OTC advice and Q&A from Pharmacist to Pittsburgh (Seltzer: school, allergy)
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I realize I have taken on quite a task by wanting to give everyone in the Pittsburgh area advice and answer questions about OTC and prescription drugs. To prevent this from being pages long, I will first give some basic advice and tell you some things everyday consumers should know about OTC products. Please feel free to ask me any questions at all about pharmaceuticals of any kind.
First of all – OTC products are a gimmick!! What I mean is that every OTC label you see that reads “severe flu,” “cough and cold,” “woman’s pain,” “arthritis pain,” “severe congestion” etc and on and on and on – these are GIMMICKS. Every one of those combination products consists of roughly the same exact 4 or 5 ingredients, and in fact, most pharmacists will not recommend combination products at all as most are overkill and you always want to take as few ingredients as you can to treat your symptoms.
PAIN MANAGEMENT
No matter what the label says or what it is indicated for, there are essentially only four kinds of OTC pain medicines.
Ibuprofen, naproxen, and aspirin are all NSAIDs (non-steroidal anti-inflammatory drugs). Ibuprofen and naproxen are the most potent on the list and are very similar to one another. The only true difference between ibuprofen and naproxen is their duration of action. Naproxen is the longest acting NSAID. Both are very hard on the stomach and should be taken with food and long-term use of either can lead to stomach ulcers and bleeding. I personally recommend and prefer ibuprofen out of all four.
NSAIDs DO have an anti-inflammatory component, unlike acetaminophen which DOES NOT. Therefore, it wouldn’t make much sense to take Tylenol for treating inflammatory pain (i.e. burns, puncture wounds, fractures, and swelling) because it does not have an inflammatory component – although Tylenol’s label will still claim to treat these pains.
Despite being only a mediocre analgesic (pain-killer) and having no anti-inflammatory properties, Tylenol is a useful drug. It is extremely safe if taken correctly and is the ONLY pain-killer approved for pregnant women, nursing women, and children below the age of 13. It is also rarely associated with any type of allergy. It is a good anti-pyretic (fever reducer) – but don’t forget, the other three are also anti-pyretics. Essentially, the NSAIDS can do everything that Tylenol can do and more - but Tylenol is the safest and rarely leads to stomach problems.
Tylenol must be taken correctly, though, or even it can be very dangerous. It can be hard on the liver and should be taken sparingly by those who may have liver disease. The rule is that you MUST NOT exceed 4000 mg per day of acetaminophen. A normal extra strength Tylenol has 500mg per tablet. Therefore, you should NEVER exceed 8 tablets in one day no matter what your directions are to take it. If you follow this rule, Tylenol is the safest, but not the best, pain-killer OTC.
Aspirin is also an NSAID but is a bit different than ibuprofen and naproxen. Aspirin is also an anti-platelet which will cause thinning of the blood and should NEVER be taken by those on coumadin or heparin etc. Aspirin should also NEVER be taken by anyone below the age of 13 as it has been heavily associated with Reye’s syndrome. If a child is harboring certain viruses (like chickenpox or the flu) in their body and takes aspirin, Reye’s syndrome can develop. Although it has not been conclusively documented to lead to Reye’s Syndrome, most pharmacists will also never recommend ibuprofen or naproxen for children under the age of 13 because they are so chemically similar and do have cross-sensitivity (which means if you are allergic to aspirin it is very possible to also be allergic to ibuprofen and or naproxen). Use Tylenol for children under the age of 13.
Many people take “baby aspirin” which is any aspirin that is 81mg as oppose to normal 325mg. 81mg is enough to give the “anti-platelet” affects but not enough to be used as a pain-killer. Taking 81mg of aspirin a day has been documented to reduce the risk of heart attack, stroke, or other cardiovascular events. 81mg a day is rarely associated with stomach conditions, unlike the normal 325mg strength, which just like the other NSAIDs, can lead to ulcers and bleeding if taken on very regular basis.
NONE of these OTC pain-killers can be used to treat neurophatic pain which is pain associated with your nervous system. This pain is often described as “burning,” “tingling,” “electric-shock,” “pins-and-needles,” and may be similar to the feeling of having one of your feet badly “fall asleep.”
Another thing to note is that pain associated with infections and viruses is no different than any other pain! If you have Strep and have a horribly soar throat, use ibuprofen by mouth! Lozengers may numb and soothe, but a normal pain-killer will do the job plenty!
