When you try an over-the-counter drug for the first time, do you read the label? More than half of pharmaceutical customers don’t. Do you at least check for warnings and side effects? Ninety percent of folks couldn’t be bothered. And 70 percent admit they’ve taken more than the recommended dose at one time.
This apparent carelessness with OTC drugs may be why 170,500 hospitalizations occur every year as a result of people taking these seemingly innocuous medicines, with the FDA estimating that about half of those cases are preventable.
OTC drugs are available without a prescription for a reason; they’re considered relatively safe for the bulk of the population. But no drug is without risk, even when used as instructed; and when used incorrectly, the chance of harm greatly increases.
Thanks to ads that encourage us to knock out every headache, stuffy nose, and fever with an instant fix, the public has become blasé about taking OTC drugs, especially painkillers. Compounding this problem is the alarming fact that only about one third of people taking an OTC drug can name the drug’s active ingredient.
Is it really so important to know those long, complicated names? Actually, it is, especially if you’re taking multiple products containing the same active ingredient.
Consider this scenario: You wake in the morning with a painful knee from yesterday’s run. You pop four Tylenol. By noon, the pollen is making you congested and sneezy. You take some Benadryl Allergy and Sinus medicine so you can focus at work. Over a lunch meeting, you have a glass of wine. After work, you take more allergy stuff and meet friends at Music in the Park. They bring a pitcher of margaritas. You knock back a couple and dance the whole night. Before bed, your knee is acting up again, so you swallow a few more Tylenol.
What’s wrong with this picture? The Tylenol and allergy meds both contain acetaminophen. The Tylenol was extra strength (did you notice?) and combined with the allergy med, added up to 4,200 mg, which you ingested within 18 hours. (The daily maximum dose of acetaminophen from all sources is 4,000 mg during 24 hours.) Even worse, you had three alcoholic drinks, which could have overloaded your liver to a potentially dangerous level.
Might you get away with it? Sure. But then again, you might not. Taking too much of a painkiller, whether in a single large dose or smaller doses that exceed the daily limit, is risky. When coupled with alcohol or other medications, it becomes downright dangerous, and can impair the functioning of your liver, kidneys, or heart, as well as cause gastrointestinal bleeding.
Each painkiller, of course, is a little different, but there are two basic groups: acetaminophen and NSAIDS (non-steroidal anti-inflammatory drugs).
NSAIDS include aspirin, ibuprofen (Advil and Motrin), and Naproxin (Aleve), as well as prescription Celebrex. The beauty of NSAIDS is that they reduce both pain and inflammation. The downsides are as follows.
Gastrointestinal bleeding. Over-the-counter NSAIDS work by blocking two enzymes (COX-1 and COX-2) from producing inflammatory compounds called prostaglandins. However, when COX-1 is quashed, it can no longer carry out one of its beneficial actions, which is to protect the stomach lining with mucus. As a result, your inflamed shoulder might feel better, but your stomach could take a beating, especially with high doses or long-term use.
Signs of gastrointestinal damage are nausea, heartburn, abdominal pain, tarry stools, weakness, ulcers, and hemorrhage, though some people with gastrointenstinal (GI) damage have no symptoms. Every year, more than 100,000 people are hospitalized with GI complications from using NSAIDS. To address this problem, prescription NSAIDS were developed that only inhibit COX-2, theoretically protecting the stomach. Celebrex is a COX-2 inhibitor.
Heart issues. Researchers have found that some NSAIDS increase the chance of heart attack and stroke, especially for people with, or at risk for, heart disease. Celebrex carries the greatest risk, followed by ibuprofen. (Prescription Vioxx and Bextra were removed from the market precisely because of this risk.) Even healthy people who regularly pop NSAIDS may increase their risk of dying from heart problems.
Kidney damage. At high doses, NSAIDS constrict blood flow to the kidneys. If blood flow is already reduced because of kidney, heart or liver problems, flu, or a person’s advanced age, NSAIDS can damage the kidneys, sometimes irreparably. Kidney disease is more common now because of the growing incidence of type 2 diabetes and high blood pressure. Kidney disease damages the organ slowly over time, and most people don’t know they have it until failure is imminent.
Pregnancy risks. The Canadian Medical Association published a study showing that ibuprofen and naproxen may increase the risk of miscarriage by more than twofold in the first trimester. WebMD advises women in late pregnancy to also avoid ibuprofen due to risks to the fetal heart.
Acetaminophen doesn’t reduce inflammation, but neither does it cause GI bleeding. For that reason, it’s considered to be a safer drug for many people than NSAIDS. But if used improperly, it can severely damage the liver. Many people are unaware that acetaminophen is found in hundreds of OTC preparations, often in combination with other drugs for treating cold, flu, allergy, headache, and backache. One product may contain 325 mg, another 650, so always read the label and don’t exceed 4,000 mg in a 24 hour period. If you have liver disease, or drink two to three alcoholic drinks per day, or if you’re fasting, you need to avoid or severely limit acetaminophen.
Children’s doses are based on the child’s weight, so be sure to follow instructions closely and use the dosing cup or syringe provided. Be aware that a new, lower dose of children’s acetaminophen is now on the market, in addition to the original, higher dose. Be sure to read the label carefully and don’t assume that a capful of one product is equal to a capful of another.
Be a smart consumer. Talk to your doctor or pharmacist if you have any questions about what medication to take for a particular condition, especially if you have existing health issues or are taking other medications. A good rule of thumb is to take the lowest effective dose for the shortest possible time. With drugs, if a little is good, more is definitely not better.
Sources: January 2002 Harris Interactive poll for the National Council on Patient Information and Education; Federal Register Vol. 64, No. 51, March 17, 1999, “Over the Counter Human Drugs, Labeling Requirements, Final Rule.”
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