This entry was posted on Friday, October 7th, 2005. It was last revised on Tuesday, April 11th, 2006.
I live with a doctor. My mom was a nurse. You would think I know exactly what kinds of OTC drugs to take when. I always have to read or ask again.
I sat down with a family physician in March 2005 and decided to ask some common questions about OTC medicine and then transcribe it to remind myself of these simple instructions. The following is a rough transcript of that conversation. The doctor said that they have this conversation five times a day in their practice.
Summary: Common cold, cough, & pain treatment for the common man. In general, take over-the-counter drugs based on your symptoms.
The following conclusions are based on generalities, your side effects may vary. This is my personal advice, not professional medical advice. Follow these instructions at your own risk. Always consult your physician about your individual concerns (drug interactions, risks, etc.).
There are several different kinds of OTC drugs for pain treatment. Some of the ones you may be familiar with are acetaminophen, naproxen, and ibuprofen. Of course you may know them as their brand-name equivalents: Tylenol, Aleve, and Advil. Let’s get one general principle straight: a drug is a drug is a drug. In general, it doesn’t matter which large-scale drug company is packaging them.
It is always a good idea to find out the generic name for any drug you are prescribed and look for the best price. Mainline U.S. drug stores/pharmacies usually have their own brand of everything (e.g. CVS, Eckerd, Walgreens), so check them out. Don’t forget superstores like Wal-Mart, K-Mart, and Target. Grocery stores too.
Don't forget that drugs can have side effects. Sometimes things get even more complicated if you are already on medication for something else. Again, consult a professional. By the way, mixing alcohol with some drugs can do you more harm than good (e.g. Acetaminophen).
Most drugs have a maximum dosage. That is, you don’t want to overdose. Read the bottle. Sometimes doctors will recommend you take a little more of a given drug because they know more about it. Generally, the directions on the bottle will suggest lower doses. Drug manufacturers may recommend a lower maximum dose so they can save their necks. Taking lower doses can reduce side effects.
It is not that hard. If a drug manufacturer recommends a maximum dosage of 2000 mg/day then you can sometimes take the medicine in different ways. For instance, take one 2000 mg pill, two 1000 mg pills, or four 500 mg pills. You get the picture. It’s all in the way you want to do it. Take smaller doses more frequently if you want more control over your own dosage.
The following are adult dosages. Children dosages will be less.
You can take acetaminophen + naproxen together or acetaminophen + ibuprofen together. In case you didn’t get that, don’t take naproxen and ibuprofen together. If you are taking naproxen for pain and your pain is not getting better within a few days then stop taking it. Your stomach will thank you. And, yes, achiness or being achy is a dull form of pain.
What you want is an antihistamine. Here are some common ones to pick from:
Take a decongestant like Pseudoephedrine (Sudafed). It is a vasoconstrictor that shrinks swelling primarily in nose. It relieves built-up pressure in the head. The maximum dose is 240 mg/day. Take 60 mg, 4x/day or 120 mg, 2x/day or 240 mg, 1x/day. Side effects include possible insomnia or elevated blood pressure. Take smaller doses (30 or 60 mg) if you are sensitive. Taper it off at night so you can sleep.
You may also wish to try a nasal saline spray, nasal irrigation techniques (e.g. using a Neti Pot) or Oxymetazoline hydrochloride (Afrin). For the Neti Pot, mix 1/4 tsp. table salt with about 8 oz. of warm water and put it in the Rhino Horn. The recommended dosage for Afrin is 2 sprays per nostril, twice a day, for 2-3 days max.
Coughs can be a little tricky. Sometimes your cough is productive and things are coming up. Other times it seems that your coughing is not productive at all and you are just coughing with no results.
You probably need a cough expectorant. The main ingredient is Guaifenesin and it is used to loosen and bring up phlegm. Clearing that out is a good thing and drinking lots of water and eating food along with taking the medicine should help. The ingredient is found in Robitussin Guaifenesin and Mucinex expectorant. For Robitussin Guaifenesin (100 mg/tsp), you can take 4 tsp. every 4 hours. For Mucinex (600 mg/tablet), you can take one tablet, 4x/day or 2 tablets, 2x/day.
You may want to take a cough suppressant (an antitussive) if your cough is really bad or is affecting your sleep. If your cough is productive (stuff is coming up) then don’t a take suppressant. There are several options to pick from, but the active ingredient will most likely be Dextromethorphan (DM, DXM). Robitussin DM is popular or you could try a sustained or time release version like Delsym. For Delsym, you can take 2 tsp. every 8-12 hours.
There is no panacean fix in the world of colds. The fact of the matter is that if you have a virus your symptoms will probably progress and change from day-to-day. For instance, you may start off with a sore throat, but the next day you only have a runny nose, and then your congested, and then later you have a cough. Why take a medicine that is treating symptoms you don’t have? In the long run it is probably cheaper and more effective to buy the separate products and treat symptoms as they come. Here are some other problems with all-in-one jobs:
Some companies will package up common sense for you and make you pay for it. For instance, the “AM pill” will be a decongestant and the “PM pill” will be an antihistamine. It is a gimmick. Just buy the separate items and treat as needed.
