Stocking Your Medicine Cabinet (Part 2)

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Harvard Medical School
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Stocking Your Medicine Cabinet (Part 2)


Harvard Medical School


Second in a series

Drug stores carry a dizzying array of over-the-counter products for what ails you. Choosing among the dozens of brands and types of medicine can be confusing and frustrating.

Last month I discussed which drugs to have on hand for coughs and colds; for pain, inflammation and fever; and for diarrhea. Now I will list my picks of medicine cabinet must-haves for heartburn, constipation and first aid.

These recommendations are general and may not be the best for some people with certain medical conditions or taking certain drugs. So, always ask your doctor, and make sure you read the label to see if the products are right for you.

It bears repeating that if you have small children in the house or are visited by children, you should have a bottle of ipecac on hand and the telephone number for the Poison Control Hotline (800-222-1222) in plain sight. Poisonings still happen, and young children are especially at risk.

Antacids

Many adults have occasional heartburn. While it is best to avoid the foods that cause your problem, there are several ways to deal with occasional symptoms. That burning sensation is caused by stomach contents (including acid) getting up into your esophagus. Antacids, such as Maalox and Mylanta and others, work by neutralizing the acid. Most antacids contain either aluminum or magnesium hydroxides or a calcium salt. Liquid preparations usually work better and faster than tablets. My recommendation is to use a store brand of a double-strength antacid that contains either aluminum or magnesium hydroxide. Be aware that aluminum hydroxide and calcium salts can produce constipation in some people and magnesium hydroxide can cause diarrhea.

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Laxatives

All of us have occasional bouts of constipation. This may be due to lack of physical activity, eating fewer fruits and vegetables, or not drinking enough fluids. Laxatives come in many forms, including stimulants such as bisacodyl (Correctol, Dulcolax and generics) and bulking agents such as Metamucil. Despite all of the claims, no one kind is right for everyone.

The best approach to constipation, especially if it becomes problematic, is diet and exercise. Long-term use of laxatives, especially the stimulants, is not a good idea and can lead to problems. Fiber-containing bulk laxatives are an expensive way of doing what you can do more enjoyably by changing your diet to include more fruits and vegetables.

Both fiber and stimulant laxatives have been shown to improve the number of bowel movements in people with chronic constipation. Improvements in stool consistency and reductions in abdominal pain also have been shown. So the choice is yours. Make certain that you read and follow the instructions. If you take tablets containing bisacodyl don’t chew them. The coating is designed to release the drug in the intestine, so if you chew the tablet you break down the protective layer. The drug is a sufficient irritant to the stomach to produce vomiting.

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First Aid Products

There is an amazing array of first aid products available. Many are designed to reduce the risk of infection (antiseptics) and reduce the pain from minor cuts and abrasions (local anesthetics). Antiseptics often contain either an iodine-based product (povidone iodine) or benzalkonium chloride. There is no evidence that any of these products reduce the risk of infection or promote wound healing. Irrigation with tap water is more than adequate for all but the most contaminated wound. For young children, topical products that contain a local anesthetic may provide sufficient pain relief to allow for a tear-free cleansing of the wound. I recommend solutions that have lidocaine as the active ingredient.

For most minor cuts and scrapes, bandages (such as Band-Aid) are optional. If the wound isn't in an area that will get dirty or be rubbed by clothing, you don't have to cover it. If the cut or scrape is in an area that is likely to get dirty (such as the hand) or will be irritated by clothing (such as the knee or elbow), covering it with a bandage is a good idea. If a bandage is used, it should be changed daily.

Deep or large scrapes should be seen and treated by a health-care professional. He or she may dress it with an occlusive or semiocclusive bandage, which will reduce the risk of scarring and speed healing.

Next month, in the third and final article in this series, I will list a catchall of items that should — and should not — be in your medicine cabinet.

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Harold J. DeMonaco, M.S., is senior clinical associate in the Decision Support and Quality Management Unit at the Massachusetts General Hospital and is currently a Visiting Scholar at the MIT Sloan School of Management. He is author of over 20 publications in the pharmacy and medical literature and routinely reviews manuscript submissions for eight medical journals.

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Last updated September 23, 2013


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