Transcript More is More

The Dangers of Choosing Combination Products Over
Single Active Ingredient Products
Christine Marie Manalo
Debbie Chen
Megan Sailors
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Introduction to our topic and its importance
 Main issue
 Why people choose combination over-the-
counter (OTC) products?
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OTC combination products examples
Scenarios
Dangers of choosing combination products
 Side effects, adverse drug events
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Solutions, prevention
 Labels, smart panels, phone applications, internet
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Many OTC combination products out there
that contain the same active ingredients.
Patients purchase combination products to
relieve only one symptom.
Patients end up ingesting unnecessary active
ingredients that can lead to more side effects,
adverse drug events, and ultimately, an
increase in the cost of healthcare.
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Patients purchase products without looking
at the labels, and thus are not aware of the
multiple active ingredients.
Patients do not take the time to read labels
and do not follow directions for use.
Patients want to save money by purchasing
one product with multiple ingredients so they
can use it repeatedly for various symptoms.
Convenience.
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Products containing acetaminophen
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Actifed® Plus (as a combination product containing Acetaminophen, Pseudoephedrine, Triprolidine)
Alka-Seltzer® Plus Cold & Sinus (as a combination product containing Acetaminophen, Phenylephrine)
Anacin® (as a combination product containing Acetaminophen, Aspirin, Caffeine)
Backprin® (as a combination product containing Acetaminophen, Caffeine, Magnesium Salicylate)
Codimal® (as a combination product containing Acetaminophen, Chlorpheniramine, Pseudoephedrine)
Comtrex® Cold and Cough (as a combination product containing Acetaminophen, Dextromethorphan,
Phenylephrine)
Contac Sinus® (as a combination product containing Acetaminophen, Pseudoephedrine)
Coricidin® (as a combination product containing Acetaminophen, Chlorpheniramine)
Dayquil® (as a combination product containing Acetaminophen, Dextromethorphan, Pseudoephedrine)
Dimetapp® Cold And Fever (as a combination product containing Acetaminophen, Brompheniramine,
Pseudoephedrine)
Dristan® Cold Non-Drowsy (as a combination product containing Acetaminophen, Pseudoephedrine)
Drixoral® Sinus (as a combination product containing Acetaminophen, Dexbrompheniramine,
Pseudoephedrine Extended Release Tablet)
Dryphen® (as a combination product containing Acetaminophen, Chlorpheniramine, Phenylephrine)
Duraflu® (as a combination product containing Acetaminophen, Dextromethorphan, Guaifenesin,
Pseudoephedrine)
Duratuss® A (as a combination product containing Acetaminophen, Guaifenesin, Phenylephrine)
Emagrin Forte® (as a combination product containing Acetaminophen, Caffeine, Guaifenesin,
Phenylephrine)
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More products containing acetaminophen
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Excedrin® (as a combination product containing Acetaminophen, Aspirin, Caffeine)
Excedrin® Back & Body (as a combination product containing Acetaminophen, Aspirin)
Excedrin® PM (as a combination product containing Acetaminophen, Diphenhydramine)
Midol PMS® (as a combination product containing Acetaminophen, Pamabrom, Pyrilamine)
NyQuil® Cold/Flu Relief (as a combination product containing Acetaminophen, Dextromethorphan,
Doxylamine)
Sinus Aid® (as a combination product containing Acetaminophen, Pseudoephedrine)
Sinutab® (as a combination product containing Acetaminophen, Pseudoephedrine)
Sudafed® PE Cold & Cough (as a combination product containing Acetaminophen, Dextromethorphan,
Guaifenesin, Phenylephrine)
Sudafed® PE Sinus Headache(as a combination product containing Acetaminophen, Phenylephrine)
Supac® (as a combination product containing Acetaminophen, Aspirin, Caffeine)
Suphedrin Sinus® (as a combination product containing Acetaminophen, Pseudoephedrine)
Tavist® Allergy/Sinus/Headache (as a combination product containing Acetaminophen, Clemastine,
Pseudoephedrine)
