Chronic Disease OTC

You cannot use OTC to replace conventional prescription drugs, you cannot superimpose OTC with the same ingredients as prescription drugs, and you cannot suspend routine disease course monitoring during use. All three are indispensable.

Not long ago, when I was doing a free clinic in a community pharmacy, I met retired Aunt Zhang. She had suffered from essential hypertension for 8 years and had been keeping it under control by taking valsartan regularly. When she caught a cold in autumn, she went to the pharmacy to buy compound paracetamol and took it. After taking it for three days in a row, she felt dizzy and couldn't stand. When she came to measure her blood pressure, her blood pressure soared to 165/97mmHg. After asking about her medication history, she realized that the pseudoephedrine contained in the cold medicine she bought can constrict blood vessels and raise blood pressure, which exactly counteracts the effect of antihypertensive drugs. It was like taking antihypertensive drugs for several days in vain.

Later, I talked to Dr. Li from the Department of Cardiology. He was so angry that he slammed the table and said that this was the third patient that month who had lost control of his blood pressure due to indiscriminate consumption of OTC. This is also the core reason why many specialists are "conservative" and firmly oppose patients with chronic diseases to buy OTC on their own. Reason: Most patients with chronic diseases need to take more than three kinds of prescription drugs for a long time. Their liver and kidney functions are inherently weaker than that of healthy people. The ingredients of many OTC compound preparations are opaque and can easily interact with prescription drugs, which can either offset the efficacy of the drug, increase the metabolic burden, or even cause acute complications. Diabetic patients drink cough syrup with sucrose indiscriminately, and old chronic bronchitis patients with gastric ulcers take compound licorice tablets to relieve their coughs and cause gastric bleeding. Such cases are really too common in clinical practice.

However, last year when I was giving a publicity talk on chronic diseases with Pharmacist Wang from the Community Health Service Center, she had a completely different view. She was a typical "pragmatic" person: It is unrealistic to ban patients with chronic diseases from using OTC across the board. It is impossible for patients with high blood pressure to have occasional headaches and patients with diabetes to have occasional allergies. They have to go to the hospital to get ibuprofen and loratadine, right? The number of community hospitals is already tight, and it is a waste of medical resources to prescribe commonly used drugs. As long as the contraindications are clearly explained to patients, OTC can save a lot of trouble for chronic disease groups. We who provide pharmaceutical services often say, "Patients with chronic diseases choose OTC. First look at the contraindications and then the efficacy. If the contraindications are crossed, no matter how good the efficacy is, it will be in vain." This is actually the truth.

It's quite helpless to say that many people's understanding of OTC is still at the stage of "it won't kill you anyway", especially many old patients who have suffered from chronic diseases for more than ten years. They feel that they have never taken any medicine, and it is more convenient to choose OTC. However, it is this kind of self-confidence that is most likely to cause trouble. The most outrageous case I have ever seen was an old man suffering from type 2 diabetes. Hearing the old man say that a certain red-labeled OTC Chinese patent medicine could "radically cure diabetes," he stopped taking metformin for five years. Half a month later, he was sent to the ICU for ketoacidosis. After he was rescued, the old man regretted it. He said that if he had known better, he would have taken a medicine box and asked the community doctor, so he would not have suffered this crime.

Don’t let your guard down when you see a green label Class B OTC. Take the most common ibuprofen, which is indeed a very safe Class B OTC. However, if you are a coronary heart disease patient who has been taking aspirin for a long time, eating ibuprofen will increase the risk of gastrointestinal bleeding. Many people don’t know this at all. There are also many people who think that OTC Chinese patent medicines have no side effects, which is a misunderstanding. Many cold and cough medicines contain Western medicine ingredients that are anti-allergic and antipyretic. If the ingredients overlap with the prescription medicines you usually take, it means that the dosage of the medicine is invisibly increased, and the risk is not small.

In fact, the body of patients with chronic diseases is like an old machine with adjusted parameters. If you add an uncalibrated part at will, even a small screw that looks inconspicuous, it may cause the entire machine to jam. OTC is that small screw. It does not mean that it cannot be used. You must first check whether it matches the original parameters. When you are unsure, don’t listen to random recommendations from drugstore shopping guides. Take an extra 30 seconds to scan the [Precautions] column in the instructions. If the first item says, “People with serious chronic diseases such as hypertension, diabetes, and kidney disease should take it under the guidance of a physician.” Don’t just take it. Take a photo and ask the community doctor who often follows you. It only takes 2 minutes, and it is much better than eating blindly and causing an accident.

In the final analysis, OTC leaves convenience for patients with chronic diseases, not a gap. Only by paying more attention to your body can this convenience really help you instead of adding trouble.