When prescription drugs reach over the counter
It used to be so simple. Take two aspirin and call your doctor in the morning. Whatever it was that ailed you, if it could wait until morning, over-the-counter aspirin was likely the drug of choice. In fact, it was probably the only choice. Today, the wide array of nonprescription drugs lining store shelves in their candy-colored packaging offers an enticing range of relief. Yet, for many, it creates utter confusion. One or two brands have given way to many, often differentiated as much by their marketing as their formulas.
And then there’s the dizzying number of forms — hard pills or soft gels, caplets or capsules, liquid or tablets — as well as their strengths, their directions, their effects. Despite our bewilderment, because these drugs are available over the counter, we are free, if not relegated, to wander among the options, searching for ways to make our nonprescription decisions ourselves.
“The list of drugs used to be a mile long and one-inch deep,” says Mariann Novarina, pharmacist and director of Pharmacy for Community Hospital. “Today, the depth and breadth and all the categories designed to serve diverse needs can be overwhelming. To choose the right drug for your body chemistry and circumstances, you need to have access not just to the drug, but to information about the drug as well. That’s why you need to consult your pharmacist or doctor.”
Your doctor and your pharmacist are also well-equipped to discuss the directions for taking your drug of choice, to clarify the directions on the packaging, and to tailor them to you specifically.
“You may not think something you buy over the counter is a concern,”says infectious disease specialist Dr. Robert Geise. “But Tylenol®, for instance, has always been an over-the-counter drug, and we have learned that it can have significant liver toxicity. You can run into problems by taking too much.”
The presumed-safe over-the-counter drugs, then, are not necessarily safe unless you follow the directions that suit your particular situation, your particular chemistry. A nonprescription drug is still a drug.
“There is some kind of magic surrounding prescription drugs,” says Novarina. “Perhaps because access is limited and you need a doctor’s order, people are motivated to follow directions and take exactly what the prescription says. But with over-the-counter drugs, we choose for ourselves. Maybe we’re assuming they’re less potent so we take twice as much or follow our own directions. That can be dangerous.”
“As the Food and Drug Administration continues to find that the value to society outweighs any potential side effects,” says Novarina, “more and more prescription drugs are getting pushed over the counter where the consumer has direct information and access.” Consider drugs such as Claritin®, a medication formulated to control allergy symptoms, quite recently held just out of arm’s reach by a prescription but now offered over the counter.
You’ve seen the magazine ads that present some lovely image of a woman dancing allergy-free among the butterflies on one side of the ad, with all the prescribing information printed on the back. Much of this is geared toward aging Baby Boomers, who are apt to take these various medications in the interest of continuing their active lifestyle.
“The previous generation took whatever the doctor prescribed,” says Novarina. “But this generation shows up, magazine in hand, to help themselves select from among the plethora of choices on the shelves. Others choose certain over-the-counter medications because a friend or family member endorsed it from his or her own experience. But different formulas work better for different people.”
How do we handle this new freedom and responsibility?
The fact that your cousin swears by Claritin to alleviate his allergy symptoms doesn’t mean that Allegra® won’t be better for you. What’s the chance you know just enough and have just enough access to these over-the-counter medications to make a mistake — possibly a serious one? Ask your doctor if the drug you’re considering makes sense for you.
Another consideration in purchasing over-the-counter drugs that used to be available only by prescription is that what may have been covered as a prescription by your health insurance plan will not be covered as an over-the-counter medication. So, what may have cost you anywhere from nothing to a modest copayment will now set you back the full sticker price.
“The cost of prescription drugs falls off the drug benefit plan and into our pockets once the drug loses its prescription requirements,” Novarina says. “Although we imagine that over-the-counter drugs cost less than prescription medications, the issue is who’s paying for them. What may have become more accessible over the counter might, instead, become cost prohibitive.”
| Over the Counter Name |
Purpose |
| AmLactin lotion (Lac-Hydrin®) |
skin moisturizer |
| Claritin® |
to relieve allergy symptoms |
| Femstat® |
feminine antifungal medicine |
| LamisilAT® cream |
topical antifungul cream |
| NaphconA® |
eye drop decongestant and antihistamine |
| NasalCrom® |
to prevent and treat allergy symptoms |
| Pepcid® AC |
to prevent heartburn and indigestion |
| PrilosecOTC® |
to mitigate acid-related stomach/esophagus irritation |
| TagametHB200® |
to alleviate pain from ulcers in stomach/small intestine |
| Vasacon®-A |
eye drops to relieve rhinitis or eye irritation caused by allergy |
| Zantac75® |
short-term treatment of active duodenal ulcer or active gastrointestinal ulcer |