Give Your Medicine Cabinet A Makeover For The New Year
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There are three general categories of products that should be in your medicine cabinet: things used daily, things used occasionally, and things used in an emergency.

1. Products used daily:



• Prescription medicines
  
  
• Over-the-counter medicines: generally, an OTC medication that you use daily should be one you have discussed with your physician, who agrees that you should take it daily (e.g. aspirin to prevent heart attack in patients at increased risk).
  
  
• Vitamins/supplements: most adults can benefit from a daily multivitamin. Women in particular generally need calcium supplementation, and menstruating women may need iron as well. All women of reproductive age-whether or not they are planning to get pregnant--should take folic acid (400 mcg/day) to prevent birth defects in future or unintended pregnancies. Ask your doctor whether you require any additional specific supplements daily, and at what dose.
  
  
• Sunscreen: depending on your location, this will be year-round or seasonal. Sunscreen is a critical part of your defense against sunburn, and damaging exposure, which could lead to skin cancer. Don't forget that you get exposed even if you are only outside for a relatively short time, even if you're not sunbathing, even if it's cold (e.g. facial sunburn while skiing), and even while driving Glare from water or snow will increase your risk. While you're at it, don't forget to protect your eyes with sunglasses, and your lips with an agent that contains sunscreen.
  
  
• Toothpaste/dental floss: Brushing and flossing are important daily hygienic activities to prevent not only dental problems, but systemic illnesses as well. Be sure to change your toothbrush every 3 months or after a serious throat or respiratory illness (e.g. flu, strep throat). Do not share toothbrushes!
  
  
2. Products used occasionally/frequently:



• A thermometer
  
  
• Headache/pain/fever medicines: This category includes stocking several different products for symptoms you, your family members, or your visitors may have occasionally or routinely. In some people or conditions they may be easily substituted for each other (e.g. headache); in some people or conditions there may be particular reasons to select one over another. One of the most common questions is about the differences between Tylenol® (acetaminophen) and aspirin. Aspirin has numerous benefits and uses: it reduces fever, pain, and inflammation; is taken by many people daily to reduce the risk of heart attack or certain types of stroke; and is even given in emergency situations when someone is having a heart attack. It also has many side effects, however, including that it may cause or exacerbate bleeding, it causes allergies in some people, and it may cause Reye's syndrome in children with certain viral infections (which is why aspirin should never be given to children under 12 unless directed by a physician); each of these side effects can be severe or even fatal. Enteric-coated aspirin (e.g. Ecotrin®) or buffered aspirin (e.g. Bufferin®) products have been developed to reduce the risk of gastrointestinal (GI) irritation and bleeding . Tylenol® (acetaminophen) is an excellent drug to reducing fever and pain, but it does not reduce inflammation. It is generally safer than aspirin in recommended doses, but when the maximum recommended dosage is exceeded, it may cause liver complications. Excedrin® is a product which combines aspirin, acetaminophen and caffeine; while it also reduces fever and mild to moderate forms of pain, it is also particularly effective for treating mild moderate migraine headaches. One dose contains about the same amount of caffeine as one cup of coffee; if you have been told to avoid caffeine because of certain medical problems, discuss this with your physician. Ibuprofen (e.g. Motrin®, Advil®, Nuprin®) and naproxen (e.g. OTC Aleve® or prescription Naprosen®), are non-steroidal anti-inflammatory drugs (NSAIDs). Drugs in this class will reduce fever as well as aspirin, but they are much more effective in reducing inflammation and treating certain types of pain. NSAIDs are the drugs of choice for muscle aches, menstrual cramps and arthritis, for example. Most NSAIDs have the same side effects as aspirin, however, often including shared allergies.

Tylenol® is also considered to be safe throughout pregnancy or before or after surgery; aspirin products should not be taken in the last three months of pregnancy or, ideally, within 3-6 weeks of surgery unless directed by a physician.

If you find you are taking products in this category daily to self-medicate, see your physician. There may be more effective choices for your particular problem, or, you may have a different condition responsible for your symptoms. In the case of "rebound headaches", for example, your choice of medicine may actually be contributing to the problem. In the case of the worst headache of your life, or a severe headache which increases or which does not respond to OTC medication within 2 days, contact your physician. In the case of toothache that doesn't respond to symptomatic treatment with OTC medications, see your dentist. In the case of menstrual cramps that don't respond to OTC NSAIDs, see your gynecologist.

