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.
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.
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.
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.
Nasal decongestants can aggravate high blood pressure
and should not be used in people with uncontrolled high
blood pressure without permission from the doctor.
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.
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.
Avoiding outdoor allergens
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
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.
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
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
moist areas such as bathrooms, kitchens, and basements can reduce indoor mold
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
Wear masks while vacuuming or dusting.
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>.
Reviewed by William C. Shiel Jr., MD, FACP, FACR on 9/24/2013