Medicines that can be obtained without a prescription (OTC - over the counter) are part of every home pharmacy. They are mostly used for pain, high fever, colds and allergies.

Are we using them properly and what is their effect? Are we forgetting the fact that these are drugs which, although commercially available, have definite indications, contraindications and side effects? This guide will answers to these and other questions related to self-treatment.

The most common groups of OTC preparations

Painkillers

Medicines that soothe headaches, muscle pain and reduce fever have different ingredients and method of operation. Therefore, it is not irrelevant which one of them we use when we feel some of these symptoms.

Aspirin and medicines for lowering high temperature (non-steroidal anti-inflammatory drugs, NSAIDs) ease pain and inflammation by blocking the production of chemicals called ‘prostaglandins’, which are produced at sites of injury or damage.

This group includes acetylsalicylic acid (Aspirin), ibuprofen (Advil, Motrin), naproxen (Naprosyn), ketoprofen (Orudis) and acetaminophen/paracetamol (Tylenol).

Antihistamines

They work by blocking the receptors that cause allergic reactions, sneezing, coughing and mucus production in the sinuses and the bronchi. These medicines include diphenhydramine (Benadryl), brompheniramine (Bromax), and chlorpheniramine (Chlor-Trimeton).

Decongestants

In the case of nosebleeds, medicines from this group have the ability to narrow the surface blood vessels in the nasal cavity, which stops the bleeding. They are used in form of drops, and the most commonly used decongestant is pseudoephedrine (Sudafed).

Cough relief medicines

There are two types of these medicines: cough suppressants and expectorants. The first block the cough reflex, and soothe coughing, and the second stimulate coughing to clear out the mucus from the respiratory tract.

Read the Declaration!

It is very important that when buying the medicine you pay attention to all the information contained in the declaration in order to find out what are the effects and side effects of the medicine, because no medicine is completely harmless and without possible side effects. Standardized declarations contain the following information:

• Active ingredients: these are chemical ingredients of a medicine that act on symptoms we feel. Sometimes it can only be one ingredient, sometimes more of them.
• How to Use: this section contains the symptoms for which the medicine is used.
• Dosage: instruction on the daily dose of the medicine and time intervals between the doses.
• Inactive ingredients: these are the chemical substances in the product that do not directly affect the symptoms, but can cause an allergic reaction to the drug.
• Warning: contains the possible side effects, the list of diseases and other medicines due to which you should not use it, foods that slow down or increase its effect, as well as a warning whether it affects the working ability.
• Other information: mainly concerning the ways of storing the medicine after opening, and the shelf life.

Maximum effect - minimum risk

Medicines that we obtain without prescription may help, but they may also harm us if we do not use them in the right way - according to the symptoms, at the recommended doses and intervals of consumption.

Since we are not always able to diagnose our own symptoms, or more associated symptoms, it is best to consult a doctor or pharmacist before buying the nonprescription medicine. It is necessary to do this if we use some other medicines, because the combination of medications can cause more harm than good.

The advice is desirable for some other reasons. Certain foods increase or decrease the effect of the medicine (essential for dosing) or slow down or speed up the metabolism of its active substances (essential for the interval of consumption). Also, some of these medicines make the skin more sensitive, so more caution is necessary when exposed to sunlight, and in sensitive people and children, these medicines can cause stomach problems.

Medicines obtained without a prescription (nonprescription drugs) should be treated as those issued on doctor's prescription. It means:

• Carefully read all the information contained in the declaration;
• Take the medicine as recommended by the manufacturer, but also as advised by a doctor or pharmacist;
• Do not combine medicines on your own - consult with a professional instead;
• Use the medicine for as long as recommended, do not interrupt or prolong the treatment, and do not change the medical therapy;
• Medicines should be swallowed whole, only in exceptional cases tablets or capsules may be crushed with teeth and swallowed, which will be emphasized by a doctor or pharmacist. This is extremely important, because medicines usually work during decomposition in the digestive tract.

Potential side effects

Nonprescription drugs have potentially small risk to the health of adults, which is not the case when it comes to children and elderly people who use other medicines.

Find information about Kratom at Kratom Exchange

Aspirin and medicines from this group commonly cause stomach problems. It may be nausea and bleeding, characteristic for the elderly. It is usually the result of consuming higher dose than recommended, or using the medicine for a longer period than optimal. These medicines may also affect the increase in blood pressure, especially if used simultaneously with other therapy for blood pressure regulation. High doses of aspirin are risky for people with liver disease, juvenile arthritis and rheumatic fever.

Acetaminophen/paracetamol (Tylenol) is safe medicine for most users, but if used for prolonged periods, and simultaneously with medicines that contain caffeine or codeine, it can cause kidney damage.

