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• If allergy symptoms do not improve after 1 week, patients should stop use and talk to their doctor. • Patients should not use Nasacort Allergy 24HR for the common cold. • An adult should supervise nasal spray use in children aged 2 to 12 years. Nexium 24HR Nexium 24HR is indicated to treat fre- quent heartburn that occurs 2 or more days per week. It is available as 20-mg capsules and is taken once a day in the morning. 6 Prescription versus OTC: • OTC Nexium is only available in 20-mg capsules compared with the 20-mg and 40-mg capsules available as prescription. Counseling Points: • Instruct patients to take this medication with a glass of water before eating in the morning. • Capsules should be swallowed whole, not crushed or chewed. • If they require Nexium for more than 14 days, instruct patients to stop use and ask a doctor. Flonase Allergy Relief Flonase Allergy Relief is indicated to relieve symptoms of hay fever or other upper respiratory allergies. It is available as a nasal spray and is used once a day. 7 Prescription versus OTC: • It contains the same strength as pre- scription Flonase. Counseling Points: • Patients may start to feel relief after the first day of use and may achieve the full effect after several days of regular once-a-day use. • Patients should use Flonase every day because full effectiveness is usually achieved after 3 or 4 days of continu- ous use. • Parents should talk to their child's doc- tor if their child needs to use the spray for longer than 2 months a year. Rhinocort Allergy Spray Rhinocort Allergy Spray is indicated to relieve symptoms associated with AR. It is available as a nasal spray and is typi- cally used once a day. 8,9 Prescription versus OTC: • It contains the same strength as pre- scription Rhinocort Aqua. • When comparing prescription and OTC labeling, there is a slight differ- ence in how the recommended starting and maximum doses are broken down between age groups. Counseling Points: • Patients may see an improvement in allergy symptoms within 10 hours of first using the nasal spray. • Advise patients they must continue to use the nasal spray as directed because maximum benefit may not be achieved until approximately 2 weeks after they begin treatment. How These Recent Switches Will Affect Our Health Care With the continuous approval of pre- scription drugs for OTC availability, health care is moving toward a more self- care approach. Not only does this offer patients additional treatment options, but it allows patients more control over their health. The implications on cost savings and spending can go both ways. With the ability to self-treat, health care costs may decrease by reducing the number of doctor visits. However, health care costs may increase if there is an increase in the number of emergency department visits due to misuse and preventable adverse events. In addition, patients may no longer receive drug coverage on OTC medications once they make the switch. In turn, the costs are being transferred to the patient from insurance companies. Implications of Nexium on our Health Care PPIs are a top-selling drug class, and many patients continue to take them for long periods of time. Research has indi- cated that up to 70% of PPI utilization is for unapproved uses. 10 With Prilosec and Nexium now available over the counter, patients have easy access to medications that were not only prescribed by a medi- December 2015 PharmacyTimes.com 33 } page 40