The tongue is normally covered with pinkish-white, tiny bumps (papillae), which are fine, hairlike, short projections.

With geographic tongue, patches on the surface of the tongue are missing papillae and appear as red, smooth “islands,” often with slightly raised borders.

These patches, or lesions, give the tongue a geographic, or map-like, appearance.

The lesions often heal in 1 area and then migrate to a different part of the tongue.

Geographic tongue is also known as benign migratory glossitis.

 include discomfort and pain; irregular, red, and smooth patches; and frequent changes in the location, shape, and size.

 may include family history and fissured tongue.

 includes mouth rinses with anesthetics, antihistamines, and corticosteroids; OTC pain relievers; and vitamin B supplements.

Articles

Geographic tongue is an inflammatory but harmless condition affecting the surface of the tongue.

Pharmacy Clinical Pearl: Geographic Tongue

® has been a constant source of up-to-date, practical information for the pharmacy community and has led the way in presenting valuable information on the OTC market—in print and via online venues.

Ten years ago, we expanded our reach with this useful guide to OTC products, a special collaboration with U.S. News & World Report, to help consumers make informed decisions based on the expert opinions of our pharmacy readers.

More than ever, patients are turning to OTC products to treat conditions like allergies, arthritis, coughs, colds, migraines, and gastrointestinal issues.

OTC products are cost-effective and offer patients a convenient self-treatment option. As blockbuster prescription drugs become available over the counter, pharmacists are being called on to make recommendations from among the 1000-plus OTC brands available.

® OTC Recommendations Survey, conducted by Healthcare Research & Analytics (HRA®), asked thousands of pharmacists for their recommendations on brands in 149 OTC categories. In these pages, products are organized by health section and in detailed charts that show the percentage of pharmacists who recommend each product. The charts also show the number of recommendations that retail pharmacy professionals make each month. (Note: Survey percentages in charts total 100%.)

As pharmacists continue to counsel consumers on OTC choices, our 2022 

® OTC Recommendations Survey provides pharmacists guidance by showcasing the brands and products that were most highly recommended by their peers.

 to bring these pharmacists’ top recommendations of OTC products directly to consumers. The leading brands receive a “#1 Pharmacist Recommended” award issued jointly by 

As pharmacists continue to counsel consumers on OTC choices, our 2022 Pharmacy Times OTC Recommendations Survey provides guidance.

Pharmacy Times is Leading the Way

Pharmacy shelves can be confusing for some patients and overwhelming for others.

With years of training and perhaps many more of experience in staffing a community pharmacy, most pharmacists can navigate even the longest OTC shelves with ease. Nary an item exists about which we don’t have some knowledge. When asked for help, we coach relatives and friends alike almost subconsciously. Still, for many not in our social networks, and even some who are, the OTC aisles can be frustrating.

To the average patient, the pain medication aisle offers many options. But pharmacists know that the category is dominated by 3 active ingredients, a few also-rans, and niche topical products. To nonpharmacists, the cold and cough section looks like a mess, flush with combination products and conflicting messages about daytime wakefulness, high blood pressure, nighttime effectiveness, and an ever-raging efficacy debate about all types of congestion.

For patients with special needs, the OTC product options can be overwhelming and impossible to navigate alone.

Nearly 2 decades ago, I was working one of my first shifts at a community pharmacy when a patient approached the window and said, “Can you help me find a medication?”

I said “Certainly, what can I find for you?” as I walked out the door and into the OTC aisle on my way to lunch.

I proceeded to walk the patient over to the area where the active ingredient she wanted was found and give her a quick run-through of the products.

She ended our encounter by saying, “I want to thank you for coming out here with me. I can’t read, and I’ve never had a pharmacist come show me. I’ve always relied on somebody else in the aisles to grab the product for me.”

Those 90 seconds had a profound effect on me, and as a result, I have never neglected to ask patients whether they want me or another staff member to help them find a product. Please don’t forget that more than 40 million Americans have low literacy skills, more than 8 million very low literacy, and another 8 million almost none or none.

 In addition, more than one-third of Americans (36%) have low health literacy and cannot identify common medical terminology or medications.

 There are millions more who are health literate but do not read or speak English as a first language.

