Counseling Patients on OTC Pain Medications
Acetaminophen, nonsteroidal anti-inflammatory (NSAID) drugs, and other non-opioid over-the-counter pain medications can be somewhat challenging for patients to manage on their own. Pharmacists play a critical role in patient education to ensure they are not only using the medications correctly, but they are not creating serious risks to their health with potential drug interactions.
When counseling a patient, question them about their past and current NSAID use. Explore specific drugs rather than asking about NSAID use in general, because some patients may not be aware that a certain medication is classified as an NSAID.
If a patient has cardiovascular risk factors such as high blood pressure, high cholesterol, diabetes, obesity, or is a smoker, direct them toward using acetaminophen rather than an NSAID.
Be mindful of how NSAIDs interact with other medications including anticoagulants antihypertensives, corticosteroids, and alcohol. Take time to ask about the patient’s tobacco and marijuana usage history.
Patients who chronically use NSAIDs should be advised to complete a metabolic panel every year with the complete blood count every four months to check for anemia. It is also a good idea to suggest noninvasive screening for bleeding with urine or stool testing.
Make sure to stress to patients, particularly those with liver or kidney issues, that acetaminophen use can cause cumulative toxicity both alone or in combination products such as opioid pain medication. Be sure patients know that drinking three alcoholic drinks per day while taking acetaminophen carries the risk of hepatotoxicity.
In elderly patients, discourage the use of aspirin whenever possible. Aspirin should also be avoided by anyone with kidney or liver impairment, and anyone taking anticoagulation medication because of a bleeding risk. While taking a proton pump inhibitor or misoprostol reduces this risk, it is not eliminated.
Aspirin should also be avoided in children and young adults who are experiencing flu-like symptoms or have the chickenpox, as it has an association with Reye’s syndrome.
Children who are younger than two years old must have a doctor’s consent to use acetaminophen. The doses need to be based on weight, and range from 10 to 15 mg per kilogram of weight every 4 to 6 hours with no more than five doses in a 24-hour period. Help the parent base the dose on the child’s weight in pounds to ensure correct dosage administration.
Children older than six months can use ibuprofen at a recommended dose of 4 to 10 mg per kilogram in weight every 6 to 8 hours with no more than four doses per 24 hour period. Help the parents base the dose on the child’s weight in pounds to ensure correct dosage administration. Advise parents to give the medicine with food or milk to reduce the risk of stomach upset. If stomach upset worsens, parents should be advised to discontinue the use of ibuprofen. Ibuprofen should not be used for more than three consecutive days.
Any discussions about over-the-counter pain medication used should be specific to the patient and personalized based on their current condition, lifestyle, and prescription medication use. Allow the counseling session to help the patient make the best decision about which pain reliever to use. Pharmacists are well-versed in analyzing drug interactions, making them a great source of information for patients who have concerns about their pain medications.