September 25 2000


September 25 2000

Things have changed since those days. Now, over-the-counter medicines (OTCs) go through a rigorous testing process and must provide a detailed list of ingredients, as well as proof of their effectiveness. But, while medicines don't make it to non-prescription-drug status unless they can provide a very high level of safety, the fact remains that they are powerful remedies that need to be used carefully. That's why they're sold mainly in pharmacies with a registered pharmacist on staff. Says Ellen Mary Mills, vice-president, policy and public affairs for the Canadian Association of Chain Drug Stores (CACDS): "It's critical that people understand what they're taking, why they're taking it and how to take it."

Mills points out that no member of the health-care team knows more about prescription and nonprescription medications than pharmacists, who receive four to five years of university training on the makeup of drugs, their effects on the body and their use for disease prevention and treatment. What is more, most people have a drugstore nearby, and there is a good chance it keeps longer hours than your average doctor's office. "Who's more accessible?," asks David Bloom, chief executive officer of Shoppers Drug Mart. "In some cases, your drugstore may even be open 24 hours, with a pharmacist available to help. There's no cost for that accessibility." If you have any doubt about which medication to take, or whether you might be better off seeing a doctor, Bloom urges, run it past your local pharmacist. Why? For one thing, overuse of OTC products can mask the symptoms of a serious health condition. For example, Ken Burns, a pharmacist with Errington IDA in Chelmsford, Ont., had one patient request cough medicine because he was coughing up blood. Burns calmly suggested a doctor's visit instead. Turned out the young man had pneumonia. "If you hadn't sent me, the doctor said I'd have been dead in a week," he told Burns.

Burns points out that most patients do quite well self-medicating for minor everyday complaints, "But sometimes when people are ill, their distinction between what's normal and what's not normal is a little off."

Another potential problem is the danger of drug interactions between one OTC and another prescription or non-prescription drug. For children, the elderly and patients who suffer from allergies, diabetes, high blood pressure, asthma and other medical problems, even nonprescription drugs can have dangerous side-effects. "Even a spoonful of sugary cough syrup can send blood-sugar levels way up for diabetics," points out John Tse, general manager of pharmacy for London Drugs in Richmond, B.C. "It's always a good idea to run an OTC past your pharmacist. It costs nothing, and it could save you from a serious illness."

Self-care on the rise

More and more Canadians are self-medicating for minor illnesses, from colds and flu to heartburn, headaches and allergies, according to statistics compiled by the Nonprescription Drug Manufacturers Association of Canada (NDMAC) and ACNielsen. Overall, 76 per cent of Canadians reported using a non-prescription medication in the 12 months prior to July, 1997, compared with just 68 per cent the year before.

Gerry Harrington, director of public and professional affairs for NDMAC, believes the trend is positive. "Canadians are seeking out information from pharmacists, from health books and various other sources of information mostly for the purpose of self-care," he points out. As well, he says, we're less likely to run to the doctor for minor complaints. "If you've got a vaginal yeast infection," explains Rita Assouline, a pharmacist with Pharmaprix in Montreal, "and you've had it before, you know the symptoms. You can pick up an anti-fungal like Canesten® or Monistat® and treat yourself." The benefit of that: it saves you time and the health-care system money that is not spent on an unnecessary visit to the doctor. A 1995 Queen's Health Policy study, for example, found that simply moving non-sedating antihistamines from prescription to non-prescription status saved the Ontario government some $16 million in costs.

The kicker, however, is that you should always talk to your pharmacist about over-the-counter medications, especially before using them for the first time. "We know those medications inside and out, so we can give quite a bit of advice," says Assouline. "In the case of a vaginal yeast infection, for example, you should be checked by a doctor first, for more serious conditions, like gonorrhea, candidiasiss or a bacterial infection."

Many pharmacies now track all of the drugs that patients are using, including prescription and nonprescription medicines, and herbal products. A recent research project by the Jean Coutu pharmacy chain in Quebec found that 70 per cent of the interventions pharmacists made regarding the use of over-the-counter products either improved the treatment outcome for patients or resulted in a recommendation to see a doctor.

