OTC Medications

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Over the counter (OTC) medications are drugs that are available for purchase without a prescription. There are a wide range of OTC medications, including drugs for pain relief, seasonal allergies and allergic reactions, sinus infections, fungal infections, digestive problems, skin problems, sleeping problems, eye problems, and many more. Fibromyalgia patients may rely on a number of OTC medications to treat their symptoms. Most often, patients will use OTC pain relievers to try and manage the persistent pain associated with fibromyalgia, as well as other musculoskeletal products designed to relieve stiffness and improve range of motion. In addition, fibromyalgia patients may also turn to OTC medications designed to help with sleep problems, as well as various dietary and herbal supplements to treat a number of symptoms and comorbid conditions.

OTC Pain Relievers

The prevailing understanding of fibromyalgia is that it results from disordered pain processing, rather than muscle or nerve inflammation. Nevertheless, OTC pain relieving medications are frequently used by fibromyalgia patients in an attempt to control the daily pain they experience, as well as the pain that results from exacerbated symptoms and other conditions (such as menstrual cramping or headaches). Some patients obtain relief from such use, whereas others do not.

Examples of OTC pain relievers include acetaminophen (Tylenol), non-steroidal anti-inflammatory drugs (NSAIDS) such as ibuprofen (Advil or Motrin) and naproxen (Aleve), as well as aspirin. Although these drugs are generally safe to use for most people, they can have significant side effects when consumed in too large a dose or in combination with other medications. For example, excess acetaminophen can result in severe liver damage or even death, and may cause some people to have severe allergic reactions. Use of ibuprofen and naproxen can increase the risk of heart attack and stroke, especially with chronic use. Ibuprofen and naproxen can also interact negatively with certain medications known as ACE inhibitors, which are used to treat high blood pressure. In addition, ibuprofen can also cause constipation, diarrhea, gas, dizziness, nervousness, and ringing in the ears, as well as a severe allergic reaction in some individuals. Naproxen can cause similar side effects, as well as mouth sores, drowsiness, difficulty sleeping, cold symptoms, and hearing problems. Overdose is also a possibility with acetaminophen, ibuprofen, and naproxen. Due to the fact that many multi-symptom OTC products may contain one of these pain relievers in addition to other ingredients (especially those products  designed to treat the common cold and influenza), it is important to read labels carefully when taking OTC medications, in order to avoid ingesting more than the recommended daily dose.

OTC Medications for Digestive Health

Many fibromyalgia patients experience gastrointestinal and digestive symptoms, including gas, bloating, diarrhea, and abdominal cramping. A wide variety of OTC products are available to help treat these symptoms, including medications that provide supplemental fiber (such as Benefiber), as well as medications designed to relieve gas and bloating (such as Gas X). Laxatives, such as Exlax may also be useful, and products like Pepto Bismol, Maalox, and Pepcid can help with indigestion and reflux. Prilosec and Prevacid may also be useful to some individuals.

OTC Medications for Sleep Difficulties

Disrupted sleep is prevalent among fibromyalgia patients, due in part to the chronic pain they deal with on a daily basis and the resulting impact on the body’s ability to rest and refresh itself. While prescription sleep aids are available, they have a considerable number of side effects that may make them unattractive options to many people. Fortunately, a number of OTC sleep aids are available, which may help fibromyalgia patients fall asleep easier or remain asleep longer. It is important to note, however, that medications designed to assist with sleep (whether prescription or OTC), are only designed to be used for short-term periods, and should never be used for prolonged periods of time. The best option to help improve sleep for individuals who suffer from sleep disorders is likely a combination of lifestyle changes and sleep hygiene practices. Nevertheless, examples of common OTC sleep aids that may provide short-term relief for some fibromyalgia patients include Benadryl, Unisom, melatonin, Sominex, Tylenol PM, and Nytol.

Most of these products contain an antihistamine drug as their active ingredient, usually diphenhydramine or doxylamine. Antihistamines are usually taken to help relieve allergies and cold symptoms, however their sedative properties make them attractive ingredients for OTC sleep preparations. It is important to know about potential side effects of these medications, and contraindications to their use. Both diphenhydramine and doxylamine can cause daytime drowsiness, dry mouth, dizziness, and impaired memory. Melatonin supplements may lead to similar side effects, in addition to abdominal pain, anxiety, irritability, confusion, and depression. Furthermore, individuals who have narrow-angle glaucoma, asthma, chronic obstructive pulmonary disease (COPD), liver disease, or urinary problems, should not take products containing diphenhydramine or doxylamine. In addition, alcohol should always be avoided when using sleep medications as it can intensify their effects and lead to increased sedation. 

OTC Medications for Depression

Approximately 30% of fibromyalgia patients are clinically depressed at the time of their diagnosis. Although a wide variety of prescription medications are available, many of which successfully treat depression for a large number of patients, some people are unable to find an antidepressant they can take due to undesirable side effects, cost, or other factors. Fortunately, several natural products – all of which are available in over the counter preparations – have shown proven effectiveness at treating depression in a variety of individuals.

For example, St. John’s Wort has been shown repeatedly in clinical studies to improve mood, decrease anxiety, and improve depression-related sleep disturbances in individuals with both mild and severe depression. St. John’s wort has even been shown to be as effective as certain common tricyclic antidepressants (such as Tofranil) and selective serotonin reuptake inhibitors (SSRIs) including Prozac, Zoloft, and Paxil (Kim et al., 1999; Linde et al., 1996; Philipp et al., 1999). Its effectiveness has been so well-demonstrated in fact that the American College of Physicians recommend in their clinical guidelines that St. John’s wort can be considered as a viable option for the short-term treatment of mild depression (Snow et al., 2000). Be advised, however, that St. John’s wort has not been shown to be more effective than conventional antidepressant therapies, and has the potential to interfere with a number of prescription medications. The same general findings apply to the supplement known as SAMe, which has been shown to work better than placebo and equally as well as various conventional antidepressant therapies. It is also endorsed by the American Psychiatric Association as a likely effective alternative therapy for depression (Bell et al., 1994; Delle et al., 2002; Papakostas et al., 2010).

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References

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2.        Acetaminophen. MedlinePlus.    Last updated January 15, 2012; Accessed May 14, 2012.

3.        Ibuprofen. US National Library of Medicine.  Last reviewed October 1, 2010; Accessed May 14, 2012.

4.        Sleep aids: Understand over-the-counter options. December 10, 2011; Accessed May 14, 2012.

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9.        Calapai G, Crupi A, Firenzuoli F, et al. Serotonin, norepinephrine and dopamine involvement in the antidepressant action of hypericum perforatum. Pharmacopsychiatry. 2001;34:45-49.

10.     Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand Suppl. 1994;154:15-18.

11.     Bell KM, Potkin SG, Carreon D, Plon L. S-adenosylmethionine blood levels in major depression: changes with drug treatment. Acta Neurol Scand Suppl. 1994;154:15-18.

12.     Papakostas GI, Mischoulon D, Shyu I, et al. S-adenosyl methionine (SAMe) augmentation of serotonin reuptake inhibitors for antidepressant nonresponders with major depressive disorder: a double-blind, randomized clinical trial. Am J Psychiatry. 2010;167:942-948.

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