When going OTC is a smart choice—and when it’s not

Sometimes the best remedy is available without a prescription

Published: May 2015

You might be tempted to rush to a doctor for a prescription medication when you’re dealing with nagging knee pain, a couple of days and nights of heartburn, or the misery of a migraine. But for certain common ailments, our Consumer ­Reports Best Buy Drugs analysis shows that over-the-counter drugs may be the way to go.

Some work at least as well as a prescription medication and may cause fewer or less severe side effects. And because many OTC drugs were once prescription-only, they can have a long track record of safety and effectiveness.

What’s more, OTC drugs can save you the time and cost of an office visit, and may be less expensive, especially if they are available as low-cost generics. In general, if your symptoms are infrequent, mild to moderate, and resolve within a week or so, treating yourself with an OTC drug is a reasonable option. Otherwise, you should see your doctor.

Allergies

Rx choices: Steroid sprays mometasone (Nasonex) and ciclesonide (Omnaris).

OTC options: Steroid nasal sprays fluticasone (Flonase Allergy Relief) and triamcinolone (Nasacort Allergy 24HR).

Research suggests that nasal steroid sprays are the most effective stand-alone medications. They can reduce congestion, sneez­ing, watery eyes, itchiness around the eyes and nose, and postnasal drip. These two available OTC drugs are just as effective as their prescription versions. (Both were prescription-­only until a year or two ago.)

When to see a doctor: If you haven’t received an allergy diagnosis, see your doctor. You might be suffering from a cold, the flu, or a sinus infection. It can be difficult to distinguish those conditions from allergies on your own. Also see your doctor if allergy symptoms don’t improve with OTC treatment after two weeks or so. You might need an additional—or a different—drug.

Prevention pointers: If you can, stay indoors as much as possible on peak allergy days. According to a Consumer Reports National Research Center survey, one-fifth of Americans were "highly satisfied" with the relief they got from avoiding allergy triggers. The respondents also said that when the avoidance strat­egy worked, it was a more effective allergy treatment than OTC drugs.

Find out which allergy treatment is right for you in our free Consumer Reports Best Buy Drugs report on antihistamines.

Chronic constipation

Rx choices: The laxative lactulose (Cholac and generic) and lubiprostone (Amitiza).

OTC options: The laxative polyethylene glycol (MiraLax and generic). MiraLax is just as effective as prescription lactulose for chronic constipation. In addition, it has a long record of safety and is generally well-tolerated. We caution against using OTC stimulant lax­atives such as bisacodyl (Correctol, Dulcolax) and senna (Senokot, Ex-Lax), and their generic equivalents, for more than a few days; they’re less effective than polyethylene glycol and might cause more side effects, such as cramping.

When to see a doctor: Reasons to schedule an office visit include blood in your stool, having the frequency of your bowel movements drop to less than three per week for at least two weeks, or finding that MiraLax hasn’t helped within one week. You may have another condition, or need a prescription med­ication or other treatment to relieve your constipation and help prevent complications such as hemorrhoids.

Prevention pointers: Eat more fiber-rich foods such as vegetables, fruits, whole grains, legumes, and beans (for women older than 50, aim for 21 grams of fiber daily; men, 30 grams). If that doesn’t work, try a daily OTC fiber supplement. Our analysis found that those containing psyllium (Metamucil and generic) are best. And don’t ignore the urge to go. That can lead to irregularity and chronic constipation.

Heartburn or GERD

Rx choices: Proton pump inhibitors (PPIs) such as dex­lan­so­prazole (Dexilant) and pantoprazole (Protonix and generic).

OTC options: For occasional heartburn, first try antacids, such as Maalox, Mylanta, Rolaids, and Tums, or acid-reducing H2 blockers, such as famotidine (Pepcid AC and generic) and ranitidine (Zantac 75, Zantac 150, and generic).

If your doctor has diagnosed GERD—a chronic acid reflux that can lead to esophagus damage—and recommends a PPI, try a generic version of OTC lansoprazole (Prevacid 24HR) or om­eprazole (Prilosec OTC). Research shows that they work just as well as pricier prescription PPIs. Those are also our CR Best Buy picks.

But don’t take those drugs without a GERD diagnosis from your doctor. And be aware: They are meant to be taken preventively—not for immediate relief—and for a limited time. PPIs can have significant side effects, including a higher risk of pneumonia, a potentially deadly infection, and bone fractures.

When to see a doctor: If you have heartburn two or more times per week for several weeks or if OTC antacids or H2 blockers don’t provide relief, make that appointment. Tell your doctor if you take antibiotics, blood-thinning drugs such as clopidogrel (Plavix and generic) and warfarin (Coumadin and generic), or anti-anxiety benzodiazepines such as diazepam (Valium and generic). All can interact with PPIs; Plavix in serious ways. PPIs can also increase the effects of diazepam and warfarin.

