A Pharmacist's Guide to OTC Therapy: OTC Products and the Diabetic Patient

Ms. Terrie is a clinical pharmacy writer based in Haymarket, Virginia.

Various OTC products are currently on the market to meet the specific needs of patients with diabetes. Examples of categories of OTC products marketed specifically for the diabetic population include products for allergies, cough/ cough and flu, oral care, and multivitamin supplements. Many of the allergy and cough/cold products that are marketed for this patient population are formulated free of sugar, alcohol, dextrose, sucrose, sorbitol, sodium, fructose, glycerin, and dyes. In addition, various OTC products for the general population are also sugar-free and alcohol-free.

In addition, various dermatologic products are marketed for the diabetic patient population for both skin and foot care (Table). According to the American Diabetes Association, as many as one third of individuals with diabetes will experience a skin disorder at some point that is either caused or affected by diabetes.¹ Examples of dermatologic products marketed for the diabetic population include moisturizer creams and lotions such as Nexcare Hand and Body Lotion (3M Inc) and DiabetAid Moisturizing Lotion (Del Pharmaceuticals Inc), antifungal creams, callus creams, and topical products for foot pain, tingling, and numbness, which is often associated with neuropathy, such as Zostrix Neuropathy Cream (Healthcare Products) and

Neuragen PN

and NeuraGEL (Origin BioMed Inc).

Pharmacists can assist patients with diabetes by making them aware of the availability of these specialized products, as well as guide them in the proper selection and use of OTC products. Pharmacists should remind patients to always seek the advice of their primary health care provider or a pharmacist prior to using any OTC products, including alternative/complementary medications or supplements, especially if they are unsure about the appropriateness of use. Patients should be advised to use caution when using certain medications, which may either lower or raise blood glucose levels. For example, the hypoglycemic effect of insulin and some oral hypoglycemic agents may be enhanced by taking large doses of aspirin,aspirin, and the use of decongestants, such as pseudoephedrine, can elevate blood glucose levels.^1,2 Allergy and cough and cold products such as Diabetic Tussin products (Health Care Products) are formulated without decongestants.

Patients should be reminded that being sick or not eating properly when not feeling well can affect blood glucose levels and that they should monitor blood glucose levels more frequently when feeling ill. Patients seeking advice about dermatologic products should be reminded about the importance of routine foot care and to immediately seek medical care if any cuts or injuries show signs of not healing or possible infections. They should not attempt to self-treat.

Prior to recommending the use of any OTC products to patients with diabetes, pharmacists should ascertain the appropriateness of self-care, as well as evaluate the patient’s current allergy/ medical history and drug profile to prevent potential drug—drug interactions and/or contraindications.

During counseling, pharmacists should ensure that patients understand the proper use of these products and remind patients about the importance of adhering to the directions and warnings listed on the product labels. When possible, patients should avoid the use of medications that contain sugar or alcohol. They should also avoid the use of multi-ingredient formulations of cough/ cold medications to prevent unnecessary use of medications. Pharmacists should also seize every opportunity to remind patients about the importance of practicing good oral hygiene, adhering to their recommended treatment plans, and having routine check-ups with their primary health care provider.