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Stocking Your Medicine Cabinet –
What to have and why

October/November 2009 – Vol. 13, No. 10/11

Editor: Janet M. Pollard, MPH

Fall has arrived, and with it comes another season of cold and influenza (“flu”) viruses. It is believed that these viruses are more easily spread in the fall and winter months because we begin to spend more time indoors and in close proximity to one another, thus, making the spread of the illness more prevalent.

Cold and flu may not be the only thing peaking where you live. For some people, allergies are in high gear as the seasons change, blowing in new allergens that may not have been present in the months before. And, although there is conflicting evidence, many people with arthritic-type pain say it peaks when the weather changes to cold, rainy days.¹ Fall sports and exercise are also in gear, bringing people out to the field – and muscle pain issues along with it.

No matter what the time of year, most all of us will experience discomfort of some sort at some time that may not be severe enough to require immediate attention from a doctor, but it could use some self-care at home. In spite of our best efforts to prevent the transfer of viruses to one another, sometimes we end up sick. And, in spite of our efforts to prevent injuries and accidents, they sometimes happen. For some individuals, pain due to chronic conditions like orthopedic impairments, arthritis, fibromyalgia, or other rheumatic conditions² is part of everyday life. In fact, almost half of all Americans (about 133 million) live with at least one chronic condition.³ Knowing how to handle these conditions at home can improve life quality.

If you are experiencing pain or discomfort due to illness or injury, the best thing to do is to call your doctor to ensure the best course of treatment can be started early.⁴ “Usually, colds and flu simply have to run their course.”⁴ These illnesses are viral in nature (caused by viruses not bacteria); they can’t be fought with antibiotics – only bacterial infections can be fought off with antibiotics. It is helpful to know your medicine and non-medicine options for self-care so you can care for pain and discomfort appropriately at home when needed. This issue of HealthHints will act as a guide to what over-the-counter (OTC) medicines are commonly available and how to use them safely, as well as non-medicine options that may work just as well for particular ailments/symptoms.

Choosing & Using OTC Medicines: Know what you’re taking

Over-the-counter medicines are those you can get without a prescription from your doctor; however, this does not mean they cannot be harmful. It is important to use only the medicine you need, in the amount (dose) you need, for the appropriate time period to be safe and effective. It is common for people to think that OTC medicines are safe at any dose and in any combination, simply because they are sold without a prescription. People often think “more is better” or “an adult dose cut in half is about the amount appropriate for a child.” None of these statements could be further from the truth.

“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.

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.”⁵

Here are some important guidelines to follow when purchasing and taking (or giving) OTC medicines.

Before you take an OTC medicine, read and thoroughly understand the information on the “Drug Facts” label.⁶ Reading this information may be overwhelming considering the number of OTC drugs available, but take the time. “Next to the medicine itself, label comprehension is the most important part of self-care with OTC medicines.”⁵ Read the label every time – even if you have taken or given the medicine before – to make sure there have been no changes and you are giving or taking the medicine safely and appropriately. The Drug Facts label contains the following items:

