Many people are aware of the potential dangers of taking prescription medications and the effects that may result if they are misused. However, most people are unaware that over-the-counter medications can also have very serious side-effects when misused. It is a very common misconception that since OTCs are available without a prescription, they are not "real drugs" and are safe to take regardless of the printed instructions.
Many OTCs contain multiple ingredients that are common amongst other drugs, even though they are designed to treat different conditions. For example, the main ingredient in Tylenol is acetaminophen. All Tylenol products ranging from Tylenol arthritis to Tylenol cold and sinus contain at least one standard dose of acetaminophen if not more. The same holds true for variations of Advil, Aleve, Bayer aspirin, and many other medications. It is a common practice to take a cold medication for sinus congestion and immediately take another pain killer for an accompanying headache. However, many cough/cold/allergy medications already contain a standard dose of acetaminophen or other pain killer. Therefore, an individual is receiving a double dose of the pain killer. This practice results in an unintentional overdose. It is estimated that "nearly half of the 175 million adults who take over-the-counter pain relievers admit to exceeding the recommended dose, and few are aware of the potential risks" that may result.1
In addition to disregarding the instructions on the medicine label, many people are also unaware or ignore the risk of the side effects that may result from misusing over-the-counter medications. On April 13, 2007, a high school cross country runner died from an overdose of the main ingredient in pain relieving creams and patches such as Bengay and IcyHot. Although poisoning from this particular medication is rare, it is only one of many examples of how consumers fail to read and abide by the instructions and the consequences that can result.
Acetaminophen, when taken in high quantities, or frequently over a long period of time, can lead to irreversible liver damage. This risk is increased with frequent alcohol consumption. NSAIDs have been known to lead to stomach ulcers and bleeding. A study conducted by the FDA discovered that approximately "16,500 people die and 103,000 are hospitalized each year because of NSAID-related problems."1 These statistics can be drastically reduced by simply reading and abiding by the instructions and asking a doctor or pharmacist if any questions or uncertainty arises.
The following is a list of factors2 that may increase the risk of toxicity associated with NSAIDs:
Although the main focus of this article was on pain killers, caution needs to be taken when consuming any over-the-counter medications ranging from Pepto-Bismol and Alkaseltzer to Tums to Robitussin. Just because a prescription is not needed to obtain these medications doesn't mean they can't carry dangerous side effects when misused.
1. Does reading the entire label really matter?
Reading and understanding the entire Drug Facts label is important
for preventing an overdose or possible complications from interactions with other
medications. Labels also contain the dosage and guidelines for children, as well
as possible side effects that may result from taking the medication.
2. How do I read the label?
The labels are divided into several sections including active ingredients - the
main ingredients that elicit the pain relief, uses - conditions it treats, warnings
and storage instructions, directions - dosages for adults and children, other information,
inactive ingredients, and questions/comments. All OTCs are required by law to have
all of this information on the medicine package. For more information on how to
read a label please follow this link: 5 Tips for Taking Over-the-Counter Medicine Safely (selecthealth.org)
3. I've been taking a "double dose" for most of my life and haven't had any
problems - is it really a big deal?
OTCs have a daily maximum recommended dose for a reason. If high levels of OTCs
are ingested on a regular basis, serious consequences may result ranging from liver
damage to bleeding of the stomach, and possibly even death - in extreme cases. Although
prescriptions often contain higher doses of common medications, they are controlled
by physicians so they can closely monitor each individual situation in order to
prevent serious complications. It is possible to develop a tolerance or feeling
as though the medicine isn't working. This may occur when medications are consumed
on a regular basis. If this occurs, it is important to continue to follow the instructions
on label or discontinue the medication, but not "double up" the doses. Talk to a
pharmacist, doctor, or healthcare professional for more information on how to safely
adjust medications or dosing instructions.
4. Can OTCs and prescriptions contain the same type of medicine?
Yes. Prescriptions and over-the-counter medications can contain the same or similar
ingredients. However, prescriptions generally contain higher doses of the active
ingredient or contain a combination of active ingredients.
5. How do I know if an OTC will interfere with my prescription or other meds?
Many [or all?] medications will have a list of other medications that will cause
an adverse reaction with the medication in question. WebMD is an online source that
has a database of most prescription and nonprescription medications. It gives a
description of what the medication is, what it's used to treat, possible side-effects,
and which medications it interferes with, among other things. However, it is best
to talk to a doctor, pharmacist, or healthcare professional before taking a new
medication (OTC or prescription). It is also important to inform the doctor of all
OTC medications you are taking on a regular basis.
For more information on how NSAIDs work, please refer to the article in the sports medicine articles section entitled "NSAIDs". If you have questions or concerns about any medication OTCs or prescriptions that you are currently taking or considering, please talk to your doctor, pharmacist, or healthcare professional. You may also visit any of the following sites:
http://www.fda.gov
http://www.webmd.com
http://www.lef.org/protocols/appendix/otc_toxicity_01.htm