Antihistamines have a sedative effect, which slows the motor skills, disturbs concentration and attention, so be careful while driving, working - especially if operating machine, and walking. Additional side effects are dry mouth and eyes.

Decongestants can cause nervousness, moodiness, insomnia, loss of appetite, difficulty urinating, increase in blood pressure and blood sugar levels and mild heart disorders.

Cough medicines contain codeine, which can cause short-term nausea, sedation (drowsiness) and constipation. Some of these products (mainly those based on dextromethorphan) can cause confusion, agitation, nervousness.

Drug interactions are not negligible risk factor of possible side effects. The metabolism of each medicine is different; a combination of several medicines changes their decomposition, thus the expected effect. If the medicines are combined without consulting a doctor or pharmacist, medical condition may worsen, rather than improve.

Alcohol is not recommended during treatment with any medicine, even if they are obtained without prescription. The combination of active ingredients of the medicine and alcohol may cause a number of disorders, primarily gastrointestinal bleeding.

Risk groups

Children: If used according to instructions and advice of your doctor or pharmacist, medicines obtained without prescription are not particularly risky for children. What should be taken into account is that the metabolism of children works differently than of adults, so it is essential that parents read all the information on the medicine. The declaration contains strictly specified dose depending on the child's age, desired intervals of consumption and possible side effects. In addition, there are some general rules to be followed:

• Acetaminophen/paracetamol (Tylenol) is a good choice to soothe the pain;
• Ibuprofen (Advil, Motril) should not be given to children younger than 6 months;
• Aspirin should not be given to those under the age of 18 years because of the risk of Reye's syndrome (bleeding)
• Decongestants, coughs and colds medicines are not recommended for children under 2 years because of the increased risk of side effects.

Elderly: As a rule, elderly people use medicines for chronic diseases and disorders, so the greatest danger lurks from a combination of medicines and their impaired metabolism in the organism (idiosyncrasies). Because of this, older people should certainly consult a doctor before purchasing medicine to relieve symptoms they are currently feeling. The potential danger of using these medicines is bleeding from the gastrointestinal tract. Certain medicines also have some specific side effects:

• Pseudoephedrine (decongestant) can cause disturbances in the urinary tract and cause an increase in blood, as well as intraocular pressure, which, if it persists, can cause glaucoma. Medicines from this group are not compatible with beta-blockers, antidepressants, insulin and other medications for lowering blood sugar levels.

Pregnant and breastfeeding women:

• Acetaminophen/paracetamol is considered a safe painkiller during pregnancy;
• Aspirin is not recommended for use during pregnancy. Although the risk is small, it can still cause damage to the fetus and cause problems during childbirth;
• Acetaminophen/paracetamol and ibuprofen are safe painkillers in breastfeeding women;
• Aspirin should be avoided during breast-feeding, because its ingredients are present in the milk, which can cause rashes and vision problems in infants;
• Antihistamines should also be avoided, especially prolonged taking. The ingredients of these medicines pass into mother's milk, and may cause babies to become nervous and tearful. These medicines can cause the reduction of breast milk secretion.

Can the common cold be treated?

There is no medicine for the most common viral cold. Medicines can only alleviate symptoms and thus enable the organism to fight off viruses. In addition to the use of recommended medicines, it is important to adhere to the specific lifestyle regime:

• Stay at home and rest, especially if you have a fever;
• f you are a smoker, forget about cigarettes while you have a cold. And if you are not, avoid being in the room where the people are smoking;
• Drink more fluids - water, tea, fruit juices, and soups;
• Do not drink alcohol;
• Rinse your mouth several times a day with warm water in order to mitigate sore throat;
• Use salt water as nose drops. This will help you easily remove the mucus, and will not damage the delicate tissue of the nasal cavity;
• If you decide to buy some of the medicines to relieve cold symptoms, be sure to consult your doctor or pharmacist

Table 1. Progress of colds and OTC products that are commonly used

The right dose of the medicine for children

When the doctor says that the medicine should be administered every 6 hours, that means four times a day (at the time of breakfast, lunch, snacks and bedtime). Many parents interpreted these instructions differently, so they wake up a child during the night to give him/her therapy.

The recommendation that the medicine should be used every 8 hours means - three times a day.

Particular attention should be paid to dosage. Liquid medicines have dozers that should be used, or in the instructions it says how much of the medicine fits into one teaspoon. Carefully weigh the doses of these medicines and do not give more than recommended, because that will increase its effect.

If you notice any reaction to medicine in a child (nausea, allergies), you should immediately contact the doctor, and consult him/her about the further use of the medicine or adequate replacements.

Note: The names of the medicines in this text are given as International Nonproprietary Names - brand names may vary, but each preparation states non-proprietary name of the medicine.