Prevention pointers: Keep a food diary to help you pinpoint foods that trigger flare-ups. Try eating smaller meals and avoid lying down for at least 3 hours after eating. Raise the head of your bed by 6 to 8 inches. Losing weight, if you’re overweight, and avoiding alcohol might also help.

For more detailed information on treating heartburn, GERD, and acid reflux, see our free report, and see our tips for getting relief without drugs

Insomnia

Rx choices: Zolpidem (Ambien and generic), eszopiclone (Lunesta), and ramelteon (Rozerem).

OTC options: Diphenhydramine (Ben­a­dryl Allergy, Nytol, Sominex, and generic) and doxylamine (Unisom and generic). Prescription sleep medications have a long list of potential side effects, including dizziness, unsteadiness, and daytime sleepiness. Sleep-driving, sleep-eating, memory lapses, and hal­lu­ci­na­tions have also been reported. For occasional insomnia, OTC sleeping pills that contain diphenhydramine or doxylamine might help. But don’t use them for more than a night or two because they can cause next-day drowsiness, confusion, constipation, dry mouth, and trouble urinating. Nondrug treatments, such as cognitive behavioral therapy, and our prevention pointers below, are safer.

When to see a doctor: If you have insomnia three or more nights per week for at least a month, schedule an appointment. Your doctor can help identify the underlying cause, which can include asthma, bladder and prostate problems, fibromyalgia, heartburn, men­o­pause, sleep apnea, and certain drugs. Your doctor may also refer you to a sleep therapist.

Prevention pointers: Exercise, minimize alcohol and caffeine in the hours before bed, and quit smoking. Turn off electronics 2 hours before bedtime. Keep consistent wake and sleep times. And if you can’t sleep, get out of bed and do something relaxing, such as reading, until trying to catch your zzz’s again.

Need help getting a good night's sleep? Before considering a sleeping pill, try these approaches.

Joint pain (osteoarthritis)

Rx choices: Celecoxib (Cele­brex and generic).

OTC options: Advil or Motrin IB (and generic ibuprofen), Aleve (and generic naproxen), and Tylenol (and generic acetaminophen). Our analysis shows that nonprescription nonsteroidal anti-­inflammatory drugs such as Advil and Aleve can relieve pain as well as Celebrex. But consider trying acetaminophen first. Pro­longed use of ibuprofen and naproxen can cause serious side effects, including gastro­intestinal bleeding and stomach ulcers. And because of the potential risk to your liver, our recommendation is never to exceed 3,250 milligrams of acetaminophen daily or less. (Tylenol recommends no more than 3,000 milligrams per day for some of its products.)

When to see a doctor: If you take these drugs for longer than 10 days or the recommended doses on the label don’t bring relief, call your physician.

Prevention pointers: Stretching, muscle strengthening, physical therapy, and losing excess weight can re­duce discomfort and might eliminate or sharply reduce the need for medication. Ask your doctor or physical therapist to help you develop a safe exercise program.

Migraine headaches

Rx choices: Sumatriptan (Imitrex and generic) and rizatriptan (Maxalt and generic).

OTC options: Advil or Motrin IB (and generic ibuprofen), Aleve (and generic naproxen), and combination products that contain acetaminophen, aspirin, and caffeine (Excedrin Extra Strength, Excedrin Migraine, and generic). Studies have shown that those OTCs can help some migraine sufferers with mild or infrequent pain.

When to see a doctor: If the OTC drugs don’t work or you need to take them more than once or twice per week, see a physician. Overusing OTC painkillers can cause rebound headaches, leading to pain that can persist and become more frequent over time.

Your doctor can help determine whether you might need a prescription medication. He or she can also make sure you don’t have another type of headache, one that might require a different treatment.

Prevention pointers: Keep a diary to help you figure out what triggers your migraines, and avoid those items or situations. Common culprits include alcohol, caffeine, certain kinds of cheese, dehydration, airplane travel, skipping meals, and stress. Biofeedback, acupuncture, massage, and other relaxation strategies might also help prevent migraines from occurring.

Avoid OTCs for overactive bladder

 

The Oxytrol for Women patch, available only with a prescription until 2013, is now OTC. But our medical experts caution against treating yourself for an overactive bladder without a diagnosis. Potential side effects of prescription overactive bladder medications, as well as the OTC patch, include dry mouth, constipation, blurred vision, and dizziness. Plus the drugs work only moderately well, reducing bathroom visits by only two to three per day. More important, overactive bladder symptoms can stem from another condition, such as a bladder infection, or result from side effects of medications.

If you have leakage or frequent, sudden, strong urges to urinate, or urinate so often that it interferes with your life, see a doctor. If the cause is an overactive bladder, before suggesting medication your doctor should recommend bladder training (slowly increasing the time between bathroom trips and using relaxation techniques when you feel urges to go) and Kegel exercises to strengthen the pelvic muscles that help control urination. Other important—and potentially easier—steps are cutting back on caffeine and alcohol, and drinking less between dinner and bedtime.


Editor's Note: This article originally appeared in Consumer Reports On Health July 2015 newsletter. 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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