Also, NEVER exceed more than 4000mg a day of Aspirin, 3200mg of ibuprofen, and 1500mg of Naproxen in one day. That being said, do not fear these medicines, they are good at controlling pain. For example, if the pain is bad enough and your stomach can handle it, you can take four- 200mg tablets of ibuprofen at one time = 800mg. This may seem like a lot and the label may not recommend anymore than two at a time, but prescription strength ibuprofen comes in 800mg tablets, and MANY people are on those, so 800mg as one dose won't hurt you. Likewise, prescription strength naproxen is 500mg per tablet. The most important thing to watch out for is to never exceed the daily maximum doses I provided. The OTC labels give you a very low maximum to avoid lawsuits.
I will give you an example of a gimmick now. Excedrin, the Headache Medicine, is nothing more than regular strength acetaminophen, + regular strength aspirin, + a bit of caffeine. It has no special ingredient at all that is "headache" specific. Oh, and Excedrin Migraine formula is the EXACT same thing, go look. Excedrin Tension Headache is a bit different, it is extra strength acetaminophen + a bit of caffeine as oppose to regular strength acetaminophen. What a little extra acetaminophen has to do with tension headaches is anybody's guess. Why did Excedrin decide to use acetaminophen anyway since a large portion of headache pain is inflammatory and since we all experts now, we know acetaminophen doesn't have an anti-inflammatory component! Gimmick.
Any pain-killer that says PM is nothing more than the pain-killer + Benadryl (diphenhydramine, an anti-histamine) because the anti-histamine makes you drowsy.
If you found this helpful I will do more for other things like Cough & Cold and Heartburn! Please feel free to ask me anything.
A side note on herbals. DO NOT TAKE OTC herbals. EVER. There is no regulating agency at all (like the FDA) that ensures the safety, quality, and purity of herbals. We have no idea what the appropriate strengths are for these medicines, their quality can vary widly from season to season, many are EXTREMELY harmful and many we have no idea how they work or what they do. Many thin your blood, some are toxic to the liver and kidneys, some can exacerbate certain conditions like auto-immune diseases, some can worsen diabetes.
I'm sure many are benign and are harmless and may even be somewhat useful, but do not trust them. PLEASE do yourself this favor.
I will let you ponder one thing. NEVER underestimate the greed of the pharmaceutical empire. Do you honestly believe that if an herb was truly "a miracle drug" or truly did what it claims to do to such a great extend.. do you doubt for one second that the active ingredient wouldn't be extracted, purified, and cashed in on by pharmaceutical guru's? Trust me, it would be, and sometimes is. A great many of our prescription drugs come from chemicals found in plants and nature, but they are purified, tested, documented, researched, studied, and in the end, go through a ridiculously scrupulous FDA approval process and are more often than not rejected!
We all know the FDA doesn't catch every problem - but they do catch an awful lot. Just imagine things you are taking that the FDA isn't even TRYING to catch problems for. Believe me, herbals are take at your own risk - and it's not a risk I would EVER take, especially after going through Pharmacy school.
... Fortunately, Boylocke remembered to add "for Pittsburgh" to the title, thereby saving him the embarassment of a "Stay on topic, please" response from the moderator.
A side note on herbals. DO NOT TAKE OTC herbals. EVER. There is no regulating agency at all (like the FDA) that ensures the safety, quality, and purity of herbals. We have no idea what the appropriate strengths are for these medicines, their quality can vary widly from season to season, many are EXTREMELY harmful and many we have no idea how they work or what they do. Many thin your blood, some are toxic to the liver and kidneys, some can exacerbate certain conditions like auto-immune diseases, some can worsen diabetes.
I'm sure many are benign and are harmless and may even be somewhat useful, but do not trust them. PLEASE do yourself this favor.
I will let you ponder one thing. NEVER underestimate the greed of the pharmaceutical empire. Do you honestly believe that if an herb was truly "a miracle drug" or truly did what it claims to do to such a great extend.. do you doubt for one second that the active ingredient wouldn't be extracted, purified, and cashed in on by pharmaceutical guru's? Trust me, it would be, and sometimes is. A great many of our prescription drugs come from chemicals found in plants and nature, but they are purified, tested, documented, researched, studied, and in the end, go through a ridiculously scrupulous FDA approval process and are more often than not rejected!
