Page 1143 - Basic _ Clinical Pharmacology ( PDFDrive )

CHAPTER 63 Therapeutic & Toxic Potential of Over-the-Counter Agents 1129

TABLE 63–3 Hidden ingredients in over-the-counter (OTC) products.

Hidden Drug or Drug Class OTC Class Containing Drug Selected Product Examples
Alcohol (percent ethanol) Cough syrups, cold preparations Theraflu Nighttime (10%); Vicks NyQuil Cold & Flu Liquid (10%); Vicks
NyQuil Cough (10%)
Mouthwashes Listerine (27%); Cepacol (14%)
Antihistamines Analgesics Advil PM; Excedrin PM; Goody’s PM Pain Relief Powder; Tylenol PM
Menstrual products Midol Complete; Pamprin
Sleep aids Nytol; Simply Sleep; Sominex; Unisom
Aspirin and other salicylates Antacids Alka-Seltzer Original; Alka-Seltzer Extra Strength
Antidiarrheals Pepto-Bismol (bismuth subsalicylate); Kaopectate (bismuth subsalicylate)
Menstrual products Pamprin Max
Cold/allergy preparations Alka-Seltzer Plus Formulation: Cold; Cold and Cough; Night Cold
Caffeine (mg/tablets or as Analgesics Anacin Advanced Headache (65); Excedrin Extra Strength (65); Excedrin
stated) Migraine (65); Goody’s Headache Relief Shot (65/60 mL)
Menstrual products Midol Complete (60); Pamprin Max (65)
Stimulants NoDoz Maximum Strength (200); Vivarin (200)
Local anesthetics (usually Antitussives/lozenges Cepacol Sore Throat Lozenges; Chloraseptic Sore Throat
benzocaine)
Dermatologic preparations Bactine; Dermoplast; Solarcaine
Hemorrhoidal products Americaine Ointment; Tronolane
Toothache, cold sore, and teething Anbesol; Kank-A; Zilactin-B
products
Sodium (mg/tablet or Analgesics/antacids Alka-Seltzer Original Effervescent Tablet (567); Alka-Seltzer
as stated)
Extra Strength Effervescent Tablet (588); Alka-Seltzer Gold (309)
Cold/cough preparations Alka-Seltzer Plus Formulations: Day and Night Cold (416);
Cold & Cough (415); Severe Cold & Flu (416); Night Cold (474);
Cold Sparkling Original (476)
Laxatives Fleets Enema (4439 mg, of which 275–400 mg/enema is absorbed)
Sympathomimetics Analgesics Sine-Off; Tylenol Sinus
(ephedrine, phenylephrine)
Asthma products Bronkaid; Primatene Tablets
Cold/cough/allergy preparations Advil Cold & Sinus; Alka-Seltzer Plus (many); Dimetapp (many); PediaCare
(many); Robitussin (many); Sudafed (many); Theraflu (many); Tylenol Cold
(many); Tylenol Allergy (many)
Hemorrhoidal products Preparation H (cream, ointment, suppository)

acetaminophen by adults or children can cause serious, and old due to serious and potentially life-threatening adverse events
often fatal, hepatotoxicity (see Chapter 4). Antihistamines may associated with accidental overdose including arrhythmias, halluci-
cause sedation or drowsiness, especially when taken concurrently nations, and encephalopathy. Drug information sources for OTC
with sedative-hypnotics, tranquilizers, alcohol, or other central products include the Handbook of Nonprescription Drugs, the most
nervous system depressants. comprehensive resource for OTC medications. It evaluates ingredi-
Finally, use of OTC cough and cold preparations in the pedi- ents contained in major OTC drug classes and lists the ingredients
atric population has been under scrutiny by the FDA based on a included in many OTC products. Facts and Comparisons eAnswers
lack of efficacy data in children less than 12 years of age and reports is an online reference that is updated monthly; it provides detailed
of serious toxicity in children. Following a thorough review, the OTC product information and patient counseling instructions.
FDA recommends that OTC cough and cold agents (eg, products Any health care provider who seeks more specific information
containing antitussives, expectorants, decongestants, and antihista- regarding OTC products may find useful the references listed
mines) not be used in infants and children younger than 2 years below.