A trip to the pharmacy can be an overwhelming experience for someone simply trying to choose an over-the-counter medication to treat a symptom. Not only are there so many choices but people also have to worry about how a new medication might interact with a medication you’re currently taking.
How do you know which OTC medication is best for you?
Allina Health pharmacist McKaya Kastner shares how you can navigate the confusion of OTC medications and how to decide which medication is best for you.
Selected Podcast
Clearing up the Confusion for Over the Counter Medications
Featured Speaker:
Learn more about McKaya Kastner, PharmD
McKaya Kastner, PharmD
McKaya Kastner, PharmD is a board-certified pharmacotherapy specialist with interests in diabetes, asthma, cardiovascular health, smoking cessation and patient education.Learn more about McKaya Kastner, PharmD
Transcription:
Clearing up the Confusion for Over the Counter Medications
Melanie Cole (Host): A trip to the pharmacy can be an overwhelming experience for someone simply trying to choose an over-the-counter medication to treat a symptom. Not only are the varieties of choices so huge, but people also have to worry about how taking a new medication might interact with a medication you’re currently taking. My guest today is Dr. McKaya Kastner. She’s a pharmacist with Allina Health. Welcome to the show, Dr. Kastner. So, wow, this is a huge topic, and there are so many. Let’s just start with something pretty simple like headaches, and body aches, and the NSAID aisle because to me, that’s a huge aisle. When we’re looking at Tylenol, Motrin, ibuprofen, Aleve, naproxen, all of these things, what do you tell people about looking for on the label? What should we look for?
Dr. McKaya Kastner (Guest): You’re absolutely right, there are a ton of options out there. Actually, there are over a hundred thousand different over-the-counter items and especially when you look at something like the headache aisle, the pain aisle, there’s numerous combinations of things like ibuprofen and Tylenol and different strengths. One of the first things that I recommend doing is looking at the box. The box actually has a wealth of information on which medications to choose, what is actually inside the pill, the strength of the medication, how many you should take, and some different side-effects to look out for. Looking at that box is actually a great starting place.
Melanie: Now, when we’re looking at that box – and you said there’s different strengths. Some are 200 milligrams, some are 400, or 100 -- and then the confusing thing for consumers, Dr. Kastner, is that we see Motrin next to the pharmacy brand –
Dr. Kastner: That’s absolutely right.
Melanie: Okay, so we’re looking at what is what’s considered an over-the-counter generic version, and is there a difference?
Dr. Kastner: That’s a great question. Typically, there is not any difference in the effectiveness of a generic versus a brand name medication. Most of those generic medications that are sitting on the shelf will say, “Compared to Aleve,” or, “Compared to Advil,” and so you’re able to see which medications are the same brand in generic.
Melanie: Okay, that’s good to know because they always do say that, “Compared to --,” and I’m just never sure whether that’s really what you’re supposed to compare it to. Now, for somebody – we’re talking about pain, but what about fever? Is there a difference between taking acetaminophen, or taking ibuprofen when you’re dealing with a fever for yourself or your child?
Dr. Kastner: Yeah, exactly right. Typically, acetaminophen or brand name Tylenol is good for pain and fever where medications like NSAIDS – ibuprofen, Aleve – are really good for inflammation, so better maybe for a headache, or joint pain, something like that. There is a difference, and if you are confused, one of the best recommendations I could give is to grab those two boxes and bring them up to the pharmacist, let him know what symptoms you’re having and ask what they think would be the best.
Melanie: Well, you just got right in front of me on that one because that was going to be my next question. Can we, with all of the confusion, walk up to our pharmacist -- if we’re dealing with over-the-counter and not something that’s prescription – and get a consultation and say, “Which one of these should I use?”
Dr. Kastner: Oh, absolutely, I think that pharmacists really enjoy answering those types of questions and it’s really the reason that they put the over-the-counter aisles right in front of the pharmacy. So yes, always bring those medications – feel comfortable bringing those medications up to the pharmacist and asking those questions, especially if that’s your pharmacy that you go to, they’re going to have a list of your prescription medications. They can look down that list and make sure there’s not going to be any interactions and really give you a good consultation on that over-the-counter item.
