1. From Prescription to OTC
Sapna N. Patel
UCSF Pharm. D. Candidate 2008
Preceptor Dr. Craig S. Stern
Febuary 29, 2008

2. Significance Unable to track usage
Difficult to obtain patient’s entire medication profile
Many potential DDIs unidentified
May be more cost-effective for employers/patients to switch to OTC usage
Many insurances do not cover OTC products
Pts more likely to postpone seeking medical treatment
PUD/GERD represent 2 of the Top 5 most expensive conditions to treat

3. Prescription Drug Categories now OTC
Non-Sedating Antihistamines
Loratadine (Claritin®, Claritin D®)
Loratadine (Alavert®, Alavert D®)
Cetirizine (Zyrtec®, Zyrtec D®)
Histamine Receptor Blockers
Cimetidine (Tagamet®)
Famotidine (Pepcid®)
Nizatidine (Axid®)
Ranitidine (Zantac®)
Proton Pump Inhibitors
Omeprazole (Prilosec®)

4. Peptic Ulcer Disease
Definition: Open sores on the inside lining of the stomach, small intestine, or esophagus
Causes:
Helicobacter pylori infection (90%)
Long-term use of NSAIDs
Common Symptoms:
Epigastric pain
Weight loss
Bloating
N/V
Feels “better” after eating

5. Peptic Ulcer Disease (cont.)
Treatment:
NEVER self treat
See MD to be tested for H. pylori

6. Role of OTC Proton Pump Inhibitors (PPI)
MOA: Inhibits acid formation by inhibiting H+/K+ ATPase pump
Available: Prilosec
Administration: 20mg daily before breakfast
Place in Therapy:
H. pylori (-): 4-8 week regimen under supervision of MD
ADRs: Acid rebound, abdominal pain, diarrhea, headache, pneumonia
Must know why before breakfast.
Rx Strength: 20mg twice daily

7. Patient Counseling Minimize fatty foods, spicy foods and caffeine
Smoking cessation
Minimize alcohol consumption
Use NSAIDs only if absolutely necessary
Eat smaller meals more often vs. large meals
Weight loss

8. GERD (Gastroesophageal Reflux Disease)
Definition: Movement of stomach contents into the esophagus
Causes:
Big meals
Fatty foods
Alcohol/Smoking
Lying down after a meal
Obesity
Common Symptoms:
Difficulty Swallowing
Acidic taste in mouth
Coughing
Roughness of voice
Chocolate, onions, spicy food

9. H2 Receptor Blockers
MOA: Stops histamine from stimulating the gastric parietal cell, therefore inhibiting acid secretion
Available: Cimetidine (Tagamet®), Famotidine (Pepcid®), Nizatidine (Axid®), Ranitidine (Zantac®)
Administration: Before meals
Place in Therapy:
Mild Severity: Infrequent symptoms and short duration (< 2x/week)
ADRs: N/V/D, constipation, dry mouth, drowsiness, dizziness
Refer if symptoms more than 2x a week

10. Patient Counseling Weight loss Decrease fatty food intake
Smoking cessation
Decreasing alcohol intake
Avoid laying down for 3 hours after meals

11. Allergic Rhinitis
Definition: Immune reaction due to exposure to allergens
Risk Factors:
Family history
Male
Firstborn status
Early use of antibiotics
Exposure to indoor allergens
High IgE levels
Common Symptoms: (perennial or seasonal)
Conjuctival, nasal, pharyngeal itching
Rhinorrhea
Sneezing

12. Role of OTC Anti-histamines
MOA: Blocks peripheral histamine H(1)-receptor activity
Available: Claritin®, Alavert®, Zyrtec®
Administration: Variable
Place in Therapy:
Mild or intermittent allergic rhinitis symptoms
Combined with the decongestant, pseudoephedrine, provide better symptom relief
ADRs: Dry mouth, headache, drowsiness, fatigue
ADRs for pseudoephedrine sulfate: hypertension, insomnia, irritability, and headache
Histamine H1 receptor location, all come in “D” forms, Asthma: (allergic asthma) 10 to 20 mg ORALLY once daily has been used for up to 8 weeks
Idiopathic urticaria, chronic: 10 mg ORALLY once daily , The second-generation agents appear to be similarly efficacious to each other

13. Patient Counseling Allergen Identification: Skin testing (by MD)
Avoid Allergens
Pollens
Insects
Animal allergens
Molds
Molds: (which are difficult to differentiate from other perennial allergens by history alone)

14. Summary Globally, PUD/GERD represent expensive conditions to treat
Many prescription medications are now found OTC
Benefits may include a more cost-effective choice for employers/patients
Downfalls include information lost regarding patient’s medication profile leading to suboptimal medication management
Non-coverage of OTC products by insurances may lead to patient not purchasing medication
Possible worsening of outcomes due to lack of treatment

15. References
patients/ pdfs/ UnderstandGIBleednew.pdf 281k 27/Jan/2008
Antossian T, Madera X, Stern C. Peptic Ulcer Disease, California Pharmacist 9/2005 pp
Stern C, Antossian T, Choo C. Gastroesophageal Reflux Disease, California Pharmacist 6/2005 pp25-30.
Micromedex Drugdex Evaluations-Pepcid, copyright 2006 by Thomson MICROMEDEX.
Micromedex Drugdex Evaluations-Loratadine, copyright 2006 by Thomson MICROMEDEX.
Micromedex Drugdex Evaluations-Cetirizine, copyright 2006 by Thomson MICROMEDEX.
UpToDate-Allergic Rhinitis, copyright 2007 by deShazo R, Kemp S.
Kasper D, Braunwald E, Fauci A Harrison’s Principles of Internal Medicine 16th edition, copyright 2005.