Four out of five American adults commonly take over-the-counter medications, most often to treat ailments like aches and pains, coughs and colds, fever, allergies, skin disorders, and heartburn and other digestive problems. The reasons are easy to understand. OTCs are convenient, readily available in groceries and big box stores as well as pharmacies, and they are less expensive than going to the doctor and perhaps paying for a costly prescription.
According to the Food and Drug Administration, there are more than 300,000 over-the-counter drug products on the market, a number that continues to grow as an increasing number of medications move from prescription to OTC status. According to the Consumer Healthcare Products Association, an industry trade group, since 1975, more than 100 ingredients, indications or dosage strengths have transitioned from prescription to OTC status.
Last year, Americans spent about $44 billion on OTC drugs which, the industry claims, saved the health care system about $102 billion in doctor visits, diagnostic tests and prescription medications. In addition to saving consumers time and money, OTCs give many people a sense of control over their health and well-being.
That’s all to the good if OTC drugs are used appropriately, for an indicated condition in the proper dosage and for no longer than the recommended time. However, 1 in 5 adults who self-medicate admit to taking more than the recommended dose or using the medication more frequently than the label indicates.
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Tylenol and liver damage
Even if OTCs are used correctly, there can be problems. Some drugs should not be taken by people with certain health conditions, or be combined with other drugs – prescribed or over the counter – because of the possibility of adverse interactions.
For example, acetaminophen, the active ingredient in Tylenol and its many competitors, is the most widely used OTC, commonly taken to relieve pain or fever. But acetaminophen is also a frequent ingredient in other often-used OTC products, including many cough, cold and allergy remedies, and prescribed pain relievers like Percocet and Vicodin. In excessive amounts, acetaminophen can cause severe liver damage.
Overdoses of acetaminophen result in 30,000 hospitalizations annually, often because of acute liver failure. A study of 500 people published in 2012 in The Journal of General Internal Medicine revealed that 24 percent would unwittingly exceed the safe limit of 4,000 milligrams of acetaminophen over a 24-hour period when taking a single product containing the drug. About 46 percent would overdose when taking two products at the same time that contain this pain reliever.
According to the National Council, a third of Americans say they combine medications when treating multiple symptoms, but only 1 person in 10 says they read the entire label of each drug taken; therefore, most are unaware of potentially toxic duplications or harmful interactions.
Seeking a sales advantage, many companies that make OTCs offer products with multiple ingredients meant to treat several symptoms simultaneously. However, many consumers do not need all the active drugs in a given product and thus needlessly increase their risk of toxicity.
About 40 percent of OTC drugs are used by people older than 65, who are most likely to have health issues that may contraindicate the use of certain over-the-counter medications. Because of chronic health problems, age-related changes in how well the body processes drugs, and the sheer number of prescription medications many older people tend to take, they face the greatest risk of adverse side effects and drug interactions.
Among drug-related hazards disproportionately faced by older patients are falls, depression, confusion, hallucinations and malnutrition.
Other common problems
Just because a drug is sold over the counter does not mean it’s harmless. Laxatives, for example, are said to be the most misused over-the-counter remedy, and I don’t mean by people who abuse them in an effort to lose weight. When taken too often to prevent constipation, stimulant laxatives can cause dependency. The bowel can lose its ability to function without them.
Over-the-counter sleeping pills that contain antihistamines can have the opposite problem: losing their effectiveness over time, which can result in people taking more than the recommended dose. They should not be used for more than two weeks. Even if taken as directed, they can result in daytime sleepiness, dizziness and a thickening of bronchial secretions.
Some people with chronic heartburn take antacids that counter the effects of stomach acid. But these can also cause diarrhea or constipation, and block the absorption of certain prescription medications. Better choices now available over the counter are H2 blockers (like Pepcid and Zantac) and proton-pump inhibitors (like Nexium, Prilosec and Prevacid) that stop the production of stomach acid. But these drugs may also pose dangers when taken long term, including bone fractures and magnesium deficiencies that can lead to seizures.
When NSAIDS, or nonsteroidal anti-inflammatory drugs, like aspirin, ibuprofen and naproxen, are taken too long, they can likewise pose dangers, including bleeding ulcers, kidney or liver damage and an increased risk of a heart attack or stroke. And so on.
Talk to your pharmacist
Although OTC drugs are generally safe when used occasionally and correctly by healthy adults, those with chronic health problems can risk potentially serious adverse reactions. FamilyDoctor.org includes a list of medical conditions that may require extra precautions: asthma; bleeding or clotting disorders; breathing problems; diabetes; enlarged prostate; epilepsy; glaucoma; gout; heart disease; high blood pressure; immune system, kidney or liver problems; Parkinson’s disease; and psychiatric or thyroid problems.
People who have underlying health problems or who routinely take one or more prescription drugs would be wise to consult their doctors before taking an OTC drug. At the very least, check with the pharmacist. If you fill all your prescriptions at the same pharmacy, potential adverse drug interactions are easier to pick up. Failing that, carry with you a list of all the prescription and OTC medications you take to show the pharmacist.
Among other sensible precautions when using an OTC drug: Read the entire label, including ingredients, dosages, time limits and warnings; note whether the drug should be taken with food or on an empty stomach; don’t mix medicines with alcohol; avoid taking vitamin-mineral supplements at the same time; and, if you experience an allergic or adverse reaction, write down the likely cause so you can avoid that ingredient in the future.