We all know the FDA doesn't catch every problem - but they do catch an awful lot. Just imagine things you are taking that the FDA isn't even TRYING to catch problems for. Believe me, herbals are take at your own risk - and it's not a risk I would EVER take, especially after going through Pharmacy school.
May I add to this? I studied herbs and herbology for a book I was writing where one of the characters was a wife who had knowledge of herbs -- so while I am not as knowledgable about this as either a pharmacist (who has to know how to compound drugs, otherwise he'd spend five years in school to learn counting) or a doctor herbologist -- Boylocke is BEYOND RIGHT.
Herbs are nothing to be messed around with. My husband took St. John's Wort under our physician's care (regular doctor -- Brent was having WAY too many side effects from anti-depressants for a mild situational depression) and they worked. But my doctor had a full work up on him and we discussed it and researched it before we did it.
I have a friend who was treating herself for hypothyroidism with herbs... and all my study on that said HERBS DON'T WORK on hypothyroidism. One of the articles was written by a doctor who makes his living prescribing herbs -- and he said you can't treat low thyroid with herbs.
She almost killed herself -- hypo isn't fun (and I know what I am talking about -- I'm hypo too.)
It's too easy for someone to walk into a health food store and tell the clerk I have XXX, and have a clerk say oh -- take XXX! You'll be fine! A clerk in the health food store may do a lot of reading, but their training is how to work a cash register and balance a Zon machine at night.... don't put your life into unskilled hands.
(by the way -- the more I read about herbs, the more herbs I saw that were taken and refined and then chemically made into real drugs. If I only hadn't gotten mired in the middle of that book it might have sold... that's my biggest trouble -- really good at beginnings and endings -- it's that whole middle part that I suck at ....)
I've always been confused about which painkillers were good for which kinds of pains. Thanks, Boylocke.
However, I'm torn. If this thread hadn't been listed under Pittsburgh, I never would have noticed it, but technically doesn't it belong under Health & Wellness, where potentially MORE people will see it who are looking for this info?
Should we ask the Mods/Admin to move it? This is good stuff.
Should we ask the Mods/Admin to move it? This is good stuff.
Meh, I'd rather it be here for all my Pittsburgh friends. I'm sure the health and wellness people have already posted and talked about this kind of stuff in great length. I'd rather it specifically benefit Pittsburgh and the friends I have made here. If it is, in fact, beneficial.
Quote:
It's too easy for someone to walk into a health food store and tell the clerk I have XXX, and have a clerk say oh -- take XXX! You'll be fine!
This used to be me! I worked at GNC for over 2 years before pharmacy school. I wish I could go back and do it all over again! I shudder to think about all the herbs I sold..
I've always been confused about which painkillers were good for which kinds of pains
I hate how Advil has bred people to think there are different pain medicines for different areas like "knee" "back" "elbow." That's crazy. Just know that neuropathic pain cannot be treated by OTC products and that it is a rare pain usually only associated with those with certain disease states. Otherwise, all other pain is just thrown into two category's, to make it simple, inflammatory or non-inflammatory. If it's inflammatory pain you don't want to use Tylenol, and you know why. If it's non-inflammatory pain you could use any of the four of them to treat it just fine! Some might be more effective than others or act longer than others, but you catch my drift.
Like I said, out of the NSAIDS, and if you are above 12, I always recommend Ibuprofen. Naproxen makes a lot of people feel funny for some reason, including me, and has a few rare side effects not associated with ibuprofen!
I hate how Advil has bred people to think there are different pain medicines for different areas like "knee" "back" "elbow." That's crazy. Just know that neuropathic pain cannot be treated by OTC products and that it is a rare pain usually only associated with those with certain disease states. Otherwise, all other pain is just thrown into two category's, to make it simple, inflammatory or non-inflammatory. If it's inflammatory pain you don't want to use Tylenol, and you know why. If it's non-inflammatory pain you could use any of the four of them to treat it just fine! Some might be more effective than others or act longer than others, but you catch my drift.
Like I said, out of the NSAIDS, and if you are above 12, I always recommend Ibuprofen. Naproxen makes a lot of people feel funny for some reason, including me, and has a few rare side effects not associated with ibuprofen!
I'm lucky, then -- I take naproxen for my osteoarthritis in my knees. I take 2 "Aleve" in the AM and I'm good for the day. Mondays and Fridays are my hardest days at work, and I may take 2 more in the evening, but it's well within my guidelines of the prescription version I used to take.