Tavist® Sinus (as a combination product containing Acetaminophen, Pseudoephedrine)
Theraflu® Sore Throat (as a combination product containing Acetaminophen, Chlorpheniramine,
Pseudoephedrine)
Tricom® (as a combination product containing Acetaminophen, Chlorpheniramine, Pseudoephedrine)
Tylenol® Cold (as a combination product containing Acetaminophen, Dextromethorphan, Pseudoephedrine)
Unisom® With Pain Relief (as a combination product containing Acetaminophen, Diphenhydramine)
Vicks 44® Cold, Flu and Cough (as a combination product containing Acetaminophen, Chlorpheniramine,
Dextromethorphan, Pseudoephedrine)
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Products containing ibuprofen
 Advil® Allergy Sinus (as a combination product containing
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Chlorpheniramine, Ibuprofen, Pseudoephedrine)
Advil® Cold and Sinus (as a combination product containing
Ibuprofen, Pseudoephedrine)
Advil® PM (as a combination product containing Diphenhydramine,
Ibuprofen)
Dayquil® Pressure and Pain (as a combination product containing
Ibuprofen, Pseudoephedrine)
Dimetapp® Sinus (as a combination product containing Ibuprofen,
Pseudoephedrine)
Dristan® Sinus (as a combination product containing Ibuprofen,
Pseudoephedrine)
Motrin® PM (as a combination product containing Diphenhydramine,
Ibuprofen)
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Products containing aspirin
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Alka-Seltzer® (as a combination product containing Aspirin, Citric Acid, Sodium Bicarbonate)
Alka-Seltzer® Extra Strength (as a combination product containing Aspirin, Citric Acid, Sodium Bicarbonate)
Alka-Seltzer® Morning Relief (as a combination product containing Aspirin, Caffeine)
Alka-Seltzer® Plus Flu (as a combination product containing Aspirin, Chlorpheniramine, Dextromethorphan)
Alka-Seltzer® PM (as a combination product containing Aspirin, Diphenhydramine)
Anacin® (as a combination product containing Aspirin, Caffeine)
Anacin® Advanced Headache Formula (as a combination product containing Acetaminophen,
Aspirin, Caffeine)
Aspircaf® (as a combination product containing Aspirin, Caffeine)
Bayer® Aspirin Plus Calcium (as a combination product containing Aspirin, Calcium Carbonate)
Bayer® Aspirin PM (as a combination product containing Aspirin, Diphenhydramine)
Bayer® Back and Body Pain (as a combination product containing Aspirin, Caffeine)
BC Headache (as a combination product containing Aspirin, Caffeine, Salicylamide)
BC Powder (as a combination product containing Aspirin, Caffeine, Salicylamide)
Emagrin® (as a combination product containing Aspirin, Caffeine, Salicylamide)
Excedrin® (as a combination product containing Acetaminophen, Aspirin, Caffeine)
Excedrin® Back & Body (as a combination product containing Acetaminophen, Aspirin)
Goody's® Body Pain (as a combination product containing Acetaminophen, Aspirin)
Levacet® (as a combination product containing Acetaminophen, Aspirin, Caffeine, Salicylamide)
Saleto® (as a combination product containing Acetaminophen, Aspirin, Caffeine, Salicylamide)
Supac® (as a combination product containing Acetaminophen, Aspirin, Caffeine)
Vanquish® (as a combination product containing Acetaminophen, Aspirin, Caffeine)
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Single symptom, single combination product
used
Treats symptom, but may have side effects due
to exposure to unneeded ingredients:
 Oh I’m congested today. *Looks in OTC aisle* Oh I’ll
take Tylenol Sinus *grabs Tylenol Sinus Congestion &
Pain Severe out of plethora of Tylenol Sinus/Allergy
boxes * BUT pt could just select Claritin D (behind the
counter) to treat just the congestion or maybe even
regular Claritin -- ask your pharmacist! Don’t need
APAP and guafenisen in the Tylenol selected
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Multiple symptoms, multiple combination
products used
Treats symptoms, but can increase risk of side
effects/toxicity due to multiple active
ingredients and additive dose of ingredients
 I’m so bloated and cramping…I think I need to take
some Midol. I’m also feeling a bit sick, so I’ll take
some Nyquil before I got to bed too. *both
combination products contain APAP as active
ingredients, so can easily take higher doses of it
without knowing and risk liver toxity*
Misuse of combination products
can lead to serious adverse drug
events!