• Active Ingredient. Know the “active ingredient.” It is what makes the medicine work and is listed at the top of the Drug Facts label. Sometimes an active ingredient can be used to treat more than one medical condition. For example, an active ingredient used to treat headache may also be used in cold medicines.⁷ “Two medicines with the same active ingredient should NOT be used at the same time.”⁸ Doing so can result in an overdose.
• Uses. This section of the label tells you about the problems the medicine will treat. Look for a product that will treat only the symptom(s) you have.⁹ For example, if you have a runny nose, don’t choose a product that also treats coughs and headaches.⁶ There is no point in taking extra medicines that you don’t need.
• Warnings. This section tells you when you should talk to your doctor first and when you shouldn’t use the medicine (such as when pregnant or breast-feeding, when you have a chronic health condition, or when you are taking other drugs that might negatively interact with this one). The warnings section also tells you about possible side effects, when you should stop taking the medicine, and things you shouldn’t do while using the medicine (e.g., eating certain foods, driving or operating machinery if the medicine has a sedating effect). And, of course, it tells you to keep medicines away from children.⁹
• Directions. This section tells you how to safely use the medication – how much to use, how often to use it, and for how long you can use it.⁹ Be very careful when giving medicines to children. When possible, use the child’s weight rather than age for dosing purposes. Never guess how much to give a child. Note that “infant” drops are often significantly stronger than the “children’s” version of the same medicine – so do not give a larger dose of infant medicine to young children.¹⁰ Never try to cut adult strength medicines in half or estimate a child’s dose from an adult product.¹¹ Know your measurements – a tablespoon is abbreviated tbsp. and a teaspoon is abbreviated tsp. A tablespoon holds three times as much as a teaspoon. A teaspoon is equal to “5 cc” or “5 ml.” Use the dosing tool provided with the medicine. If one is not provided, ask your local pharmacist for one, or purchase one at your local drug store. Never use a kitchen measuring spoon, which could provide an inaccurate dose.⁷
• Other Information. This section tells you how to store your medicine when you aren’t using it (e.g., at what temperature, away from moisture or direct sunlight).⁹
• Inactive Ingredients. The inactive ingredients are mixed with the active ingredients to form a pill, add color or flavor, or help the medicine last longer.⁹ The inactive ingredients do not help to treat the symptoms, but you should be aware of them if you or someone in your care is allergic to such ingredients.

You will also want to note the expiration date. This date is not found on the Drugs Fact label, but should be imprinted elsewhere on the label. It lets you know the date after which you shouldn’t use the medicine. It is important to dispose of medicines after their expiration date since they may have lost their effectiveness or become harmful in some way. For information on the safe and proper disposal of your medicines, see How to Dispose of Unused Medicines.

Don’t forget to check the packaging and contents when you purchase medicines. “First, check the outside packaging for such things as cuts, slices, or tears. Second, once you are at home, check the label on the inside package to be sure you have the right medicine. Make sure the lid and seal are not broken. Third, check the color, shape, size, and smell of the medicine. If you notice anything different or unusual, talk to a pharmacist or another healthcare professional.”⁷

Store medicines away from heat, moisture, and sunlight in a place out of reach of children. If, for any reason, you suspect overdose, contact the Poison Control Hotline at 1-800-222-1222 (open 24 hours a day, 7 days a week), or call 9-1-1.

Using Multiple Medications: Safety and effectiveness

Sometimes you need more than one medicine when treating an illness or injury. In these cases, it is important to watch for:

• duplicate ingredients and
• duplicate usage.

Duplicate ingredients. Check the active ingredient(s) in each OTC medicine to make sure you are not taking (or giving) more than one product with the same active ingredient. Because many cough and cold preparations contain the same active ingredient as pain relievers, it is possible to take (give) two different products that contain the same active ingredient without realizing it.¹¹ In fact, there are over 600 products that contain acetaminophen.¹² Consider the possibilities, and be sure to double check the Drug Facts label.

Duplicate usage. Check that you aren’t using two medicines to treat the same symptom. For example, two cold medicines could contain different active ingredients, but both of those ingredients act as fever reducers. That’s duplicate usage and should be avoided.¹¹

Don’t hesitate to ask your doctor if you have questions or need advice on product selection.¹¹

Always talk with your doctor before starting any OTC medicines if you are already taking prescription medicines. Drug interactions can cause severe negative side effects. Always let your doctor know about any medications, vitamins, or herbal supplements you are taking to avoid negative drug interactions.

Know Your Non-Medicine Options: What you can do without medicine

Many medicines are used simply to treat symptoms, and although they may make you feel better for a time, they will not “cure” your illness or injury. Cough and cold medicines, especially, have come under scrutiny as to their safety and effectiveness for children under 6 years old.¹³ Cold and influenza (“flu”) (PDF) are caused by viruses that usually have to run their course and cannot be treated with antibiotics (which only fight bacterial infections – not viruses). In many cases, there are non-medicine, self-care measures you can take that may be just as effective at relieving symptoms as OTC medications. Here are some non-medicine options that may be effective:

