WebMD Feature from "Women's Health" Magazine
By Madonna Behen
You feel too horrible to sort through the dizzying array of meds in aisle six. Which is why we've done the work for you: Here are pharmacists' top picks for the best over-the-counter drugs on the market.
Browsing through your favorite boutique trying to decide between the Citizens or the Sevens? Now, that's fun. But standing in the drugstore, puzzling out which heartburn medicine to buy as your lunch burrito burns a hole in your stomach? Not so much . . .
In a recent survey conducted by Harris Interactive for the National Council on Patient Information and Education, 66 percent of adults said that picking the right nonprescription drug is enough to make their heads spin. But mulling over the endless choices--there are more than 100,000 OTC meds crowding the shelves--gets a lot easier when you check with the experts. That's what the American Pharmacists Association did when it surveyed 5,000 practicing pharmacists earlier this year to find out which OTC products they recommend most often. Here are their top choices for treating those annoying ailments--from hay fever to headaches--that can ruin your day. Study this list--and get well soon.
Cold Sores
The Drug: Abreva
Why it's No. 1: Got that telltale tingle that signals that a cold sore the size of Donald Trump's ego is about to sprout on your lip? Abreva can bring it to a screeching halt. "It prevents the virus from infecting healthy cells, which stops the cold sore from erupting," says W. Steven Pray, Ph.D., D.P.H., professor of nonprescription drugs at Southwestern Oklahoma State University College of Pharmacy in Weatherford. The drug works by creating a barrier around skin cells that makes it more difficult for the cold sore virus to penetrate them. "No other nonprescription product can do that."
Generic: None. The soonest one could be available is 2014.
Fine print: Dash to a drugstore the minute you feel a cold sore coming on. "Once the sore develops, using Abreva isn't as effective, because the time for prevention has passed," says Elaine D. Mackowiak, Ph.D., R.Ph., professor of pharmacy practice at Temple University School of Pharmacy in Philadelphia. "At that point, you can use any topical cold sore treatment, such as Anbesol, Orajel, or Zilactin, to reduce discomfort."
See a doc if the sore hasn't healed after 10 days.
Constipation
The Drugs: Metamucil and Ducolax
Why they're No. 1: When it comes to making regular deposits, the magic word is fiber. Metamucil is druggists' remedy of choice because it contains psyllium, a natural plant fiber that softens and bulks up your stools. (It may sound counterintuitive, but it's easier for your digestive system to transport soft, bulky stools than hard, small ones, which can stick to the walls of the colon and block the way.) Plus, "Metamucil is effective and safe to take every day," Pray says, which means you can use it to help prevent system backups.
The one snag is that the medication can take time to work--usually 12 to 72 hours--which is why pharmacists also recommend Dulcolax, a stimulant laxative that does the trick in less than 12 hours. "Dulcolax stimulates the nerves that propel food through your body's gastrointestinal tract," says Paul L. Doering, M.S., distinguished service professor of pharmacy practice at the University of Florida College of Pharmacy in Gainesville. "It gets things moving, but it's gentler than other stimulants, so it won't leave you doubled over the toilet in pain."
Generic: Psyllium for Metamucil and bisacodyl for Dulcolax
Fine print: If you use Metamucil powder, gulp it down as soon as you mix it with water, says Janet Engle, Pharm.D., clinical professor of pharmacy practice at the University of Illinois at Chicago College of Pharmacy. Otherwise you'll end up with a thick, rubbery (and wholly undrinkable) blob in your glass. Doering also warns against taking a stimulant laxative like Dulcolax for more than a few days in a row. Use it longer than that, he says, "and your bowels may start to rely on the medication to do their job."
See a doc if you're backed up for more than week.
Diarrhea
The Drug: Imodium A-D
Why it's No. 1: When a case of the runs tethers you to the toilet, Imodium A-D can help slow the flow. "It reduces the frequency of bowel contractions, so everything moves at a calmer pace," Pray says. "It also gives your stools more firmness." All of which makes for a happy colon. Bismuth subsalicylate, the active ingredient in Pepto-Bismol, another popular option, isn't as strong, which means the drug doesn't slow things down as efficiently, according to Kim Broedel-Zaugg, Ph.D., professor of pharmacy practice at Ohio Northern University College of Pharmacy. "But with Imodium, you're definitely going to find relief." So being more than five feet away from the nearest bathroom is no longer cause for panic.
