The Dangers of Choosing Combination Products Over Single Active Ingredient Products Christine Marie Manalo Debbie Chen Megan Sailors

 Why people choose combination over-the- counter (OTC) products?  OTC combination products examples  Dangers of choosing combination products  Side effects, adverse drug events  Solutions, prevention  Labels, smart panels, phone applications, internet

 Many OTC combination products contain the same active ingredients   Consumers 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.

 Not reading or not understanding the Drug Facts panel, and thus unaware that there are multiple active ingredients  Cost: save money by purchasing one product with multiple ingredients so they can use it repeatedly for various symptoms  Convenience

 Products containing acetaminophen  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)

 More products containing acetaminophen  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)

 Products containing ibuprofen  Advil® Allergy Sinus (as a combination product containing 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)

 Products containing aspirin  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)

…selecting products without adequate information can lead to serious adverse drug events!

 Prevention:  Reading labels  Technology:  Phone apps, Smart panels  Medilyzer  Web sources  Familydrugguide.com  Always consult the pharmacist

 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:  Smart Phone on the go ▪ iPhone, Android and BlackBerry (coming soon)  Smart Panel in the pharmacy  Website at home

 Powerful OTC drug information tool  Dosage Instructions  Drug Interaction Checker  OTC Side Effect information  How Do You Use the Medilyzer iPhone Application? 1. Scan Barcode or type in  A picture of the medication will appear 2. Touch the picture of the medication  Active ingredients, warning, dosage information & comparable generic products will appear 3. Compare multiple medications, touch “Check Interaction” located on the main screen ▪ Green check = OKAY to take medications at the same time ▪ Red stop sign = DO NOT take the medications and the same time and consult the pharmacist

1. Scan Barcode or type in  A picture of the medication will appear

1. Touch the picture of the medication  Active ingredients, warning, dosage information & comparable generic products will appear

1. Compare multiple medications, touch “Check Interaction” located on the main screen ▪ Green check = OKAY to take medications at the same time ▪ Red stop sign = DO NOT take the medications and the same time and consult the pharmacist

 A 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.

 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-to-know information on the go.  Lowers Costs  Scan any brand medication and find the equivalent generic product that the store carries  Multi-Lingual  Use the system in any language.

 MedlinePlus: Drugs, Herbs and Supplements  ml ml  Mayo Clinic: Health Information  information/DrugHerbIndex information/DrugHerbIndex  Family Drug Guide 

 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