Doc's Thoughts

There is a lot of confusion surrounding over the counter (OTC) medicines. What works? What doesn’t? I will try to go through most of the common medicines with my take on if they are worth your money or not.

First off as a physician, I do not buy medicines that are combinations of different medicines. There are 2 reasons for this. 1) Usually they cost more than buying each individual medicine. 2) I don’t want to be taking medicine that I don’t need. Instead, I buy the generic single form of each medicine and take what I need for the symptoms that I am having. Instead of “Tylenol Cold multi-symptom nighttime” which has in it acetaminophen, chlorpheniramine, dextromethorphan, and phenylephrine; I would pick each individual active ingredient and decide which one I want for my symptoms.

Below is a list of the common OTC medicines and my take on each one. As with everything in life, I am sure there will be people that disagree with me. However, I unapologetically present the following list of OTC medicines and how well I feel they work. Remember every medicine has potential deadly side effects and if you have a chronic illness or are uncertain about anything you should contact your doctor before taking medicines. Also the side effects and complications are just the tip of the iceberg, please read all instructions on the medicines to make sure you can take them. I will use the generic name for them followed by some of the brand names they go by.

Ibuprofen (Advil, Motrin): Works wonders for mild to moderate pain, including the achy feelings you get with viral illnesses. It is the only medicine I take for muscle strains and joint sprains. Ibuprofen also is excellent at controlling fever. It has a couple of potential serious problems. 1) People with kidney disease should not take it. 2) People with ulcers should not take it. 3) There is some link to NSAIDs (the class of medicine ibuprofen is in) and to risk of strokes and heart attacks. 4) It should not be taken for more than about a week straight without contacting a physician to make sure it is OK. A dosage for healthy children over the age of 6 months is 10mg/kg every 8 hours. Children under 6 months should not take it. Adult dosages is 400mg every 8 hours, however doctors routinely prescribe up to 800mg every 8 hours. You should never take more than 800mg every 8 hours.GRADE: A+

Acetaminophen (Tylenol): Works fairly well for mild to moderate pain. Excellent at bringing fevers down. This is one medicine that is in a lot of the compounded OTC medicines, so it is easy to overdose on and not realize it. If you overdose on it, it can cause liver failure. People with liver disease should contact their doctor before taking it. Dosage for pediatrics is 15mg/kg every 6-8 hours. Adult dosage is 1 gram every 6-8 hours. When you have a really high fever it works well to take acetaminophen, then 4 hours later take ibuprofen, then 4 hours later acetaminophen. GRADE A

Pseudoephedrine (Sudafed): This works well on runny noses. It tends to dry up a lot of the mucus that your body produces. In Missouri this is behind the pharmacist’s desk and you have to specifically ask for it. People with heart problems or high blood pressure should contact their doctor before taking this. It can give you energy/nervousness also, so you should not take this in the afternoon if you want to sleep at night. I usually will take the 8 hour dose in the AM and it will take me through the rest of the day, but it will wear off by night time to allow me to sleep. This can cause a false positive drug test for amphetamines, so be careful if you are routinely tested. I typically recommend this medicine only to adults, even though there is a pediatric dosage. Take as directed on the box, usually 2 pills. GRADE B

Guaifenesin(Mucinex): The idea behind guaifenesin is that it thins out your mucous and allows you then to cough out the mucous build up in your chest. I am indifferent on this medicine. Some people say it works for them and studies are equivocal. I personally don’t use it, but there are no major reasons not to try it if you are desperate. There are no major side effects. GRADE C

Phenylephrine (Sudafed PE): Short answer: It doesn’t work, save your money. Long answer: Phenylephrine is used by physicians for several different things. We do know it increases blood pressure, dilates your eyes, and can cause people with BPH not to be able to urinate. The ability of phenylephrine to actually decrease mucous production or cough has only been “proven” by one article that was published by the drug manufacturer. All the other articles say it is no better than placebo. GRADE F

Dextromethorphan (Robitussin DM): Studies are all over the place. Anecdotally, most patients tell me it does not work, and I would tend to agree. There are only a few good (notice I didn’t say great) cough medicines and they are all prescription except for one: honey. There has been one notable study that honey can actually reduce your child’s cough during bedtime. Dextromethorphan is a drug of abuse, mainly by school age children. GRADE C-

Diphenhydramine(Benadryl): No doubt about this one. It works at what it is supposed to do. It relieves itching for allergic reactions. It also works to reduce hives. OTC medicine makers use it for it’s off label effects on the body. It makes you sleepy, so most of the “night time” medicines have diphenhydramine as an active ingredient. You don’t know your coughing if you are to sound asleep to wake up from it. Men with BPH should also be wary of this one, because it can cause urinary retention. Also, paradoxically it can cause some kids to get hyper instead of sleepy. Read the box for the appropriate dosage. GRADE A

Chlorpheniramine (Chlor-trimetron): This is another antihistamine. There has not been a great deal of studies done on this. However, seeing as how this medicine is usually combined with other medicines, it probably doesn’t do a great job at what it is supposed to do. It does seem to make people drowsy, so it sometimes replaces the diphenhydramine in some night time preparations. GRADE D

So there you have a small list of OTC drugs and what I think of them. If you would like me to expand this list to include non-cold and flu medicines write me an email and I will update the page. Remember, every person is different and nothing replaces going to a good doctor to help you manage all of these medicines. If you are uncertain or have any underlying medical problems, please talk to your doctor before taking any of these medicines.