Generic: Loperamide HCl
Fine print: Try to pinpoint the cause of your gastrointestinal distress before you pop a pill, Engle recommends. In some cases, you may actually be better off just riding it out. "If you've got a case of food poisoning, for example, taking an antidiarrheal drug will prevent toxins from being flushed from your body, prolonging the entire episode," she says.
See a doc if your diarrhea hasn't gone away after 48 hours or you develop a fever.
Hay Fever and Allergies
The drug: Claritin
Why it's No. 1: "Allergens trigger your immune system to release histamine (an inflammatory compound), which causes runny nose, itching, sneezing, and congestion," Mackowiak says. Claritin sets up a roadblock against that histamine release to prevent allergy symptoms from occurring. Plus, it's much less likely than other OTC antihistamines to cause drowsiness, a common side effect. In fact, a 2005 study by researchers at the Washington Neuro-psychology Research Group in Washington, D.C., found that seasonal allergy sufferers who took Claritin were as alert and focused as those participants who didn't have allergies.
Generic: Loratadine
Fine print: The drug works best if you take it before you're exposed to the allergy trigger, Mackowiak says. So swallow a Claritin 30 to 60 minutes before you head out to mow the lawn or visit your boyfriend's cat-lady aunt.
See a doc if your symptoms don't let up or they become more severe while you're taking the medication.
Heartburn
The drug: Prilosec OTC
Why it's No. 1: The top dog here is the first and only OTC option in a breakthrough class of drugs known as proton pump inhibitors (PPIs). This one knocks out heartburn by shutting down the acid-producing cells in your stomach. (Antacids like Tums or Mylanta merely neutralize stomach acid after your body has already made it.) "Plus, antacids work for only one to three hours, but Prilosec can give you relief for up to 24 hours," Engle says.
Generic: None. The soonest one could be available is 2008.
Fine print: Prilosec OTC works best if you have frequent heartburn (two or more days a week). If your symptoms are triggered by only certain foods--like that burrito lunch--you can also get relief, Engle says, by taking an OTC H2 blocker such as Pepcid AC or Zantac 75 before a meal. If you take it after a meal, when your belly's already in full revolt, you'll have to wait an hour or more before you start feeling better.
See a doc if your heartburn is accompanied by difficult or painful swallowing, vomiting, or bloody or black stools.
Hemorrhoids
The drug: Preparation H Ointment
Why it's No. 1: TV commercials for this product may feature geezers, but hemorrhoids (swollen, painful veins around the anus and rectum) aren't just a late-life affliction. Flare-ups can happen when you're constipated (all that pushing), and they're especially common during and after pregnancy (ditto). This tried-and-true remedy (it's been around for more than 50 years) contains a combination of three lubricants--mineral oil, petrolatum, and shark liver oil--to soften and protect the skin, plus a topical version of phenylephrine HCl, a vasoconstrictor that shrinks tissues and relieves itching.
Generic: Any hemorrhoid treatment that contains the same active ingredients
Fine print: Although the ointment got highest marks in the survey, Doering recommends Preparation H cream with maximum-strength pain relief. "It won't stick to your skin as well as the ointment, so it's messier, but it has a local anesthetic (pramoxine HCl) that reduces pain," he says.
See a doc if bleeding occurs, or if the problem persists for more than a week or worsens.
Motion Sickness
The drug: Dramamine Less Drowsy Formula
Why it's No. 1: If just the thought of getting on a boat makes you want to hurl, the drug to turn to is Dramamine, and this version is less likely than others to make you sleep through your scuba lesson. "The nausea occurs when the part of the brain that detects motion gets mixed signals," Pray says. "The same thing happens when you're reading a book while riding in a car. Your body feels motion but your eyes don't register the movement, which sets you up for what is called a 'sensory conflict.' Dramamine blocks the receptors in the central nervous system that give you those mixed signals." Meclizine hydrochloride, the active ingredient, is just as effective at preventing motion sickness but is less likely to make you nod off than dimenhydrinate, the ingredient in the original form of Dramamine.
