OTC Medications

OTC (Over-the-Counter) Medications

Definition

OTC medicines are drugs that are considered safe and effective for the treatment of minor ailments and can be sold by a pharmacist without a valid prescription.

Self-Medication

• Selection and use of medicines by individuals to treat self-recognized minor illnesses.
• Promoted by World Health Organization for quick relief where healthcare access is limited.
• Also called responsible self-medication when used appropriately.

Classification of Medicines

1. Prescription Medicines

• Dispensed only with a valid prescription.

2. Pharmacist-Only Medicines

• Supplied by pharmacists based on professional judgment.

3. OTC Medicines

• Available without prescription.
• Used for minor ailments such as:
• Headache
• Fever
• Cold
• Indigestion

Advantages of OTC Medicines

Advantages

1. Safe and effective when used correctly.
2. Approved by regulatory authorities.
3. No consultation fee.
4. Saves waiting time.
5. Easily accessible.
6. Cost-effective.
7. Reduces burden on healthcare facilities.

OTC Drug Categories

1. H₂-Receptor Antagonists

Uses

• Heartburn
• Acid indigestion
• Sour stomach

Examples

Drug	Dose
Cimetidine	200 mg BD
Famotidine	10–20 mg daily
Nizatidine	75 mg BD
Ranitidine*	75 mg BD

Note: Do not use for more than 2 weeks without medical advice.

Mnemonic: CFNR = Cimetidine, Famotidine, Nizatidine, Ranitidine

2. Acne Preparations

Example

• Benzoyl Peroxide (2.5%, 5%, 10%)

Uses

• Mild to moderate acne

Directions

• Apply once or twice daily.
• Reduce frequency if irritation occurs.

3. Allergy and Cold Preparations

Antihistamines

Drug	Dose
Chlorpheniramine	4 mg every 4–6 h
Brompheniramine	4 mg every 4–6 h
Clemastine	1.34 mg every 12 h
Diphenhydramine	25–50 mg every 4–6 h

Key Point

• Relieve symptoms of allergic rhinitis and hay fever.
• Diphenhydramine causes significant drowsiness.

Mnemonic: "CBDC"

• Chlorpheniramine
• Brompheniramine
• Diphenhydramine
• Clemastine

4. Analgesics and Antipyretics

Uses

• Pain
• Fever

Drug	Dose
Aspirin	300–600 mg every 4–6 h
Acetaminophen (Paracetamol)	300–600 mg every 4–6 h
Ibuprofen	200–400 mg every 4–6 h
Naproxen	200 mg every 8–10 h
Ketoprofen	12.5 mg every 4–6 h

Important Points

• Acetaminophen has no anti-inflammatory action.
• Suitable liquid formulations available for children.

Mnemonic: AAINK

• Aspirin
• Acetaminophen
• Ibuprofen
• Naproxen
• Ketoprofen

5. Antacids

Example

• Magnesium hydroxide + Aluminum hydroxide

Uses

• Hyperacidity
• Gastric discomfort

Advantage

• Balanced combination reduces constipation and diarrhea.

6. Anthelmintics

Example

• Pyrantel Pamoate

Dose

• 11 mg/kg

Important Points

• Treat all household members.
• Maintain environmental hygiene to prevent reinfection.

7. Antidiarrheal Agents

A. Bismuth Subsalicylate

• 600 mg four times daily

B. Loperamide

• Initial: 4 mg
• Then: 2 mg after each loose stool
• Maximum: 16 mg/day

Important Points

• Loperamide is a synthetic opioid that does not cross the CNS.
• Avoid in febrile diarrhea.

Mnemonic: BL

• Bismuth
• Loperamide

8. Topical Antifungal Preparations

Drug	Formulation
Clotrimazole	1% cream, vaginal insert
Tolnaftate	1% cream/solution/powder
Miconazole	2% cream, vaginal tablet

Uses

• Tinea pedis
• Tinea cruris
• Tinea corporis
• Candidiasis

Mnemonic: CTM

• Clotrimazole
• Tolnaftate
• Miconazole

9. Topical Anti-inflammatory Preparations

Example

• Hydrocortisone 0.5–1%

Uses

• Insect bites
• Allergic dermatitis
• Contact dermatitis
• Hemorrhoids

Application

• Apply 3–4 times daily.

10. Anti-Seborrheal Agents

Examples

Drug	Strength
Selenium Sulfide	1–2%
Zinc Pyrithione	1–2%

Uses

• Dandruff
• Seborrheic dermatitis

Directions

• Apply to scalp for 5–10 minutes.
• Use 2–3 times weekly.

