OTCs Today
Lauren Howell, PharmD
It is no secret that navigating OTC medication use can be confusing for patients. Taking multiple medications, interpreting hard-to-read instructions on product packaging, and managing several different conditions or disease states at one time only adds to the confusion, especially for older adults.
Ensuring that older adult patients are stocked with the appropriate medications in their medicine cabinet is one way pharmacists can help this patient population navigate acute illnesses without having to make an extra trip to the pharmacy, eliminate confusion, and prevent drug interactions and worsening chronic illnesses.
Fever, aches, and pains
Acetaminophen is the safest option for older adults looking to treat occasional aches and pains or fever. Other options such as aspirin and NSAIDs can cause adverse effects including GI bleeding, ulcers, increased BP, and fluid retention, which can be especially dangerous for individuals with heart or kidney conditions. Acetaminophen, overall, has a better safety profile for older adults.
An important counseling point for acetaminophen is to monitor the total daily dose that is being taken. For most adults, the maximum daily dose is 4,000 mg. However, frail older adults, individuals with liver disease, and adults who drink alcohol regularly may need a lower daily dose. It is important to consider that many OTC combination products contain acetaminophen. Older adults may not realize that some of these products contain acetaminophen and can unintentionally take more than the recommended amount. At point of sale, pharmacy personnel can ensure that patients realize OTC products they are buying contain acetaminophen, when applicable.
Another option for treating joint pain is diclofenac topical gel. Although diclofenac is an NSAID, the topical formulation prevents it from being absorbed as much systemically, leading to far fewer adverse effects than NSAIDs that are taken orally.
Allergies
Antihistamines that contain loratadine, cetirizine, and fexofenadine are safe for most older adults who have regular or seasonal allergies. They can help treat multiple symptoms including sneezing, runny nose, itchy eyes, and nasal congestion.
First generation antihistamines such as diphenhydramine, chlorpheniramine, brompheniramine, and dimenhydrinate should be avoided in older adults to prevent drowsiness, falls, confusion, constipation, and trouble urinating.
If the patient’s primary symptoms are runny nose and congestion, having a nasal spray on hand can be beneficial. Corticosteroid nasal sprays that contain fluticasone, triamcinolone, or budesonide can provide faster relief than oral options, and fewer adverse effects.
If the patient is mainly experiencing eye-related symptoms, such as itchy or watery eyes, antihistamine eye drops containing olopatadine or ketotifen can be more effective than oral options.
Nasal congestion
When older adults are experiencing nasal congestion from a cold or sinus infection, saline spray or saline nasal wash should be the first medication suggested. Not only are they effective, but they are also much safer than oral decongestants for most older adults.
Oxymetazoline, a decongestant nasal spray, avoids the systemic adverse effects of oral decongestants but can only be used safely for a few days. Overuse can cause rebound congestion.
Counseling patients
Anytime an older adult is buying an OTC product, pharmacists have a great opportunity to counsel them on OTC medication safety and ask them about what OTC medications they may be taking on a regular basis. Even OTC medications that are safe for most older adults may not be appropriate for certain individuals.
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). ■