We tend to think of health care products that can be picked up at any store as harmless. Though they are easily available, over-the-counter (OTC) products are still medications. They include vitamins, supplements, herbal and homeopathic remedies. Many are used to self-treat minor illness. Although you can buy them without a prescription, OTCs can affect existing conditions or react with your current medications.

To avoid problems, keep a record of all your regular prescriptions and OTC medications. Share this information with your healthcare providers.

Sick day strategies

The best time to discuss sick day strategies with your doctor is before you get sick.

People with diabetes often find their blood glucose elevates when they become ill. For this reason, frequent checks are important when you are sick. If your blood glucose is over 14 mmol/L, check your ketones.

Frequent diarrhea, vomiting or inability to drink fluids can dehydrate you. In this case, you may need to stop taking some of your current medications until you are well. Check the Canadian Diabetes Association’s sick day medication list.

The following table shows OTC medications commonly used by adults to self-treat minor illness. Always read the label, as many OTCs contain multiple ingredients including added sugar. Sugar includes sucrose, lactose, dextrose, glucose and fructose. The guide also explains when you should seek medical attention.

When in doubt about whether or not to take an OTC product, always check with your pharmacist. This simple precaution helps to protect your health.

After meal glucose level	A1C	Weight loss
Canagliflozin	0.7%	Less than or equal to 4 kg
Dapagliflozin	0.5%	2 to 3 kg

