Getting the Most Out of Over-the-Counter Medicines

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Pain relievers, cough suppressants, nasal sprays – these and other over-the-counter medicines are supposed to help us feel better when we have minor illnesses. But do these medicines really work? And what safety issues do we need to be aware of when taking these drugs or giving them to our kids? Charita Ray, DO, a family medicine physician at University Hospitals, outlines which medicines you should take and when -- as well as special safety considerations when giving over-the-counter drugs to children.

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Transcript

Pete Kenworthy

You know, what may be worse than being sick is seeing someone you love get sick.

Macie Jepson

No kidding. That's so true. And we've seen it a lot in our family, Pete. You know, before our daughter had sinus surgery, she was sick quite often. And the thing about her is we could guess, usually correctly, exactly how it would play out; a sore throat or a cough that would literally like bypass the nose altogether and go straight to the chest. So, when at school, obviously, we'd load her up with everything you can imagine to the point that her roommates like gave her a hard time about it. And she'd say, take my medicine, please. Anything you need, just take it. But she was definitely well-equipped.

Pete Kenworthy

Yeah. Yeah. And you think about that, over-the-counter medication, multi-billion dollar industry, right? OTC medication. And it makes sense, right? We would do just about anything to feel better, right?

Macie Jepson

You're right. I'm Macie Jepson.

Pete Kenworthy

And I'm Pete Kenworthy. And this is Healthy@UH. So, are these results just in our head? Or do over-the-counter medications really shorten an illness or maybe they just mask the illness? Well, joining us to lay out the good, the bad and the ugly of over-the-counter medications is a family medicine physician at University Hospitals, Dr. Charita Ray. Thanks for being with us.

Dr. Charita Ray

Thanks for having me. It's a pleasure being here.

Pete Kenworthy

So, this is a broad topic. Things like acetaminophen, ibuprofen, over-the-counter medications, they have great reputations, right? But then we get into things like cough suppressants, nasal sprays, decongestants. They don't have those same reputations. So, first, just to clear up some confusion, people may be confused about over-the-counter pain relievers. Can you tell us the difference between acetaminophen, ibuprofen, aspirin? And then are one of these more appropriate for certain illnesses or conditions than others? And, and feel free to use those brand names so people know what you're talking about, too.

Dr. Charita Ray

OK. Sure. I guess I'll start with acetaminophen which is our old favorite of Tylenol. Our grandmother's love it. I love it. It's great. It is awesome at what it does. And what it does is mainly bring down fever. We love it. It is pretty non-toxic for the most part. For adults, we can use the standard dosing. Normal strength is about 500 milligrams. I tell my patients, you know, go ahead, take that 500 milligrams, and you should be able to bring down that fever. If we have to double that we're OK. I do find parents getting a little sticky when it comes to our little ped patients, because all of these things, all the medications are going to be dosed by their weight. So, we can run into problems with weight-based dosing for our pediatric patients. So, you can't just say, oh, you know, just go ahead and take that 200 milligrams. They'll be OK. They're adult size. Like we actually have to come and actually get the actual dosing for those patients because it's a drug, and it can be toxic to the body. Acetaminophen is going to go through your liver. So, we have toxicity. That's where we're kind of going to see it.

So, we have Tylenol lovers and they go over for an adult. That's 4,000 milligram dosing over a 24 hour period. They can start to have some really, really bad effects to their liver. And we have to catch it with our over-the-counter medications because most of your cold medications are going to have acetaminophen in it. So, by the time you take your Tylenol, and by the time you take your like the Tylenol Cold and Flu or the Tylenol PM, you're going to start adding up to that 4,000 very, very quickly. So, we definitely have to monitor that.