If you’re not in a pharmacy that you typically go to, one of the things I recommend is to have a list of your current prescription and over-the-counter medications. That’s good to bring to the pharmacy if you have questions, but it’s also good to bring to your doctor’s office. A lot of times your doctors don’t know what kind of things you pick up over-the-counter – whether that’s supplements, or herbals, or over-the-counter products – and so having a good, complete list that you bring to every doctor and every specialist just makes sure that the medications you’re taking are safe.
Melanie: That’s great advice. Now, we hear from the American Academy of Pediatrics that they don’t want us using certain cough and cold medications with our children anymore, and some of these medications have actually been taken not off the over-the-counter, but away from where we can just grab them and back where you are. Tell us a little bit about some of the cough and cold medications out there. What should we be looking for? What is pseudoephedrine and all of these different things that we see in there?
Dr. Kastner: Yeah, that’s absolutely right. Pseudoephedrine is a medication for congestion -- so when you really have a stuffy nose – and it’s one that we keep behind the counter. The reason that is is just because it can be used to make illicit substances, especially methamphetamines, and so we just like to have a better idea of who’s picking that up and who’s using it, and making sure it’s getting in the hands of people who truly need it.
The other thing that you mentioned was pediatric medications. When we look at those bottles, a lot of times they’re not recommended for patients younger than two – sometimes younger than four. It’s really important when you’re looking for medications for your children to pick up and look at the back of the box and see what ages are recommended. The other thing that’s important with pediatrics is there’s typically different doses for different ages or for different weights, so looking at that and making sure you’re giving your patient the right dosing – or your daughter or son the right dosing. And also making sure that you’re using a proper measuring device, so not our kitchen spoons at home -- we just can’t make sure they’re very accurate -- asking your pharmacist for a measuring spoon or buying one at the pharmacy, so we make sure we give our children the right amounts of medication.
Melanie: Okay, so when we’re talking about coughs and colds there’s a bunch of sprays out there and decongestants, things like Afrin, and saline sprays, and all of these kinds of things as well. Does using those, Doctor, do they actually make the sinuses swell up even more? They may clear you up for the evening so that you can get a decent night sleep, but after the fact, Dr. Kastner, do we then – can they cause trouble if you use them for more than a few days?
Dr. Kastner: That’s a great question. I think you’re referring to Afrin specifically. That’s a medication that goes in, and it constricts our vessels in the nose so that it can clear up some space so that we can breathe. And you’re exactly right, if we use that medication for longer than three days what we tend to see is some rebound congestion, so when you maybe wouldn’t have normally felt congested, you start to feel a little stuffy without using that medication. It’s important again, to look at the back of the box. On Afrin, it actually says not to use for longer than three days, to give yourself a medication holiday or a little break from that medicine, and then you could always use it later in the month. But you’re right, checking the back of the box, making sure that you’re using it for the right amount of time is very important, so you don’t run into some of those avoidable side-effects.
Melanie: And what about topicals, because there are a lot. There’s for pain relief, there’s for muscle relaxing, there’s for rashes and itching, there’s cortisone, and antihistamines and – there’s different things that you see, and you’re not sure what all of these – which you can use on maybe a wound, which one you can use on a little rash on a child, so what are we looking for on the topicals?
Dr. Kastner: When you look at the back of the box, again, it’s going to give you a lot of information. Right away, at the top, it will tell you what the cream or ointment is for, and as you start to work down the back of the box, you’ll find things like warnings about when or when not to use it. Some of the products will actually say, “Do not use on an open wound or broken skin.” I would start there to get an idea of which one might be right for you.
Speaking of over-the-counter topicals, one of the new ones that just came out that used to be a prescription-only medication is Lidocaine. I’ve been recommending that a lot of patients who have trouble taking some of those other over-the-counter NSAIDs or pain relievers that we talked about previously. Lidocaine is a nice option because you put it right on the area of pain and it helps to numb and relax that area. You’re right, there’s a lot of topical medications out there. Again, looking at the back of the box is going to be a great place to start and then bringing them up to your pharmacist if you have more questions – or your doctor is another good option.
Melanie: Wrap it up for us then, Dr. Kastner, because we’ve hit some of the good, main points, but there are so many more to cover. What do you want listeners to know about discussing these kinds of questions with their local pharmacist -- making friends with that pharmacist so that it’s somebody that they can trust as a partner in their healthcare?
