As a pharmacist, there are questions that I am asked regularly. I have compiled a list of the 5 questions that I am asked most often.

Q. What can I take to soothe my sore throat?

A. The questions I am most frequently asked are about cough and cold products. At our pharmacy there is an entire wall of medications marketed specifically to treat colds. Most of these products contain more than one medication. In general, whenever I make a recommendation, it is for the product containing the fewest medications that will relieve most of the patient’s symptoms. For example, when a patient’s only symptom is a sore throat, they are not needing a combination product containing unnecessary medications like decongestants or cough suppressants. I usually suggest that patients try either acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) that many people already have at home. The second suggestion I make is to suck on candies like lemon drops or a lozenge like Halls or Vicks which increases saliva production and soothes the throat. Some people like the products containing topical anesthetics like Chloraseptic or Cepacol, but I find that they numb my tongue more than my throat.

Q. What should I use for constipation? (I am not joking, I get asked this all the time!)

A. Everyday I help several people pick out a medication to treat constipation. I always remind people that the best way to prevent constipation is through eating fiber, drinking plenty of fluids and exercise. My recommendations for constipation are age specific. If a child has constipation, I might recommend trying prune juice first or using a glycerin suppository. However, most of my questions are for adults, especially elderly patients.

I find it easier to talk about laxatives when they are grouped into these 5 categories: bulk forming agents, stool softeners, stimulant laxatives, emollient laxatives, and osmotic laxatives.

1. Bulk forming agents like Metamucil and Benefiber help to increasing fiber intake, but they take about 3 to 7 days to work and need to be taken with plenty of water. I often recommend these medications as more of a preventative therapy.
2. Stool softeners or docusate (Colace), are used to soften the stool. They do not push anything through the intestines, they only soften what’s there to make the stool easier to pass. These take about 1 to 2 days to work. I recommend this medication if a patient is straining to pass a stool and producing a very hard stool.
3. Stimulant laxatives are probably the most common type of laxatives people use; these include senna (Senokot and Exlax) and bisacodyl (Dulcolax). They work “overnight” or in 6 to 8 hours. I recommend these for occasional use, and I warn people that they can cause some side effects like abdominal cramps. The down side of stimulant laxatives is that they can cause some dependence, so if a patient uses them regularly, their bowel muscles can start to rely on the medication to have a bowel movement.
4. Emollient laxatives like mineral oil work by lubricating the stool to help the stool pass more easily. They have the risk of causing lipoid pneumonia if they are accidentally inhaled into the lungs, so I usually don’t recommend them, although they also work in about 6 to 8 hours.
5. Osmotic laxatives work by drawing water into the intestines. They include medications like lactulose, glycerin suppositories, magnesium citrate and sodium phosphate. Lactulose is a good option for most people to relieve constipation. It is not absorbed into the bloodstream, and can be used in children or adults, but it takes about 1 to 2 days to work. If a patient is needing immediate relief, I usually recommend glycerin suppositories which work in about 15 minutes. Medications like magnesium citrate and sodium phosphate are often used as part of bowel cleaning prior to a colonoscopy. They also work very quickly, but they can cause electrolyte imbalances in some patients.

However, if a patient has not had a bowel movement in 7 days, is extremely uncomfortable or has other symptoms I will send them to see their doctor immediately.

Q. What should I take for heartburn?

A. Heartburn or gastric reflux is a very common problem. If people have severe or frequently recurrent symptoms, I refer them to their doctor. For occasional heartburn I am usually comfortable recommending a product. My first recommendations are always lifestyle changes. For example, I ask the patient to try raising the head of their bed, not by sleeping with extra pillows, but by putting something like a couple books under the legs at the head of their bed. Also tips like not lying down immediately after eating, stopping smoking, and reducing stress may also relieve symptoms. Most patients can identify foods that exacerbate their heartburn like fatty foods or caffeine and then inturn avoid eating these specific foods. If a patient would like to try a medication and has mild symptoms, they might try antacids like Tums for occasional relief. These work quite quickly to help neutralize stomach acid, but they only work for about 2 hours or so. The medications I recommend most often are ranitidine (Zantac) or famotidine (Pepcid). These medications are called H2 receptor blockers and work by reducing the amount of acid that your stomach produces. They work quite well for some patients and are usually taken once or twice daily. I always suggest that if these medications do not resolve the symptoms, that they should see their doctor. There are medications that more completely block stomach acid production called proton pump inhibitors (PPI) but these medications require a prescription.

Q. Is this (generic brand) medication the same as the (brand name)?

A. Almost every day somebody asks me if generic acetaminophen is the same as Tylenol. My short answer is “yes, the medication is the same in both products”. There can be some differences in fillers and coating of the tablets, but the medication portion is the same in either product. Ten times out of ten I will recommend the generic equivalent of a medication because of the cost saving to the patients. However, some people would rather pay the extra money to by the brand name because they are more familiar with it, and frankly, with the placebo effect of many drugs being about 30%, if they want the brand name, I am not going to try to persuade them to use the generic.

Q.What should I take for back pain?

A. Many people suffer from various degrees of back pain which can be caused by a wide range of problems. If the patient is experiencing moderate or severe back pain, has other symptoms or has a history of a back injury, I will refer them to their doctor. If they have acute, mild lower back pain, they might want to try some over-the-counter options.

• People may achieve symptom relief using an analgesic such as acetaminophen (Tylenol). Acetaminophen is usually very well tolerated and has very few side effects and drug interactions, so it is usually my first recommendation.
• People who don’t respond to acetaminophen may want to try an anti-inflammatory analgesic like ibuprofen (Advil, Motrin).
• Some patients find that muscle relaxants help their pain. Most of the over-the-counter muscle relaxants contain the medication methocarbamol. The most familiar of these products are Robaxacet (containing methocarbamol and acetaminophen), Robaxisal (methocarbamol and acetylsalicylic acid) and Robax Platinum (methocarbamol and ibuprofen). These muscle relaxants have more side effects like drowsiness and are probably only about as effective as single ingredient analgesics like ibuprofen, so I don’t recommend these products very often.

I also encourage most patient to maintain their usual level activity, and I emphasize that bedrest can actually reduce the time it takes their back to heal. If patients do not feel relief in about 3 to 4 weeks or if the pain worsens, I advise them to see their doctor. I think that it is also important to discuss back pain prevention with patients to reduce the risk of re-injury. Some of these measures include using proper lifting techniques, maintaining good posture, keeping a healthy body weight and exercising regularly.