For Many, It Is Their Only Access to Affordable Care

The average consumer-patient makes 26 trips a year to a pharmacy for OTC products.

 For many, pharmacists are the only access they have to a health care provider during the course of a year, or 2, or 3. From the 20-something intrepid who is anxious about her first pregnancy test to the highway contractor with nagging headaches and in need of shoes that allow his feet to breathe better, pharmacists are it—whether we like it or not. True, many consumer-patients can walk into one of more than 60,000 pharmacies or 750,000 OTC retail locations in the United States, pick out an appropriate OTC product, and administer it optimally. But many cannot do this on their own.

Meanwhile, OTC counseling should be covered by insurance and, for the uninsured, by the Health Resources and Services Administration.

OTC selection and counseling is an important responsibility for many licensed health care professionals, but especially for community pharmacists. We are the front door to the health care system for nearly everyone who opts to stay in the front yard and engage in self-care if they are allowed. We need to occupy that front yard and the OTC aisles and be paid to do so. For a low cost, consumer-patients should be able to request a 5-minute or 10-minute consultation for OTC medications and products. It could do a lot of good. In the meantime, pharmacists should do their best with yet another unpaid but highly valuable service to the community.

is the executive director of Community Pharmacy Enhanced Services Network (CPESN) USA, a clinically integrated network of more than 3500 participating pharmacies.

1. Adult literacy in the United States. National Center for Education Statistics. July 2019. Accessed May 20, 2022. 

https://nces.ed.gov/pubs2019/2019179/index.asp

2. Health literacy fact sheets. Center for Health Care Strategies. Accessed May 20, 2022. https://www.chcs.org/resource/health-literacy-fact-sheets/

3. How is low health literacy identified? Center for Health Care Strategies. October 2013. Accessed May 20, 2022. 

https://www.chcs.org/media/How_is_Low_Health_Literacy_Identified.pdf

4. OTC sales statistics. Consumer Healthcare Products Association. Accessed May 20, 2022. https://www.chpa.org/about-consumer-healthcare/research-data/otc-sales-statistics

Pharmacists possess abundant knowledge about health modalities and medications that they should share with patients.

Seize the Opportunity to Help Those Who Need Special OTC Counseling

® has been calculating pharmacists’ OTC recommendations and publishing an annual survey.

The purpose of our survey is to collect current data on the OTC brands pharmacists recommend most frequently and to ascertain the number of recommendations pharmacists make each month as they work with patients and counsel them on health conditions.

In their daily practice, pharmacists across the country make more than 140 million recommendations to patients every month. As the most accessible, and among the most trusted, health care providers, pharmacists play a key role in their patients’ health and wellness through counseling and product recommendations. Pharmacists are truly a constant source of health care information for the public.

® OTC survey has grown each year since its launch in 1997 when 85 therapeutic categories were included. This year, we surveyed 15 distinct health sections and covered 149 therapeutic categories. As the OTC market has grown, 

® has responded by adding new health sections and new OTC products to the survey. As new therapeutic categories develop and the OTC market continues to evolve, 

® OTC survey will be available to consumers through a special collaboration with 

. The results of the survey will be available on the 

 website, along with useful consumer articles, many of them contributed by 

In addition to the valuable charts that summarize the OTC products most often recommended by pharmacists in 15 distinct health areas, this edition of the 

® includes a number of articles related to the use and management of OTC products. This issue provides articles that focus on the latest information on cough and cold treatments, topical solutions, and oral care.

® features an easy-to-use format that provides pharmacists with OTC product information at their fingertips. The color-coded guide is organized for easy access to the multitude of OTC brands that pharmacists recommend each day. The Table of Contents can be found on page 2, each health section is highlighted, and in-depth product charts are found throughout the guide.

These OTC product recommendations are also housed at 

, where the information is searchable both by category and product name. Designed for use by pharmacists, this site helps users navigate the latest products.

Since 1997, Pharmacy Times has been calculating pharmacists' OTC recommendations and publishing an annual survey.

26 Years Strong

Many individuals experience acid reflux from time to time.

Gastroesophageal reflux disease (GERD) is mild acid reflux that occurs at least twice a week or moderate to severe acid reflux that occurs at least once a week.

