FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

TELL YOUR DOCTOR WHAT'S IN YOUR MEDICINE CABINET

Question: I've been taking Tagamet HB since it came on the market. When I took prescription Tagamet several years ago, I took it for a few months. Isn't it safe to take the non-prescription Tagamet HB for that long for my stomach pain despite the label warnings to the contrary?

Answer: Non-prescription medications are generally safe and effective. But as I'm sure you know, any medication that can do good can also do harm if it is used incorrectly. The U.S. Food and Drug Administration uses several criteria to determine if a medication is safe for non-prescription sales. First, it must have a wide margin of safety. That is, taking considerably more than the label directions specify is unlikely to cause harm. Equally important, the average person must be able to correctly diagnose the condition for which the medication is used.

Tagamet HB and prescription Tagamet contain the same "active ingredient" but in different amounts. The "HB" version has 100 mg of cimetidine; the prescription product has more. While the Tagamet HB is excellent for heartburn; prescription-strength Tagamet is for ulcers, esophagitis and related conditions.

Taking Tagamet HB for an extended period of time isn't, in itself, harmful. There is good reason, however, to restrict its use to about two weeks. Any condition that lasts longer than this probably isn't simple heartburn. Perhaps it is an ulcer. Or worse yet, it could be stomach cancer. If your indigestion and heartburn lasts for more than a few weeks, see your doctor instead of continuing to take non-prescription medication. The doctor will help you find the cause of the symptoms, and then he or she can talk with you about the proper treatment.

Tagamet HB represents a growing trend. In the past 20 years, more than 50 prescription medications have become available over the counter (OTC). Most of these are now common "everyday" names. Good examples are the antihistamines, sometimes in combination with a decongestant, that are marketed for allergies and colds. Who hasn't heard of Sudafed or Dimetapp! Also, Afrin and Neo-Synepherine are examples of nose sprays that once were prescription only. Ibuprofen joined the battle for headache cures against Tylenol and aspirin in 1984. Now our stomachs are being soothed by the Tagamet HB you are taking along with Pepcid AC and the soon to be released version of Zantac.

So why do companies want to market their products OTC rather than by prescription? Profit is the answer. Fourteen of 23 drugs that have switched to OTC availability since 1975 are now first or second in sales in their class of medications. And in truth, this usually works out better for everyone else, too. When a person correctly self-diagnoses his or her own medical problem, it leads to both a quicker recovery and saves the time and expense of an unnecessary doctor visit.

There are two important points I would like to have you remember from this column. The first is that OTC medications have label directions that generally suggest a limited period for their use. This is for your safety. If you have misdiagnosed your condition, you then should take time to see your family physician for his or her expert diagnosis and proper treatment. In many cases, too long a delay might turn a potentially curable illness into a terminal one. That's why I always advise my patients to schedule an office visit, or at the very least call me, if an OTC medication doesn't clear up a medical problem in the time period specified on the label.

The second point is that OTC medications are potent and truly effective medications. They have the same capacity for producing "drug interactions" as prescription medications. Therefore, it is important to tell your doctor about any OTC drug you are taking because of the potential that they could "fight against" and render useless or even harmful any prescription medication your doctor may be thinking of prescribing.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.