Mnemonic: SZ

• Selenium sulfide
• Zinc pyrithione

11. Antitussives

Examples

Drug	Dose
Codeine + Guaifenesin	10–20 mg every 4–6 h
Dextromethorphan + Guaifenesin	10–20 mg every 4 h or 30 mg every 6 h

Uses

• Dry cough

Mnemonic: CD

• Codeine
• Dextromethorphan

12. Decongestants

Topical

• Oxymetazoline
• Xylometazoline
• Phenylephrine

Oral

• Pseudoephedrine
• Phenylpropanolamine

Uses

• Nasal congestion
• Rhinorrhea

Key Point

• Pseudoephedrine has the least CNS stimulation.

Mnemonic: OXPP

• Oxymetazoline
• Xylometazoline
• Phenylephrine
• Pseudoephedrine

13. Expectorants

Example

• Guaifenesin

Use

• Facilitates mucus removal from respiratory tract.

Important Point

• Only expectorant with good evidence of efficacy.

14. Laxatives

Types

A. Bulk Forming

• Increase stool bulk.

B. Stool Softeners

• Docusate sodium.

C. Saline Laxatives

• Used for acute constipation.

Important Point

• Bulk-forming agents and stool softeners are safest for long-term use.

Quick Revision Table

Category	Example
H₂ Blocker	Famotidine
Acne Drug	Benzoyl peroxide
Antihistamine	Chlorpheniramine
Analgesic	Paracetamol
Antacid	Mg(OH)₂ + Al(OH)₃
Anthelmintic	Pyrantel pamoate
Antidiarrheal	Loperamide
Antifungal	Clotrimazole
Anti-inflammatory	Hydrocortisone
Anti-seborrheal	Selenium sulfide
Antitussive	Dextromethorphan
Decongestant	Pseudoephedrine
Expectorant	Guaifenesin
Laxative	Docusate sodium

Exam Mnemonic for OTC Categories

"Happy Acne Allergies And Antacids Avoid Diarrhea; Fungi Hate Seborrhea, Tough Colds Expect Laxatives."

(H₂ blockers → Acne → Allergy → Analgesics → Antacids → Anthelmintics → Diarrheals → Antifungals → Hydrocortisone → Seborrhea → Antitussives → Decongestants → Expectorants → Laxatives)

OTC Medications – Pharm.D 2nd Year Notes (Part II)

15. Pediculicides (Anti-Lice Agents)

Uses

Treatment of head lice (Pediculosis).

Examples

1. Permethrin 1%
2. Pyrethrins + Piperonyl Butoxide

Directions for Use

• Apply to dry hair and scalp.
• Wet entire scalp and hair thoroughly.
• Leave for 10 minutes.
• Add water, lather, and rinse.
• Avoid contact with eyes.
• Comb out nits (lice eggs).
• Repeat treatment if reinfestation occurs.

Counseling Points

• Wash combs, brushes, bedding, and clothing.
• Check family members for infestation.
• Avoid eye contact.

Mnemonic: PP = Permethrin + Pyrethrins

16. Sleep Aids

Example

Diphenhydramine

Dose

25–50 mg at bedtime

Mechanism

• First-generation antihistamine
• Produces CNS depression and sedation

Uses

• Temporary management of insomnia

Adverse Effects

• Drowsiness
• Dry mouth
• Dizziness

Counseling

• Avoid alcohol.
• Do not drive or operate machinery after use.

17. Smoking Cessation Aids

Examples

1. Nicotine
2. Nicotine Polacrilex (Nicotine Gum)

Uses

Helps reduce nicotine withdrawal symptoms during smoking cessation.

Important Points

• Requires gradual dose reduction (weaning).
• Follow instructions carefully.
• Quit rates are higher than placebo.

Counseling

• Do not smoke while using nicotine replacement therapy.
• Follow prescribed schedule for tapering.

Hidden Ingredients in OTC Products

Important Note

Many OTC medicines contain potent ingredients that patients may not recognize.

Problems

• Drug duplication
• Drug interactions
• Diagnostic confusion
• Increased adverse effects

Pharmacist's Role

• Review all prescription and OTC medicines.
• Identify duplicate ingredients.
• Prevent interactions.

OTC Counseling Questions

Purpose

To collect adequate information before recommending an OTC product.

Patient Assessment Questions

Medication History

• Which prescription medicines do you take regularly?
• Which OTC medicines are you currently using?
• Do you use herbal medicines?

Disease History

• What symptoms are you experiencing?
• How long have you had these symptoms?
• Have you consulted a doctor?

Previous Experience

• Have you used this medicine before?
• Did you experience any side effects?

Demographic Information

• Age
• Sex
• Pregnancy status
• Breastfeeding status
• Allergies
• Weight

Mnemonic: WWHAM

• W – Who is the patient?
• W – What are the symptoms?
• H – How long have symptoms been present?
• A – Action taken already?
• M – Medication being taken?

Patient Counseling Steps

Step 1: Introduction

The pharmacist should:

• Introduce himself/herself.
• Establish rapport.
• Explain available assistance.
• Discuss appropriate OTC product selection.

