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The Informed Parent

Over-the-Counter Medications; A Review for Parents

by John H. Samson, M.D., F.A.A.P.
Published on Jan. 01, 1997

As you walk through the drug store, the shelves of brightly colored boxes and bottles of medications sing the siren song of "cures". Each one vies for your attention. "I can squelch your cough. I'll dry up your runny nose. I'll sooth your scratchy throat. I can stop your diarrhea--if you just purchase me."

Most often the temptation is too great. The ailing patient buys a preparation guaranteed to control the flu. Once home, the inability of the concoction to quell the symptoms is tolerated without complaint, and another colorful bottle adorns the medicine cabinet shelf, only to expire into obscurity.

Not all over-the-counter (O.T.C.) preparations are useless. In fact, some are extremely helpful in alleviating symptoms of common conditions. In order to help you become informed parents I have compiled a generic list of O.T.C.preparations. It is far from exhaustive, and, as you will notice, for the most part the list avoids trade names.

Any attempt to include doses per patient size is beyond the scope of this article. The labels are usually careful in delineating proper doses for age or weight. If you are not clear about the dose always consult your physician or pharmacist before giving any to your child. Never guess the dose. Be absolutely sure.

On the whole, multiple combination preparations should be avoided. The medication that promises to suppress the cough, dry the nasal secretions, liquefy mucus in the lungs, decrease pain, control fever and help a sick child fall asleep should be viewed with some skepticism. It is difficult to dry nasal secretions at the same time as liquefying lung mucus.

In general, select the sign or symptom most bothersome or incapacitating to your child. If necessary, select a preparation aimed at that. If in doubt, you must check with your child's physician.

After the generic name in some categories I have listed trade names. This is to help you identify the category with common preparations. In no way do I intend to endorse the products mentioned or give disapproval to products left out.

ANALGESIC: these are pain controllers. They are effective for headaches, muscle aches, sprains, etc. They should not be used for stomach aches or neck pain unless discussed with a physician since these symptoms may be indicators of a surgical problem or meningitis respectively. Some physicians feel muscle or skeletal pain is more effectively decreased by ibuprofin. In general, acemetaphen or ibuprofin are effective "pain killers". As everyone knows, aspirin should not be given to children or adolescents because of its association with the potentially fatal Reye's Syndrome. In special carefully monitored situations, it may be used under direct physician supervision. Parents sometimes forget acemetaphen comes in suppository form. These are extremely useful in children who are vomiting or little ones who refuse oral medication.

ACEMETAPHEN: Tylenol, Feverall, Tempra

IBUPROPHEN: Motrin, Advil

ANTIACID: these substances are used to temporarily control heartburn by neutralizing stomach acid. For children, one must be careful in administering medication for abdominal pain without a physician's evaluation first.


ANTIDIARRHEA PREPARATIONS: frequent diarrhea stools and cramps are annoying to the patient. Once again, one must be very cautious in using these medications for infants and toddlers. In some cases, diarrhea, particularly blood tinged, can indicate a medical condition that needs immediate professional medical care. This class of O.T.C. preparations should be used only after consulting your physician for small children, children with diarrhea and fever, or bloody diarrhea.


ANTIEMETIC: in general, oral medications purported to stop vomiting are not very effective. Usually the nauseated patient does not selectively retain the antivomiting syrup. An old time antiemetic is Coke Syrup. However, I have never found it particularly helpful. Most effective anti-emetics come in suppository form, and are dispensed by prescription only.

ANTIHISTAMINE: these are antiallergy medications. They are effective in controlling hayfever symptoms, hives, itching and allergy-provoked headaches. Interestingly, they are a major component of "cold medications" since they can cause nasal mucus to become more tacky and less free flowing. Generally they do very little for viral or bacterial infections of the nose. Nevertheless, millions of dollars are spent yearly by parents trying to dry up the runny nose of a cold. They are most effective for nasal discharge of an allergic nature. Most children experience a sedative side effect; a small percentage experience a stimulatory effect. I would primarily use these preparations for allergic conditions.

