What is OTC

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Pain Relievers

If you drink more than 1 alcoholic beverage per week and use NSAIDs,

including aspirin, you may be at increased risk of GI bleeding.

People who consume 3 or more alcoholic beverages each day should

consult their physician before using any pain reliever.

Acetaminophen is much less likely than NSAIDs to be associated with

GI problems, including bleeding. But to minimize the risk of serious

liver injury, you should never take more than the recommended daily

dose (4g per day).

Antihistamines, Decongestants and Cough Medicines

The combination of OTC antihistamines and alcohol can increase

drowsiness, especially in elderly people. In addition, alcohol makes

the drowsiness, sedation and impaired motor skills associated with

the cough suppressants dextromethorphan (in products such as

Drixoral, Robitussin) and codeine worse.

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Special Groups

Some groups of people may be more likely to experience the side

effects associated with OTC medicines. The sections below include

tips for using OTC medicines in the following special populations:

• Children

• Older adults

• Pregnant or breastfeeding women

• Other groups

Children

When used properly, OTC medications pose little risk to children.

However, children metabolize drugs differently than adults. You

should know how OTC drugs will affect your children before you use

them. Talk with your family doctor if you have any questions about

giving your child OTC medicines.

• Acetaminophen is generally considered the treatment of choice

for children's pain relief.

• Do not give ibuprofen to a child younger than 6 months of

age.

• Do not give aspirin to children under the age of 18 because

of the risk of Reye's syndrome (a drug reaction that can lead to

permanent brain injury).

• Do not use nasal decongestants, cough medicines and cold

medicines in young children, especially those under 2 years of age.

These medicines can produce dangerous side effects. In addition,

cough and cold medicines are not effective in treating young

children.

It can be helpful for parents and other caregivers to keep track of

the medicine a child is taking. One way to do that is with a

medication log. Using a log can help avoid giving too much medicine

or giving it too often. It can also provide important information to

your family doctor if there is a problem.

A PDF version of the medication log is available. Download PDF now (1

page / 15 KB). About PDFs.

Medicine and Your Child: How to give the right dose

Here are some tips on giving the right dose:

• When your doctor says to give the medicine " every 6 hours "

that generally means the medicine is taken 4 times a day (for

example, at breakfast, lunch, supper and bed time). It doesn't

generally mean to wake the child up in the night to take medicine.

And " take every 8 hours " generally means the medicine should be taken

3 times a day.

• Pay close attention to the dosage given on the label. Labels

for liquid medicines give measurements in both teaspoons (tsp) and in

milliliters (mL). Your pharmacist can give you a measuring device (a

spoon that's made especially for measuring medicine, a syringe or a

cup) that's labeled with both tsp and mL. Your pharmacist should also

show you how to use it. One tsp is not the same as 1 mL. Read the

label carefully and make sure you give the right amount of medicine

to your child. An ordinary kitchen teaspoon may not hold the correct

amount of medicine.

• Measure the medicine carefully. If you're using a measuring

cup, set it on a level surface such as a countertop and then pour the

medicine in it.

• " If a little medicine is good, a lot is better (or will work

quicker) " is wrong. Giving too much medicine can be harmful. Be sure

you only give the recommended dose of each medicine.

• If you use a syringe-type measuring device to give liquid

medicine to your child, first throw away the small cap of the

syringe. Children can choke on these caps.

• If your child has a bad reaction to a medicine or is allergic

to a medicine, tell your doctor right away. Also, keep a record of

the following information at home: the name of the medicine, the

dosage directions, the illness the medicine was used for and the side

effects the medicine caused.

Older Adults

The elderly use a number of medications at the same time and

therefore need to pay careful attention to drug-drug interactions

between OTC medications and prescription medications. Older adults

should talk with their doctor about the medicines they take and

potential interactions with OTC medicines.

• There is a relatively high risk of kidney disease and GI

bleeding in elderly patients who use NSAIDs. Discuss this risk with

your family doctor.

• Pseudoephedrine can increase blood pressure and the pressure

in your eye that can lead to glaucoma. It can also make existing

blockages in the urinary tract worse. Pseudoephedrine interacts

negatively with many other drugs such as beta-blockers,

antidepressants, insulin and some medications that treat low blood

sugar.

• If you use a monoamine oxidase inhibitor (MAOI), a type of

prescription antidepressant, or take any medication for a seizure

disorder, you should avoid using pseudoephedrine. Pseudoephedrine can

change the way these drugs work in your system. Some common MAOIs

include Marplan (generic: isocarboxazid), Nardil (generic: phenelzine

sulfate) and Parnate (generic: tranylcypromine sulfate).

• If you use a MAOI, you should not use dextromethorphan.

Dextromethorphan interferes with the way MAOIs work.

Pregnant or Breastfeeding Women

Pregnant or breastfeeding women should talk with their doctor before

using any medicine. Some can affect your baby. The following are some

general guidelines.

Pregnancy

• Acetaminophen is generally considered safe for short-term

pain relief during pregnancy.

• Avoid using aspirin during pregnancy. It can cause birth

defects or problems during delivery.

• Avoid using other NSAIDs, especially during the third

trimester of pregnancy. They can cause heart defects in the baby.

Breastfeeding

• Acetaminophen and NSAIDs such as ibuprofen provide safe pain

relief for women who are breastfeeding.

• Avoid using aspirin because it is excreted in breast milk and

can cause rashes and bleeding problems in nursing infants.

• Limit long-term use of antihistamines. Antihistamines are

excreted in breast milk, and may cause side effects such as sedation,

irritability, crying and sleep disturbances in nursing infants.

Antihistamines may also interfere with the production of milk.

General Tips

These steps can help minimize the risk of side effects during

pregnancy and breastfeeding:

• Talk to your doctor about possible alternatives to medicine.

• Avoid the use of medicines during the first trimester.

• Take oral medicines after nursing or before the infant's

longest sleep period.

• Avoid the use of extra-strength, maximum-strength or long-

acting medicines.

• Avoid " combination " products.

• Watch your infant for possible side effects, such as a rash,

difficulty breathing, headache or other symptoms that your child

didn't have before you took the medicine and then breastfed.

Other Groups

People with health problems such as kidney disease, heart disease,

diabetes, asthma, blood clotting disorders or gout may be at

increased risk of side effects associated with OTC medicines.

This chart contains detailed information on use of OTC pain relievers

in patients with these and other medical conditions.