How to Counsel Patients on OTC Painkillers

Nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophen, and other non-opioid OTC analgesics used to treat pain are particularly difficult for patients to self-manage.

Retail pharmacies increasingly recognize customers as patients. This creates an opportunity to provide patient education, enhance compliance with therapy, facilitate clinical evaluation, and follow up on patients’ questions and concerns.

Pharmacists also have insight into drug interactions and comorbid conditions that complicate analgesic therapy.

Robert L. Barkin, MBA, PharmD, FCP, DAAPM, DACFE, wrote an article about the pharmacist’s role in facilitating the selection of non-opioid OTC analgesics in a recent issue of American Journal of Therapeutics.

He provided several useful suggestions about interactions with patients who need painkillers:

· Question patients about past and current NSAID use by carefully exploring specific drugs (“Are you taking [drug]?”), rather than asking about NSAIDs in general.

· Steer patients with cardiovascular risk factors (eg, diabetes, hypertension, hypercholesterolemia, smoking, obesity, and dental plaque) toward acetaminophen rather than NSAIDs.

· Be mindful of NSAIDs’ interactions with other products (corticosteroids, anticoagulants, antihypertensive, and alcohol) and also ask about patients’ tobacco and marijuana history.

· In patients who use NSAIDs chronically, recommend a complete metabolic panel annually with a complete blood count every 4 months to monitor for anemia.

· Suggest non-invasive screening for bleeding using occult blood stool or urine tests.

Pharmacists should also stress to patients—especially those with liver or renal insufficiency—that acetaminophen causes cumulative toxicity, both alone and in combination products. Specify that consuming 3 alcohol drinks per day with acetaminophen carries a high risk of hepatotoxicity, rather than using abstract terms such as “social drinking”.

Aspirin use for pain is discouraged in elderly patients, those with renal or hepatic impairment, and those receiving anticoagulation due to bleeding risk. Co-administration of a proton pump inhibitor or misoprostol reduces but does not eliminate this risk.

Discussions on this topic should be patient-specific, patient-focused, patient-centered, and personalized. Ultimately, pharmacist counseling allows patients to make the best decisions about their own care.