Show 1360: The Pros & Perils of OTC Drugs

In this broadcast, we answer listeners’ questions about over-the-counter drugs. If you have bought a medicine without a prescription, how do you use it wisely? Dr. Stefanie Ferreri, Distinguished Professor in Pharmacy Practice at the UNC Eshelman School of Pharmacy is standing by, along with Joe and Terry, to answer your questions about the pros and perils of OTC drugs.

On this live show, you are the star. Call in your question or your comment to 888-472-3366 between 7 and 8 am EDT on October 21, 2023. Please feel free to email your questions ahead of time to radio@peoplespharmacy.com.

Pros & Perils of OTC Drugs:

If you suffer from seasonal allergies, you have no doubt wished for a decongestant from time to time. Perhaps you have even gone to the drugstore to purchase a pill to clear your stuffy nose. How well did it work?

Phenylephrine Is Ineffective as an Oral Decongestant:

One of the most common ingredients in medicines marketed to ease congestion from allergies, colds or flu is phenylephrine. https://www.peoplespharmacy.com/articles/is-phenylephrine-a-worthless-decongestant This compound was initially patented in 1927, so scientists have had plenty of time to learn about it. For years, they have been telling us that it is ineffective as an oral decongestant. (Nasal sprays are a different story.) So why did it take the FDA until 2023 to determine that it does not work?

Is Phenylephrine a Red Flag for Other OTC Drugs?

Are there other nonprescription products on the market that might be nearly as useless as phenylephrine? We suspect so. Cough medicines have also been scrutinized and come up short. The primary ingredient in a lot of cough syrup is dextromethorphan. Randomized controlled trials show that it is not more effective than placebo for suppressing cough (British Journal of Clinical Pharmacology, May 2008).

What About Guaifenesin?

Another popular ingredient in cough medicines is called guaifenesin. It is supposed to loosen mucus in the airways so that it can be coughed up more easily. Unfortunately, it doesn’t appear to do this very well when people have respiratory tract infections like colds or flu (Respiratory Care, May 2014). Sometimes it is recommended to help reduce mucus secretion in chronic conditions like COPD. However, the evidence supporting its efficacy is not strong (Chronic Obstructive Pulmonary Diseases, Oct. 23, 2019).

Reducing Fever–a Mistake?

There is an entire category of medications in the pharmacy that actually does exactly what we expect it to do: reduce fever. But is that always wise? Acetaminophen (the ingredient in Tylenol), aspirin and NSAIDs like ibuprofen (Advil, Motrin IB, and house brands) or naproxen (Aleve) can all lower the temperature when someone has an infection. Too often, though, we don’t stop to consider that fever is one way that our bodies use to try to fight infection. It is part of the immune response, and interfering with it does not speed healing.

Safety of Acid-Suppressing Drugs:

Another area in which medicines perform as anticipated is acid suppression. Two different categories of drugs, the H2 blockers like Zantac or Pepcid, and the PPIs such as Nexium or Prevacid, work quite well most of the time. They curtail the production of stomach acid, which can often help ease heartburn. But what is the price? The original ingredient in Zantac, ranitidine, was taken off the market a few years ago because it could be converted to a carcinogen, NDMA.

The PPIs are even more effective at reducing stomach acid. However, they have the potential to cause troublesome side effects over the long term. They may disrupt the microbiota of the digestive tract, resulting in C diff infections and disastrous diarrhea. Studies have also linked these popular pills to chronic kidney disease, strokes, heart attacks and osteoporosis.

Learning About OTC Drugs Side Effects:

If we are to be knowledgeable about the pros & perils of OTC drugs, we need information about their side effects as well as their efficacy. After all, such medicines don’t change their nature or lose their side effects when they move from prescription to OTC shelves. On the other hand, customers don’t get a lot of side effect information on nonprescription pills. There is nothing like the printed flyer that is provided with a prescription. How can we learn about the possible pitfalls of these medicines so we can weigh the benefits against the risks?

This Week's Guest:

Stefanie Ferreri, Pharm.D., is the Henry L. Smith and James L. Olsen, Ph.D., Distinguished Professor in Pharmacy Practice and Chair of the Division of Practice Advancement and Clinical Education at the UNC Eshelman School of Pharmacy. Her main research interests include advancing clinical practice in the community-pharmacy setting.
https://pharmacy.unc.edu/directory/ferreri/