Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
What are some important considerations for the safe use of OTC products?
To use OTC products safely, it is important to understand (1) their side effects, (2) their effects on other underlying medical conditions such as diabetes mellitus, high blood pressure, asthma, and other conditions, (3) their interactions with other prescribed medications such as antidepressants, blood thinners, and high blood pressure medicines, and (4) the product's limitations.
The following guidelines are provided to help consumers make more informed choices when selecting OTC products:
Always read the labels and know the ingredients in the products. Never take more than the recommended dose without checking with your doctor first.
Do not use aspirin-containing medicines for children and teenagers with influenza, chickenpox, or other viral illnesses. Rare cases of Reye's syndrome have been associated with the use of aspirin in this population. Reye's syndrome is a serious illness characterized by liver damage, vomiting, and sometimes coma. It has a 50% mortality rate, and those who survive can be left with permanent brain damage. Therefore, acetaminophen-containing products or NSAIDs are recommended for children with fever. NSAIDs may be used in children over 6 months of age.
Aspirin and NSAIDs can cause ulcers and increase the risk of bleeding and should be avoided by people with known ulcer disease or certain blood diseases. People who are scheduled for elective surgeries should inform their doctors that they are taking aspirin or NSAIDs.
A true aspirin allergy is rare. Aspirin allergy consists of hives, occasionally difficulty breathing, and rarely shock, within three hours of taking aspirin. Aspirin allergy is most common among individuals who have asthma, urticaria, and nasal polyps. Individuals with aspirin allergy should also avoid NSAIDs because they are chemically similar to aspirin.
Aspirin can cause complications during pregnancy and should be avoided during pregnancy.
Aspirin can increase the effectiveness of blood thinning by warfarin (Coumadin) and may increase the risk of bleeding.
Topical (sprays or mists) nasal decongestants act more quickly than oral nasal decongestants. However, the effects of topical nasal decongestants are short lived. Topical nasal decongestants should be used for only three to five days at a time since more prolonged use can lead to rebound congestion with worsening nasal congestion. Patients with rebound congestion complain of stuffy nose despite frequent applications of the nasal decongestant. Treatment of rebound congestion involves the slow withdrawal of the nasal decongestant (one nostril at a time) and applying saline nose sprays or drops to provide moisture.
Oral nasal decongestants can interfere with the action of a class of antidepressants called MAO inhibitors.
Oral nasal decongestants can affect diseases such as hyperthyroidism, diabetes mellitus, and coronary artery disease. Oral nasal decongestants and antihistamines can also precipitate urinary obstruction in patients with enlarged prostates (prostate hypertrophy or BPH). Patients with these conditions should consult their doctors before using OTC products.
Many OTC antihistamines can cause drowsiness, particularly the first-generation antihistamines. People taking antihistamines should avoid driving or performing activities that require alertness. They should also avoid alcohol and other sedatives.
Some antihistamines can cause excessive drying of secretions, making it difficult to clear secretions from the respiratory tract. The accumulation of dried secretions in the airways can aggravate breathing difficulties in people with chronic bronchitis and emphysema.
Infants and young children are sensitive to the side effects of antihistamines and nasal decongestants. They can become irritable, restless, or drowsy with these medications. Occasionally, hallucinations and psychosis can occur. Therefore, the parents or caretakers of infants and young children with cold or allergy symptoms should consult their pediatrician before using any of these products. Recent concerns by the FDA suggest that young children should not take many of the commonly used cold and cough medicines.
OTC cough suppressant medications are generally not recommended for use in infants and children with colds. Studies have shown that they are not beneficial and may have harmful side effects. The American Academy of Pediatrics recommends that the cough associated with respiratory viral infections be treated with fluids and increased humidity rather than antitussives. If coughing is severe enough to interfere with a child’s sleep, it is important to consult a pediatrician to determine if there is another cause for the cough and whether cough suppressant medication is warranted.
Avoiding outdoor allergens
People who are sensitive to outdoor allergens should follow pollen counts and avoid outdoor activities when pollen counts are high.
Keep the house and car windows closed and use air conditioners.
People who are allergic to grass should avoid playing in grassy areas during spring and early summer.
Individuals who are allergic to outdoor molds should not mow the grass, rake leaves, or disturb compost.
Avoiding indoor allergens
Placing pillows, mattresses, and box springs inside airtight plastic covers that are cleaned weekly can reduce house dust mite exposure. Avoid down pillows.
Removing dust-collecting furniture such as bookshelves, TV cabinets, stuffed toys, rugs, and other dust-catching fabrics from the bedrooms can also reduce house dust mite exposure.
Keeping pets outside or at least keeping them away from the bedroom of an allergic individual can help decrease animal allergen exposure. Washing cats frequently can help decrease cat allergens. It may be necessary to remove the cat from the household.
Venting moist areas such as bathrooms, kitchens, and basements can reduce indoor mold exposure.
HEPA air filtration devices (freestanding or installed in the air heating or cooling system of the home) can decrease the amount of pollen, mold spores, and animal allergens in the air. HEPA filtration devices installed on vacuum cleaners can reduce the circulation of house dust mite feces while vacuuming.
Wear masks while vacuuming or dusting if you are susceptible to allergic reactions to indoor allergens.
United States. Centers for Disease Control and Prevention. "Cold Versus Flu." Sept. 19, 2013. <http://www.cdc.gov/flu/about/qa/coldflu.htm>.
United States. National Institutes of Health. Daily Med. <http://dailymed.nlm.nih.gov/dailymed/about.cfm>.
United States. U.S. Food and Drug Administration. "Drugs." Nov. 3, 2011. <http://www.fda.gov/Drugs/default.htm>.