Generic: Meclizine
Fine print:The key word in this product name is "less," Mackowiak says. In some cases, "it may still make you feel a bit sleepy," she says. So test-drive it before getting behind the wheel.
See a doc if you have severe, uncontrollable vomiting.
Poison Ivy or Oak
The drug: Cortaid
Why it's No. 1: Last off-the-grid adventure leave you with the itchies? Grab Cortaid, which will decrease the swelling and discomfort of poison ivy faster than anything else. Just read the label before you get in line for the cashier, Doering says. "Several products on the market bear the Cortaid brand, including a kit that gets the poison ivy toxin off your skin, but they don't all contain hydrocortisone, so you'll still feel pretty miserable."
Generic: Hydrocortisone
Fine print: It's not a good idea to use hydrocortisone on large areas (anything bigger than the size of your palm), because too much could be absorbed into your bloodstream, leading to side effects such as inflammation and peeling, itchy, or irritated skin, Doering says.
See a doc if itching remains severe despite use of the product, if symptoms persist for more than seven days, or if the rash covers a large area. You may need an oral steroid instead, Pray says.
Red Itchy Eyes
The drug: Naphcon-A
Why it's No. 1: Unlike drops that simply treat the appearance of red eyes by constricting the blood vessels, Naphcon-A also contains an antihistamine to relieve itchiness caused by allergies.
Generic: Allergy eye drops containing the decongestant naphazoline and the antihistamine pheniramine
Fine print: Using an eye drop containing a decongestant for more than three days in a row can make your eyes redder than they were to start. "A decongestant works by shrinking swollen vessels, which restricts the amount of blood in the area," Pray explains. "But if you use it too often, when it wears off, your body sends a flood of blood back, which causes a rebound effect"--essentially magnifying the original problem.
See a doc if your eyes feel gritty, your vision becomes blurred, or the condition worsens or persists for more than 72 hours.
Stuffy Nose
The drug: Sudafed
Why it's No. 1: You feel stuffier than a debutante ball, not because your head is full of mucus but because your blood vessels are swollen, Engle says. "The active ingredient in Sudafed (pseudoephedrine) is a vasoconstrictor that's very effective at shrinking those vessels." Decongestants that contain the vasoconstrictor phenylephrine don't work as well because most of the drug is broken down in the stomach before it even enters the bloodstream, Doering says. Another perk: Sudafed comes in sustained-release forms. "Some are formulated to last up to 24 hours, but a phenylephrine product will only work for four hours at most," Engle says.
Generic: Pseudoephedrine
Fine print: If Sudafed keeps you up at night, Doering recommends a nose spray or drop containing oxymetazoline, such as Afrin. "Its relief isn't as long-lasting, but you'll be spared the insomnia because the medication is deposited directly into the lining of the nose, rather than being circulated through your bloodstream." (Just don't use it for more than a week, or your body will try to compensate for the effect of the medicine by sending more blood to the area, leaving you even more congested.)
See a doc if your symptoms don't improve within a week or you're also running a fever.
Tension Headache
The drug: Tylenol
Why it's No. 1: Pharmacists are looking after your gut with this medicine cabinet staple. Aspirin and ibuprofen can also kill a headache, but druggists know they can irritate the stomach, causing cramps and sometimes bleeding. "Compared with other headache relievers, Tylenol has the fewest side effects and interactions with other drugs," Doering says.
Generic: Acetaminophen
Fine print: Knock back fewer than three cocktails a day if you're taking Tylenol, Mackowiak says. "Combining large quantities of alcohol and acetaminophen can cause serious liver damage."
See a doc if your headache worsens or lasts for more than 10 days.
Yeast Infections
The drug: Monistat
Why it's No. 1: When you've got an itch you can't scratch in public, reach for a tube of Monistat, which kills the overgrowth of the fungus that causes a yeast infection. "This is the only product that's available in seven-day, three-day, and one-day formulations," Pray says.
Generic: Miconazole
Fine print: While the one-day and three-day formulations can cut down on the number of nights you spend in misery, it can still take up to a week for the infection to disappear, Pray says. "Some women come in on the third day and say they need another package," he says. "I tell them to wait it out another day or two." The shorter formulas keep working even after the last dose, so you might not feel better until after you've emptied the package.
See a doc if your symptoms don't improve or they worsen after treatment.
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