Generic Over-The-Counter (OTC) Products Available – What Type Should I Get?

Prescription Brand vs. Generic
Before we answer the question on what type of Generic OTC products are available, let’s first discuss the difference between prescription brand and generic. It takes about 10 years and costs about $1 billion for pharmaceutical companies to develop a drug that meets rigorous drug testing and Food and Drug Administration (FDA) approval. After approval, the drug is launched under a “Brand Name” (also known as Trade Name) that is usually more likeable and interesting than the actual chemical name for the drug.

Once a drug’s patent expires, other drug companies may pursue the generic form of the drug without having to undergo FDA approval. This is when the medication is called “Generic” and the drug is called by its chemical name. These companies have a simpler process where they just need to match dosage, route of administration, and concentration of the active ingredient. The branded drug is still available but once the generic form of the drug is launched, most insurance companies will cover generic at a lower copay compared to a branded medication.

Self-Diagnosing
In order for a prescription medication to become available OTC, the drug manufacturer must apply for a new drug application. The FDA reviews the safety profile, effectiveness of the medication and whether the condition the medication is indicated for is self-diagnosable.

Once the medication has received approval for OTC status, patients have the opportunity to save on cost by avoiding expensive branded medications that are not covered by their insurance. However, self-treating assumes the patient can accurately self-diagnose the condition. The patient also must deal with choosing from a wide array of eyedrops available over-the-counter.

Types of Generic OTC Products
If you have eye discomfort, you have the option of choosing between artificial tears or eye drops for ocular allergies. Artificial tears may provide temporary relief of dry eyes for patients that have intermittent symptoms. However, if your eye problem is specifically redness and itchy eyes related to ocular allergies, there are two generic medications that no longer need a prescription.

• Pheniramine Maleate/Naphazoline Hydrochloride (Active Ingredients)
Pheniramine Maleate is an antihistamine to stop the itch and Naphazoline Hydrochloride is a decongestant/vasoconstrictor that gets the red out. Both of these are the active ingredients for Naphcon-A, Opcon-A, and Visine-A. The dosage is one to two drops up to four times a day. For patients that have anatomically narrow angle or narrow angle glaucoma, this eye drop is contraindicated. Adverse reactions include dilation of pupils, increased eye redness, irritation, discomfort, blurry vision, punctate keratitis (a breakdown of the cells in the cornea), increased tearing, and elevated eye pressures. It is advised to use these drops for short-term use only due to risk of rebound hyperemia. This means overuse of an eye drop that shrinks the eye’s blood vessels may cause the vessels to become more fragile with time. Eventually a reverse effect may occur where the blood vessels stop shrinking and instead expand to a point where the red eyes are worse than before.

• Ketotifen Fumarate
This ingredient is found in Zaditor (Alcon), Alaway (Bausch & Lomb), Zyrtec Itchy Eye Drops, and Claritin Eye Drops. The dosage is one drop twice daily, every 8-12 hours. Common side effects are redness of the eyes, headache and rhinitis. Interestingly this also has a dilation of the pupil side effect but the incidence is low.

What Type of Generic OTC Eye Drop Should I Get?
We’ve finally reached the point where we can answer this question. If you can accurately self-diagnose your eye problem and determine ocular allergies is the proper diagnosis, you may consider Ketotifen Fumarate. Keep in mind that many patients fail on OTC eye drops. Truly, the best treatment relies on an accurate diagnosis. I advise making an appointment with your optometrist to examine your eyes and provide the correct diagnosis. Rather than asking what type of eye drop should I get, the better question to ask is how do I accurately diagnose my eye problem? If you agree your eyes deserve the best, then stop self-diagnosing and call for an appointment with your local optometrist.

Margie Recalde, OD, FAAO

California Optometric Association

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