OTC & Herbal Medications


A GUIDE FOR THE PHARMACIST By Nick A. Kallis R.Ph., Clinical Instructor OSU

Although normally safe for the general population, OTC drugs can be potentially dangerous or fatal to Person In Recovery (PIRs). Remember PIRs seem to be supersensitive to mood altering drugs especially in early recover. Addicts, just plain and simply, react differently to drugs than the normal population whether in active disease or in recovery. OTC antihistamines such as Benadryl, Chlortrimeton, Tavist, Actifed, etc., are NOTsafe for PIRs. OTC antihistamines are mood altering and have been abused by addicts. If an antihistamine is indicated for a PIRs then a non-sedating antihistamine such as Claritin or Allegra should be used. Prescription antihistamines such as Zyrtec, Atarax, Pyribenzamine or Semprex should be avoided since they are all sedating and mood altering. OTC decongestants such as phenylpropanolamine (PPA) or pseudoephedrine should be avoided especially in those with a history of stimulant abuse since they are mood altering and structurally similar to amphetamines. Tolerance is quickly seen to pseudoephedrine's effects. Rx antihistamines with decongestants such as Claritin D and Allegra D should also be avoided. Atrovent nasal solution is an excellent option for rhinitis from allergies or a cold. Diet pills containing PPA or ephedrine are to be avoided. Ephedrine or any product containing Ma Huang and its derivatives is completely contraindicated, as it is a controlled substance with an abuse potential similar to amphetamine.

Dextromethorphan is a weak narcotic agonist. Cases of abuse and addiction have been noted in the literature and in Turkey it is used to detox opiate addicts. For these reasons expectorants, water or Tessalon Perles are recommended for cough. If a stronger cough suppressant is needed, then Dextromethorphan would be preferred to Codeine or Hydrocodone.

An obvious concern is the alcohol content in any oral preparation. Many OTC cough and cold or pain relief items have a high alcohol content that may trigger a craving or relapse. The alcohol content of any over the counter product including mouthwashes should be checked. Anti-diarrheals such as Imodium AD are safe to use but the liquid contains alcohol so tablets would be preferred. Rx anti-diarrheals such as Lomotil and Motofen contain narcotics that are dangerous to use.

For pain management all OTC painkillers are considered safe as long as the patient has no significant liver or kidney problems. Aleve, Motrin, Orudis, Aspirin and Tylenol are all safe and effective. Tylenol PM with its Benadryl component should be avoided. Indeed as a general rule, all Rx and OTC sleep aids should be avoided. The best choice of a sleep medication for a PIRs would be Trazodone (Desyrel). OTC products such as Unisom or Nytol should be avoided.

There are many herbal products available today. I would like to discuss several of the more popular products on the market. Ma Huang, and all its other names, contains the stimulant ephedrine and is not safe for PIRs. St Johns Wort is safe as it has properties that resemble other SSRI antidepressants. Kava Kava is not safe, it has sedative properties which are additive to alcohol and benzodiazepines and the literature has noted abuse and habituation. Valerian root is a drug I would not recommend as safe from the nature of its CNS actions and literature reference to withdrawal symptoms appearing after chronic use. Echinacea is safe as an immune booster. Gingko Biloba and Melatonin are also safe.

Ultimately the safest approach to any self-limiting problem such as a cough, cold or flu is "tincture of time". Conservative measures such as vaporizers, aspirin, Tylenol, heating pads, saline sprays, chicken soup, bed rest and saline gargles are effective treatments. DO NO HARM is the first rule of medicine. Any mood-altering chemical may do more harm than good to PIRs. If you are unsure whether a substance is safe or not contact an addictionologist (a physician that is accredited with the American Society of Addiction Medicine) or a pharmacist with expertise in this area.