Dr. Kastner: Yeah, I would say get to know your pharmacist. Never be afraid or embarrassed to bring up a question. Pharmacists love to answer questions, so always be willing to bring up those boxes or ask questions. And then again, always have that list of medications with you. It makes it so much easier for us to be able to look through that list of prescription and over-the-counter medications and make sure they’re the right ones and the safe ones for you.
Melanie: Thank you, so much, for being with us today. What great information. You’re listening to The Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much for listening.
Clearing up the Confusion for Over the Counter Medications
Melanie Cole (Host): A trip to the pharmacy can be an overwhelming experience for someone simply trying to choose an over-the-counter medication to treat a symptom. Not only are the varieties of choices so huge, but people also have to worry about how taking a new medication might interact with a medication you’re currently taking. My guest today is Dr. McKaya Kastner. She’s a pharmacist with Allina Health. Welcome to the show, Dr. Kastner. So, wow, this is a huge topic, and there are so many. Let’s just start with something pretty simple like headaches, and body aches, and the NSAID aisle because to me, that’s a huge aisle. When we’re looking at Tylenol, Motrin, ibuprofen, Aleve, naproxen, all of these things, what do you tell people about looking for on the label? What should we look for?
Dr. McKaya Kastner (Guest): You’re absolutely right, there are a ton of options out there. Actually, there are over a hundred thousand different over-the-counter items and especially when you look at something like the headache aisle, the pain aisle, there’s numerous combinations of things like ibuprofen and Tylenol and different strengths. One of the first things that I recommend doing is looking at the box. The box actually has a wealth of information on which medications to choose, what is actually inside the pill, the strength of the medication, how many you should take, and some different side-effects to look out for. Looking at that box is actually a great starting place.
Melanie: Now, when we’re looking at that box – and you said there’s different strengths. Some are 200 milligrams, some are 400, or 100 -- and then the confusing thing for consumers, Dr. Kastner, is that we see Motrin next to the pharmacy brand –
Dr. Kastner: That’s absolutely right.
Melanie: Okay, so we’re looking at what is what’s considered an over-the-counter generic version, and is there a difference?
Dr. Kastner: That’s a great question. Typically, there is not any difference in the effectiveness of a generic versus a brand name medication. Most of those generic medications that are sitting on the shelf will say, “Compared to Aleve,” or, “Compared to Advil,” and so you’re able to see which medications are the same brand in generic.
Melanie: Okay, that’s good to know because they always do say that, “Compared to --,” and I’m just never sure whether that’s really what you’re supposed to compare it to. Now, for somebody – we’re talking about pain, but what about fever? Is there a difference between taking acetaminophen, or taking ibuprofen when you’re dealing with a fever for yourself or your child?
Dr. Kastner: Yeah, exactly right. Typically, acetaminophen or brand name Tylenol is good for pain and fever where medications like NSAIDS – ibuprofen, Aleve – are really good for inflammation, so better maybe for a headache, or joint pain, something like that. There is a difference, and if you are confused, one of the best recommendations I could give is to grab those two boxes and bring them up to the pharmacist, let him know what symptoms you’re having and ask what they think would be the best.
Melanie: Well, you just got right in front of me on that one because that was going to be my next question. Can we, with all of the confusion, walk up to our pharmacist -- if we’re dealing with over-the-counter and not something that’s prescription – and get a consultation and say, “Which one of these should I use?”
Dr. Kastner: Oh, absolutely, I think that pharmacists really enjoy answering those types of questions and it’s really the reason that they put the over-the-counter aisles right in front of the pharmacy. So yes, always bring those medications – feel comfortable bringing those medications up to the pharmacist and asking those questions, especially if that’s your pharmacy that you go to, they’re going to have a list of your prescription medications. They can look down that list and make sure there’s not going to be any interactions and really give you a good consultation on that over-the-counter item.
If you’re not in a pharmacy that you typically go to, one of the things I recommend is to have a list of your current prescription and over-the-counter medications. That’s good to bring to the pharmacy if you have questions, but it’s also good to bring to your doctor’s office. A lot of times your doctors don’t know what kind of things you pick up over-the-counter – whether that’s supplements, or herbals, or over-the-counter products – and so having a good, complete list that you bring to every doctor and every specialist just makes sure that the medications you’re taking are safe.
Melanie: That’s great advice. Now, we hear from the American Academy of Pediatrics that they don’t want us using certain cough and cold medications with our children anymore, and some of these medications have actually been taken not off the over-the-counter, but away from where we can just grab them and back where you are. Tell us a little bit about some of the cough and cold medications out there. What should we be looking for? What is pseudoephedrine and all of these different things that we see in there?
