OTCs Today
Lauren Howell, PharmD
Over one-third of older adults report using OTC medications regularly, with use generally increasing with age. Older adults are also at an increased risk of experiencing hospitalization due to adverse drug events with these OTC medications, highlighting the importance of appropriate counseling at point of sale.
Older adults tend to be on several different medications for chronic disease states along with acute care therapies. Add in dietary supplements to meet nutritional needs and OTC medications for aches and pains, and it is no wonder that many older adults have duplications of therapy or adverse drug reactions. This is all in addition to the changes in metabolism and clearance of medications, which happen as age increases. Knowing which OTC medications are effective and safe for older adults, as well as the appropriate dose and duration, is crucial for pharmacists.
NSAIDs and pain relievers
OTC NSAIDs such as ibuprofen, naproxen, and aspirin are commonly viewed by patients as a safe option to cope with musculoskeletal pain. Despite being available over the counter, these medications are not without adverse effects and possible safety concerns, especially in the older adult population. Patients should be advised to take these medications for the shortest duration possible and to consult with a provider to ensure that NSAIDs are not contraindicated.
NSAIDs may increase fluid retention and mortality in older patients with heart failure. They may also increase the risk of AKI, GI bleeding, and peptic ulcers. Additionally, they can raise BP and worsen kidney function.
Acetaminophen is generally preferred for treating pain in older adults. However, it is important to counsel patients on the maximum daily dose of acetaminophen and to communicate that this maximum dose includes all products that are taken that may include acetaminophen. Some patients, especially those with worsening eyesight who may have a hard time reading tiny print on medication bottles and boxes, may not even realize that an OTC medication they are taking contains acetaminophen.
Anticholinergics
OTC anticholinergic medications such as diphenhydramine (Benadryl), dimenhydrinate (Dramamine), and doxylamine (Unisom) may be taken by older adults for many different reasons, such as insomnia, itchiness, allergies, and even motion sickness. These medications are also commonly included in OTC combination products for cough and cold. Patients may not even realize that combination products include these medications, making it important that pharmacists counsel patients who are purchasing these products.
Anticholinergics are a concern in the older adult population because they can lead to constipation, urinary retention, blurred vision, delirium, and even psychosis. Patients taking these medications, even though they are available over the counter, should always notify their provider so that they can be monitored appropriately.
PPIs
Commonly used to treat acid reflux and heartburn, PPIs carry their own risks and dangers when used in older adults. If a patient decides to take a PPI for heartburn, they should be advised to try discontinuing after 8 weeks due to the risk of osteoporosis, pneumonia, Clostridium difficile infections, and vitamin B12 deficiency.
What to tell patients
Many patients assume that products that are available over the counter are safe for them to take as much as needed. Despite warnings and directions on the packaging of these products, patients with vision problems may not be able to clearly read the correct directions, indications, and warnings for use.
At point of sale, pharmacists can ask patients about the OTC medications that they are purchasing, educate them on the safety of the medication, check for understanding, and encourage them to discuss these medications with their prescriber.
For more information, see APhA’s Handbook of Nonprescription Drugs, available in print in the bookstore on pharmacist.com or online in the APhA OTC module in Pharmacy Library (pharmacylibrary.com). ■