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When an OTC drug is the best, first bet

Cheaper OTC remedies may beat some expensive prescription medications

Published: September 2012

If you take prescription medicine regularly you know it can be expensive, so much so that many patients may take dangerous steps to cut costs. A recent Consumer Reports Best Buy Drug survey found that failing to fill a prescription is a common way consumers try to save, along with taking a drug that’s expired, or skipping a dose. But the best relief might already be in your medicine cabinet. For common ailments like allergies, pain, and insomnia, trying an over-the-counter drug first can often be less expensive than prescription medication, and save you time and money by cutting down on doctor visits.

To help you find the best treatments for your symptoms, we recently reviewed hundreds of studies and came up with the following advice. We also calculated the potential savings of going OTC, though your actual savings may depend on your insurance coverage.

Allergies

Instead of Allegra (fexofenadine), Clarinex (desloratadine), or Xyzal (levocetirizine)

Go OTC Alavert, Claritin (or generic loratadine), or Zyrtec (cetirizine)

Save as much as $148 a month*

Why switch?  Antihistamines block the chemical messenger histamine, one of the body’s natural defense mechanisms and the main trigger of allergy symptoms in the nose, airways, and skin. Studies show that “newer” antihistamines—both prescription and OTC, such as those listed above—are similarly effective. They all generally bring some relief in 1 to 3 hours and continue to work for 12 to 24 hours for most people. But keep in mind that even if you have just mild allergies, you might need to try a few before finding one that works best for you. Some people respond well to one antihistamine while not finding relief with another.

When to see a doctor He or she will be able to tell if your symptoms are caused by an allergy. Studies have found that some people who take prescription meds don’t actually have the condition. You could have a cold, a mild case of the flu, bronchitis, or sinusitis. But if any of those symptoms persist or are accompanied by high fever, shortness of breath, or wheezing, seek help. Also consult a doctor before taking these drugs if you have high blood pressure, a heart condition, diabetes, closed-angle glaucoma, or prostate disease.

Prevent it in the first place Stay inside during peak allergy days. A Consumer Reports National Research Center survey showed that one in five Americans were “highly satisfied” with symptom relief achieved by avoiding allergy triggers. They said that when it worked this strategy was even more effective than treating their allergies with OTC drugs.

Heartburn or GERD (gastroesophageal reflux disease)

Instead of Nexium (esomeprazole), Prevacid (lansoprazole), Zegerid (omeprazole/sodium bicarbonate), or Protonix (or generic pantoprazole)

Go OTC For occasional heartburn, try antacids such as Maalox, Mylanta, Rolaids, and Tums, or acid-reducing drugs such as Pepcid AC (famotidine), or Zantac (ranitidine). If you’ve got GERD, try Prilosec OTC (or generic omeprazole) or Prevacid 24HR (lansoprazole)

Save as much as $192 a month

Why switch? If you get occasional heartburn, nonprescription antacids will probably give you relief. But if your doctor has diagnosed GERD, she might prescribe a proton pump inhibitor, or PPI, such as Nexium, Prevacid, Protonix, or Zegerid, which studies have found to be similarly effective. Research has also shown that Prilosec and OTC versions of Prevacid will work just as well as the pricier prescription PPIs. PPIs work by blocking an enzyme necessary to make acid in the stomach. But don’t take them without a GERD diagnosis from your doctor; they’re not meant for short-term relief.

When to see a doctor If you have heartburn twice a week or more for a few weeks or if drugs like Mylanta, Pepcid, or Zantac don’t provide the relief you need, make that doctor appointment. Also talk with your doc if you’re taking antibiotics or an anticoagulant like Plavix after having a heart attack; a blood-thinner such as Coumadin (warfarin); or benzodiazepines such as Valium (diazepam) for anxiety, because they can interact with PPIs. In the case of Plavix, taking a PPI could actually reduce the effectiveness of the drug and put you at risk of having another heart attack. And PPIs can increase the effects of Valium (and generic diazepam) and Coumadin (and generic warfarin).

 Prevent  it in the first place Try eating smaller meals and avoid lying down for at least 3 hours after eating. Losing weight and avoiding alcohol can also help.

Insomnia

Instead of Ambien (or generic zolpidem), Lunesta (eszopiclone), or Rozerem (ramelteon)

Go OTC Benadryl, Nytol, Sominex (or generic diphenhydramine)

Save as much as $47 a week

Why switch? OTC antihistamines that contain diphenhydramine can cause sedation and sleepiness as a side effect, temporarily helping to relieve mild insomnia. Although relatively inexpensive and easy to buy, they can also cause unwanted side effects, including next-day drowsiness, confusion, constipation, dry mouth, and trouble urinating. But keep in mind that prescription medications can come with their own disturbing side effects.