Pharmacists are the most common source of OTC info

When it comes to information on over-the-counter products, pharmacists are the health-care professionals most likely to be consulted, according to a Health Vision 98 consumer survey. Overall, 24.7 per cent of the survey respondents had talked to a pharmacist about an OTC product, compared with the 21.4 per cent who had consulted a doctor. And when it came to information on how to use a medication, more than twice as many respondents (28.8 per cent) talked to their pharmacist compared with those who spoke with their doctors (13.3 per cent).

“Improper usage of OTC products definitely is harmful because a lot of symptoms or medical conditions may be masked by the OTC,” says Simon Ng, general manager of pharmacy and health care for Zellers/Bay Pharmacies.

Barry Peachment, director of pharmacy operations for Canada Safeway Ltd., doesn't find that surprising. "The public is beginning to recognize that pharmacists are really the experts on drugs," he says, pointing out that it's the pharmacist's job to keep abreast of information on new drug products, as well as potential drug interactions and side effects. Many pharmacies now offer private counseling areas where people can discuss sensitive issues without others overhearing. Other drugstores hire pharmacists or pharmacy students to rove the aisles of non-prescription drug products and answer any questions that come up.

Richard Mayrand, vice-president of professional activities for Jean Coutu in Quebec, points out that, with an increasing number of former prescription products moving to over-the-counter status, the need for pharmacists to monitor purchases more closely is growing. Making the right choice can be confusing, he says, but pharmacists are there to help. "If patients have questions about OTCs, they shouldn't hesitate to ask. That's why OTCs are sold in pharmacies ... so that someone is available to offer advice."

Since 1994, the average number of times a day pharmacists report counseling on OTCs has risen from 10 to 13.

What's more, according to Pharmacy Post's sixth annual "Survey on OTC Counseling and Recommendations," when a pharmacist recommends a non-prescription drug product, consumers listen. The survey found that a pharmacist recommendation resulted in a purchase 90 per cent of the time.

"We have an aging society and people are living longer than they were before for various reasons," points out David Bloom, chief executive officer of Shoppers Drug Mart. "That means governments are going to have to make that health-care dollar stretch further and one way to do that is to really take advantage of the unique knowledge and experience of community pharmacists."

Dangerous combos

Drug interactions can be lethal, but, contrary to popular belief, they are not only caused by prescription drugs interacting with other prescription drugs. Dangerous drug interactions can occur when you mix non-prescription drugs with prescription products, as well as with other over-the-counter medications, herbal products and even foods.

Here are just a few of the possible combinations that could have unwanted results:

■ ASA (contained in Aspirin®) in combination with garlic tablets or white willow bark (often used to soothe arthritis pain): since all three have blood-thinning properties, a combination of the two could lead to increased bleeding or stomach problems.

■ Antacids (Dioval®, Gelusil®, Maalox®) or acid suppressives (Zantac® and Losec®) and the antibiotic tetracycline: absorption of the antibiotic can be reduced by up to 90 per cent.

■ Ulcer medication cimetidine (Tagamet®) and blood thinner warfarin (Coumadin®): Cimetidine prevents or slows the metabolism of warfarin, thereby enhancing its blood-thinning effect and increasing the risk of bleeding complications.

■ Cold medications (containing the decongestants pseudoephedrine and phenylproponolamine) and St. John's Wort (a herb commonly used to treat depression): taking them together could lead to a sharp rise in blood pressure.

TLC for the common cold

Caused by any of about 200 viruses, the common cold has proved stubbornly resistant to a cure. "A cold generally lasts about a week, whether you treat it or not," says Katherine Christidis, regional pharmacy operations manager for Zellers/Bay Pharmacies. "And it can be a long, miserable week." Antibiotics won't help, because they work only on infections caused by bacteria, while colds are caused by viruses. "But there are a number of over-the-counter drugs that can relieve your symptoms," says Christidis. Here are her tips for coping with colds:

■ If you have a stuffy nose and pain in your sinuses, you might want to use a nasal decongestant to help you breathe easier, and either acetaminophen, ASA or ibuprofen can help relieve head and muscle aches.

■ Look carefully at the cough medication you choose, suggests Christidis. If you have a dry hacking cough, you're better off with a cough suppressant (look for "DM" on the label). For a wet cough, try an expectorant to loosen phlegm and clear your breathing passages.

■ If you're buying a multiple-symptom cough remedy, look carefully at the ingredients to avoid double-dosing. "Many cold and flu medications will have Tylenol® in them," points out Christidis. "So you want to make sure you don’t take additional Tylenol® on top of that."