Ibuprofen or Motrin, Advil, Aleve. These guys are NSAIDs, and I'm sure you guys heard that quite frequently, especially with everything that's going on right now. Should you take them? Should you not take them? Is it going to be harmful for you? And the most part, the answer is no. They're pretty safe. They do have some risks, of course. They work a little bit differently from Tylenol where they're excreted. So, Tylenol is excreted again through the liver. But as far as Advil, Motrin, ibuprofen, the NSAID guys, they're going to go through your kidneys. So, that's where you're going to see the toxicity kind of build up. They are great at reducing inflammation, and that's going to be everywhere. So yes, you can take it for pain. I have patients that are like, oh, just minor aches and pains, they’re great, too. But they do have the added benefit of being able to bring down fevers as well and just the general achiness. So, I do have, I've seen patients and parents alike go ahead and kind of alternate their usage of a Tylenol and a ibuprofen or Tylenol and Aleve so that they're not hitting any one organ, you know, all the time, so they can get the relief that they need and it's mostly symptomatic or, I guess, comfort care and making you feel better but not hitting both of those organs at the same time. But pretty safe all in all.

Pete Kenworthy

Before we move on to aspirin, you said, you kept saying with ibuprofen, NSAID. And just so people understand what that is. It's, it's the nonsteroidal anti-inflammatory drug. But what does that mean? I mean, I, I see those words, and I know what the letters mean, but what does it mean from a clinical perspective?

Dr. Charita Ray

In a clinical perspective, it really is working with like Cox-2 inhibitors here. And it is blocking pain receptors, and we're bringing down inflammation that way. Aspirin is another old and favorite of a lot of people. I don't personally use it too much in the setting of your general cold symptoms. But it definitely can be used as aspirin is also a Cox-2 anti-platelet inhibitor. So, it works similar. It kind of, it thins the blood a bit, but it works as a pain reliever as well. But I tend to stay away from it personally just due to its anti-platelet functionality. But it definitely has uses when we come to our people that have cardiovascular diseases. It's very useful for them or people who have had things like stents or strokes and things of that nature. So, I think that it's great in that regard. But as far as just a general pain reliever, I generally stick to the ibuprofens, the Motrins, the Tylenols just due to the increase bleeding reasons, personally.

Pete Kenworthy

All right. Let's move on, Doctor, to kids from this high level, too. And a couple of things here. Number one, I've heard, you should never give aspirin to a child, so you can start with that. And then we'll move on to some other over-the-counter medications, but let's start with aspirin. Why not give aspirin to kids?

Dr. Charita Ray

It's toxic for very young children. So, that's why we tend to stay away from it. It can have one use, however. In Kawasaki's disease, that is the treatment. You give the kid aspirin, but it is a very specific medication that is given in a very specific instance. Otherwise, we stay away from aspirin in small children.

Pete Kenworthy

OK. So, let's look at other over-the-counter medications. Some of them actually say pediatric on them, right? So, what is special about these kids-only medications? Are the ingredients different? Are the doses different? Or are there age parameters for over-the-counter medications? I know at the beginning you talked about it's a weight thing, so maybe it's a combination of age and weight?

Dr. Charita Ray

It can be, but you really have to be careful because there are some ingredients in the over-the-counter medications that are still not recommended by your medical society. So, the American family practice physicians, all of us, they have basically said like very specifically, certain things are not allowed. But they are still in these products. So, you just have to be mindful. Go to the store, make sure that you're reading your labels cause it's very important. Age is also very important as well, because like I said, we can't really give aspirin to small children, but above the age of 12, you’re OK. There are other medications such as like your decongestants. You don't want to give those to little kids either. Really that cutoff is going to be the age of 12. So, you want to use decongestants, Ipratropium nasal spray, those type of guys, that cut off is 12.

But as far as other over-the-counter medications, you want to stick with saline. The saline-based products, they have like saline little nose drops for little kids that get really congested. They have more natural things like honey can be used over the age of one that can help with suppressing the cough. So, if you have these products that have saline in them, they have more the natural things like honey, over the age of one, then you can go ahead and use these things. But if they start to have the, I call it the adult things. So, if you're seeing guaifenesin, you're seeing dextromethorphan, you’re seeing phenylephrine, those are not for kids. They can be very toxic to the small bodies. So, we don't want them to have that ingestion and possibly having it being toxic for them because they are so small. And again, a lot of things are going to be weight dosed.

