An ounce of prevention may well be worth a pound of cure but in the world of over-the-counter medicines, an ounce of anything is also 28,350 milligrams, and that little factoid is precisely what lands tens of thousands of Americans in hospital emergency rooms every year.
Four in every five adults in this country commonly take over-the-counter medications. They’re sold just about everywhere. You can find them in grocery stores, drugstores, mini-marts and even gas stations, which tends to make them seem innocuous.
But over-the-counter medicines can kill you if you’re not careful.
Matt Lambie is a board-certified pharmacotherapy specialist. As the pharmacy clinical manager at the Indian River Medical Center, he’s keenly aware of potential pitfalls associated with over-the-counter medications.
Ricardo Bannatyne is a clinical pharmacist at the Sebastian River Medical Center, a pharmacy owner with 25 years of experience and a consultant to the hospital’s surgical center. He, too, knows the dangers of not taking overthe-counter medications seriously.
“90 percent of the people will tell you all the prescription medications they take [but] they will never tell you about the over-the-counter ones because they don’t classify those as important enough to tell about and that is a problem,” Bannatyne says.
“Many patients may not even be aware of all the ingredients in their over-the-counter products, which often contain as many as four medications,” says Lambie. “Many of these ingredients are often not needed, which only increases the risk.”
It’s a bigger risk than most people realize.
The New York Times reported in November that overdoses of acetaminophen – the active ingredient in Tylenol, Excedrin, Alka-Seltzer Plus and many generic painkillers and other over-the-counter products – is the root cause behind some 30,000 acute liver failure hospitalizations each year.
The Journal of General Internal Medicine puts the safe level of acetaminophen at 4,000 milligrams per 24-hour period. That’s less than one-seventh of an ounce and it is all too easy to exceed the recommended level.
“It’s important to note,” explains Lambie, “that this [4,000 milligram] recommendation is intended for the average, healthy adult. Some advocate a maximum of 3,000 milligrams as an added level of safety.”
Nonetheless, fully 20 percent of American adults admit to knowingly taking more than the recommended dosage of pain killers containing acetaminophen.
Plus, over-the-counter cough, cold and allergy products such as Cepacol, Coricidine, Dayquil, Dimetapp, Robitussin, Sinutab, Sudafed and Theraflu also contain acetaminophen as do some prescription drugs including Ultracet, Percocet and Vicodin.
Acetaminophen, however, is far from the only readily available over-the-counter product that can cause severe health problems.
Laxatives and enemas for example, are among the most commonly misused and over-used non-prescription products.
In fact, the Times reports that after prolonged use of laxatives, “The bowel can lose its ability to function” altogether. Additionally, laxatives containing stimulants can quite literally create a dependency or addiction.
“Fleet enemas,” Bannatyne adds, “Can be especially dangerous. It’s a phosphate enema. It’s the phosphate that’s the problem.” Excess amounts of phosphate in patients with existing kidney problems can be fatal.
Over-the-counter sleeping pills containing antihistamines present another problem. According to Lambie, “Antihistamines are not the greatest sleep aids as they often leave one feeling hung-over the next morning and carry the risk of serious side effects, especially in the elderly.” They also lose their effectiveness over time and that can lead to people far exceeding the recommended dosage.
Heartburn remedies and NSAIDS, (non-steroidal anti-inflammatory drugs) such as Pepcid, Zantac, Prilosec, aspirin, ibuprofen and naproxen can also pose a risk of serious and sometimes deadly problems.
Nearly half of all over-the-counter drugs currently available – and there are well over 300,000 of them out there on which we, as a nation, spend a whopping $44 billion annually – are used by people over the age of 65 and that’s yet another problem.
People in that age bracket are more likely to have underlying chronic health issues along with age-related difficulties in the way their bodies process any drug. Moreover, seniors are far more likely to be taking multiple prescription medications. That further increases the possibility of adverse drug interactions.
Perhaps not surprisingly, the National Council on Patient Information and Education found that most people, including seniors, don’t fully read the information on their over-the-counter drug labels. Seniors may have been taking Bayer aspirin for decades so they feel they know it, but they may not know – or remember – that combining that aspirin with their Coumadin prescription could be a recipe for disaster.
Bannatyne quickly interjects, “Their doctor might tell them not to take aspirin with their Coumadin, but might not mention Motrin or Aleve which are [chemically] very similar to aspirin and would have the same effect.”
In an effort to save money on their packaging costs, manufacturers of the 300,000-plus over-the-counter products on the market are selling smaller and smaller bottles of their products. As the bottles shrink, so also does the size of typeface used to print the product’s active ingredients and warnings, and that makes reading them all the more difficult.
Remember: Simply because something is sold at your corner mini-mart doesn’t mean it’s harmless. The best advice is to read the labels and to ask questions.
Bannatyne points out, “We have a state of Florida law that says pharmacists have to offer counseling to every patient when they pick up their prescriptions,” and most pharmacists are more than happy to answer questions about over-the-counter medications, too.
Patients can also ask their physician for advice about which OTC meds are safe and what the appropriate dosage is. The life you save by knowing more about the over-the-counter medications you take may very well be your own.