Quick Guide to Using Over-The-Counter Medications
Symptoms and Conditions	Treatment and Medications	Comments
Pain and fever
Check with your doctor if you: fever is associated with a stiff neck or seizures temperature is greater than 40 C (104 F) fever continues for longer than three days pain continues for longer than 10 days.	Acetaminophen (Tylenol, Excedrin) 325 to 650 mg every four to six hours when needed, maximum 4000 mg of acetaminophen per day (12 of 325 mg regular strength tablets, or eight 500 mg extra strength tablets)	No effect on blood glucose Check labels, as many products contain acetaminophen Add up all the milligrams (mg) of acetaminophen from all medications (prescription and non-prescription) Use caution if you have liver disease, or consume excess alcohol
	Acetylsalicylic acid, known as ASA (Aspirin, Bufferin, Entrophen) 325 to 650 mg every four to six hours when needed *Daily low dose ASA (81 to 162 mg) is often taken to reduce cardiovascular (heart and blood vessel) risk - check with your doctor to see if this applies to you.	Safe in low doses Taking 3000 mg daily can cause low blood glucose Should not be used by anyone under 18 years of age Increases the risk of gastrointestinal (digestive tract) bleeding
	NSAIDS (non-steroidal anti-inflammatory drugs) Ibuprofen (Advil, Motrin) 200 to 400 mg every four to six hours when needed, maximum 1200 mg/day Naproxen sodium (Aleve) - 220 mg every eight to 12 hours, maximum 440 mg/day	No effect on blood glucose Increases risk of gastrointestinal bleeding May increase blood pressure Can decrease renal function, especially with long-term use Do not take if you are dehydrated.
Upset stomach and indigestion
Check with your doctor if you have: symptoms that last longer than two weeks trouble or pain when you swallow bloody vomit or stools stomach pain that is ongoing chest pain, shoulder pain or pain that spreads to your arms, neck or shoulders with shortness of breath weight loss for no reason nausea or vomiting.	Aluminum hydroxide Magnesium hydroxide Calcium carbonate Simethicone for gas (Gas-X) These ingredients are found in various combinations and concentrations. Sugar-free products include Diovol, Maalox, Gaviscon regular liquid and Gelusil regular liquid.	No effect on blood glucose Check label for dosage, as this varies with the strength of the medication Antacids can interact with many other medications - check with your pharmacist Do not take within two hours of other medication Aluminum and calcium antacids can cause constipation Magnesium antacids can cause diarrhea
	H-2 antagonists Famotidine (Pepcid AC) 10 to 20 mg twice daily, maximum 40 mg per day Ranitidine (Zantac) 150 mg when needed, maximum 300 mg per day	No effect on blood glucose Prevents indigestion Take famotidine 10 to 15 minutes, or ranitidine 30 to 60 minutes before eating If you require calcium supplements, use calcium citrate when taking H-2 antagonists.
	Proton-pump inhibitor (PPI) Omeprazole (Olex) 20 mg once daily, for up to four days to treat frequent heartburn. If symptoms last longer than 14 days, see your doctor.	No effect on blood glucose If you require calcium supplements, use calcium citrate if taking a PPI
Allergies and hay fever
Check with your doctor if you have tried appropriate medication for two weeks without relief.	Sedating antihistamines Chlorpheniramine (Chlor-Tripolon) 4 mg every four to six hours Diphenhydramine (Benadryl) - 25 to 50 mg every six to eight hours	No effect on blood glucose May cause drowsiness - avoid alcohol and use caution if operating machinery Avoid this medication and check with your doctor if you have glaucoma, thyroid or prostate problems
	Non-sedating antihistamines Cetirizine (Reactine) – 5 to 10 mg daily Loratadine (Claritin) – 10 mg daily Desloratadine (Aerius) – 10 mg daily	No effect on blood glucose Cetirizine may cause drowsiness in five per cent of people
	Sodium cromoglycate Cromolyn Eye Drops (Opticrom) one to two drops in affected eye up to four times daily Nasal Spray (Cromolyn) one spray in each nostril up to six times daily	No effect on blood glucose Works by reducing allergic response Discard bottles 30 days after opening
Colds See Pain and fever section (above) and Cough and Sore throat sections (below).
Check with your doctor if you have: difficulty breathing a history of respiratory disease a fever of greater than 38.5 C (101.3 F) for longer than 24 hours severe throat pain prolonged nasal congestion with purulent (yellow or green) discharge severe headache or neck pain.	Decongestants Phenylephrine: 2.5 to 10 mg every four to six hours Pseudoephedrine: 30 to 60 mg every four to six hours	Products containing oral decongestants increase blood glucose and blood pressure Avoid or use with caution if you have heart disease, high blood pressure, kidney disease, glaucoma, thyroid disease, diabetes or prostate problems
	Long-acting nasal decongestant sprays Oxymetazoline (Dristan Long Lasting, Drixoral Nasal Spray) Xylometazoline (Otrivin) Use as labelled	Do not use longer than five days to avoid rebound congestion
	Saline nasal solutions use as labelled	Safe to use to soothe a stuffy nose and loosen mucus
Cough – dry
Check with your doctor if your cough: lasts longer than seven days is accompanied by a high fever or severe sore throat, as above for colds.	Dextromethorphan, known as DM (Benylin DM, Robitussin DM, and multi-ingredient products) 10 to 20 mg every four hours or 30 mg every six to eight hours, maximum 120 mg/day	No effect on blood glucose Dose varies with formulation so check label
	Codeine 7.5 mg every four to six hours Tylenol #1 or generic – Also contains acetaminophen and caffeine One to two tablets every four to six hours Note: cough syrups with codeine usually contain sugar in the formulation.	No effect on blood glucose May cause drowsiness and constipation
Cough - loose
Check with your doctor if your cough: lasts longer than seven days is accompanied by a high fever or severe sore throat, as above for colds.	Guaifenesin 200 to 400 mg every four hours,maximum of 2400 mg/day Sugar-free liquid versions include Benylin E and Robitussin.	No effect on blood glucose Drink plenty of liquid If the cough is not disturbing your sleep, use a product without additional dextromethorphan; this allows the cough to clear your chest of the phlegm that has been thinned by the guaifenesin
Sore throat
Check with your doctor if your sore throat: is severe and lasts longer than two days is accompanied by a high fever, headache, nausea or vomiting.	Any lozenge will bring moisture to the throat and relieve a dry irritated throat. Cough drops containing menthol may help with nasal stuffiness. Sugar-free products include Halls Sugar Free, Bentasil, and Fisherman’s Friend Sugar Free.	Suitable for occasional use if you get no relief from gargling with salt water
Diarrhea
Check with your doctor if you have: diarrhea lasting longer than two days diarrhea that is accompanied by a fever over 38.5 C (101.3 F) bloody or black stool signs of dehydration – increased thirst, decreased passing of urine, feel weak or light-headed, a dry mouth and tongue.	Loperamide (Imodium) Two tablets (4 mg) to start, then one tablet after each loose bowel movement, maximum of eight tablets (16 mg) per 24 hours	No effect on blood glucose
	Attapulgite (Kaopectate) One dose is two tablets or two tablespoons Recommended maximum of seven doses of regular strength, or six doses of extra strength	No effect on blood glucose Do not take within two hours of other medication
Nausea and vomiting
Check with your doctor if you have: nausea and vomiting that has lasted longer than two days without a known cause significant weight loss signs of dehydration (see diarrhea) blood in the vomit a recent history of head trauma altered level of consciousness (decreased alertness).	Dimenhydrinate (Gravol) 50 to 100 mg every four to six hours as needed	No effect on blood glucose Takes 30 minutes to work May cause drowsiness; avoid alcohol and use caution if operating machinery May cause constipation and blurred vision
Constipation
Prevention is important. Regular exercise, increasing dietary fibre, and drinking plenty of fluids daily can relieve constipation naturally. Check with your doctor if: you have rectal pain or bleeding you have blood in the stool the constipation is accompanied by fever, abdominal pain, nausea or vomiting the constipation lasts longer than two weeks, or is recurring over a period of three months or longer	Psyllium (Metamucil) 2.6 to 7.5 gm in eight ounces (850 mL) of water Maximum 30 gm per day	No effect on blood glucose This bulk (fibre) forming agent usually works overnight Do not take within two hours of other medications Take with at least 250 mL of water
	Sennosides (Senokot) 8 to 15 mg, once per day	No effect on blood glucose This stimulant laxative usually works overnight
	Docusate sodium (Colace) 50 to 500 mg per day at bedtime	No effect on blood glucose Do not take within two hours of other medications Works by bringing water into the bowel, softening the stool and making it easier to pass May take up to three days to work.

Diabetes and over-the-counter medications Check with the pharmacist before you buy

You have the sniffles, so you head to the store to pick up something to ease your symptoms. If you have a chronic disease or take prescription medication, it is wise to check with the pharmacist before you buy. Why the caution?

Sick day strategies

After meal glucose level

A1C

Weight loss

Quick Guide to Using Over-The-Counter Medications

Symptoms and Conditions

Treatment and Medications

Comments

Pain and fever

Upset stomach and indigestion

Allergies and hay fever

Colds

Cough – dry

Cough - loose

Sore throat

Diarrhea

Nausea and vomiting

Constipation

Check the Canadian Diabetes Association’s sick day medication list

Diabetes and over-the-counter medications
Check with the pharmacist before you buy