Macie Jepson

So, Doctor, if my kid is sick and I only have over the counter meds for adults, what is your recommendation? That I get myself to the drugstore? Or is there ever a time that we can fiddle with the dose and make that OK for our kids?

Dr. Charita Ray

OK. So, if we're in a bind and we're looking in the cabinet, we're saying, OK, what can we give them? We can actually use things like Tylenol and ibuprofen, but they are very weight dependent. So, if you have a child, you're going to use about 10 milligrams per kilogram. So, if you have a 200 milligram tablet for an adult of ibuprofen, I’d say, you may need to cut that in half to be able to give it to your child as long as the dosing equivalent is the same. So, if you needed 100 milligrams, you cut the 200 milligrams in half. If they are able to take the full two based off of your calculation, you can give them the full two. But again, we have to also think about, are they able to swallow these things? Is it going to become a risk for them when they're swallowing? Like most kids can't swallow large pills. But if you, by chance have the liquid form, you can use those in smaller kids. Older kids, you just go ahead and weight-dose it for them.

So, I know that we don't really think in kilograms…even I use calculators when I'm dealing with my pediatric patients. But roughly one kilogram is going to be equal to two pounds. So, if you have, say a 100 pound child and you go, we want the kilogram for that, you would divide it by two, so that we’re looking at a 50 kilogram per whatever dosing that you're doing.

Pete Kenworthy

And you said, you said 10 milligrams per kilogram? So, now we're down to 50 kilograms so you can give 500 milligrams for that weight of child.

Dr. Charita Ray

Correct. Yeah.

Pete Kenworthy

OK.

Macie Jepson

Thank you for that explanation, Dr. Ray. I want to talk now about what many would consider the Holy Grail in the medicine cabinet, and that is cough medicine. I mean, does it really actually help?

Dr. Charita Ray

It does. It helps. It makes you feel better. But again, we have to see how much of things that we are taking and if they are beneficial. It's going to be supportive care. It's not going to necessarily take away the disease process itself. So, if you have a cold that's caused by a virus, the virus is going to run its course. But we do want you to feel better. So, the things like guaifenesin which is a cough suppressant that's used in majority of your over-the-counter medications can help with that.

Pete Kenworthy

So, you brought up decongestants, antihistamines, and I get confused with those two things, right? When you're stuffy that that's the kind of stuff you turn to. So, what can you tell me about the differences, first of all, between decongestants and antihistamines? And then, are there safety issues there, too. For example, if you have high blood pressure or should you not take them for too long? What are the things to watch out for with those things?

Dr. Charita Ray

Oh, absolutely. So, yes, they are great things to have in your repertoire, but you should not be taking any of things for extended periods of time. So, if a normal cold is going to really peak within one to three days, so if you're on day 14 of a cold, and you're not getting any better, you should always seek attention by your primary care and urgent care before continuing to just take any of these medications. But for example, like the mucolytics and the expectorants, they are going to be thinning those secretions and those mucus productions that you have and kind of help you to cough that stuff up so it's easier to expel. So, it's just a thinning agent that works with the secretion so that you can actually cough it up. An antihistamine is going to work kind of like those main things they're like Benadryl, those guys, those antihistamines are going to kind of calm everything down, I would say. So, when you feel stuffy, and you can't talk, and everything is like, I can't do anything, I just feel so stuffy, the antihistamine can take the, kind of the allergic piece out of it where everything is just kind of had a mass effect and bring and calm everything down, which is useful.

