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A GP’s guide to your medicine cabinet

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As a doctor who constantly prescribes and recommends medication, it’s easy to forget that over-the-counter medications, supplements and alternative treatments make up a huge proportion of the drugs people use every day.

In these days of Dr. Google, people are more empowered than ever to do their own research and make treatment choices without ever seeing a doctor. Unfortunately though, as the saying goes, a little bit of knowledge can be a dangerous thing. In this article, I’m going to cover the basics of some over-the-counter (OTC) drugs you may be using regularly to help you use them correctly and safely.

Paracetamol

This is one of the commonest medications used for pain and fever, but in recent years it has reportedly been responsible for poisoning up to 150 Australians per week. The Therapeutic Goods Administration (TGA) advises:

  • Always follow the directions on the label.
  • Take the recommended dose.
  • Don’t take paracetamol for more than a few days at a time unless specifically advised to by a doctor or pharmacist.
  • Don’t take more than one medicine containing paracetamol – some cough/cold, sinus and period pain medicines also contain paracetamol – check the label or ask your pharmacist.
  • Always store the medicine in a safe place, out of the reach of children.
  • If an overdose is taken, ring the Poisons Information Centre (131 126) or go to a hospital straight away.
  • If pain persists, see your doctor.
  • For more information ask your pharmacist or doctor.

They also recommend that when giving it to children you should check that the strength and dose of the preparation you’re using are correct for the child’s age and weight.

Non-Steroidal Anti-inflammatories (NSAIDs)

These are commonly used for aches, pains, and fever caused by inflammation. They also help period pain by reducing chemicals called prostaglandins that contribute to uterine cramps and bleeding. These drugs include ibuprofen, naproxen, aspirin, diclofenac, and celecoxib. NSAIDs are often used long-term for musculoskeletal conditions like osteoarthritis but beware the potential unwanted side effects which can include:

  • Stomach pain, reflux and stomach ulcers
  • Reduced blood clotting, increased bleeding
  • Miscarriage or bleeding in pregnancy
  • Exacerbation of asthma
  • Kidney disease
  • A small increase in strokes and heart attacks

Different products will have different dosing guidelines, but as an example, naproxen 250mg tablets (eg. Naprosyn) is used for period pain by taking two tablets at the first sign of period pain and then one every 6-8 hours for the next two to three days (maximum six tabs per day). NSAIDs should be avoided in pregnancy, before operations and if you have stomach ulcers, allergies, liver or kidney disease. Always check with a chemist or GP if you’re not sure about using them and make sure you stay within the dosing recommendations on the pack.

Heartburn and reflux medications

These are very commonly used OTC drugs; in fact if you develop heartburn from using NSAIDs or over-indulging in Christmas cheer you may well be in need of one! Antacids are taken to neutralise the stomach acids and provide immediate relief from heartburn. They are generally pretty safe but can contain a lot of sodium so use with caution if you are on a salt or fluid-restricted diet or if you have kidney problems. Using too much of some antacids may also cause calcium overload, diarrhoea or constipation.

Another OTC heartburn drug is ranitidine (eg. Zantac). It works by reducing acid secretions in the stomach and is generally well tolerated and safe in pregnancy but get your GP’s advice if you have liver or kidney disease or porphyria.

Sleep enhancers

Sleep-deprived zombies will often stagger off to the chemist in search of some medicinal relief. Over-the-counter options include regulated medications and complementary or alternative preparations; the difference is that to be approved by the TGA for sale as a regulated medication, drugs are put through extensive testing to prove their safety and effectiveness.

Most OTC medications sold as sleep promotors are actually sedating antihistamines (allergy medications); they are effective but can leave you feeling somewhat “hung over” the next morning, so perhaps take them early in the evening to give them more time to wear off. These include doxylamine (eg. Dozile, Restavit) and diphenhydramine (eg. Unisom gel, Snuziad, Benadryl). They are generally safe in pregnancy, but always check anyway.

There are a range of complementary and herbal preparations to help with sleep, such as valerian, kava and passionflower. Evidence regarding the efficacy and safety of complementary treatments can be patchy or contradictory though, so do you research carefully and ask the retailer lots of questions.

Cough and cold preparations

We often use analgesics (pain-relieving medication) like paracetamol or NSAIDs to help with the pain of sore throats, headaches, and muscle aches. OTC cough and cold preparations are often a combination of several different drugs including paracetamol or an NSAID, so be particularly careful not to take additional doses. For example, Codral Day and Night contains paracetamol plus a decongestant and a sedating antihistamine, so you’ll need to consider the potential for allergic reactions and unwanted side effects from all the individual ingredients.

People who are desperate for some relief from their unpleasant symptoms will often choose these products but it’s important to understand that there isn’t strong evidence that they work well, and many are unsuitable for young children.

Healthdirect states that “decongestants containing pseudoephedrine, phenylephrine, oxymetazoline or xylometazoline must not be used in children younger than 6 years. Use salt water (saline) nasal sprays or drops instead of a nasal decongestant for these children. Before using a decongestant, check with your doctor or pharmacist if it is safe for you or your child.” That’s good advice for starting any new treatment, particularly if you have other medications or medical conditions which might be affected.

The information provided in this article is provided for information purposes only. You should seek assistance from a health care professional when interpreting these materials and applying them to your individual circumstances. If you have any concerns about your health, consult your general practitioner. Information provided in this article does not imply endorsement of third-party services or products and cannot provide you with health and medical advice.

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