Most Americans don’t think twice about taking over-the-counter medication to treat a variety of ailments.
Before seeing a doctor, many take non-prescription drugs for such conditions as allergies, colds and flu, headaches, toothaches and constipation. In 2015, U.S. residents made nearly 3 billion retail trips to buy OTC products, according to the research organization IRI based in Chicago.
Taken as directed, non-prescription medications are typically safe and effective, says Dr. Michael Lynch, a toxicologist at the University of Pittsburgh Medical Center and director of the Pittsburgh Poison Center. But some OTC drugs can cause health problems and even death if taken in the wrong dosage or in the wrong combination with other medications, including prescription meds.
Deadly Overdoses
Acetaminophen — the active ingredient in Tylenol, which makes an array of products to treat arthritis, headaches, sinus congestion and cold and flu symptoms — was associated with about 360 deaths nationwide in 2016, according to the American Association of Poison Control Centers. Officials are still working on the 2016 database, so the final number could change, says Angela Gonzales, a spokesperson for the association. In the U.S., about 60,000 people a year are hospitalized for acetaminophen overdose complications, according to a study published in 2016 in the Journal of Clinical and Translational Hepatology; the vast majority of these incidents aren’t fatal. Overdosing on acetaminophen is the leading cause of acute liver failure in the U.S., according to the Acute Liver Failure Study Group, a project funded by the National Institutes of Health. The substance accounts for 46 percent of incidents of acute liver failure in the U.S., says Dr. William Lee, founder of the study group and a professor of internal medicine at UT Southwestern Medical Center in Dallas.
Using more than the recommended amount of acetaminophen over a period of several days rather than taking a large single dose at one time or in one day accounts for the vast majority of accidental overdoses, Lynch says. “Our experience is that people with unintentional acetaminophen toxicity have it from taking excessive doses over time, usually days, to treat some kind of pain,” he says. A study published in the Annals of Internal Medicine in 2016 found that 52 percent of 935 patients who suffered an acetaminophen overdose between the years 1998 and 2013 took too much of the substance unintentionally.
“I think sometimes people get impatient, they want that quick fix,” says Heather Free, a pharmacist based in the District of Columbia and a spokesperson for the American Pharmacists Association. “They assume the medication will alleviate all kinds of pain, so they keep taking more and more” without realizing they may be overdosing, says Free, who is the director of clinical initiatives at Maxor National Pharmacy Services. Overdosing isn’t the only concern, either; acetaminophen use during pregnancy, for example, has been linked to child behavior problems.
[See: Your Guide to Over-the-Counter Pain Relief.]
Safe Dosage Levels
Each over-the-counter medication that contains acetaminophen has between 325 to 650 milligrams of the substance, according to Harvard Health Publications. The makers of Tylenol have lowered the maximum daily dose for single-ingredient Extra Strength Tylenol from 4,000 milligrams to 3,000 milligrams per day.
Some people who keep track of their Tylenol intake may nonetheless overdose on acetaminophen because they unknowingly take other medications that contain it. More than 600 over-the-counter and prescription medicines contain acetaminophen, according to the National Council on Patient Information and Education. Over-the-counter drugs that can have acetaminophen include Anacin, Benadryl, Midol and Sudafed. Prescription medicines that contain the substance include Lortab, Percocet and Vicodin.
Antihistamines Dangerous for Infants
Other OTC medications can also have harmful effects if taken in the incorrect dosage or in the wrong combination with other drugs. For example, in early May, the Connecticut Child Fatality Review Panel issued an alert to parents and other caregivers of infants to avoid giving antihistamines like Benadryl to infants to get them to be quiet or go to sleep.
The alert was prompted by the deaths of at least three children since 2015, each about a year old, who were given antihistamines, says Dr. Kirsten Bechtel, co-chairman of the panel and an associate professor of pediatrics and of emergency medicine at the Yale School of Medicine. Adults should never provide antihistamines to children under age 2, she says, since they can cause cardiac arrhythmia, seizures and hallucinations. They should be used under the guidance of a licensed medical provider to treat a specific medical condition, such as eczema, she says.
[See: Behind the Window: What Pharmacists Do.]
Bad Combinations
Other non-prescription medications can cause health problems if taken in the wrong combination with other drugs or with herbal remedies. For example, if aspirin is taken with such nonsteroidal anti-inflammatory drugs as Advil, Alleve and ibuprofen, it could cause stomach upset or, in severe cases, gastrointestinal bleeding, says John Beckner, senior director of strategic initiatives at the National Community Pharmacists Association. And taking blood thinners to prevent clots while also ingesting NSAIDs could cause internal bleeding.
When taken together, St. John’s Wort — an herbal supplement taken to treat depression and anxiety — and medication containing the cough suppressant dextromethorphan can also have negative effects. This combination could create a buildup of the neurotransmitter serotonin, which can cause side effects such as confusion, sweating and, in rare cases, death, says Connie Kang, an assistant professor of clinical sciences at Keck Graduate Institute School of Pharmacy, which is a member of the Claremont Colleges consortium in California.
Experts recommend these strategies to assure you take OTC medications safely:
1. Read labels carefully. “Many times, people don’t read the labels of their medications,” Free says. “People really need to pay attention to those instructions; they’re there for a reason.” Carefully note the directions regarding dosage and whether the medication should not be used if you have a certain condition, such as high blood pressure, and whether it should not be taken in combination with other drugs. “For OTC medications, the warnings the FDA feel are essential should be on the package,” Lee adds. “The reason to read the labels is because acetaminophen is found in so many medications, more than 600 different OTC medications, so you may be taking several different drugs containing acetaminophen at the same time, and you wouldn’t know it unless you read the labels carefully.”
2. Talk to your doctor or pharmacist. If you have any doubt about the safety of a medication, ask your physician or pharmacist, says Dr. Eduardo Guerrero, a staff physician at Whitman-Walker Health, a community health center in the District of Columbia. “I’ve intercepted patients who were on chronic pain meds who were taking medication with high levels of acetaminophen,” he says. “I try to steer them to products that are acetaminophen-free.” These include NSAIDs such as ibuprofen.
3. Don’t hesitate to ask for help from a pharmacist other than your own. People don’t always buy their OTC drugs from the store where their pharmacist is located. If you buy non-prescription drugs at a store where you don’t know the pharmacist, don’t be shy about asking him or her for help, Kang says. “They’ll be glad to help you even if they aren’t your regular pharmacist,” she says. You can also call a regional poison center at 1-800-222-1222 from anywhere in the U.S. 24 hours a day to talk to an expert who can help you with questions about medications free of charge, Lynch says. There are 55 poison centers nationwide.
[See: The 5 Latest Poison Control Threats Kids Face.]
4. Don’t leave anything out. When consulting with your doctor or pharmacist, tell him or her every drug, herbal supplement or medicated cream you’re taking, Kang says. The more information your health care professional has, the better he or she will be able to assist you. “Be sure to include a complete medication history, which includes prescription, over-the-counter drugs and vitamins and herbal supplements,” Free says.
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OTC Products: How Much Is Too Much? originally appeared on usnews.com
