Over the Counter Medications for common
ailments and possible overdoses
Rhynn Malloy, Cynthia Herrera, Katrina Karpowitch
PGY-1 Pharmacy Residents
Northwestern Memorial Hospital
The speaker has no potential or actual conflicts of interest with this presentation
What can be treated?
• Pain
• The common Flu/Cold
• Heartburn/Upset stomach
2
Pain
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Ibuprofen (Advil, Motrin)
• Naproxen (Naprosyn, Aleve)
• Aspirin
• Uses:
 Fevers
 Rheumatoid arthritis/Gout/Osteoarthritis
pain/inflammation
 Musculoskeletal pain/Bone pain
 Dysmenorrhea pain
 Migraines
4
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Contraindications:
 Peptic Ulcer Disease
 Renal/Kidney Disease
 Hypertension/Heart Failure
 Coronary Artery Disease (CAD)
 Cardiovascular Disease (CVD)
• Alternative if you have Peptic Ulcer Disease or
increased bleeding risk: Celebrex
5
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Doses:
 Ibuprofen: 200mg every 4-6 hours as needed
• Max dose: 1,200mg in 24 hours
• Treatment >10 days not recommended
 Aspirin: 325mg every 4-6 hours as needed
• Max dose: 4,000mg in 24 hours
 Naproxen (sodium): 220 mg every 8-12 hours
• Max dose: 660mg in 24 hours
6
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
• Side Effects:
 Dyspepsia (indigestion)
 Ulcers
 Nausea
 Gastrointestinal bleeding
 Rash/Itching
 Kidney damage
7
Acetaminophen (Tylenol)
• Uses:
 Fevers
 Injury/Trauma pain
 Cramping, aches
• Contraindications: liver disease
• Doses: 325mg every 4-6 hours
 Max dose: 4,000mg in 24 hours
 Overdose = #1 cause of acute liver failure in the US
8
Insomnia
Melatonin
• Uses:
 Insomnia
 Limited evidence that it is effective
• Dose: 0.3mg to 5mg at bedtime
• Side effects: largely unknown
10
Valerian Root
• Uses:
 Insomnia
 Limited evidence that it is effective
 May take weeks of nightly use to be effective
• Dose: 400 -900mg at night
• Side effects: if withdrawn abruptly, may cause heart
complications and withdrawal sympmtoms
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Antihistamines
• Diphenhydramine
• Uses
 Insomnia
 Allergic reactions (skin rashes, hives)
 Congestion
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Antihistamines
• Contraindications:
 Urinary retention
 Prostate enlargement
 Angle closure glaucoma
 Cardiovascular disease
 Patients of advanced age- may interact with
medications and will increase fall risk
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Antihistamines
• Doses:
 Diphenhydramine: 25-50mg before bed
• Max use: do not exceed 14 days of nightly use
• May develop tolerance in 2-3 nights
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Antihistamines
• Side effects:
 Sedation – extending into morning after
 Dry mucous membranes
 Elevated body temperature
 Constipation
 Blurred vision
 Urinary retention
15
Cold/Flu
Management
Antihistamines
• Diphenhydramine
• Doxylamine
• Uses:
 Sinus and nasal congestion, allergy relief
 Insomnia
17
Decongestants
• Contraindications:
 Hypertension/Heart Failure
 Coronary Artery Disease (CAD)
 Cardiovascular Disease (CVD)
 Asthma
 Chronic Obstructive Pulmonary Disease (COPD)
• Alternative agents to use in hypertension:
 Antihistamines: desloratadine (Clarinex),
fexofenadine (Allegra), cetirizine (Zyrtec)
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Decongestants
• Doses:
 Phenylephrine HCl: 10mg every 4 hours as needed
