A Pharmacist's Guide to OTC Therapy

JANUARY 01, 2008
Yvette C. Terrie, BSPharm, RPh

Low-dose Aspirin for CVD Prevention
Urinary Incontinence Supplies

Low-dose Aspirin for CVD Prevention

Cardiovascular disease (CVD) continues to be the leading cause of death among men and women in the United States. Once thought to affect primarily men, the incidence of CVD continues to rise among women. Statistics from the American Heart Association (AHA) reveal that in 2007, an estimated 1.2 million individuals in the United States will have a first or recurrent coronary attack, and an estimated 452,000 of these individuals will die.1 CVD is the leading cause of death among women, accounting for an estimated 38% of all deaths,2 and it is responsible for more deaths among women than the next 5 leading causes of death combined, including all forms of cancer.3

Benefits of Aspirin Use

Various studies have demonstrated that a daily aspirin regimen can reduce the risk of a nonfatal first heart attack by approximately 32% and may reduce the risk of death by up to 23% if administered when a heart attack is suspected and for 30 days thereafter.4,5

More than 50 million adults in the United States routinely take aspirin for long-term prevention of CVD, with daily doses ranging from 81 to 325 mg.6,7

Debate persists about the appropriate long-term daily dosage of aspirin for cardiovascular protection. In a report published in the May 9, 2007, issue of the Journal of the American Medical Association, researchers who reviewed 11 clinical trials concluded that there was no current clinical evidence to support that higher doses of aspirin were more effective than lower doses of 75 to 81 mg daily for cardiovascular protection.6,7

The AHA recommends that the use of aspirin be considered in patients who have had the following conditions, if aspirin is not contraindicated8:

  • Myocardial infarction
  • Unstable angina
  • Ischemic stroke (caused by blood clot)
  • Transient ischemic attacks

In February 2007, the AHA updated its aspirin guidelines for preventing CVD in women.9,10 Although the 2004 guidelines did not recommend aspirin use in healthy women or those with low cardiovascular risks, the 2007 revisions recommend that routine use of aspirin may be considered in women aged 65 and older—regardless of cardiovascular risk status—if benefits outweigh the risks.9,10 The AHA also recommends increasing the upper dose of aspirin for women at high risk for developing CVD from 162 to 325 mg daily.9,10

A variety of low-dose aspirin products are currently on the market, including chewable tablets, enteric-coated tablets and caplets, as well as formulations for women that also contain calcium (Table).


Advice for Patients

Pharmacists are likely to encounter many patients seeking advice on aspirin regimens and preventive therapy, as well as proper selection of aspirin products. All patients should be advised to consult with their primary health care provider before starting an aspirin regimen—especially if they have preexisting medical conditions—to determine if any aspirin regimen is suitable for them.

Before recommending aspirin therapy, it is imperative for pharmacists to assess the patient's allergy history and concurrent medical and medication history to screen for possible contraindications and drug interactions. In addition, pharmacists should counsel patients thoroughly about the proper use of aspirin products, as well as inform them of potential adverse effects and the importance of routine monitoring with their primary health care provider.

Patients should be reminded that if they are having a dental or surgical procedure to always alert the health care provider that they are currently taking aspirin. Pharmacists also should use this opportunity to remind patients to contact their primary health care provider if they have any questions or concerns.

Finally, pharmacists can remind patients of nonpharmacologic measures that also may minimize their cardiovascular risks, such as maintaining a healthy weight, eating a balanced diet low in fat, adopting an exercise routine if appropriate, lowering cholesterol and blood pressure, if necessary, as well as quitting smoking. Pharmacists can direct patients to the various educational resources available that provide information about cardiovascular health and preventive care.


  1. Know the Stats, Get the Facts, 2007. American Heart Association Web site. www.americanheart.org/downloadable/heart/116861545709855-1041%20KnowTheFactsStats07_loRes.pdf.
  2. Facts about women and cardiovascular diseases. American Heart Association Web site. www.americanheart.org/presenter.jhtml?identifier=2876.
  3. Heart Disease and Stroke Statistics. American Heart Association Web site. www.americanheart.org/downloadable/heart/1166711577754HS_StatsInsideText.pdf.
  4. Role of Aspirin. Bayer HealthCare Web site. www.bayeraspirin.com/ha_role.htm.
  5. Primary Prevention of Cardiovascular Events. Bayer HealthCare Web site. www.bayeraspirin.com/emerging/primary.htm.
  6. Lie, D. Low Dose Aspirin Best for CVD Prevention. Medscape Web site. www.medscape.com/viewarticle/556309.
  7. Reinberg, S. Low Dose Aspirin Best for Preventing Heart Attack. MedicineNet Web site. www.medicinenet.com/script/main/art.asp?articlekey=80993&pf=3&page=1.
  8. Aspirin in Heart Attack and Stroke Prevention. American Heart Association Web site. www.americanheart.org/presenter.jhtml?identifier=4456.
  9. Heart Disease and Women. Bayer HealthCare Web site. www.bayeraspirin.com/hdwomen/undertreatment.htm.
  10. Updated Guidelines Advise Focusing on Women's Lifetime Heart Risk. American Heart Association Web site. www.americanheart.org/presenter.jhtml?identifier=3045524.