Most individuals can manage the discomfort of GERD with lifestyle changes and OTC medications. But some individuals with GERD may need stronger medications or surgery to ease symptoms.

Symptoms may include a burning sensation in the chest usually after eating, chest pain, difficulty swallowing, regurgitation of food or sour liquid, and the sensation of a lump in the throat.

Risk factors may include certain foods, connective tissue disorders, delayed stomach emptying, eating large meals, obesity, pregnancy, or smoking.

Diagnosis tools include ambulatory acid probe test, esophageal manometry, upper endoscopy, and x-ray.

Treatment includes antacids such as Mylanta, Rolaids, and Tums. They also include medications such as H2-receptor blockers cimetidine (Tagamet), famotidine (Pepcid), and nizatidine (Axid). Proton pump inhibitors may also be used, such as Prevacid and Prilosec.

Most individuals can manage the discomfort of GERD with lifestyle changes and OTC medications.

Gastroesophageal Reflux Disease

Consuming caffine and chocolate may trigger attacks among a significant proportion of young adults with migraines, according to the results of a study published in 

The research, conducted among female students and employees of King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Jeddah, Saudi Arabia, sought to evaluate an association between migraines and the food served on campus.

The authors noted that lifestyle-related factors can significantly increase the chance of developing migraines, as some constituents of food may induce the release of vasoactive substances that cause blood vessels to dilate and result in migraines.

They also noted that recent changes in the dietary habits of the cohort, trending toward consumption of coffee and other tyramine-rich foods, have had a negative impact on productivity because of a greater frequency of migraine attacks.

The prevalence of migraines in Saudi Arabia is 26.9%, with a male-to-female ratio of 1:2.9, according to the study authors.

The investigators used 2 questionnaires, the first of which surveyed participants about the characteristics of their headaches. Those who met the International Classification of Headache Disorders (ICDH-III) criteria for migraines were given a second questionnaire to analyze the characteristics of their migraines as well as aggravating factors related to diet and lifestyle.

The survey population included 352 students and 58 faculty members. Results showed that 165 out of 410 (40.24%) achieved the criteria for migraines. Of those 165, 7.8% of participants reported a significant association between caffeine and headaches, and 2 (2.2%) reported an association between chocolate and headaches.

The results showed a higher incidence of migraine among university employees (48.28%) than students (38.92%), which the authors said may be attributable to increased responsibilities and work-related stressors.

The only foods reported to trigger migraines were chocolate and caffeinated beverages, with approximately 10% of participants indicating a link between caffeine and chocolate consumption. Only 2.2% of participants indicated that chocolate triggered a headache, whereas 7.8% indicated that caffeine caused their headaches. There was no association observed between migraine attacks and citrus fruits, pickles, cheese, or other dairy products.

“Migraine may represent underrated social and economic burdens entailing absenteeism, excessive medical costs, and impaired quality of life,” the authors wrote, concluding that “the recent shift in dietary habits in our community... [toward] excessive consumption of coffee and other tyramine-rich food items has negative consequences on productivity and the economy. Our results can be conceivably extrapolated to reflect the effect of dietary habits on other streams of society, including companies, firms, schools, and workplaces that are consumed by the new dietary trends,” they concluded.

Aladdin YS, Alsharif R, Mattar W, et al. Migraine prevalence and analysis of dietary habits in relation to headache in the female population: a single-center study from Jeddah, Saudi Arabia. 

. 2022;14(5):e24848. doi:10.7759/ cureus.24848

Caffeine and Chocolate Consumption May Trigger Migraines

Patients often ask pharmacists to recommend OTC medications for coughs, sore throats, and stuffy noses. These products typically contain antihistamines, antipyretics, cough suppressants, nasal decongestants, or a combination thereof (see TABLE). To provide the best care, pharmacists should verify a few things before making a recommendation.

When talking to patients about cough and cold products, it is important to determine which products can help with symptom management. When assessing treatments, the pharmacist should consider not only the patient’s medication regimen but also disease states and other OTC drugs being used.

They should also counsel patients about the risk of duplicate therapy so as to avoid exacerbating possible adverse effects. After gathering information about the patient’s medications and allergies, the pharmacist can consider OTC options.

