to have any unwanted effects on the baby, breast-feeding mothers still need to be careful. Always ask your doctor or pharmacist before taking any medicine while breast-feeding. A doctor or pharmacist can tell you how to adjust the timing and dosing of most medicines so the baby is exposed to the lowest amount possible, or whether the drugs should be avoided altogether.

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Four Common OTC Medications

The four most common types of OTC products and how each works:

Pain Relievers
The OTC products that relieve your headache, fever or muscle aches are not all the same. That's because the pain relievers you see in the aisles of your local drug store or pharmacy are either nonsteroidal anti-inflammatory drugs (called NSAIDs, which include aspirin, ibuprofen, naproxen and ketoprofen) or acetaminophen. Each of these drugs has a different way of working

Aspirin and NSAIDs relieve pain by stopping the production of prostaglandins, which are natural chemicals in the body. Prostaglandins irritate nerve endings, triggering the sensation of pain. Commonly used NSAIDs include:

  • Aspirin, the medicine in products such as Bayer® and St. Joseph®
  • Ibuprofen, the medicine in products such as Advil® and Motrin IB®
  • Naproxen, the medicine in products such as Aleve®
  • Ketoprofen, the medicine in products such as Orudis KT®

Acetaminophen relieves pain and reduces fever. We don't completely understand the way acetaminophen relieves pain. We do know that unlike aspirin and NSAIDs (which work in the skin, muscles and joints), acetaminophen blocks painful sensation in the brain and the spinal cord.

Antihistamines work by blocking the receptors that trigger itching, nasal irritation, sneezing and mucus production. The three types of antihistamines are:

  • Diphenhydramine, the medicine in products such as Banophen, Benadryl Allergy and Diphenhist

  • Brompheniramine, the medicine in products such as Dimetapp Allergy

  • Chlorpheniramine, the medicine in products such as Aller-Chlor, Chlo-Amine and Chlor-Trimeton Allergy

Decongestants work by narrowing blood vessels in the lining of the nose. As a result, less blood is able to flow through the nasal area, and swollen tissue inside the nose shrinks. Pseudoephedrine is the only decongestant used in OTC products. Pseudoephedrine is in products such as Allermed, Genaphed and Sudafed.

Cough Medicines
Cough medicines are grouped into two types: antitussives and expectorants. Antitussives, or cough suppressants, block the cough reflex.

  • Dextromethorphan is a common antitussive and is in products such as Delsym, Drixoral, Pertussin CS and Robitussin Pediatric

Expectorants, on the other hand, are thought to thin mucus and make coughing more productive in clearing the mucus from the airway.

  • Guaifenesin is the only expectorant used in OTC products and is in products such as Guiatuss, Robitussin and Tusibron. Guaifenesin is also used in the treatment of fibromyalgia (FM). If you're already using Guaifenesin for FM be sure not to over-dose yourself by using products containing Guaifenesin without first talking to your doctor or pharmacist.

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Alcohol and OTC Medicines

Pain Relievers
If you drink more than 1 alcoholic beverage per week and use NSAIDs, including aspirin, you may be at increased risk of GI bleeding. People who consume 3 or more alcoholic beverages each day should consult their physician before using any pain reliever.

Acetaminophen is much less likely than NSAIDs to be associated with GI problems, including bleeding. But to minimize the risk of serious liver injury, you should never take more than the recommended daily dose (4g per day).

Antihistamines, Decongestants and Cough Medicines
The combination of OTC antihistamines and alcohol can increase drowsiness, especially in elderly people. In addition, alcohol makes the drowsiness, sedation and impaired motor skills associated with the cough suppressants dextromethorphan (in products such as Drixoral®, Robitussin®) and codeine worse.

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OTC drugs rarely come in one-size-fits-all. Here are some tips about giving OTC medicines to children:

  • Children aren't just small adults, so don't estimate the dose based on their size

  • Read the label. Follow all directions

  • Follow any age limits on the label

  • Some OTC products come in different strengths. Be aware!

  • Know the difference between TBSP (tablespoon) and TSP (teaspoon). They are very different doses

  • Be careful about converting dose instructions. If the label says two teaspoons, it's best to use a measuring spoon or a dosing cup marked in teaspoons, not a common kitchen spoon.

  • Don't play doctor. Don't double the dose just because your child seems sicker than last time.

  • Before you give your child two medicines at the same time, talk to your doctor or pharmacist.

  • Never let children take medicine by themselves.

  • Never call medicine candy to get your kids to take it. If they come across the medicine on their own, they're likely to remember that you called it candy.

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Child-Resistant Packaging

Child-resistant closures are designed for repeated use to make it difficult for children to open. Remember, if you don't re-lock the closure after each use, the child-resistant device can't do its job keeping children out!

It's best to store all medicines and dietary supplements where children can neither see nor reach them. Containers of pills should not be left on the kitchen counter as a reminder. Purses and briefcases are among the worst places to hide medicines from curious kids. And since children are natural mimics, it's a good idea not to take medicine in front of them. They may be tempted to "play doctor" with your medicine later on.