This has been covered before. I won’t waste much time. Colds are generally viral, but the flu is viral too. Viruses have trophism or are trophic. That means each one has a specific area they target.
If the initial onset is in your head then it may be a cold. Examples are rhinovirus (trophic to nose), adnovirus, or parainfluenza virus.
The flu (influenza) is a particular kind of viral problem. It generally has an abrupt onset. In other words, people say “I got sick this hour,” or “It hit me like a ton of bricks.” The lung is the main target. People usually have a cough to start, a fever over 101 degrees F. There is not not much head stuff initially.
There is a treatment for influenza, but it is prescribed and you have to show up to your doctor within 36 hours of the onset. This drug does more than treat symptoms, it reduces viral replication. Believe it or not, the treatment is actually to prevent Rheumatic fever. Older drugs include amantadine or flumadene. Newer drugs include tamiflu and Relenza (zanamivir). Tamiflu comes in a capsule and is considered much easier to take than Relenza, an inhaled powder.
Now let’s imagine you are having a fever or headache. You might think you have a cold. But then you get 1.) a red, sore throat, 2.) swollen lymph nodes and/or 3.) nausea and/or abdominal pain. If you don’t have a cough with a stuffy nose and sneezing to accompany it, then it might be bacterial, e.g. strep throat.
If you have a bacterial problem then you would probably be taking antibiotics. I think there is a tendency, for those who don’t know any better, to ask for antibiotics if they are having flulike symptoms. These two, bacterial and viral infections are commonly mixed up.
Take antacids like Rolaids, Tums, Maalox, Mylanta, or Gaviscon
Well, I hope this has helped many of you. This is, by no means, an exhaustive list and should not be used as a substitute for regular visits to your doctor. I regret that we didn’t cover sputum (phlegm) color. Alas, maybe in another revision. Hope all is well.
| Symptom(s) | Generic Name | Trade Name | Dosage |
|---|---|---|---|
| Pain (e.g headaches, throat pain, aches) and fever | Acetaminophen | Tylenol | 1000 mg, 4x/day |
| Naproxen | Aleve, Anaprox, Naprosyn | Take this with food. Two 220 mg tablets, 2-3x/day | |
| Ibuprofen | Advil, Motrin, Nuprin | 600-800 mg, 3-4x/day | |
| Sneezing, itchy symptoms, runny nose, and/or hives | Loratadine | Claritin | 10 mg, 1x/day |
| Chlorphenamine/Chlorpheniramine | Chlor-Trimeton | 4-8 mg, 2x/day | |
| Diphenhydramine | Benadryl, Dimedrol | 25 mg, 4x/day | |
| Clemastine | Tavist | 1-2 mg, 1-2x/day | |
| Nasal congestion | Pseudoephedrine (New: Phenylephrine) | Sudafed | 240 mg/day. Take 60 mg, 4x/day or 120 mg, 2x/day or 240 mg, 1x/day |
| nasal saline spray | --- | --- | |
| nasal irrigation techniques | Example: Neti Pot | Mix 1/4 tsp. table salt with about 8 oz. of warm water and put it in the Rhino Horn | |
| Oxymetazoline hydrochloride | Afrin | Two sprays per nostril, twice a day, for 2-3 days max | |
| Chest congestion (e.g. thick mucous) | Guaifenesin | Robitussin Guaifenesin (100 mg/tsp) | 4 tsp. every 4 hours. Drink lots of water and eat food. |
| Mucinex expectorant (600 mg/tablet) | one tablet, 4x/day or 2 tablets, 2x/day. Drink lots of water and eat food. | ||
| Dry hacking cough | Dextromethorphan (DM, DXM) | Robitussin DM | --- |
| Delsym | 2 tsp. every 8-12 hours | ||
| Nausea & vomiting | Dimenhydrinate | Dramamine | Drink lots of fluids, but avoid milk products. 1 tablet every 4 hours |
| ℞ - Promethazine | Phenergan | Tablets or suppositories. 1-2 every 4 hours | |
| ℞ - Ondansetron | Zofran | 4 mg, every 4 hours | |
| Diarrhea | Loperamide | Imodium | Drink lots of fluids. 2 mg, one with each loose stool. 8 per 24 hours for 3 days. If blood appears in your stool (not just on paper) then notify your doctor |
| Heartburn | Quick Relief | ||
| antacids | Rolaids, Tums, Maalox, Mylanta, or Gaviscon | --- | |
| Better Longterm | |||
| Ranitidine | Zantac | 150 mg, 2x/day | |
| Famotidine | Pepcid | 20 mg, 2x/day | |
| Nizatidine | Axid | 150 mg, 2x/day | |
| Best | |||
| Omeprazole | Prisolec | 20 mg, 1-2x/day | |
| ℞ - Lansoprazole | Prevacid | 30 mg, 1x/day | |
| ℞ - Rabeprazole | Aciphex | 20 mg, 1x/day | |
| ℞ - Esomeprazole | Nexium | 40 mg, 1x/day | |
| ℞ - Pantoprazole | Protonix | 40 mg, 1x/day | |