Dr. Kastner: Yeah, that’s absolutely right. Pseudoephedrine is a medication for congestion -- so when you really have a stuffy nose – and it’s one that we keep behind the counter. The reason that is is just because it can be used to make illicit substances, especially methamphetamines, and so we just like to have a better idea of who’s picking that up and who’s using it, and making sure it’s getting in the hands of people who truly need it.
The other thing that you mentioned was pediatric medications. When we look at those bottles, a lot of times they’re not recommended for patients younger than two – sometimes younger than four. It’s really important when you’re looking for medications for your children to pick up and look at the back of the box and see what ages are recommended. The other thing that’s important with pediatrics is there’s typically different doses for different ages or for different weights, so looking at that and making sure you’re giving your patient the right dosing – or your daughter or son the right dosing. And also making sure that you’re using a proper measuring device, so not our kitchen spoons at home -- we just can’t make sure they’re very accurate -- asking your pharmacist for a measuring spoon or buying one at the pharmacy, so we make sure we give our children the right amounts of medication.
Melanie: Okay, so when we’re talking about coughs and colds there’s a bunch of sprays out there and decongestants, things like Afrin, and saline sprays, and all of these kinds of things as well. Does using those, Doctor, do they actually make the sinuses swell up even more? They may clear you up for the evening so that you can get a decent night sleep, but after the fact, Dr. Kastner, do we then – can they cause trouble if you use them for more than a few days?
Dr. Kastner: That’s a great question. I think you’re referring to Afrin specifically. That’s a medication that goes in, and it constricts our vessels in the nose so that it can clear up some space so that we can breathe. And you’re exactly right, if we use that medication for longer than three days what we tend to see is some rebound congestion, so when you maybe wouldn’t have normally felt congested, you start to feel a little stuffy without using that medication. It’s important again, to look at the back of the box. On Afrin, it actually says not to use for longer than three days, to give yourself a medication holiday or a little break from that medicine, and then you could always use it later in the month. But you’re right, checking the back of the box, making sure that you’re using it for the right amount of time is very important, so you don’t run into some of those avoidable side-effects.
Melanie: And what about topicals, because there are a lot. There’s for pain relief, there’s for muscle relaxing, there’s for rashes and itching, there’s cortisone, and antihistamines and – there’s different things that you see, and you’re not sure what all of these – which you can use on maybe a wound, which one you can use on a little rash on a child, so what are we looking for on the topicals?
Dr. Kastner: When you look at the back of the box, again, it’s going to give you a lot of information. Right away, at the top, it will tell you what the cream or ointment is for, and as you start to work down the back of the box, you’ll find things like warnings about when or when not to use it. Some of the products will actually say, “Do not use on an open wound or broken skin.” I would start there to get an idea of which one might be right for you.
Speaking of over-the-counter topicals, one of the new ones that just came out that used to be a prescription-only medication is Lidocaine. I’ve been recommending that a lot of patients who have trouble taking some of those other over-the-counter NSAIDs or pain relievers that we talked about previously. Lidocaine is a nice option because you put it right on the area of pain and it helps to numb and relax that area. You’re right, there’s a lot of topical medications out there. Again, looking at the back of the box is going to be a great place to start and then bringing them up to your pharmacist if you have more questions – or your doctor is another good option.
Melanie: Wrap it up for us then, Dr. Kastner, because we’ve hit some of the good, main points, but there are so many more to cover. What do you want listeners to know about discussing these kinds of questions with their local pharmacist -- making friends with that pharmacist so that it’s somebody that they can trust as a partner in their healthcare?
Dr. Kastner: Yeah, I would say get to know your pharmacist. Never be afraid or embarrassed to bring up a question. Pharmacists love to answer questions, so always be willing to bring up those boxes or ask questions. And then again, always have that list of medications with you. It makes it so much easier for us to be able to look through that list of prescription and over-the-counter medications and make sure they’re the right ones and the safe ones for you.
Melanie: Thank you, so much, for being with us today. What great information. You’re listening to The Well Cast with Allina Health, and for more information, you can go to AllinaHealth.org, that’s AllinaHealth.org. This is Melanie Cole. Thanks, so much for listening.