Page 1141 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 63 Therapeutic & Toxic Potential of Over-the-Counter Agents 1127

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
Sleep aids Diphenhydramine Reduces Avoid use in: children <12 years • Insomnia persisting for >2 weeks may
(Nytol, Sominex) difficulty in of age; combination with be a sign of a serious underlying medical
falling asleep. alcohol, other antihistamines, condition.
Doxylamine (Unisom) or sedatives; individuals with
angle-closure glaucoma; men
with trouble urinating due to
an enlarged prostate gland.
Use caution when driving or
operating machinery.
Adverse effects include:
dizziness, constipation, and dry
mouth.
Smoking Nicotine polacrilex Reduces with- Avoid use in: children • Nicotine replacement products in addition
cessation aids gum (Nicorette) drawal symp- <18 years of age; women who to behavioral support approximately
toms (including are pregnant or breastfeeding; double the long-term cessation rates
Nicotine polacrilex nicotine craving) individuals with temporoman- compared with placebo.
lozenge (Nicorette) associated dibular joint disease (gum only); • Nicotine replacement products can be
Nicotine transdermal with quitting individuals with allergies to used in combination to improve long-term
patch (Nicoderm CQ) smoking. adhesive tape (patch only). Use abstinence rates.
patch with caution in patients
with a history of dermatologic • The patch may aid in improved adherence
conditions (eczema, psoriasis, (once-daily dosing).
ectopic dermatitis). • Do not use lozenge if allergic to soya (soy
beans).
Gum
Adverse effects include: jaw
soreness, hiccups, dyspepsia,
throat and mouth irritation,
nausea, vomiting,
lightheadedness.
Lozenge
Adverse effects include: mouth
irritation, nausea, hiccups,
cough, heartburn, headache,
sore throat, dizziness.
Transdermal patch
Adverse effects include: local
skin reactions (erythema, itch-
ing, burning), headache, and
sleep disturbances (insomnia,
abnormal/vivid dreams).

The recommendations listed in Table 63–2 are based on the appropriate based on the patient’s symptoms, underlying
efficacy of the ingredients and on the principles set forth in the health conditions, and whatever is known about the medica-
following paragraphs. tions the patient is already taking. Many products with the
same brand name contain different ingredients that are
1. Select the product that is simplest in formulation; in general,
single-ingredient products are preferred. Combination products labeled for different uses. For example, multiple products
may contain effective doses of some ingredients and subthera- (with different active ingredients) carry the Allegra name,
peutic doses of others. Furthermore, there may be differing including Allegra Allergy (fexofenadine), Allegra-D (fexofena-
durations of action among the ingredients, and there is always dine and pseudoephedrine), and Allegra Anti-Itch Cream
a possibility that the clinician or patient is unaware of the (allantoin and diphenhydramine).
presence of certain active ingredients in the product. 4. Recommend a generic product if one is available.
2. Select a product that contains a therapeutically effective dose. 5. Be wary of claims of specific superiority over similar products.
3. Consumers and providers should carefully read the “Drug 6. For children, the dose, dosage form, and palatability of the
Facts” label (Figure 63–1) to determine which ingredients are product are prime considerations.