Page 1139 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 63 Therapeutic & Toxic Potential of Over-the-Counter Agents 1125

TABLE 63–2 Ingredients of known efficacy for selected over-the-counter (OTC) classes. (Continued)

Generic Name
OTC Category (Brand Example) Labeled Use Warnings Considerations
Decongestants, Oxymetazoline (Afrin, Temporary relief Avoid use for >3 days. Use • Long-acting agents (oxymetazoline-
topical Mucinex Full Force, of nasal con- with caution in patients with: containing products) are generally
(intranasal) Vicks Sinex) gestion due to heart disease; high blood pres- preferred.
common cold, sure; thyroid disease; diabetes;
Phenylephrine hay fever, upper trouble urinating due to an • Topical decongestants should not exceed
(Neo-Synephrine) respiratory aller- enlarged prostate. 3 days to prevent rebound nasal congestion
gies, or sinus (eg, worsening or recurrence of congestion
symptoms).
congestion and Adverse effects include:
pressure. sneezing, burning, stinging,
dryness, and rhinorrhea.
Decongestants, Phenylephrine Temporary relief Avoid use: in patients taking an • May be found in combination with
systemic (Sudafed PE) of sinus conges- MAOI or for 2 weeks after stop- antihistamine, antitussives, expectorants,
tion and pres- ping the MAOI. Use with caution and analgesic products.
Pseudoephedrine sure. Temporarily in patients with heart disease;
(Sudafed) relieves nasal high blood pressure; diabetes; • Extended-release pseudoephedrine
products should not be used in children
congestion due thyroid disease; trouble urinat- <12 years of age.
to the common ing due to an enlarged prostate
cold, hay fever, gland. • Federal regulations established to discour-
or other upper age the illicit manufacture of metham-
respiratory Adverse effects include: arrhyth- phetamine specify that all drug products
allergies. mias, tachycardia, high blood containing pseudoephedrine must be
pressure, anxiety, headache, stored in locked cabinets or behind the
dizziness, tremor, and insomnia. pharmacy counter and can only be sold
in limited quantities to consumers after
they provide photo identification and are
entered into a registry.
Emergency Levonorgestrel To prevent preg- Avoid use in the case of known • Available only by prescription for women
contraceptive (Plan B One-Step) nancy following or suspected pregnancy. <17 years of age.
unprotected • Should be taken as soon as possible
intercourse or Adverse effects include: heavier within 72 hours after unprotected
possible contra- menstrual bleeding, nausea, intercourse.
ceptive failure. lower abdominal pain, fatigue,
headache, dizziness, and breast • If vomiting occurs within 2 hours of taking
tenderness. the tablet, the dose may need to be
repeated.
• Use backup contraceptive after administra-
tion. Patients taking oral contraceptives
regularly should also use backup contra-
ception, such as condom, until next period
cycle starts.
Expectorants Guaifenesin Used to help Avoid use in children <2 years • The only OTC expectorant recognized as
(Mucinex) loosen phlegm of age. safe and effective by the FDA.
(mucus) and thin • Often used with antihistamines, decon-
bronchial secre- Adverse effects include: nausea, gestants, and antitussives in combination
tions to make vomiting, stomach pain, and products.
cough more dizziness.
productive. • Administer with a large quantity of fluids
for best results.
• When used for self-care, do not use
extended-release tablets in children
<12 years of age.
Laxatives Bulk formers Temporary relief Bulk formers • The safest laxatives for chronic use include
Polycarbophil, of occasional Avoid use in patients with bulk formers and stool softeners.
psyllium, and constipation and difficulty swallowing. • The bulk formers in powder formulation
methylcellulose irregularity. must be taken with adequate fluid for
preparations Polyethylene glycol 3350 optimal effect and to avoid choking.
(Citrucel, Fibercon, Avoid use in patients with
Metamucil) kidney disease.
(continued)