(Continued from Part 1. This concludes the article.)
Cold, Flu, and Allergy
Sudafed (pseudoephedrine hydrochloride 30 mg) is an oral tablet that is a nasal decongestant. Sudafed reduces sinus pressure by narrowing the blood vessels to decrease inflammation in nasal and sinus passages. It treats a symptom of the cold, allergies or flu. As a result of its misuse as a precursor for meth production, it is no longer available directly off the shelf and requires one to ask for it at a pharmacy counter. Sudafed elevates blood pressure–so don’t use if you already have high blood pressure. As a personal aside, although the recommended adult dose is two tablets or 60 mg, the full dose causes me to feel jittery/anxious and dries out my nasal passage to an uncomfortable extent.
There are several decongestant nasal sprays available that contain active ingredients similar to Sudafed (e.g., oxymetazoline hydrochloride). But we do not keep one because the dose cannot be accurately regulated and receiving an excessive dose can easily occur. If you do choose to use nasal decongestant spray, keep in mind it is designated for short-term use and immediate treatment of symptom onset. Overuse can cause damage to the sinus passages even if you believe the medication is helping you breathe better. As a young man, I had a bad experience with this phenomenon myself.
Mucinex (guaifenesin 600 mg) extended release for relief of chest congestion. This is an expectorant that helps loosen the mucus in your chest making it easier to cough up. It is important to take the extended-release tablet without chewing or crushing, because failing to follow directions will impact the drug release rate. For best results, one should drink lots of water while taking guaifenesin.
Vicks VapoRub or Mentholatum are both old standby remedies for congestion and cough suppression. Typically, ointments such as these have camphor, menthol or eucalyptus as the active ingredient.
Zinc. In recent years, limited research has implied that that zinc shortens the duration or reduces the severity of cold symptoms. For our OTC kit, my wife selected Zicam oral mist and zinc lozenges.
Elderberry. Evidence is beginning to mount suggesting that elderberry syrup provides some extent of cold and flu symptom relief.
Antihistamines (H1 blockers)
Antihistamines differ from decongestants in that they block the body’s production of histamine, which is the compound our bodies produce resulting in allergic reactions such as runny nose, runny eyes or itching. Decongestants and antihistamines are often confused with one another but they do not perform the same function. An analogy using the earlier GI OTC selections, Tums versus Prilosec, helped me understand the difference: Tums brings quick heartburn relief by neutralizing the acid present in your stomach whereas Prilosec reduces the production of stomach acid over time, eventually eliminating the occurrence of heartburn.
In terms of allergy relief, decongestants such as Sudafed can open airways relatively quickly (45 to 60 minutes for example) whereas regular use of an antihistamine such as Zyrtec works by blocking the production of histamine which is responsible for causing the symptom – nasal congestion.
Any newer less drowsy antihistamine such as Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine), Xyzal (levocetirizine), etc. can be kept on hand for general treatment of cold and allergies. Anecdotally, we’ve heard that people may prefer one antihistamine or think one works better than another. They’re all very similar in their effectiveness, so you can keep whichever one you prefer on hand. We keep the Sams Club version of Zyrtec (cetirizine hydrochloride 10mg) as our regular use allergy treatment.
Benadryl (diphenhydramine HCl 25 mg). My wife believes that everyone should have tablets or liquid on hand for emergency treatment of severe allergic reactions. (Recall from earlier that it was her only contribution to my OTC stockpile in the initial three years. She keeps close to 1,000 tablets on hand as well as oral liquid and topical spray versions). She emphasized that Benadryl is for occasional use and not to be taken daily as we do with Zyrtec. It is important not to mix and match multiple formulations at the same time, i.e., don’t take a tablet and spray the sting/bite within the dosing window (timeframe of the drugs effect/action) because the dosages are cumulative.
Astepro nasal spray (azelastine HCl 205.5 mcg per spray). An antihistamine nasal spray for temporary relief of runny or itchy nose. While under a physician’s care, my wife once used this to combat dizziness caused by a sinus infection.
For chronic allergies, there are corticoid steroid nasal sprays such as, Nasacort, Nasonex and Flonase. These reduce nasal and sinus symptoms associated with chronic allergies. They typically require daily use for two weeks to achieve full benefit followed by continuous use during the allergy season to maintain effect. These products are not related to the nasal decongestant sprays mentioned earlier and absolutely should not be confused with one another.
Hives, Itching, and Bites
Benadryl topical spray (diphenhydramine 2%), Fast relief, cooling, does not require touching (rubbing in). Remember not to mix/combine its use with other topical or oral Benadryl products.
Famotidine 20 mg (Pepcid—yep, the acid reducer) is a histamine type 2 blocker so it offers relief from some cases of hives. Only use in this manner when under a physician’s directive.
Hydrocortisone cream is a topical steroid, the original anti-inflammatory product. There are many brands and formulations but the cream is preferred since it offers good coverage, washes off, and has good absorption through skin. Maximum OTC strength is 1% but others are available by prescription.