It is important to note that many of these are sold as morning and nighttime formulations because of the ingredients they contain. Morning products typically contain an expectorant like guaifenesin, whereas those for nighttime tend to exclude nasal decongestants because of their stimulating effects, which may make falling asleep difficult. Instead, antihistamines, specifically first-generation products that have the greatest risk of sedation, are used at bedtime to help promote sleep.

Hot tea or lozenges to soothe sore throat

Drinking plenty of water or Pedialyte if diarrhea or vomiting are present and electrolyte replenishment is necessary

Cool mist humidifier to reduce respiratory irritation

Here are key points to keep in mind when recommending products to patients who are considered part of a special population or when certain disease states are present.

Avoid nasal decongestants like ephedrine, naphazoline, oxymetazoline, phenylephrine, and pseudoephedrine.

Be aware of possible high sodium content.

Coricidin HBP or its generic equivalent is recommended for multi-symptom relief.

Calculating total acetaminophen intake is important in patients who take other medications containing acetaminophen, like hydrocodone/APAP or oxycodone/APAP, or use it frequently for pain management.

The maximum daily dose is less than 4 grams of acetaminophen.

Patients should avoid non-steroidal anti-inflammatory drugs and products that contain alcohol whenever possible and use products that address specific symptoms.

Pediatric patients should not be given salicylate derivatives/aspirin because they can lead to Reye syndrome.

Children’s Tylenol or a generic should be given, with the dose based on weight.

 is a 2022 PharmD graduate of Duquesne University in Pittsburgh, Pennsylvania.

is the CEO and cofounder of STACK, a pharmacy information management platform, and a preceptor for a virtual Advanced Pharmacy Practice Experience rotation in specialty pharmacy.

1. Acetaminophen. Medscape. Accessed May 1, 2022. 

https://reference.medscape.com/drug/tylenol-acetaminophen-343346

2. Erebara A, Bozzo P, Einarson A, Koren G. Treating the common cold during pregnancy. 

3. Beutler AI, Chesnut GT, Mattingly JC, et al. Aspirin use in children for fever or viral symptoms. 

4. Aspirin: pediatric drug information. UptoDate. Accessed May 11, 2022. 

https://www.uptodate.com/contents/aspirin-pediatric-drug-information

5. Acetaminophen dosing for children. MedlinePlus. Accessed May 11, 2022. 

https://medlineplus.gov/ency/patientinstructions/000783.htm

Consider patients' disease states, medication regimens, and other regularly used nonprescription drugs.

Help Patients Manage Cold and Flu Symptoms

Despite best practice recommendations, antibiotics continue to often be prescribed without a streptococcal antigen test or culture, results from a study by Epic Research show.

This trend has been going on since before the start of the COVID-19 pandemic and is the cause of both in-person and telehealth visits, Epic Research said in a statement.

The instances in which antibiotics were prescribed without testing increased from 50.7% to 53.0% (for office visits), 72.6% to 85.5% (telephone visits), and 77.9% to 86.8% (urgent-care visits). The percentage of telehealth encounters during which antibiotics were prescribed without testing increased from 90.6% to 98.3%.

The surge in telehealth use during the pandemic might have contributed to this increase because telehealth was often used interchangeably with telephone and urgent-care visits, according to Epic Research.

The data could also be influenced by changes related to the overall decrease in communicable infections while people were sheltering in place, distancing socially, and wearing masks, according to Epic Research.

 Overall, both before and during the pandemic, the rate of antibiotic prescriptions given for sore throats without an accompanying strep test was alarmingly high, which raises concerns about future antimicrobial resistance, according to Epic Research.

 Sore throats can be caused by bacteria or viruses, and about 50% to 70% of those cases are treated with antibiotics.

However, antibiotics do not help when a sore throat has viral origins, so rapid antigen tests to determine cause would be extremely useful. Administering the antigen tests would also help physicians properly diagnose sore throats and prescribe medication. Based on data from multiple trials, there was a significant reduction in prescribed antibiotics when a rapid test was used.

A rapid antigen test should be ordered for individuals who have a modified Centor or FeverPAIN score of 2 or 3 to help diagnose group A beta-hemolytic streptococcal (GABHS) infection, according to results published in 

 GABHS infections cause about 5% to 15% of sore throats in adults and 15% to 30% in children.

