OTC (Over-the-Counter) Medications By Lisa Glickstein, Ph.D, Triplet Mom Originally printed in July 2004 More and more formerly prescription-only medications are now available to purchase without prescription in your family drug store. Using these medications carefully and well can avert some trips to the doctor, alleviate symptoms, and contribute to wellness. Using them incorrectly can cause them to lose their efficacy at best, and at worst lead to overdose. Here is a rundown of common problems and drugstore remedies. Remember that if you are taking any prescriptions (birth control pills, anti-depressants, glucophage, or meds for another medical condition) or drink alcohol daily (or binge drink) do not take OTC meds without checking with your doctor. Heartburn (acid reflux, indigestion, burning sensation in chest/throat after eating): Simple and low-tech remedies, such as antacids (neutralize acid) like Tums or Mylanta, have no side effects if taken as directed. Some have simethicone, an anti-gas remedy. More high- tech remedies include Pepcid AC and Nexium ("the little purple pill") which reduce the release or even production of acid by the stomach; more effective for chronic heartburn. These remedies can help protect the esophagus (tube leading from throat to stomach) from damage from acid reflux. Biggest danger - Chest pain from heart disease (angina) or heart attack (myocardial infarction or MI) can mimic heartburn. If you need to take an antacid or other remedy more than occasionally, you should alert your doctor so that a full examination can be performed. Untreated acid reflux can sometimes require surgery, so it should be monitored over time. If you are diagnosed with acid reflux, your doctor can counsel you on longer-term or more frequent use of appropriate medications (prescription or OTC). Yeast infections: Simple and low-tech remedies for vaginal irritation will not treat a yeast infection (Vagisil, others); OTC meds (Femstat, GyneLotrimin) should not be used if you have never been diagnosed with a yeast infection by a doctor (primary care or OB/Gyn). If you have been diagnosed and know the symptoms, use the medication recommended by your doctor according to the package directions. Finish the course of treatment, even if the symptoms disappear before it is complete. Eating yogurt (6-8 oz. per day) or taking an acidophilus dietary supplement can help shorten the course of an infection, and prevent recurrence, but is unlikely to treat an existing infection. Biggest danger - Treating yourself when you do not have a yeast infection. Other infections, including bacterial vaginosis, can cause similar irritation but require oral antibiotics to cure them. Most importantly, vaginal cancer can mimic a yeast infection, and undiagnosed can spread. Importantly, bleeding between periods is a sign that should be brought to the attention of your doctor, especially if accompanied by irritation. Ear and Nose Congestion (cold/flu, simple earache): A decongestant (Sudafed) will shrink swollen mucous membranes (the lining of your nose, throat, and ears) and can help with drainage. These contain pseudophedrine which is an upper. If they make you (or your child) too agitated, especially at night, you can switch to an anti-histamine (Benadryl, Claritin). These have a drying effect and can also help with fluid. Some make you drowsy and can help you sleep at night. An anti-inflammatory drug (Motrin, Advil) containing ibuprofen will help reduce inflammation. A decongestant OR anti- histamine, taken together with ibuprofen, in my experience, can often avert an earache. Take according to package instructions. Biggest danger - Do not give aspirin to kids with cold/flu symptoms, as they can develop a fatal syndrome called Reye's. Also, a potential problem is overdose on several combination medications or because of another prescription medication. I do not recommend combination drugs for this reason - even if you know what meds are in each one, your baby-sitter, husband, or mother(-in-law) may not read the label. Make a chart if you are giving more than one med with names and times for next dose. Fever: This does not need to be treated for medical reasons unless it is very high or your child has fever-associated seizures (in which case, speak with your doctor). If your child is running around and seems fine, do not worry about a moderate fever in itself (you will probably consult with the doctor if there are other symptoms, and keep your child out of school, however). However, if your child is uncomfortable with a fever, the best treatment is Tylenol (acetaminophen), unless there are other symptoms that would warrant an anti-inflammatory. Biggest danger - Overdose is possible with Tylenol (acetaminophen). Be careful not to exceed the recommended dose per day, and consult with your doctor if treatment exceeds two to three days about changing to a different medication. Also, if fever is associated with pain, consult with a doctor as it may be a sign of a localized infection (abscess, cellulitis, etc). Pain: First, consult with a doctor for severe pain. Generally treat with Tylenol (acetaminophen) for simple pain or headache (including growing pains, if they interfere with sleep). Motrin or Advil (ibuprofen) generally work better on pain that goes with inflammation or swelling, for example muscle aches and pains (including menstrual cramps) or toothache. Teething pain responds much better to Motrin or Advil (ibuprofen). Teething can also be treated with topical meds like children's Anbesol, or cold applied. Cold can help alleviate simple headache or joint pain (sprained ankle). Use heat for muscle aches and pain. Remember RICE for pain - Rest, Ice, Compression (e.g. Ace bandage), and Elevation. Biggest danger - As with fever, overdose is possible with Tylenol. Any pain that lasts longer than 12 hours in a child should be phoned into the pediatrician, with the exception of teething. Don't give aspirin to kids with fever or cold/flu symptoms. Sore throat can be a sign of streptococcal infection and should be referred to a doctor. Gastrointestinal complaints: For nausea and vomiting, Tums or Mylanta (whether or not caused by heartburn) can reduce the burn; Dramamine (relieves some nausea even if caused by other than motion sickness); or Pepto Bismol (for adults, or kids with simple nausea). For diarrhea: Imodium is very useful, although Kaopectate works for kids and Pepto Bismol is also good for adults. Use according to package instructions. Here's a useful hangover preventative - Benadryl and Motrin or Advil before you go to bed with two large glasses of water. Sea Bands (wrist bands) can work to prevent motion sickness. For vomiting in adults or older children, do not eat/drink for 30 minutes after vomiting ends, and then take two small sips of water (ginger ale, sprite, Gatorade), wait 30 minutes, and if it stays down take some more on the same schedule. Usually most episodes of vomiting do not last longer than three hours if you do not feed/drink too quickly. If liquids are tolerated (gradually increase the amounts), start with some dry saltines (toast, Cheerios, pretzels), again, a few bites at a time with a 30 minute rest. This really works! Avoid acidic/irritating foods, especially orange juice. Milk is okay. Rehydrate with Pedialyte, or alternating sugary/salty food and drink if episode was short in duration. In infants and toddlers, follow your pediatrician's instructions. Biggest danger - Do not give Pepto Bismol to kids with fever or cold/flu symptoms. It contains an ingredient (salicylate) which is related to aspirin. Read package directions carefully, use as directed, and report to the doctor if vomiting continues (or has a bloody or coffee ground appearance). It is rare to dehydrate with simple vomiting (e.g. not due to hyperemesis), but it can happen. Dehydration is more common with diarrhea (your intestine can secrete lots of water from your system to try to flush out the bacteria or virus that is making you sick). Bloody diarrhea should be reported to the doctor at once. A final note: Always keep OTC drugs out of reach of children, check the expiration dates and discard when they have expired. Store drugs away from extreme temperature variations.