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Beware Brand Name Creep in the Drugstore

Brand name expansion is the name of the game in OTC drugs. The more shelf space the better for the company. It can lead to confusion for consumers.
Tylenol on shelf

There was a time when buying over-the-counter medicines was pretty simple. If you wanted a non-aspirin pain reliever you bought Tylenol, the brand name for acetaminophen. If heartburn was a problem, you might choose Maalox. It contained antacids-aluminum and magnesium hydroxide. A woman with PMS might take Midol, with acetaminophen and diuretics (pamabrom and pyrilamine).

Sowing Confusion with Brand Name Expansion:

The old brands were so successful that the companies decided to extend them. Name recognition is powerful. To take advantage of it, drug companies created many products capitalizing on the same brand name.

What’s in Tylenol?

This may seem like a brilliant marketing strategy, but it creates confusion and possibly danger in the pharmacy. Let’s check out Tylenol. Once upon a time, there was only one product with this name. It contained acetaminophen and was introduced in 1955 as a prescription pain reliever and fever reducer for children. It came in a liquid formulation. In 1961 the manufacturer took Tylenol tablets over the counter for adults. The success of the brand is obvious. Tylenol is a household name.

When we visit the Tylenol website, we count over 20 Tylenol brand products. There’s the old familiar regular strength Tylenol with 325 mg of acetaminophen in each tablet. Then there’s Extra Strength Tylenol with 500 mg of acetaminophen and Tylenol Arthritis Pain with 650 mg per pill.

In addition, you can find Tylenol PM, which contains 500 mg of acetaminophen and 25 mg of a sedating antihistamine (diphenhydramine). That doesn’t take into account all the various Tylenol cold and flu, allergy and sinus products. We suspect that many people don’t have a clue about diphenhydramine or the controversy swirling about the effects of this and other anticholinergic drugs.

Someone who trusts the Tylenol brand and doesn’t bother to look closely at the label might end up overdosing on acetaminophen. By taking three or four different products throughout the day for headache, a cold, allergies or insomnia, he could go over the maximum daily dose of acetaminophen without realizing it. Excessive amounts of acetaminophen (more than 4,000 mg/day) can be dangerous to the liver.

Advil Expansion:

Once upon a time there was just Advil. It contained 200 mg of ibuprofen. No muss, no fuss. It became a very successful OTC pain reliever. Now there is also:

  • Advil Liqui-Gels with the Advil Easy Open Arthritis Cap
  • Advil Film-Coated 
  • Advil Migraine
  • Advil Menstrual Pain
  • Advil PM and Advil PM Liqui-Gels
  • Children’s Advil

All these products contain ibuprofen. Advil PM includes the same sedating antihistamine (diphenhydramine) found in Tylenol PM. Hopefully, no one will take regular Advil for arthritis pain, Advil Migraine for a bad headache plus Advil Menstrual Pain simultaneously. That would represent a triple whammy of ibuprofen.

Mucinex Multiplication:

A brand that has really caught on is Mucinex. We have lost count of how many products there now are on pharmacy shelves. Here is a partial list:

  • Mucinex Expectorant
  • Maximum Strength Mucinex Expectorant
  • Mucinex DM Expectorant & Cough Suppressant
  • Maximum Strength Mucinex DM
  • Maximum Strength Mucinex Fast-Max Severe Congestion & Cough
  • Maximum Strength Mucinex Fast-Max Night Time Cold & Flu
  • Maximum Strength Mucinex Fast-Max Cold, Flu & Sore Throat
  • Maximum Strength Mucinex Fast-Max Severe Congestion & Cough Caplets
  • Maximum Strength Mucinex Fast-Max Day Severe Cold & Night Cold & Flu Fast Dissolving Liquid Gels
  • Mucinex Sinus-Max Full Force Nasal Spray
  • Maximum Strength Mucinex Sinus-Max Pressure & Pain Liquid
  • Children’s Mucinex Multi-Symptom Cold Liquid
  • Children’s Mucinex Chest Congestion Mini-Melts

Please keep in mind that this is just a partial list. We wonder how many people understand what the ingredients on the label actually do. Some, like dextromethorphan HBr, guaifenesin, phenylephrine and diphenhydramine, are tongue twisters.

Many consumers would not know the difference between a sedating antihistamine, a decongestant or a cough suppressant. People with hypertension, for example, should probably skip the decongestant ingredient in case it elevates blood pressure. And older people worried about cognitive function may want to avoid the anticholinergic ingredient diphenhydramine.

The People’s Pharmacy Perspective:

Drugstore shelves are now cluttered with complicated, confusing brand-extension products. The smart consumer will read the fine print carefully and consult with the pharmacist before relying on what was once a trusted brand name. Why not review the labels of all the medicines you are taking to make sure you are not getting a double dose of some ingredient inadvertently?

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About the Author
Terry Graedon, PhD, is a medical anthropologist and co-host of The People’s Pharmacy radio show, co-author of The People’s Pharmacy syndicated newspaper columns and numerous books, and co-founder of The People’s Pharmacy website. Terry taught in the Duke University School of Nursing and was an adjunct assistant professor in the Department of Anthropology. She is a Fellow of the Society of Applied Anthropology. Terry is one of the country's leading authorities on the science behind folk remedies. .
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What about prescribed meds like Ibuprofen, where one tablet contains 800 mg pain reliever, vs OTC Ibuprofen which normally contains 200 mg pain relievers? Is it all right to take 4 tablets of the OTC brand to get the pain relief of the prescribed brand?

Recently the Dr. or my husband would say go to the pharmacy and get XYZ; I would get so confused with all the products, plus the comparable store brands, I would end up going home with nothing!

I had been taking Equate aspirin — without reading the label closely. It says plain as day that it contains NSAIDS. I do not need that! I have reached the age where forgetfulness is a problem and only recently did I find out that NSAIDS are a bad choice for people with my problem.

I have since switched to Equate Acetaminophen … it was on the shelf next to Tylenol and cost less. I use this for head aches.

Never have headaches so haven’t bothered to check or buy this stuff. BUT last year had upper left lung lobe removed, for cancer, and “came to” with aFIB. Surgeon had me on morphine for pain, cardiologist came and put me on Metoprolol, Flecanaide and 10 mg. Eliquis. Pain was excrutiating and Surgeon’s PA said if morphine wasn’t helping pain, she’d take me off morphine and try ibuprofen. RXed 400 mg of ibuprofen every 4 hours, so 2,400 mg. ibuprofen.

Never warned me of conflict (patient rights violation). Sent me home with two RNs signing discharge orders of same. 12 days after surgery I read all fine print, threw away ibuprofen. Other cancer MDs horrified. New cardiologist horrified. Hospital admits no error – too afraid I’ll sue when I only want to keep them from killing somebody else. I’ll never go to hospital again without my own PDR.

I take Iron, either singly or within a vitamin. Get black stools frequently from it. When I stop the Iron (which I’m not supposed to do for Anemia), stools go back to normal. So Iron can do it as well.

People take too much garbage. Try losing weight and exercising. You won’t have all that reflux.

This was extremely helpful! My doctor told me to take a “swig” of Maalox or Mylanta every night for reflux. I developed black stools that also went into black tongue and black saliva. When I told my doctor about the black stools, he immediately ordered an endoscomy. He said he had never heard of black tongue. I knew that Pepto Bismol could cause this, but had no idea there were various kinds of Maalox! Sure enough, I bought the extra strength Total Relief – I cannot wait to inform my doctor! Thank you!

Thanks. This was helpful. I had taken the Maalox Total Relief and had black stools. If I hadn’t found this article, I probably would have made an appointment with my doctor.

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