Over-the-Counter and Into Your Mouth: Not Always a Good Idea
Cough syrup, antacid, decongestants, pain relievers and topical creams for stiff muscles and joints are sold as over-the-counter (OTC) medicines at thousands of drug and grocery stores in the United States. They’re easily accessible, inexpensive (compared to prescription drugs), and totally safe, right? Not always. In fact, there are some instances when an over-the-counter drug is really not a good idea.
The Food and Drug Administration (FDA) is the governmental agency in the United States that decides whether a medicine is safe enough to be sold over the counter. The FDA has a handy checklist that’s downloadable for choosing OTC medications for adults. But taking OTC medications, warns the FDA, still has risks.
According to Harmful Interactions: Mixing Alcohol with Medicines, a publication from the National Institute on Alcohol Abuse and Alcoholism (NIAAA) of the National Institutes of Health (NIH), “some medicines that you might never have suspected can react with alcohol, including many medications which can be purchased over the counter.”
The NIAAA publication cautions that medicines, including popular remedies for cough, colds and allergies, may have many ingredients that interact with alcohol. Some OTC medicines for coughs contain up to 10 percent alcohol. Women are more susceptible to alcohol-related liver damage than men. Older individuals are at greater risk than younger ones for medication-alcohol interactions. In addition, millions of older Americans take more than one such medication at the same time.
Most Dangerous Drug/OTC Drug Interactions
Think of what’s currently in your medicine cabinet. If your household is like most families, you’ve probably got a mixture of prescription and nonprescription drugs. Some of these could prove fatal when used in combination, or in the wrong dosages.
Never combine blood thinners, such as warfarin (Coumadin), with aspirin. This may lead to excessive bleeding. If you take certain antacids, they may interfere with the ability of heart medicines, antibiotics and blood thinners to be absorbed into the blood. The result may be that the drugs either don’t work at all or are less effective. Cold remedies often contain decongestants, which may cause harmful increases in blood pressure with people taking MAO-inhibitors (a type of antidepressant) or medications for hypertension.
Food Interactions with OTC Drugs
Many medications, OTC and prescription, are intended to be taken with food or beverages (such as water or juice). But this is not always the case, and there are also instances where food or beverages negatively interact with the OTC medication.
The American Pharmacists Association (formerly known as the American Pharmaceutical Association) cautions that calcium-rich dairy products (including milk, cheese, and ice cream), vitamins containing iron, and antacids can lessen the effectiveness of antibiotics. This is particularly true with tetracycline. If you mix the foods mentioned with an antibiotic, it can cause a much slower rate of absorption into the body, and decrease the effect of the antibiotic.
Grapefruit juice is another example. Since it blocks enzymes that metabolize certain drugs, grapefruit juice should never be taken with medications to lower blood pressure, or with terfenadine, an antihistamine, or cyclosporine, a drug used to prevent transplant rejection.
Dangers of Common OTC Drugs
Millions of Americans take daily doses of acetaminophen (Tylenol), ibuprofen (Advil), naproxen (Aleve) or aspirin to relieve aches and pains, stiffness in muscles and joints, fevers and inflammation. Because they do not require prescriptions, and are touted by “experts” and advertisements as safe and effective, these OTC drugs are considered okay to use. Many Americans believe they can take them indefinitely, and they don’t even consider the potential negative side effects.
While OTC drugs are safe when taken only as directed, they are only meant to be taken for a short duration. Any symptom or condition that persists for longer than 10 days requires medical attention. Stop taking the OTC medication and see your doctor.
Let’s take several of these OTC drugs and look at the warnings and potential side effects listed on the labels.
• Aleve – This naproxen NSAID pain reliever is for temporary relief of minor aches, pains and temporary reduction of fever. Several warnings are listed on the packaging and container labels including:
o Allergy alert – Naproxen sodium may cause a severe allergic reaction, especially in people allergic to aspirin. Symptoms may include asthma (wheezing), blisters, facial swelling, hives, rash, shock, or skin reddening. If an allergic reaction occurs, stop use and seek medical help right away.
o Stomach bleeding – Naproxen sodium may cause stomach bleeding. Do not use if you have ever had an allergic reaction to any other pain reliever/fever reducer or right before or after heart surgery. Ask a doctor or pharmacist before use if you are taking any other drug. Stop use and ask a doctor if you have any signs of stomach bleeding (faintness, vomiting blood, or bloody/black stools), or if pain or fever gets worse.
o If pregnant or breast-feeding – Ask a health professional before use.
o Keep out of reach of children.
o In case of overdose – Get medical help or contact a Poison Control Center right away.
• Aspirin-Free Excedrin PM – This OTC contains acetaminophen and diphenhydramine citrate. Uses include temporary relief of occasional headaches and minor aches and pains with accompanying sleeplessness. Warnings include:
o Do not take this product, unless directed by a doctor, if you have a breathing problem such as emphysema or chronic bronchitis, or if you have glaucoma or difficulty in urination due to enlargement of the prostate gland.
o Avoid alcoholic beverages while taking this product.
o Do not take this product if you are taking sedatives or tranquilizers, without first consulting your doctor.