• Rest. Stay home and rest, especially if you have a fever.¹⁴ Getting more sleep helps your immune system fight infection. Rest is also often prescribed for minor injury to muscles and joints.
• Fluids. Drink plenty of liquids such as water, juice, and warm soups to prevent dehydration during the loss of bodily fluids from diarrhea, vomiting, perspiration, and nasal secretions.¹⁵ Note, however, that infants and children in particular may need oral rehydration solutions rather than plain water or other fluids.^16,17
• Chicken soup. Chicken soup really can help illness by breaking up congestion.¹⁸
• Gargle. Gargle with warm salt water a few times a day to relieve a sore throat.¹⁴
• Saltwater (saline) drops. Use these drops a few times a day in the nostrils to thin nasal discharge and relieve nasal congestion.^14,19 They can be purchased OTC at any pharmacy. For infants, you will need to use the saline solution and a suctioning bulb to help relieve the nasal passages.
• Cool-mist humidifier. Use a cool-mist humidifier to keep moisture in the air to loosen congestion.13,15
• Petroleum jelly. Use on the skin under the nose to relieve rawness.
• Steam. Use steam from a shower for congestion to help you breath more easily and to relieve sinus pain. You can also drape a towel over your head and breath steam in from a bowl of hot water.19,20
• Warm compresses. Place warm, damp towels around your nose, cheeks, and eyes to ease facial pain from sinuses.²⁰
• Warm bath or heating pad. Take a warm bath or use a heating pad to soothe aches and pains during a cold or flu.¹⁹ Note: If you or your child has fever, extra heat will only complicate the problem. Try a tepid bath or cool cloth to reduce fever.
• Cold or heat therapy for minor muscle or joint pain. An ice pack or frozen beans wrapped in a towel may help relieve minor aches and pains from joints and muscles. The cold can help reduce swelling and inflammation by constricting blood vessels. For some individuals, heat from a warm bath or heating pad may work. Heat therapy increases blood circulation, which can aid the healing of damaged tissues. Heat also allows tissues to stretch more easily, resulting in less stiffness, greater flexibility, and less pain.^21,22
• Chest physical therapy. This type of therapy can loosen mucus and may help infants and young children to cough it out. Lay your child across your knees, face down; cup your hand, and gently tap your child’s back. Or sit your child on your lap; lean her body forward about 30 degrees; cup your hand, and gently tap her back.¹³
• Honey. To relieve a cough, try half a teaspoon of honey for children aged 2 to 5 years; 1 teaspoon for children aged 6 to 11 years; and 2 teaspoons for children 12 years and older. If honey is given at bedtime, make sure you brush your child’s teeth afterward. Remember, it’s not safe to give honey to babies younger than 1 year¹³ due to risks for infant botulism, a rare and serious form of food poisoning.²³

“Researchers aren’t sure whether taking extra zinc or vitamin C can limit how long cold symptoms last or how severe they become, but large doses taken every day can cause negative side effects. The results of most studies on the value of herbal remedies, such as echinacea, are either negative or inconclusive, and few properly designed scientific studies of these treatments have been done in kids.”¹⁹ Talk to your doctor before you decide to take or give your child any herbal remedy or more than the recommended daily allowance (RDA) of any vitamin or supplement.¹⁹

Know Your Medicine Options: What’s in your cabinet?

“American medicine cabinets contain a growing choice of nonprescription, over-the-counter 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.”⁵ There are some options available in OTC medicines to help you decide what you need in your home pharmacy. We have created a short handout of common OTC options – types available, updates, and changes, as well as potential concerns, side effects, and risks. We hope you will find this helpful as you stock your medicine cabinet: OTC Medicines: Deciding what you need (PDF).