If you find some packages too difficult to open, and you don't have young children living with you or visiting, you should know the law allows one package size for each OTC medicine to be sold without child-resistant features. If you don't see it on the store shelf, ask.

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Protect Yourself Against Tampering

Makers of OTC medicines seal most products in tamper-evident packaging (TEP) to help protect against criminal tampering. TEP works by providing visible evidence if the package has been disturbed. But OTC packaging cannot be 100 percent tamper-proof. Here's how to help protect yourself:

  • Be alert to the tamper-evident features on the package before you open it. These features are described on the label

  • Inspect the outer packaging before you buy it. When you get home, inspect the medicine inside

  • Don't buy an OTC product if the packaging is damaged in any way

  • Don't use any medicine that looks discolored or different in any way

  • If anything looks suspicious, be suspicious. Contact the store where you bought the product and take it back!

  • Never take medicines in the dark

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OTC Checklist

Information you need before going to the store:

  • Problems(s) or symptoms(s) to be treated
  • Allergies or other health problems
  • Any medicine used for this problem before or medicine recommended by the doctor
  • Other medicines (OTC and Rx), vitamins, and other dietary supplements being used

At the store:

  • Find the group of medicines that treats the problem(s) or symptom(s) (such as pain, cough, or allergy).

  • Find the form of medicine (such as tablet, capsule, or liquid) wanted.

  • Check with the doctor or pharmacist to be sure the new medicine can be used with other medicines being used.

  • Read the "Drug Facts" label carefully on each medicine package.

More information about the drug facts label.

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How to Get the Most from Your Medicine

OTC medicines can help you feel better. But if they are taken the wrong way, they can actually make you feel worse. To use OTC medicines correctly, follow the guidelines below.

Talk to your family doctor
If there is something you don't understand about a medicine you're taking or are planning to take, ask your doctor or pharmacist. If you still don't understand, ask them to explain things more clearly. If you are taking more than one medicine, be sure to ask how the medicines will work together in your body. Sometimes medicines cause problems when they are taken together. This is called a drug interaction.

Below is a list of questions you can ask your doctor to learn how to use each medicine correctly and safely:

  • What does the medicine do?
  • When and how should I take the medicine?
  • What are the possible side effects (reactions your body may have to the medicine)?
  • Will the medicine react to any other medicines, foods or drinks?
  • Should I avoid any activities while I'm taking the medicine?
  • How will I know if the medicine is working?

Know about the medicine you take
You should know the following things about each medicine you take:

  • Name (generic name and brand name)
  • Reason for taking it
  • How much to take and how often to take it
  • Possible side effects and what to do if you experience them
  • How long to continue taking the medicine
  • Special instructions (taking it at bedtime or with meals, etc.)

Know what to avoid while taking the medicine
Some foods can cause side effects, such as upset stomach, if you are taking medicine. Drinking alcohol is generally not a good idea while you are taking medicine. Some medicines cause reactions such as sun sensitivity (getting a sunburn or sun rash), so you may have to limit your outdoor activities or protect your skin from the sun.

Read the label to see what to avoid while you are taking an over-the-counter medicine. Follow the instructions just as you would with a prescription medicine. If you have questions, ask your doctor or pharmacist.

Follow these dos and don'ts:

  • Do read the label carefully.
  • Do take your medicine exactly as your doctor tells you to.
  • Do make sure that all of your doctors have a list of your current medicines.
  • Do make sure your family knows what medicine you're taking and when you're to take it

  • Don't combine Rx medicines and OTC medicines unless your doctor says it's okay
  • Don't stop taking a medicine without first talking to your doctor
  • Don't change how often you take a medicine without first talking to your doctor
  • Don't take someone else's medicine
  • Don't use medicine after its expiration date
  • Don't crush, break or chew tablets or capsules unless your doctor tells you to.

Understand generic vs. brand name
Medicines come in both brand names and generics. Generic medicines are generally cheaper. Compare the list of ingredients. If the generic has the same ingredients as the brand name, you may want to consider using it. But be careful: the generic may contain different amounts of certain medicines. Ask your doctor or pharmacist if you have questions about which medicine to choose.

Follow these tips for choosing medicines

  • If you have questions, ask your doctor or pharmacist
  • Although it can seem overwhelming, take the time to look at all the choices
  • Read the label carefully and note what symptoms the medicine will treat
  • Look for a medicine that will treat only the symptoms you have
  • Note how much medicine you should take, and what side effects it may cause
  • Note what medicines or foods you should not take with the medicine
  • Check to see if the medicine causes problems for people with certain health problems (such as asthma, glaucoma or hypertension)

Know when to call your doctor
If you're taking an OTC medicine and it doesn't seem to be working, call your doctor. Your symptoms can get much worse if you wait too long to get treated by your doctor. Call your doctor if you have side effects or any concerns about the medicine you're taking.

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