Zanfel wash for contact dermatitis from poison oak, poison ivy sumac and related plants. This may be the most expensive product on our OTC list. It is used similar to a soap in that a small amount is rubbed into the contact area with wet hands for several minutes. It does not produce a lather and it has a slightly gritty feel. After three or so minutes, the area of skin is rinsed well with clean water. I have used Zanfel on my face, arms and legs multiple times after encountering poison oak mowing or cutting wood and I am convinced that it works.
Calamine lotion is a mixture of calamine and zinc oxide for drying out of blisters due to poison oak, ivy and sumac.
Sting-Kill ampules contain a mixture of benzocaine for pain relief and menthol for itch relief. The ampules are crushed then applied to the site of a bee sting or insect bite.
Witch Hazel is a skin astringent that causes the skin to tighten and small blood vessels to constrict. It is used reduce skin irritations due to insect bites, pimples, or small cuts. It is also the active ingredient in some hemorrhoid wipes.
Oral Care OTCs
DenTek temporary repair kit for caps and fillings. This kit contains a “putty” filler and small two ended application tool that are used to form a temporary filling or serve as a short-term adhesive to hold loose crowns or caps in place until one can seek dental care.
Orasol Anesthetic Gel and/or Kanka oral liquid (20% benzocaine). For pain relief in the mouth for tooth ache, gum pain, canker sore, etc.
Eugenol Oil is a dental analgesic used for temporary pain relief due to tooth ache. The treatment kit contains cotton pellets that you saturate with the oil then apply to the cavity.
Chloraseptic spray. Contains phenol for temporary relief from a sore mouth or throat.
Chapstick/Aquaphor ointment for chapped, cracked or dry lips. In a pinch, it can also be used to bring relief to a dry nose.
Eye Care Products
Bausch and Lomb Soothe lubricant eye drops. Used to moisturize dry or irritated eyes. These are preservative free and come in single use vials. For long-term storage it is important to select single use vials over a drop-tainer that is easily contaminated and has a finite shelf life once opened.
Eye Wash eye irrigation solution is a sterile solution of purified water that can be used to flush the eye. This kit comes with an eye cup to aid in the flushing action.
It is my wife’s opinion that paying more for a recognized name brand is important for ophthalmic products since they will have been produced in an established and focused sterile product manufacturing facility.
Miscellaneous Topical
NeilMed Wound Wash Sterile saline for wound irrigation.
Dr. Scholl’s Corn and callus remover. Contains salicylic acid and works by causing the skin to peel off layer by layer. Should be used in conjunction with corn pads or mole skin padding.
Antifungals
Monistat 3 (miconaxole nitrate 200 mg vaginal insert). Various products are available for vaginal yeast infections. Monistat 3 was selected over Monistat 1 because the total dose was much lower even though the treatment is over three days instead of a single dose. The insert was chosen over the internal cream with applicator because it is easier to use and less messy. Most kits also come with an external vaginal cream.
My wife chose 4 topical antifungal products, each containing a different active ingredient: miconazole nitrate powder spray (2%), tolnaftate liquid spray (1%), butenafine hydrochloride cream (1%) and clotrimazole cream (1%). These four antifungal medications were chosen in formulations sold to address jock itch, although each is also suitable for athlete’s foot. Take note that the reverse is not true, i.e., don’t use an athlete’s foot antifungal to treat groin issues. The dosage form (cream, powder or liquid) impacts the suitability based on the administration site, comfort of application and how quickly the drug takes action. The “-azoles” have additional anti-inflammatory action which can help with symptom relief. Terbinafine antifungals (she did not find an OTC product at our local Wal-Mart) work faster than and have shorter therapy duration than those available here so if you find a product with terbinafine it would be worth adding to your OTC kit.
With mention of the antifungals, our household list is complete. You may have noticed that we do not keep any multi-(active) ingredient products such as some well-known cold medicines. There are two reasons for this. First, most of those products are bulk liquids, and in general the product life is shorter for liquid formulations and the risk of contamination at use is greater. The second reason is that a premade mixture can have an adequate dose of some component medications and too little of another active ingredient. By selecting the individual drugs, we as patients retain control over the quantity(ies) of medication we are taking with respect to additional drugs and retain the longest possible shelf life by choosing solid dosage forms.
Currently, we have multiple replacements of the allergy and analgesic products but need to purchase additional supply of other OTC’s. I must say thank you to my wife for her guidance and gift as well as for reviewing this article to make certain I didn’t mis-represent her explanations. Moving forward I now know what products to keep in stock and with her explanations have a better idea of when and how to use them. As a result of writing this article, we have reorganized our OTC medications by purpose and stored similar products together. As she read the original draft, I heard her laugh at least three times so I hope you too have found value and entertainment from my OTC preparation journey.