 

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

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References:

1. John’s Hopkins Medicine (2009). Does Weather Affect Arthritis Pain? [on-line]. Retrieved September 29, 2009. From http://www.johnshopkinshealthalerts.com/reports/arthritis/44-1.html.
2. National Academy on an Aging Society (1999). Chronic conditions: A challenge for the 21st century [on-line]. Retrieved September 29, 2009. From http://www.agingsociety.org/agingsociety/pdf/chronic.pdf.
3. Centers for Disease Control (2008). Chronic disease overview. Retrieved September 29, 2009. From http://www.cdc.gov/NCCdphp/overview.htm.
4. U.S. Food and Drug Administration (2008). Get set for winter illness season [on-line]. Retrieved September 10, 2009. From http://www.fda.gov/downloads/ForConsumers/ConsumerUpdates/UCM143453.pdf.
5. U.S. Food and Drug Administration (2009). Over-the-counter medicines: What’s right for you? [on-line]. Retrieved September 9, 2009. From http://www.fda.gov/Drugs/EmergencyPreparedness/
   BioterrorismandDrugPreparedness/ucm133301.htm.
6. American Academy of Family Physicians (2006). OTC drugs: Getting the most from your medicine [on-line]. Retrieved September 10, 2009. From http://familydoctor.org/online/famdocen/home/otc-center/basics/851.html.
7. U.S. Food and Drug Administration (2009). Kids aren’t just small adults – medicines, children and the care every child deserves [on-line]. Retrieved September 10, 2009. From http://www.fda.gov/Drugs/EmergencyPreparedness/
   BioterrorismandDrugPreparedness/ucm133414.htm.
8. U.S. Food and Drug Administration (2009). Drugs: Consumer’s room [on-line]. Retrieved September 10, 2009. From http://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsing.
9. U.S. Food and Drug Administration (2007). Medicines in my home [on-line]. Retrieved September 23, 2009. From http://www.fda.gov/medsinmyhome.
10. U.S. Food and Drug Administration (2009). A guide to safe use of pain medicine [on-line]. Retrieved September 23, 2009. From http://www.fda.gov/consumer/updates/painmeds022309.html.
11. National Council on Patient Information and Education (2004). Ten tips for parents [on-line]. Retrieved September 10, 2009. From http://www.bemedwise.org/ten_ways/top_tips_parents.htm.
12. U.S. Food and Drug Administration (2009). Health bulletin: Use caution with pain relievers [on-line]. Retrieved September 10, 2009. From http://www.fda.gov/Drugs/EmergencyPreparedness/
    BioterrorismandDrugPreparedness/ucm133426.htm.
13. American Academy of Pediatrics (2008). My child has a virus, how can I help her feel better? [on-line]. Retrieved September 23, 2009. From http://www.aap.org/publiced/BR_infections.htm.
14. American Academy of Family Physicians (2008). OTC medicines and how they work [on-line]. Retrieved September 10, 2009. From http://familydoctor.org/online/famdocen/home/otc-center/basics/otc.html.
15. Nemours Foundation (2008). Medications: Using them safely [on-line]. Retrieved September 1, 2009. From http://kidshealth.org/parent/system/medicine/medication_safety.html.
16. Nemours Foundation (2007) Dehydration [on-line]. Retrieved September 1, 2009. From http://kidshealth.org/parent/fitness/problems/dehydration.html.
17. Nemours Foundation (2008). Vomiting [on-line]. Retrieved September 1, 2009. From http://kidshealth.org/parent/firstaid_safe/emergencies/vomit.html.
18. Mayo Clinic (2008). Influenza (flu) [on-line]. Retrieved August 31, 2009. From http://www.mayoclinic.com/health/influenza/DS00081.
19. Nemours Foundation (2007). Common cold [on-line]. Retrieved September 1, 2009. From http://kidshealth.org/parent/infections/common/cold.html#.
20. Mayo Clinic (2007). Acute sinusitis: Do over-the-counter treatments help? [on-line]. Retrieved October 8, 2009. From http://www.mayoclinic.com/health.acute-sinusitis/AN01230.
21. Mayo Clinic (2008). Back pain guide [on-line]. Retrieved April 22, 2009. From http://www.mayoclinic.com/health/back-pain-treatment/ba99999.
22. Mayo Clinic (2009). Sprains and strains [on-line]. Retrieved October 14, 2009. From http://www.mayoclinic.com/health/sprains-and-strains/DS00343.
23. Mayo Clinic (2008). Is it true that honey can cause infant botulism? [on-line]. Retrieved October 13, 2009. From http://www.mayoclinic.com/health/infant-botulism/HQ00854.