How Do US Gastroenterologists Use Over-the-Counter and Prescription Medications in Patients With Gastroesophageal Reflux and Chronic Constipation?

The purpose of this study was to assess how gastroenterologists use over-the-counter (OTC) and prescription medications to treat gastroesophageal reflux disease (GERD) and chronic constipation (CC) in their patients. This study included a total of 3,600 randomly selected American Gastroenterological Association (AGA) members who were mailed a 27-question survey that assessed their perceptions and use of OTC and prescription medications. A total of 830 gastroenterologists (23.1%) completed the survey.

The results of the study are as follows: For a typical patient with acid reflux, 50% of gastroenterologists recommended OTC proton pump inhibitors (PPIs), 13% recommended an OTC histamine-2 receptor antagonist, and 33% recommended a prescription PPI. In a typical CC patient, 97% of gastroenterologists initially utilized OTC treatments. The vast majority of gastroenterologists felt that OTC brand name and store brand PPIs (76%) and polyethylene glycol (90%) were equally effective. Despite these statistics, very few gastroenterologists “always” or “very often” directed their patients to purchase a store brand PPI (35%) or laxative (40%). In addition, gastroenterologists tended to underestimate the cost savings associated with store brand medicines and had limited knowledge regarding the regulation of store brands.

The results of this study reveal 2 main points: 1) Among US gastroenterologists, OTC medications now dominate the primary therapy for GERD and CC; 2) Despite feeling that name brand and store brand PPIs and laxatives are equally effective, the majority of gastroenterologists recommend brand name medicines and underestimate the cost savings associated with store brands. The results of this study are pertinent to pharmacy practice. Community pharmacists can play an important role in helping patients save money by explaining that store brand OTC medications are usually just as effective as name brand medications. Since pharmacists are medication experts, it is our job to look out for additional factors that come along with using medications such as cost. The cost of medications can pose as a burden to many patients, and affordability is part of the larger picture when we assess medication adherence and access to medications. This study shows that many patients are not recommended to take non-name brand OTCs in many cases, but we could play a role in fixing this situation by explaining that store brand generics are the same medications as the name brand medications.

My question posed to colleagues: What role do you think pharmacists can play in helping patients save money on medications, especially in the case of store brand vs. name brand OTCs as highlighted in this study? Do you think it’s important that pharmacists help patients save money on their medications, or do you think that should not be part of our jobs?

Study confirms phenylephrine ineffective for nasal congestion

The goal of this study was to determine if phenylephrine, a widely used nasal decongestant, is effective at the 10mg dose in adults with seasonal allergic rhinitis(SAR).

The study was a multicenter, parallel, open label trial with randomized conditions and 540 participants, all of whom were adults with SAR but were in otherwise good health. The patients were subjected to 7 days of treatment with either 1omg tablets of PE(daily dose ranging from 10-40mg) or with a placebo. The clinical endpoint was the mean change from baseline in reflective nasal congestion score.

The results of the study were that none of the different groups(10mg, 20mg, 30mg, or 40mg daily) had a statistically significant change from baseline congestion. The study also found that PE was tolerated in daily doses up to 30mg, with 18.4% of patients experiencing an adverse reaction to treatment, the most common being headache(3.0%).

This study is interesting to me as many people commonly use OTC decongestants that contain phenylephrine, however this study seems to suggest that they will not be seeing any real effect from its use. As pharmacists, we can use the information from this study to suggest patients use a different OTC decongestant that is more likely to produce an actual effect.

Link to Article

Ibuprofen: Risk, Comorbidities, and Pain Management

Non-Steroidal Anti-inflammatories (NSAIDS) are a commonly used class of drug for pain management, as well as their anti-inflammatory component, and many patients seem to falsely believe that they are harmless. This leads to patients taking them when they may not necessarily need to, without concern for drug interactions or long-term effects. After a recent safety review, the FDA is requesting updated warning labels for over-the-counter NSAIDS. The FDA warns that NSAIDS can increase the risk of heart attack, heart failure, and stroke, not only for patients with heart disease, but also for those without heart disease or risk factors.

NSAIDS are especially useful in treating patients with arthritis, but the American College of Rheumatology advises patients with heart disease to take acetaminophen instead, due to an extensive list of side effects and potential risks. Before recommending OTC pain medications, a healthcare provider should be aware of disease states or conditions, such as kidney or liver disease, hypertension, asthma, patient age, and other medications such as steroids, diuretics, and anticoagulants. Although Tylenol can cause serious liver damage, and lacks anti-inflammatory properties, it is just as effective as ibuprofen for pain and fever reduction, without the extensive side effect profile.

Topical NSAIDS are another potentially safer method of treatment for osteoarthritis inflammation. Because they remain more localized, systemic effects are not as prevalent, and adverse effects were found to be minimal. This information came from a review of randomized, double-blind trials, published in Cochrane Database Systemic Reviews by researchers at Oxford. Ultimately, patients need to be made more aware of the risks associated with NSAIDS, especially such it is such a commonly used prescription and OTC pain medication.

As pharmacists, I think this raises important points about what information to gather from a patient, such as their disease states and medications, before recommending OTC pain medications. With topical pain medications gaining more momentum, and more information available on their side effect profile, do you think this will change the nature of OTC pain medication counseling?

Anderson, Jennifer. Ibuprofen: Risk, Comorbidities, and Pain Management. Today’s Geriatric Medicine.


Histamine-1 receptor antagonism for treatment of insomnia

A double-blind, randomized research study was conducted to compare and contrast the effects of histamine-1 receptor antagonist treatment in insomniacs versus a placebo control, versus an already FDA-approved insomnia treatment. In this study, researchers compared several previously lead studies. Total sleep time, number of awakenings, sleep latency, and sleep efficiency were evaluated in 65 trials.

Histamine-1 receptor antagonists include over-the-counter antihistamines. This is important to recognize because many community pharmacists and healthcare providers prescribe over the counter sleep aids, and so it is necessary to evaluate the effectiveness of these drugs. Historically, some OTC antihistamines have been FDA-approved for insomnia treatment.

However, this study concludes that there have been no sound studies to support the use of histamine-1 receptor antagonists for this indication. It was also discovered that over the counter antihistamines should not be used in younger adults in the long term, as rapid tolerance develops.

This study was very interesting and useful to research for the future. Other over the counter drugs may be studied to compare effects, and insomniacs are one step closer to being able to be better treated for their condition to receive better sleep quality.

Griend JP, Anderson SL. Histamine-1 receptor antagonism for treatment of insomnia. J Am Pharm Assoc. 2012;52:210-19.