When to see a doctor  If your insomnia lasts three or more nights a week for at least a month, schedule an appointment with your physician.

Prevent it in the first place Cognitive behavioral therapy, a form of psychotherapy where you single out and replace thoughts and behaviors that are or causing you problems, can improve sleep habits. Also, try exercising and avoid alcohol, caffeine, and smoking. And keep in mind that certain prescription drugs can cause insomnia. So can using a computer or smart phone or watching TV right before bedtime. Other things that can make you toss and turn at night include inconsistent sleep and wake-up times (on weekends, for example) and late-day napping. Finally, if you can’t sleep, get out of bed and do something relaxing, like reading, until trying to catch your zzz’s again.

Joint pain

Instead of Celebrex (celecoxib)

Go OTC The NSAIDs Advil or Motrin IB (or generic ibuprofen), Aleve (or generic naproxen), or the non-NSAID Tylenol (or generic acetaminophen)

Save as much as $265 a month

Why switch?  These anti-inflammatory drugs block the production of substances in the body called prostaglandins, which play a role in aches and pain, inflammation, fever, and muscle cramps. At low doses, NSAIDs (nonsteroidal anti-inflammatory drugs) essentially work as pain relievers. At higher doses they can actually reduce the body’s inflammatory response to tissue damage as well as relieve pain. Studies show the nonprescription NSAIDs are as effective as Celebrex.

When to see a doctor If you take these drugs for longer than 10 days or the recommended doses on the label aren’t effective, make an appointment. Prolonged use of these drugs can cause side effects including gastrointestinal bleeding, stomach ulcers, kidney failure, heart attack, and stroke. So consider taking Tylenol first.

Prevent it in the first place Regular stretching, exercise, and muscle strengthening can help prevent joint pain.

Lower back pain

Instead of Long-acting opioid pain medication, such as OxyContin (or generic oxycodone)

Go OTC The NSAIDs Advil (or generic ibuprofen) and Aleve (or generic naproxen), or non-NSAID Tylenol (or generic acetaminophen)

Save as much as $115 a month

Why switch? Unlike opioid painkillers, which block signals to the brain, these NSAIDs reduce pain by inhibiting the release of a certain enzyme that produces hormones that cause inflammation. For mild to moderate chronic pain, studies show that NSAIDs work about as well as opioid drugs and are less risky.

Opioids are only moderately effective and little is known about their long-term effects. Also, they don’t always completely eliminate pain; can cause side effects like nausea, constipation, sedation, and dizziness; and can cause your body to build up a tolerance so that you need increasingly higher doses, raising the risk of side effects. And they can actually increase your body’s sensitivity to pain and lead to addiction. To treat lower back pain, try nondrug treatments like exercise, physical therapy, and cognitive behavioral therapy. Acupuncture, massage, or yoga may help, too.

When to see a doctor If pain lasts longer than a week or two, radiates down your leg, or is accompanied by leg weakness, call your physician. Also be aware that NSAIDs have been linked with gastrointestinal bleeding, stomach ulcers, kidney failure, heart attacks, and strokes. So you may want to consider Tylenol, a non-NSAID, first. NSAIDs can also aggravate high blood pressure.

 Prevent it in the first place Clinical studies have found that exercise can help prevent non-acute back pain. Try water and walking workouts as well as aerobic exercise, weight training, and muscle endurance and stretching exercises.

Migraine headaches

Instead of Imitrex (or sumatriptan) or Maxalt (rizatriptan)

Go OTC Advil or Motrin IB (or generic ibuprofen), Aleve (or generic naproxen), or the combination products

Excedrin Extra Strength, Excedrin Migraine (or generic acetaminophen, aspirin, and caffeine)

Save as much as $31 a week

Why switch? These OTCs have been shown in studies to help some people who suffer from migraines.

When to see a doctor  Even if the OTC drugs ease your pain, you should still see a physician for a diagnosis if your migraines are moderate to severe in intensity, or they disrupt your life, or if the meds listed above don’t provide relief. Also be aware that overusing these OTC painkillers can sometimes cause rebound headaches, where the pain can persist and become more frequent over time.

 Prevent it in the first place Figure out what prompts your migraines. Culprits can include alcohol, caffeine, certain kinds of cheese, dehydration, plane rides, skipping meals, or stress.

Editor's Note: These materials were made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by a multistate settlement of consumer fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
   

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