• Low-Dose Bayer 81 Aspirin – This low-dose (81 milligram) pain reliever for temporary relief of minor aches and pains carries numerous warnings on the packaging and label.
o Because of its delayed action, this product will not provide fast relief of headaches or other symptoms needing immediate relief.
o Aspirin is not appropriate for everyone, so be sure to talk to your doctor before you begin an aspirin regimen.
o Reye’s syndrome – Children and teenagers should not use this medicine for chicken pox or flu symptoms before a doctor is consulted about Reye’s syndrome, a rare but serious illness reported to be associated with aspirin.
o Allergy alert – Aspirin may cause a severe allergic reaction which may include hives, asthma (wheezing), facial swelling, or shock.
o Alcohol warning – If you consume three or more alcoholic drinks every day, ask your doctor whether you should take aspirin or other pain relievers/fever reducers. Aspirin may cause stomach bleeding.
o Do not use if you are allergic to aspirin or any other pain reliever/fever reducer.
o Ask your doctor before use if you have stomach problems (such as heartburn, stomach pain, or stomach upset) that last or come back, asthma, bleeding problems, or ulcers.
o Ask a doctor or pharmacist before use if you are taking a prescription drug for anticoagulation (blood thinning), arthritis, diabetes, or gout.
o Stop use and ask a doctor:
- If an allergic reaction occurs – seek medical help right away
- Pain gets worse or lasts longer than 10 days
- Redness or swelling is present
- New symptoms occur
- Ringing in the ears or loss of hearing occurs
o If pregnant or breast-feeding, ask a health professional before use. It is especially important not to use aspirin during the last three months of pregnancy unless definitely directed to do so by a doctor because it may cause problems in the unborn child or complications during delivery.
o Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center right away.
Tips on Correct Use of OTC Drugs
Of course, there are times when OTC drugs are safe and effective to use. But do keep in mind the following tips:
• Read labels – Thoroughly read the labels and all information, including warnings and side-effects.
• Risks/benefits – Understand the potential risks as well as the benefits of taking the OTC drug.
• Dosage directions – Pay attention to how much and how often to take the OTC medication. Do not use more than directed.
• Restrict access – Keep all medications, prescription and OTC, out of reach of children.
• Limit use – Do not use OTC medicines for longer than 10 days. They are meant for only short-term use.
• Don’t get lazy – Just because you’ve used the OTC drug in the past with no adverse reactions, don’t think that this will always be the case. Similarly, if you don’t see immediate results, don’t think that more is better. Overdose and potentially harmful side effects may result.
• If symptoms worsen – Consult your doctor if symptoms persist or get worse.
• Talk with your doctor – Before taking any new medications, prescription and/or OTC drugs, talk with your doctor. Ask if it’s safe to take this new medication, alone or with other prescription or OTC drugs, as well as herbal products or vitamins.
• Keep a drug list – Maintain a current listing of all drugs (prescription and OTC), vitamins, herbal products you take and provide it to your doctor.
• Use a single pharmacy – To avoid potential drug interactions and other problems, use a single pharmacy for all your prescription and OTC medications.
• Never give or take medicines in the dark – Turn on the lights so that you can see what you are taking or administering. Also, never give medication to a child who is not fully awake.
• Don’t use household utensils to dispense medicine – Household spoons or utensils are not accurate enough to dispense OTC medications. Ask your doctor or pharmacist about the correct dispensing mechanism. This may be an oral syringe or medication dosing spoon.
• Check for signs of tampering – Make sure the safety seal is intact on any OTC medicines. Do not use the product if there appear to be any signs of tampering.
• Be on the lookout for duplicate ingredients – Make sure to double-check all ingredients of any other medications taken at the same time as the OTC medicine to avoid duplicate ingredients.
• Discard expired OTC drugs – Never keep OTC medications (or any prescription medicines) past their expiration date. Discard them, but do not flush them. Contact your local pharmacy, recycling coordinator, or municipality to see if there’s a hazardous waste collection center near you.
When In Doubt
It’s always better to err on the side of caution. When in doubt, ask your doctor or pharmacist about any potential drug interactions, the advisability of taking OTC and/or prescription drugs, how long to take and what other remedies may be available.
Keep phone numbers handy for use in medical emergencies, including your doctor, hospital, Poison Control Center, and emergency medical personnel.
Remember, just because it’s available at the drug or grocery store counter doesn’t mean that an OTC drug is safe to take in all circumstances. Use caution, thoroughly read all labels, and take only according to directions and dosing instructions. Do not mix alcohol and OTC or other prescription drugs. Watch out for any drug interactions. And stop taking and seek medical attention if symptoms get worse or last longer than 10 days.
The best advice is to think twice before taking any OTC medication. If you don’t really need it, or your doctor doesn’t advise it, don’t take it. Your health may be at stake.
For further information and links to other resources on OTC medicines, visit Medline Plus.