• Cough/Cold/Flu Symptom Products: If it's cold/flu season, chances are you or someone in your family will have symptoms of cough, fever, cold, stuffy or runny nose, sore throat, etc. Chances are also that these symptoms will begin as soon as your local drug store closes. The best advice is preventive: have your flu shot early in the fall and practice diligent hand-washing. But also be prepared: have your preferred cough/cold products on hand. . .including chicken soup! In general, these OTC products are confusing, because there are so many different types claiming to treat so many different symptoms. There are products available which contain only one active ingredient and combination products which contain 2 or more active ingredients. Most name brand products in this category have equivalent generic substitutes that are much less costly. Check the ingredients and treat the only the relevant symptoms. How do you decide which choice to pick? In general, there are 5 different categories of ingredients: decongestant, cough suppressant, expectorant, anti-histamine, and fever/pain reducers. Most cough/cold products have various combinations and dosages of these different ingredients. Remember that products with antihistamines are generally sedating and products with decongestants are generally stimulating; products with balanced doses of antihistamines and decongestants may have no effect. Many products come in night-time versions, which will aid sleep, which can be difficult when you're ill. If you want to use the same product for adults and children, be sure to read the label to see if children's dosages are given. Also be sure that aspirin or salicyclates are not among the ingredients. Throat lozenges and mouthwash (e.g. Listerine®, Scope®) are also helpful products to have in stock.
  
  
• Skin products: these are helpful for allergic reactions of the skin, itchy skin, or the treatment of certain recurrent skin conditions such as eczema. I recommend stocking generic hydrocortisone cream 1% (a steroid).
  
  
• Products for stomach or bowel problems: Pick your product of choice and keep it on hand. Many products in this category will help with more than one type of GI problem. For example, some products for indigestion also help with heartburn/indigestion, nausea or diarrhea (e.g. Pepto Bismol®, Tums®, Rolaids®, Mylanta®, etc.).Before using an OTC product to treat diarrhea, consider the cause. If you think you may have an infectious cause (especially food poisoning), you may want to let your body rid itself of the toxic agent or get advice from your doctor. .If constipation is a problem for you, you may want to start with prune juice or a natural, high fiber product such as FiberCon®, Metamucil®, or Citrucel®. If these are not successful, you may need a stool softener (e.g. Colace® or Correctol®) or a stimulant-laxative (e.g. Ex-Lax®, Dulcolax®, or Senokot®). Phillip's Milk of Magnesia® is a product that will help with constipation as well as indigestion. OTC enemas are also available if necessary.
  
  
3. Emergency products:
   
   
• Products for burns: DO NOT USE BUTTER OR VASELINE ON A BURN!!! For mild to moderate burns, put the affected part under cold running water immediately or submerge in a tub. You may want to treat the burn with an anti infective topical agent with a pain killer such as Neosporin Plus ® or with a preparation such as zinc oxide. Diaper rash preparations such as Desitin® or A & D Ointment® are also useful for minor burns. If the burn is severe, covers a large portion of the body or face, or blisters, consult your physician or go to the emergency room immediately.
  
  
• Products for allergies: If you or a family member have a serious known allergy, you should wear a Medic-Alert bracelet. In addition, your doctor may recommend keeping epinephrine (in an injectable Epipen® form) with you at all times and stored at home. I recommend that all well-stocked medicine cabinets keep oral antihistamine tablets (e.g. Benadryl®, diphenhydramine hydrochloride) as well, just in case. You may have a guest who has a severe allergic reaction to something in your home or a child with a peanut allergy who ate an unfamiliar food with peanut oil. Bee stings can often cause mild to severe allergic reactions and immediate treatment can be helpful. These products are also useful to have in stock because they treat seasonal allergies and can be used as a sleeping aid as well.
  
  
• Aspirin: if you think someone in your home is having a heart attack, call 911. If the person is conscious, give one dose of aspirin while awaiting emergency medical services. If they are not conscious, initiate CPR.
  
  
• Syrup of Ipecac: this will make someone vomit-most often for a child--if they've ingested poison or medicines they shouldn't have taken. Call emergency poison control (number in the front of your phone book) if you have questions about this.