COMMON PREPARATIONS: Benadryl, Chlortrimiton

ANTIPYRETIC: this group is used to control fever. They are the same preparations that were listed in the analgesic category. Debate rages concerning the best antifever medication, ibuprofen or acemetaphen. I do not want to broach this subject. No complete definite study has resolved this discussion. Both reduce temperatures and recent studies show that they are equally safe for short term, appropriate dose usage. Always remember, fever is an indicator of an infection or inflammation. In addition to lowering the fever consult your physician if you do not know the cause .


COUGH SYRUPS: this very generic term encompasses the most commonly sold group of O.T.C. preparations. There are an untold number of combinations which try to do everything. Specific types include Expectorants: they are used to liquefy secretions. Less thick and tenacious mucus does not cling to the walls of the respiratory passages. They cause less obstruction and are more easily coughed up or cleared from respiratory tract.

COMMON PREPARATIONS: Robitussin plain, or any preparation that contains glycerol guiacolate.

Antitussive: these are cough suppressants. The O.T.C. type are moderately successful in quieting a cough, but not strong enough to suppress a cough to the point of being detrimental to the patient. Most antitussives are combined with an expectorant. Some combine a decongestant or antihistamine with the cough suppressant.

The use of these combinations depends on symptoms: (1) runny nose and moist cough=decongestant and antitussive (2) nasal allergy with moist cough=antihistamine and antitussive. In general, a cough which is dry, croupy or thought to emanate from the lungs can safely use an expectorant/antitussive until your physician is consulted.

COMMON PREPARATIONS: Robitussin DM; the antitussive agent is dextro methorphan and appears in many O.T.C.preparations.

Pediacare, Triaminic D.M.

DECONGESTANT: sometimes useful in decreasing nasal discharge and stuffiness associated with "colds", nasal allergy or vasomotor nasal congestion. (The Persistent Runny Nose: Informed Parent, April 1997) Decongestants are not as effective as an antihistamine for allergy symptoms but are frequently combined with an antihistamine and used as a "cold" remedy. For viral or bacterial nasal infections these medications are relatively ineffective. On the other hand, they may control symptoms of allergic and vasomotor nasal conditions. The antihistamine works against the allergy, and the decongestant combats the vasomotor symptoms.


Decongestant alone--Sudafed

Decongestant and Antihistamine--Triaminic Syrup, Dimetapp

ELECTROLYTE ORAL FLUIDS: children with diarrhea and/or vomiting need to drink fluids that are easily absorbed, non-irritating and which replace lost sodium and potassium. These solutions are not medications that stop vomiting or diarrhea. Since they are easily absorbed and are non-irritating the symptoms may decrease. Nevertheless, they are very useful in managing the patient with gastroenteritis (stomach flu). The patient is kept from becoming dehydrated and the child's serum sodium and potassium remains in balance. The electrolyte fluids should be given in the ready-to-use concentration. Diluting it with water serves no purpose. One significant caution; if the diarrhea and vomiting continues for more than a few hours, or the patient appears very ill, always consult your physician. Severe dehydration can occur quickly in small children. Sometimes it is not obvious to the medically untrained. Remember, these liquids are not direct treatment to stop the symptoms of "stomach flu". They are designed to provide efficient fluid replacement and to maintain good hydration.

COMMON PREPARATIONS: Pedialyte, Rehydralyte

ANTIASTHMA MEDICATIONS: O.T.C. preparations to treat asthma should be avoided. Medical care and proper prescription medications are critical in the safe management of asthma patients.

Once again, this was not intended to be an exhaustive list of O.T.C. medications. The intent was to give you an understanding of how these preparations work. Brand names are not as important as generic types, since so many of them are identical.

Being an informed parent means being able to select a preparation that combats specific symptoms. If possible use one medication instead of combinations. An appropriate dual combination usually makes more sense than the kaleidoscope of drugs that supposedly control every possible symptom at one time. Always use the least number of medications to achieve the desired effect; the less you use, the less chance of side effects.

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