• Max dose: 60mg in 24 hours
 Pseudoephedrine: 60mg every 4-6 hours as
needed
• Max dose: 240mg in 24 hours
• Nasal sprays:
 Ephedrine 0.5%: 2-3 drops not more often than
every 4 hours
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Decongestants
• Side effects:
 Elevated blood pressure
 Palpitations, arrhythmias, fast heart beat
 Restlessness, insomnia
 Anxiety
 “Rebound congestion”
• Occurs within 3-5 days of continuous use
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Antitussives and Protussives (Expectorants)
• Dextromethorphan (antitussive)
• Guaifenasin (expectorant)
• Uses:
 Cough related to post-nasal drip
 Chest congestion
21
Antitussives and Protussives (Expectorants)
• Contraindications:
 Hypertension/Heart Failure
 Coronary Artery Disease (CAD)
 Cardiovascular Disease (CVD)
 Asthma, chronic bronchitis
 Chronic Obstructive Pulmonary Disease (COPD)
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Antitussives and Protussives (Expectorants)
• Doses:
 Dextromethorphan: 10-20mg every 4 hours or
30mg every 6-8 hours
• Max dose: 120mg in 24 hours
 Guaifenasin (expectorant): 200-400mg every 4
hours
• Max dose: 2,400mg (2.4g) in 24 hours
• CAUTION: beware of combination products!
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Antitussives and Protussives (Expectorants)
• Side effects:
 Drowsiness OR excitation, nervousness
 Dizziness
 Headache
 Stomach discomfort, nausea, constipation
 Respiratory depression in high doses
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Heartburn
Heartburn-antacids
• Symptomatic treatment of heartburn and indigestion
 Tums©, Milk of Magnesia©, Maalox©, Mylanta©,
Rolaids©
Heartburn-antacids
• Things to watch out for:
 Drug interactions
 Constipation or diarrhea
 Nausea and/or vomiting
 Muscle twitching
 Confusion
 Irregular heartbeat
Heartburn-H2RAs
• Symptomatic Prevention or Treatment of acid
reflux/peptic ulcer disease:
 Pepcid© (famotidine), Zantac© (ranitidine), Tagamet©
(cimetidine), Axid© (nizatidine)
Heartburn-H2RAs
• Things to look out for:
 Drug interactions [Cimetidine] **CAUTION in patients with
kidney dysfunction**
 Diarrhea
 Abnormal heartbeat
 Flushing and/or sweating
 Nausea and/or vomiting
 Slurred speech
• Dosing:
 Famotidine: 10-20mg once to twice daily
 Ranitidine: 75-150mg once to twice daily
 Cimetidine: 200-400mg once to twice daily
 Nizatidine: 75mg once to twice daily
Heartburn-PPIs
• Treatment for chronic acid reflux, GERD, and PUD
 Prilosec© (omeprazole), Prevacid© (lansoprazole)
Heartburn-PPIs
• Things to look out for:
 Nausea and/or vomiting
 Bone pain
 Sedation
 Muscle twitching
 Abnormal heart beats
 Diarrhea
• Dosing:
 Omeprazole: 20mg once daily
 Lansoprazole: 15mg once daily
**CAUTION in patients with
osteoporosis**
Nausea
Nausea
• Pepto-Bismol© (bismuth subsalicylate)
 Symptomatic relief of upset stomach, nausea,
indigestion, diarrhea
• Dramamine© (meclizine)
 Symptomatic and preventive treatment of motion
sickness
Nausea
• Things to watch out for with Pepto-Bismol©
 Breathing problems
**DO NOT USE WITH STOMACH
 Stomach bleed
ULCERS**
 Hearing loss
 Aspirin allergy
• Dosing
 30 mL every 30-60 minutes for maximum of 8
doses/day
Nausea
• Things to watch out for with meclizine:
 Urinary retention
 Closed angle glaucoma
 Dry mouth
 Drowsiness
 Flushing
• Dosing:
 25-50mg one hour prior to traveling. Maximum dose of
50mg in 24 hours.
QUESTIONS?