It is recommended that physicians diagnose infection by combining the modified Centor or FeverPAIN test with the rapid antigen detection test before prescribing an antibiotic.

1. Butler S, Rubin-Miller L, Bowlin G, et al. Pandemic or not: strep-testing guidance overlooked for the majority of prescriptions. Epic Research. No- vember 30, 2021. Accessed January 7, 2022. https://epicresearch.org/articles/ pandemic-or-not-strep-testing-guidance-overlooked-for-the-majority-of- prescriptions

2. Cohen JF, Pauchard JY, Hjelm N, et al. Efficacy and safety of rapid tests to guide antibiotic prescriptions for sore throat. 

. 2020;6:CD012431. doi:10.1002/14651858.CD012431.pub

3. Kalra MG, Higgins KE, Perez ED. Common questions about streptococcal pharyngitis. 

Antibiotics Are Often Prescribed for Sore Throats Without a Diagnostic Test

Cold sores are tiny, fluid-filled blisters on and around your lips. These blisters are often grouped together in patches.

After the blisters break, a scab forms that can last several days.

Cold sores usually heal in 2 to 3 weeks without leaving a scar.

Cold sores spread from person to person by close contact, such as kissing.

They’re usually caused by herpes simplex virus type 1 and, less commonly, herpes simplex virus type 2.

include tingling, itching, blisters, oozing, and crusting.

options may include acyclovir (Zovirax), valacyclovir (Valtrex), famciclovir, and penciclovir (Denavir).

may include lip balms, applying cold compress, rest, and pain relievers.

Cold sores are usually caused by herpes simplex virus type 1 and herpes simplex virus type 2.

Pharmacy Clinical Pearl: Cold Sores

More than half of parents surveyed for the National Poll on Children’s Health conducted by CS Mott Children’s Hospital said that it is difficult to get their children to eat well-balanced diets, and half said their children regularly take supplements.

“A balanced diet helps children get the nutrients they need for healthy growth and development,” Sarah Clark, MPH, codirector at Mott, said in a statement. “Our poll finds thatmany turn to dietary supplements as a solution but may not always consult with a health provider.”

In addition, approximately one-third of parents said their children are picky, and another third said they don’t think their children eat enough fruits and vegetables.

Approximately 13% said that they worried their children were not getting enough of certain minerals and vitamins, and 9% said that their children needed more dietary fiber.

The national survey included 1251 parents, each of whom had at least 1 child between the ages of 1 and 10 years.

Another potential barrier to good nutrition is cost. About half of parents agreed that it is more expensive to provide children with healthy diets than with supplements.

“We know that fresh, healthy foods can be more expensive than processed or packaged items that are often higher in sodium and added sugars,” Clark said. “This can make it especially frustrating for parents when children waste or refuse to eat healthy foods.”

More than three-fourths of parents said that they gave their kids multivitamins.

Approximately half said they had also given children probiotics, live bacteria and yeast that help digestion by providing good microbes in the gut.

More than one-fifth of parents said that they have given their children omega-3 supplements, a fatty acid that supports brain development and cell growth. But about one-third said their children have not taken them regularly.

Four in 5 of those who have given their children supplements said they chose products made specifically for children.

However, only approximately 2 in 5 parents said that they discussed supplement use with their children’s doctors.

“Dietary supplements are often intended to enhance the amount of vitamins children consume through a regular diet,” Clark said. “The use of dietary supplements in children is an important health decision to discuss with doctors.”

Parents in lower-income households were also less likely to talk about supplement use with their children’s physicians compared with those in higher-income households, according to the survey.

Because supplements are classified as food by the FDA, they don’t receive the same evaluation and review as medications, which results in limited research on their efficacy and safety, Clark said.

“To minimize the risks of supplement use, parents should share concerns about their child’s diet with a pediatrician who can help them identify the best strategies to improve the nutritional quality of their child’s diet and determine whether supplements are recommended,” she said.

Half of parents regularly give kids a dietary supplement. EurekAlert. News release. April 18, 2022. Accessed April 20, 2022. https://www.eurekalert.org/news-releases/949682

Approximately one-third of parents said their children are picky, and another third said they don’t think their children eat enough fruits and vegetables.

2022 OTC Guide