The antihistamine is actually pretty safe when we have people to have a high blood pressure, because when you get to the other decongestants and the things like Sudafed, they are actually not great for our people with hypertension. The hypertensive, I love it. They have Coricidin, which is actually formulated for our people with hypertension. So, we don't want to give them something that can raise their blood pressure because your doctor's not going to like that. You're not going to like that. Your body's not going to like that. So, you have to keep your blood pressure even. And so those things like pseudoephedrine, phenylephrine, those guys will raise it. They take the guessing game out of it. Coricidin is great. It has like for BP. So, you can just pick that one up and not even have to think about like, oh, will this raise my blood pressure? No, it's formulated for me because it says that right on the packaging. But there are things that you can get over the counter from your pharmacist, like the Sudafed or the things that have the D on it. So, even if you did get like a Claritin D or Sudafed D or a Zyrtec D, then decongestant is what is going to raise their blood pressure, unfortunately. So, I do advise against that while you are, if you're hypertensive, I would do away with the Ds. Other people who do not have high blood pressure, the decongestants can give you that feeling that you're seeking, the being able to breathe out of your nose, basically.

So, if you're looking for that, that is what the decongestant will do for you. But again, you may have the side effects. Your blood pressure may raise a little bit higher. It may not be as high as a person that’s hypertensive, but it will raise. It will also maybe have like some sweating or some faster heartbeats or heart rates as well. So, it was not that I'm saying you can go just because you don't have hypertension, go and pick up a ton of, you know, Sudafed and down four or five in a day. Like you still need to do things appropriately. But they have their uses. But again, it's symptomatic care. If this is a virus or a normal cold is going to run its course, but we can make you feel better.

Pete Kenworthy

OK, Doctor, this is all pretty fascinating. There's a couple more things we need to talk about before we let you go. I heard the other day of someone who uses a nasal spray every day for like a cold symptom relief or for whatever reason they're using it. Is that OK to use a nasal spray every day? What does that actually do for you? Like, I guess it's called like Afrin, right? Or one of those kinds of things.

Dr. Charita Ray

Ah, Afrin. OK. Cause when we talk nasal sprays, you can be talking about a couple of different things. You can actually be talking about Afrin which is actually a spray that is basically a decongestant. Or you can be talking a steroid like Flonase, or you can be talking nasal saline which the answer depends on which actual one you're talking about. In the event of Afrin. Afrin is not OK to use every day. It is great in a pinch. It almost does its job too well. You can actually become dependent on this type of medication because it vaso constricts. It makes everything nice and small, and you can breathe like never before. But your nose can get very used to that. And then you find yourself rebounding. And so when you do have that sensation of getting stuffy again, you're going to reach for that Afrin, and then 17 years later, we're still on it. And it's very hard to, at that point come off of it. So, no.

Pete Kenworthy

Why is it dangerous? Why is it dangerous to keep using it every day though? I mean, it sounds like it's wonderful, right? It sounds like it could do exactly what you want it to do.

Dr. Charita Ray

Correct. But we don't want, 1) to be dependent on this medication to be able to breathe. That is not great for us. And then secondly, it can also cause some systemic problems as well, such as with people who have a cardiac disease, when you’re vasoconstricting as a vasoconstrictant, and we don't really need that in that instance. So, the directions are going to say we use it for the three days or the 72 hours, and then we give it a rest.

The other two nasal sprays that we use quite frequently, especially in family medicine are going to be saline, nasal salines and then a nasal steroid. So nasal saline is great to kind of clear out the nasal passages and keep us breathing for the moment and very well. And it is actually great for kids, too. So, if we're looking for a nasal spray for kids, the nasal salines in drops can keep everything nice and moistened for them and then kind of clear out all the guckiness and the boogies that are kind of up there in their nose and nasal passages.

Then we have a nasal steroid. Most commonly is like the Flonase, the fluticasone. We're going to have people taking those mainly for allergy purposes. So, people who have seasonal allergies, they are going to use this daily, and they can. It's very, very safe for them to do so. You can do one puff a day, one puff twice a day. It's really up to you and your physician to decide together what will be most effective for you. However, this is not like an emergency medication. You're not going to use this and say tomorrow, boom, I am, my allergies are great. No. Nasal steroids take a little bit of time to build up. So, up to two weeks you will see some benefit of a nasal steroid to kind of keep all your passages nice and open.