Stomach and Intestinal
Bleeding severe
enough to require
hospitalization
 Fatal in a relatively
small number of
cases
 Kidney Failure
 Severely reduced
urine production
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Ringing in the ear
Blurred vision
GI
 Diarrhea
 Heartburn
 N/V
 Stomach pain
Lungs
 Slow, labored breathing or wheezing
Nervous System
 Headache
 Agitation
 Incoherence, confusion
 Coma
 Drowsiness
 Seizure
 Dizziness
 Unsteadiness
Skin
 Sweating
 Rash
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Liver Toxicity
 One of the most common poisonings worldwide
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Symptoms
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Abdominal pain
Appetite loss
Coma
Convulsions
Diarrhea
Irritability
Juandice
Nausea
Sweating
Upset stomach
vomiting
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Acute Overdose = large
quantity at one time
 Upset stomach and
stomach pain
 Nausea/Vomiting
 Gastritis: ulcer or irritation
of stomach
Reyes Syndrome risk in
children < 15 years old
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Chronic Overdose = build-up
over time
 Fatigue
 Slight fever
 Confusion
 Collapse
 Rapid heart beat
 Hyperventilation
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Prevention:
 Reading labels
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Web sources
 Familydrugguide.com
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Technology:
 Phone apps, Smart panels
 Medilyzer
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Always consult the pharmacist
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Reading labels
 Look at drug information box in back, not just
listed symptoms on the front
 This will list active drug ingredients as well as their
indications
 Follow directions for use
 If unsure, ask the pharmacist!
 Website: http://www.medilyzer.com/index.html
 Smart Phone on the go
▪ iPhone, Android and BlackBerry (coming soon)
 Smart Panel in the pharmacy
 Website at home
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Powerful OTC drug information tool
 minimizes the health risks associated with OTC medications
 gives users a handheld OTC product database including life-saving
tools such as a drug interaction checker, OTC side effect information,
and dosage instructions.
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How Do You Use the Medilyzer iPhone Application?
 Delivers information about OTC products using the barcode located
on the medication package. Users simply type in the numbers on the
barcode and receive a picture of the medication along with important
drug facts.
 Simply touch the picture of the medication, a screen will appear where
users can view the medicine’s active ingredients, warning, dosage
information, and comparable generic products
 To compare multiple medications, users can touch “Check Interaction”
located on the main screen.
▪ Green check = OTC medications are ok to take at the same time
▪ Red stop sign = you should not take the medications together and consult with
a pharmacist.
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Comprehensive, Interactive, Multi-lingual Database of Medications
 Analyzes prescription and OTC medication information and interprets it for
the consumer
 Dosages, warnings, side effects, and interactions are personalized for each
individual based on existing health conditions entered by the consumer.
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Fast and Easy to Use
 Works quickly and accurately to ensure customer satisfaction while
minimizing health risks
 Medication comparisons happen in mere seconds giving consumers need-toknow information on the go.
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Lowers Consumer Costs and Boosts Generic or Private Label
OTC Drug Sales
 Helps people deal with the challenges of a recessio
 Customized to the store’s inventory, the Medilyzer Smart Panel™
allows users to scan any brand medication and find the equivalent
generic product that the store carries.
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Use Advertisements to Boost In-Store Sales
 Harness the power of contextual marketing by promoting in-store
products akin to customer input.
 Promote related HBC products, weekly or daily specials, store brands,
wellness initiatives or even corporate philanthropic initiatives.
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Multi-Lingual
 Allows non-English speaking consumers to use the system in their
native language.
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More is More
The MORE active ingredients contained in a
product, the MORE chances there are for
unwanted side effects
TAKE THE LEAST NUMBER OF ACTIVE
INGREDIENTS FOR SYMPTOMS