What OTC products should these pharmacists recommend?
Case 1: Acute Cough
Q: AM is a 35-year-old woman who comes to the pharmacy seeking advice on her dry, nonproductive cough, which has bothered her for the past few days along with a tickle in her throat. She has been coughing intermittently throughout the day, but it gets worse when she lies down, which has made it difficult for her to sleep. Therefore, AM wants something to suppress her cough while she sleeps. She otherwise reports feeling well and does not have any medical problems or allergies to medications. What suggestions for cough relief can you recommend to AM so she can sleep better?
A: AM’s cough could to be related to an upper respiratory tract infection or allergies. Typically, first-line treatment for a dry, nonproductive cough is a first-generation antihistamine. This can be with or without a decongestant for nasal congestion and naproxen for pain or fever. A product such as diphenhydramine would be appropriate to recommend; a common adverse effect is drowsiness, which could help AM sleep through the night. Many patients seek a product that is nonsedating; however, second-generation antihistamines lack antitussive properties and should be avoided for managing cough. Dextromethorphan is another option for patients who want to suppress their cough during waking hours. AM should be counseled to follow up with her primary care provider (PCP) if her cough worsens or lasts more than 7 days or if she develops a fever.
Case 2: Natural Remedies for a Cold
Q: AL is a 28-year-old woman who presents to the pharmacy seeking advice on cold prevention. She recently started a new job at a local daycare and is concerned about getting sick. At her last job where she worked with children, she was sick every week. She says some of her coworkers take elderberry to prevent colds. They claim a teaspoonful a day will help prevent a cold. She otherwise reports feeling well and does not have any medical problems or allergies to medications. She is interested in a holistic approach to preventing colds and would like to avoid taking prescription products because she heard they are unsafe. What suggestions for cold prevention can the pharmacist provide?
A: AL should be educated that good hand hygiene is important for preventing transmission of viruses and bacteria, so she should be instructed on how to wash her hands properly throughout the day. If she does not have access to a sink, she can use hand sanitizers. No medications are approved to prevent colds; however, the results of a few studies have shown elderberry may be effective if taken within 48 hours of flu-like symptom onset.1,2 If AL decides to take elderberry for flulike symptoms, she should follow the package instructions for dosing because there are many formulations and the dosing can vary. AL should be encouraged to avoid taking something daily for preventing colds because there are no data to support any claims. In addition, if she is considering taking elderberry to reduce flulike symptoms, she may also benefit from getting an annual influenza vaccination, which is recommended in anyone 6 months and older. Because influenza is associated with complications, such as secondary infection, hospitalization, and death, patients presenting with signs of influenza should be referred to their PCP.
Case 3: Allergic Rhinitis
Q: RD is a 40-year-old man who comes to the pharmacy looking for a nasal irrigation system. He has suffered from seasonal allergies since he was a child and today is complaining of congestion, runny nose, and watery eyes. He takes loratadine 10 mg daily during hay season to reduce his symptoms. His sister, who also suffers from allergies, recommended he try a nasal irrigation system for the congestion. He otherwise reports feeling well and does not have any medical problems or allergies to medications. What suggestions do you have for RD regarding nasal irrigation?
A: RD should be told that some study results show that hypertonic saline nasal irrigation 3 times daily can reduce symptoms after 3 to 6 weeks of treatment.3,4 Intranasal corticosteroids, such as triamcinolone acetonide (Nasacort Allergy 24 HR) and fluticasone propionate (Flonase Allergy Relief), have also been proven more effective than saline nasal irrigation. However, both isotonic and hypertonic saline nasal irrigation can improve symptoms of allergic rhinitis.4 RD should be educated on the OTC options, which include intranasal corticosteroids, second-generation antihistamines, and nasal irrigation. If he would like to try nasal irrigation, he should follow the package instructions. In addition, he should be educated on keeping the products sterile, the instructions for which vary by product.
Case 4: Allergy Testing Kit
Q: NG is a 30-year-old man who comes to the pharmacy looking for a home testing kit for allergies. He recently used a CardioChek testing kit and was amazed because it measured his total cholesterol, high-density lipoprotein cholesterol, triglyceride, glucose, and ketone levels at home, the convenience of which he appreciated. After he used the home testing kit, he sent the results to his physician. Recently, his allergies have been worse, so he started taking loratadine 10 mg daily. He has had seasonal allergies for more than 10 years, but never had allergy testing to find out exactly what he should avoid. Now that his allergies are worsening, he wants to see if there is an OTC test like CardioChek for allergies. What recommendations would you have for NG?
A: If NG is suffering from allergies and wants to know their cause, he should see his PCP who can refer him for testing and investigate why his allergy symptoms are worsening. There are 2 methods of allergy testing: skin tests give fast results and typically cost less; blood tests are helpful because they involve a single needle prick, although it takes longer to get the results.5 A home testing kit called “My Allergy Test” is no longer available and no other OTC product exists. The best option for NG would be to discuss with his PCP whether he should have allergy testing and which test would be best for him.
Dr. Mansukhani is a clinical associate professor at the Ernest Mario School of Pharmacy, Rutgers University, and a transitions-of-care clinical pharmacist at Morristown Medical Center in Morristown, New Jersey.Dr. Bridgeman is a clinical associate professor at the Ernest Mario School of Pharmacy, Rutgers University, and an internal medicine clinical pharmacist at Robert Wood Johnson University Hospital in New Brunswick, New Jersey.