As I lose weight and continue exersizing I may be able to get off them entirely.... although the longer I go, the more I think I may end up having to leave work.
Ibuprofin stopped doing anything for both Brent and me a while ago....
Every one works a little bit different and should be used differently.
The Antacids are very quick acting but also do not have a very long duration of action. Typically, antacids work in roughly 5 to 15 minutes and offer quick relief but only last for an hour or two and oftentimes do not provide enough relief. Every antacid consists of one of more of several elements that neutralize gastric acid including sodium bicarbonate, calcium carbonate, aluminum salts, and magnesium salts. They work quickly because they neutralize existing gastric acid – the acid that is causing you the discomfort now.
They are documented to have different potency. Here is the order, from low to high on their ability to neutralize gastric acid.
Therefore, products containing aluminum would work the least and products containing calcium carbonate should work the best. Here is a corresponding list of brands.
Remember, many contain more than one. For example, Maalox has both Aluminum and Magnesium. And liquids ALWAYS work faster than tablets or chewables.
Things to note about antacids – never take more than 500 – 600 mEq of an antacid per day and never take one for longer than two weeks for heartburn – see your doctor. Separate taking your normal daily medicine and an antacid by at least two hours. Pregnant and nursing women must AVOID sodium bicarbonate and safety has NOT been established in the pediatric population!
Bismuth is very similar to antacids in the way that works and also has an anti-inflammatory propertie. Likewise, it is fast acting and will also provide quick relief but does not last very long. One thing that you must note is that the chemical of bismuth is actually bismuth subsalicylate. The chemical of aspirin is actually acetylsalicylic acid. Notice a similarity? You should, they are chemically very similar, and if that’s the case, you should remember that NO child under the age of 13 should take Pepto-Bismol. It can lead to the same Reye’s Syndrome that aspirin can. There is a Children’s Pepto-Bismol, but if you look, the active ingredient is completely different from the adult version – it’s actually calcium carbonate – an antacid previously mentioned!
The H2-blockers were mostly once prescription-only but now you can get a few OTC and they are excellent and potent medicines. They do not neutralize gastric acid; they actually inhibit gastric acid secretion. They are not as quick acting as an antacid but they do last much longer and are more potent. A typical H2-blocker should give relief within 1 hour and last for roughly 6 to 8 hours. If symptoms are anticipated, take an H2-blocker one hour before the meal. Like all heartburn medicines, they should not be consecutively taken for any longer than two weeks to treat heartburn unless supervised by a physician. Antacids are actually a better option than H2-blockers for pregnant and nursing women and none are approved for children under the age of 12.
There is only one proton pump inhibitor (this is an outstanding class of drugs) available over the counter and that is Prilosec OTC (omeprazole). This medicine cannot be used for quick relief because it can take over 24 hours for it to inhibit the cells in your stomach that release gastric acid. However, after this time, these medicines are the "big guns" and omeprazole is extremely potent compared to the other options and can treat frequent heartburn occurring two or more days per week. It is taken only once per day and should not be taken consecutively for any longer than two weeks unless supervised by a physician. You may repeat this regimen every four months if needed. Proton pump inhibitors should never be taken by pregnant or nursing women.
Prilosec OTC is in the same class as Nexium, Aciphex, Prevacid, and Protonix. Theoretically, they should all be fairly equal in terms of efficacy but I know most patients believe otherwise.
As a matter of fact, Nexium and Prilosec OTC is the EXACT same chemical. Prilosec is omeprazole and Nexium is esomeprazole. The only difference (minus a ton of chemistry mumbo jumbo) is that the “es” before omeprazole in Nexium means that it is a slightly more pure version of the chemical and may lead to fewer side effects. But in terms of efficacy, they should be EXACTLY the same as they are indeed the EXACT same chemical entity.
Last edited by guylocke; 05-17-2007 at 10:01 AM..
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Excedrin Tension Headache is a bit different, it is extra strength acetaminophen + a bit of caffeine as oppose to regular strength acetaminophen. What a little extra acetaminophen has to do with tension headaches is anybody's guess. Why did Excedrin decide to use acetaminophen anyway since a large portion of headache pain is inflammatory and since we all experts now, we know acetaminophen doesn't have an anti-inflammatory component! Gimmick. 
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