Urinary Incontinence Supplies

Urinary incontinence (UI) affects individuals of all ages. Although it becomes more common in older people, it is not a normal part of the aging process. UI can be the result of anatomic, physiologic, and pathologic factors affecting the urinary tract, as well as other external factors.1

For more information on urinary incontinence, visit the following Web sites:

  1. National Association for Continence at www.nafc.org
  2. National Kidney and Urologic Diseases Information Clearinghouse at kidney.niddk.nih.gov
  3. American Urological Association at www.incontinence.org

It is estimated that more than 17 million individuals in the United States have some degree of UI, and 85% of these cases are women (Table 1).2 In addition, another 34 million individuals are affected by various degrees of overactive bladder.1 According to the National Association for Continence, an estimated 80% of UI cases can be cured or improved.3 More than 50% of individuals affected by bladder disorders rarely—if ever—discuss these issues with their primary health care provider because of embarrassment or denial, and the issues are left untreated.2

Some cases of UI may be transient and caused by the use of certain medications or by a urinary tract infection and can be reversed.4 Many UI cases can be chronic and long lasting, however, unless the individual seeks medical evaluation and treatment.4 Behavioral therapy, the use of pharmacologic agents, and surgery are the 3 main types of treatment for UI.2,5

Table 1

The Role of the Pharmacist

Key Tips for Patients

  • To avoid skin irritation, always check the skin every 2 hours
  • Always change absorbent undergarments every 2-4 hours, especially if urine loss is persistent
  • Check with primary health care provider to see if the use of skin protectants (eg, those recommended for diaper rash like zinc oxide) can be used to protect the skin
  • Always consult primary health care provider if skin irritation or signs of skin infection occur
  • Avoid foods, liquids, and other substances that may irritate the bladder
  • Try to use incontinence products that may eliminate the embarrassment of unpleasant odors

Pharmacists are likely to receive inquiries about supplies for the management of UI; therefore, it is important for pharmacists to understand the condition and be prepared to counsel and assist patients and caregivers in the selection of absorbent products. Pharmacists should always encourage patients to seek advice from their primary health care provider prior to using any of these products. Pharmacists also can be key in identifying the various medications that may contribute to or cause UI, including angiotensin-converting enzyme inhibitors, alpha adrenergic blockers, antihistamines, calcium-channel blockers, diuretics, and antidepressants.1,8

A variety of absorbent products are available that include guards/shields, undergarments, and briefs to assist in the absorption of urine (Table 2). These products can be either disposable or reusable and are available in many sizes; they may help in providing a moisture barrier to protect clothes, bedding, and furniture, as well as minimize skin contact with urine.

Selection of these products is based upon various factors, such as the amount of urine that is typically leaked, the severity and type of UI, the patient?s functional status, the patient?s personal preference, ease of use, and cost, as well as the product?s ability to control odor.1,9

Products are designed to meet the individual needs of men and women and for overnight use. Pharmacists can help patients understand the many options available for both the treatment and management of UI that may enable them to improve their quality of life.

Table 2


  1. O'Neil, Christine. Adult Urinary Incontinence and Supplies. In: Berardi R, Kroon L, Newton G, et al, eds. Handbook of Nonprescription Drugs. 15th Edition. Washington, DC: American Pharmacists Association; 2006:1077-1091.
  2. Urinary Incontinence. MedicineNet.com Web site. www.medicinenet.com/urinary_incontinence/article.htm.
  3. Treatment Options for Incontinence. National Association for Continence Web site. www.nafc.org/about_incontinence/treatment.htm.
  4. Urinary Incontinence in Adults. National Institutes of Health Web site. consensus.nih.gov/1988/1988UrinaryIncontinence071html.htm.
  5. Attends Web site. www.attends.us.
  6. Depends Web site. www.depend.com/learn/female_incont.asp.
  7. Controlling Urinary Incontinence. FDA Web site. www.fda.gov/fdac/features/2005/505_incontinence.html.
  8. Drugs that may cause urinary incontinence. Merck Manual of Health and Aging. www.merck.com/pubs/manual_ha/tables/tb57_1.html.
  9. Urinary Incontinence Products. Medline Plus Web site. www.nlm.nih.gov/medlineplus/ency/article/003973.htm.