5 OTC Meds to avoid, and better choices

Most people use non-prescription medications without giving much thought to the potential side effects or problems that may be associated with their use.  Here are 5 pretty popular OTC meds you should avoid, and better alternatives.  I bet most of you use one or more of these.  Neosporin, Topical Vitamin E, Afrin nasal spray (or other short acting nasal decongestant sprays), daily headache medications, and sedating antihistamines. 

1. Neosporin:  Neosporin in the most popular OTC topical antibacterial medication in America.  It is very popular, and very profitable for Johnson & Johnson, but they don’t tell you that up to 25% of people who use it repeatedly can develop a contact dermatitis (like poison ivy reaction) from its use.  A much better option is generic bacitracin.  Most ERs and our office no longer use Neosporin, and I recommend against its use for my patients. 
2. Topical vitamin E:  Very popular and promoted as helping healing  and lessening scarring the evidence of benefit is very sketchy if any exists, and it also can cause a severe topical skin reaction.  It is a hidden ingredient in many topical skin care products, and should be avoided.  Any product that keeps a wound moist while healing, like bacitracin mentioned above, will promote healing and reduce scarring. 
3. Afrin nasal spray:  Also lots of other quick acting nasal spray decongestants. If you read the fine print, and  it can be really fine on these tiny packages or bottles, it warns you not to use for more than 3 days.  The problem is that they work so well used for a day or two you can be tempted to continue.  Then after a week, when you stop your nose becomes so congested you cannot breath through the nose, and every time you use the spray you  get immediate relief.  The thing that really makes me frustrated is that the packages of the spray often contain large amounts of medication implying you will need to use lots of it.  Don’t be a sucker.  I recommend not using it at all if you cannot have the discipline to use only 3 days maximum.  The nasal rinses, like Neil-meds Sinus Rinse are great products, and are much better options.
4. Daily use of headache pain medications:  Rebound headaches are what keeps specialty headache clinics in business.  People with rebound headache have daily or nearly daily headaches,  that are intolerable if they don’t take their daily headache meds, but in fact are caused by withdrawal from the daily headache medication use.  If you go to a headache specialty clinic you will almost always come away with orders to stop your OTC headache med use for a month, and report back.  Most patient’s headaches are much reduced or gone after they withdraw from their Tylenol, aspirin-tylenol combinations, or other OTC headache meds.  Rebound headache is especially a problem for people with migraine headaches, who are particularly prone to rebound headaches. 
5. Antihistamine use in the elderly:  Sedating antihistamine use in the elderly, defined as over 65 years old, is common.  They are most commonly used as sleeping aids, but also for allergies.  The chance of accidental falls and automobile accidents due to falling asleep is much higher with the use of these meds, and they should be avoided.  Here I don’t have a simple alternative, you need to discuss this with your physician.  Tara Parker-Pope has an extensive article on insomnia treatment in today’s NY Times. 

Hope this had been helpful.  Coming soon: 5 OTC meds I recommend.