Step 2: Information Collection

Gather Information About

A. Patient Factors

• Age
• Sex
• Pregnancy
• Breastfeeding
• Weight
• Allergies
• Social history

B. Disease Factors

• Present illness
• Symptoms
• Duration of illness
• Past medical history
• Coexisting diseases

C. Drug Factors

• Current medications
• Previous medication history
• OTC drug history

Information to be Provided During Counseling

1. Drug Name

• Generic name
• Brand name

2. Dosage Information

• Dose
• Route
• Dosage form
• Frequency

3. Special Instructions

• Preparation
• Administration
• Precautions

4. Self-Monitoring

• How to monitor effectiveness
• Warning signs requiring medical attention

5. Storage Conditions

• Temperature
• Moisture protection
• Child safety

6. Drug Interactions

• Drug-drug interactions
• Drug-food interactions
• Contraindications

Counseling for Special Dosage Forms

The pharmacist should demonstrate proper use of:

• Inhalers
• Eye drops
• Ear drops
• Nasal sprays
• Ointments
• Patches
• Lozenges
• Gargles

Patients should repeat the demonstration to ensure understanding.

Counseling Points for NSAIDs

Common OTC NSAIDs

• Paracetamol*
• Ibuprofen
• Diclofenac

(*Paracetamol is technically an analgesic-antipyretic, not a true NSAID.)

Uses

• Fever
• Headache
• Musculoskeletal pain
• Joint pain

Important Adverse Effects

• Gastric irritation
• Peptic ulcer disease
• Renal impairment

Counseling Points

✓ Take after food.

✓ Drink plenty of water.

✓ Consult a doctor if symptoms persist.

✓ Asthmatic patients should use cautiously.

✓ Avoid combining aspirin with other NSAIDs without medical advice.

✓ Inform healthcare providers about NSAID use.

✓ Store safely away from children.

Warning Signs

Seek immediate medical care if:

• Facial swelling
• Leg swelling
• Reduced urine output
• Severe allergic reactions
• Confusion

Counseling Points for Antibiotics

Key Principle

Antibiotics should be used only under medical supervision.

Counseling Points

✓ Take at prescribed times.

✓ Complete the full course.

✓ Store properly.

✓ Keep away from children.

✓ Do not double doses after a missed dose.

✓ Report adverse effects promptly.

✓ Consult pharmacist regarding interactions.

Important Message

Incomplete antibiotic courses can contribute to antimicrobial resistance.

Counseling Points for Cold and Cough Medicines

Uses

Relief of:

• Sneezing
• Runny nose
• Nasal congestion
• Cough

Counseling Points

✓ May cause drowsiness.

✓ Avoid driving and operating machinery.

✓ Can cause dry mouth, nose, and throat.

✓ Sugar-free candies or ice chips may help relieve dryness.

✓ Decongestants may cause insomnia and restlessness.

✓ Take the last dose several hours before bedtime.

✓ Consult a healthcare professional before use with:

• CNS depressants
• MAO inhibitors

Special Populations

• Pregnant and breastfeeding women should seek medical advice before use.

Role of Community Pharmacist in OTC Dispensing

Responsibilities

1. Patient Education

• Promote safe medication use.
• Improve adherence.

2. Assessment of Minor Ailments

Common complaints:

• Headache
• Sore throat
• Common cold
• Cough
• Diarrhea
• Dysmenorrhea
• Body aches

3. Identification of Drug Interactions

Review all medications before recommending OTC products.

Clinical Example 1

Hypertensive Patient with Cold

Patient:

• Hypertension
• Taking antihypertensive drugs

Avoid:

• Phenylpropanolamine-containing cold preparations

Reason:

• May increase blood pressure.

Clinical Example 2

Ciprofloxacin + Antacid

Problem:

• Antacids reduce absorption of ciprofloxacin.

Counseling:

• Maintain at least 2-hour gap before or 4–6-hour gap after antacid administration.

Result:

• Better antibiotic effectiveness.

Exam-Oriented Quick Revision

Pediculicide

→ Permethrin 1%

Sleep Aid

→ Diphenhydramine

Smoking Cessation

→ Nicotine gum

OTC Assessment Tool

→ WWHAM

Common OTC Interaction

→ Ciprofloxacin + Antacid

NSAID Counseling

→ Take after food and with plenty of water

Cold Medicine Counseling

→ May cause drowsiness; avoid driving

Community Pharmacist Role

→ Assess, Counsel, Prevent Interactions, Monitor Outcomes

5-Mark Question: Role of Community Pharmacist in OTC Dispensing

1. Assess patient symptoms.
2. Obtain medication history.
3. Identify contraindications and interactions.
4. Recommend appropriate OTC medicine.
5. Counsel on dosage, administration, storage, and adverse effects.
6. Refer to a physician when necessary.
7. Promote rational and safe use of medicines.