Macie Jepson

So, it's good to know that the saline spray, a natural option, is a good thing. Speaking of natural remedies, listen, I'm going to admit, I bought my share of vitamin C packets at the beginning of COVID. I didn't spend $100 for a pack of 10. I wasn’t, I didn't go that crazy, but I do have them. Do they work?

Dr. Charita Ray

We have a very great need for vitamin C. It’s great. It can be an immune booster. Absolutely. Do I think that everyone should have like one packet of Emergen-C in their bag every or in their coffee or in their warm tea every day? It's not really needed. No. I believe that if you're having a well-balanced diet, you're going to get it. You're taking your multivitamin that you're taking once a day, you're going to get that vitamin C. If we're going overboard, you're probably going to pee it out anyway. So, there was some taking advantage of what was going on for sure. So no, I don't think that you should just take it to take it. If it has a use, if you are sick, go ahead. You can take those things. But don't just take it to take it. No.

Pete Kenworthy

A final question here, really. When we're talking about flu, cold, cough, stuffy nose, whatever we're talking about, when is that magical right time to finally stop trying to take care of yourself and go see your doctor?

Dr. Clarita Ray

The short answer is when you feel uncomfortable. If you are not comfortable at home, and you feel that you need to see someone, call your doctor. That can be within 24 hours of your symptoms starting, or it can be a week after. You can ask your questions. Actually, I encourage all my patients to ask your questions. If you have, you know, a question about, you know, I have a virus; I have a cold; I'm unsure, just come in. But if you are at home, and you can…I have a lot of patients that are a little stubborn and won't come to see me, which is fine…but I would say if it's getting bad, come and see us. There's no one week, two week type of thing. But if you're uncomfortable, go see your physician. Now, emergency things are a little bit different. If you are having trouble breathing, if you are retracting or using the muscles in your upper chest to breathe, not OK. If you are having chest pain, not OK. If you're having nausea and vomiting that's not going away over, I’d say, a 24 hour, 48 hour period, not OK. If you are having a fever that is uncontrolled by your Tylenol, this should again be peaking at like one to three days. If you're having fevers on day five that are uncontrolled, you need to go see someone immediately.

Those things are a little bit over the exception, but a general course is going to be one to three days at a peak. But then you can have some lingering thing for quite a while, especially when it comes to cough. Cough is a little bit fuzzy, I like to say, because you can have a cough really up to a month after your initial illness. But it should be getting better over time. So, it may be the one to three days, you get up to a week. It gets really bad, and then we're getting less and less cough over time. But you may still have that cough at, you know, day 14, at day 21. As long as the things are getting better for you, you're OK. But as long as you don't have any of those like red flag symptoms that I talked about a little earlier, then I’d say that you can probably stay at home. But if you ever, ever have any questions, do not hesitate to contact your medical professional.

Pete Kenworthy

Yeah. And I guess the thing to remember when it comes to over-the-counter medications is read the box, right? Like read what it says on the box. And if it says don't take for more than seven days, don't take for more than seven days, right? Just stop doing that and call your doctor.

Dr. Charita Ray

Agreed. And if ever in doubt, read the label, see what the purpose is for. See if it's for kids, if you're using it for your kids. But if it's an adult, use as directed.

Macie Jepson

Thank you so much for joining us today. Dr. Charita Ray, family medicine physician at University Hospitals.

Dr. Charita Ray

Thank you. It was a pleasure.

Macie Jepson

And we want to remind you, you can find and subscribe to this podcast on iTunes, Google Podcasts, Stitcher, or wherever you get your podcasts. Search University Hospitals, or Healthy@UH depending on where you subscribe.

Pete Kenworthy

For more health news, advice from medical experts and Healthy@UH podcasts, go to UHHospitals.org/blog.