A closer look
Before you leave the
Read the drug label to make sure the prescription is
drug store, get the facts.
yours and matches the one written by your provider.
Easy access belies over-the-counter drugs’ health risks
Stephanie Andrews learned her lesson the hard way.
Like most people, the 36-year-old mother of two, who asked that her real name not be used, underestimated the potency and impact of the over-the-counter (OTC) drugs she was taking to relieve her abdominal cramps.
Instead of reducing the pain, the extra doses of pain relievers actually added to her misery.
Her story starts a few years ago when she suffered a miscarriage. Her doctor offered her two treatment options. One was a surgical procedure; the other allowed nature to take its course and dispel the tissue.
She chose the latter, but that meant a few days of discomfort. Andrews’ doctor recommended 800 milligrams (mg) of ibuprofen every four hours.
But Andrews had another idea after her cramps subsided with the help of the first round of ibuprofen pills. She decided to get a head start on her next bout of pain by taking more pills.
“I tried to head it off at the pass,” she said. “I was trying to beat the pain.”
She decided not to wait for four hours as instructed; she took another 800 mg in two hours — double the recommended dose. She continued her “treatment” for two days.
Though she said “it felt good to be without pain,” the plan backfired. What she didn’t know is that stomach and kidney problems are the two main side effects associated with excessive use of ibuprofen.
She knows now. “My stomach was cramping even more,” she said.
Her doctor was a tad furious and had a few choice words after Andrews confessed. “You’re taking way too much,” her doctor warned. “Stop taking it immediately.”
The doctor instead advised her to take acetaminophen, another pain reducer. “But take it as prescribed,” she said.
Andrews says she has learned her lesson. “I still take ibuprofen as needed,” she said. “But I definitely watch how I take it.”
Misuse of OTC drugs has not received the amount of attention as prescription drugs but they are far from harmless. Part of the problem is that doctors are taken out of the process. Consumers instead diagnose their own problems, and then self-medicate — all without the benefit of any medical education.
Indeed, OTC drugs are readily available for all to use, but that does not mean that all should readily use them.
It is a common misperception that OTC drugs are not powerful and do not require the same attention to detail as prescription medications.
Many OTC drugs were at one time available only through a provider’s orders. The Food and Drug Administration (FDA) regularly evaluates the safety of prescription drugs and their ability to transition from prescription-only to OTC status. Between 2001 and 2009 the FDA approved that transition for almost 30 medications.
Some drugs that have made the switch are well known: the antihistamines Claritin-D and Zyrtec and the acid reducer Prevacid 24 HR. Ibuprofen, a common pain killer, got its walking papers about 20 years ago.
There’s one catch though. That switch and the resultant ease of access did not reduce their potency.
A practical way of viewing all OTC drugs, including vitamins and herbal supplements, is that any product that changes the way your body works or treats a condition is a drug.
But how can an untrained person make such an important medical decision? The FDA weighed in when it mandated in 2002 that all OTC drugs carry a universal “drug facts label” that clearly lists each drug’s active ingredient, uses, warnings, directions for taking, inactive ingredients and other information.
That means a consumer should be able to determine what the drug contains, if it treats the complaint, how to take it, what to watch out for and even how to store it.
That answers the question for one drug and one illness. Multiple OTC drugs or combining OTC with prescription drugs is another issue.
Take acetaminophen for example. Acetaminophen, a pain and fever reducer, is the active ingredient of several medications, both prescription and OTC. But the current maximum daily dose is 4,000 mg and prolonged excessive use can result in liver damage.
Tylenol especially is tricky because of its many products with varying potencies of acetaminophen. For instance, each pill of Tylenol for arthritis contains 650 mg versus 325 mg for regular strength. If a person does not keep an eye on how much he or she is taking, it is easy to surpass the recommended daily maximum.
Cough syrups present another sort of problem. When taken in excess, cough syrup can cause hallucinations and partially explains why teenagers are using it for cheap highs.
Herbal supplements are not without consequences either. Researchers found that St. John’s Wort — used for depression — interacts with drugs that treat HIV and other serious illnesses. Black cohosh, which women take for hot flashes, causes some drugs to stay in the system too long or move out too quickly, which reduces their effectiveness.
Dr. Donney John, the clinical pharmacist at South End Community Health Center, cautions against taking too many pain killers. “People often think ‘one pill is not cutting it’ and double the dose,” he said.
But John cautions against doing this: “You should not take a higher strength than what you need.”
Self-medicating with pain killers can be dangerous. It’s best not to take pain killers too long without seeing a doctor. “It could be masking the symptom of something more serious,” John said.