■ Other things you can do: stop smoking, drink plenty of liquids, gargle with warm salt water, use a vaporizer to keep the air moist and loosen mucus, and get plenty of rest.

Control the aches and pains of osteoarthritis

Arthritis affects some 2.7 million Canadians and costs the health-care system about $17.8 billion a year, second only to heart disease. And yet, says Denis Morrice, president of the Arthritis Society, "arthritis is still seen as aches and pains that are inevitable with old age. It's not considered a priority." Morrice believes that will change as more of Canada's nine million baby boomers begin to reach age 50 over the next few years, and more and more people understand the suffering firsthand.

Unfortunately, there is no cure for the most common kind of arthritis - osteoarthritis - a wearing away of the cartilage of the joints, either because of injury or overuse. Read on, however, for some tips on minimizing its effects:

Exercise regularly, why? it will help keep your weight under control, decrease your risk of developing arthritis and take pressure off your joints. As well, by building up your muscles, ligaments and tendons, you will bolster your "biological shock absorbers," protecting joints from further injury. Finally, exercise can release endorphins in the brain to make you feel better.

Try a supplement. Glucosamine and condroitin sulfate supplements have been touted as a "miracle cure" by some. Both substances occur naturally in cartilage and other connective tissues and serve to repair and protect them.

Study results have been mixed, but Toronto's Mount Sinai Hospital looked at the effects of glucosamine alone and concluded that, although it's not a miracle cure, it may ease the pain and discomfort for some patients. Other potential sources of relief include devil's claw (an anti-inflammatory herb) and fish oil (perhaps because of the vitamin D).

Capsaicin cream. Made of the same substance that puts the heat in hot peppers, this cream may have a mildly beneficial effect when rubbed on arthritic joints. Give it a chance, though, warns Maria Ton, a staff pharmacist with London Drugs in Delta, B.C. Advocates believe the cream interferes with the neurotransmitters that transmit pain, but it takes at least three days of steady use before you will feel the effects. If you have sensitive skin, you should avoid it.

Acetaminophen. This is still one of the best choices to ease arthritis pain, says Ton. The only mistake people make, she says, is that they don’t take a high enough dosage and then "they give up, saying it doesn't work for them." Ton recommends taking two extra-strength tablets (about 1,000 mg) every four to six hours, or as needed.

Anti-inflammatories. Originally it was believed that there was no inflammation involved in osteoarthritis, but recent research suggests that may not be the case. Ibuprofen has the dual effect of relieving pain and inflammation. Still, for patients with a sensitive stomach or those who may suffer a drug interaction, acetaminophen may well be the best choice.

“The demands from government force a pharmacy to be a commodity business — the more prescriptions we fill, the more money we make,” says Barry Peachment, director of pharmacy operations for Canada Safeway Ltd. would like to see pharmacists compensated for the real value they offer, which is counseling patients, not dispensing pills.”

Guardian angels in white coats

Five years ago, Paul Gary Lepman, of Iroquois, Ont., came down with a killer cold. After a course of medication and three weeks of lozenges and cough syrup, the cold was better, but Lepman's sore throat still persisted. "I knew it wasn't normal," says the former deep-sea diver. "I'm not the type to hang on to a cold like that."

Over the next week, Lepman stuffed down his concern and went through every kind of lozenge his local Gilmer Pharmacy carried, setting off alarms with proprietor-pharmacists Doug and Tracey Gilmer. "Anytime an illness lingers on and doesn't resolve itself, you should see a doctor," says Doug. "Sometimes, over-the-counter products will mask the symptoms of a more serious illness."

Both he and Tracey, his sister, urged Lepman to get a second opinion. "They told me: 'Don't let that go! " And he didn't. A biopsy at Ottawa Civic Hospital indicated that Lepman had throat cancer and he was given just three to six months to live. His only hope: a new and unproven surgery. "I had nothing to lose," says Lepman. "I went for it." After 14 to 16 hours of surgery, he emerged battered, but not beaten. Doug and Tracey were around to fill his post-surgery requirements, and not surprisingly, said Lepman, "I trusted their advice at all times."

That was 5 1/2 years ago. "I'm still going strong," says Lepman. "Last week, I was down at the cancer clinic and the doctors don't want to see me for another year. But I have no doubt that if I hadn't listened to Doug and Tracey, I wouldn't be here today." ■