Misuse of over-the-counter, or OTC drugs, has not received the same 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 professional medical advice.
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 therefore do not require the same attention to detail as prescription medications.
Not so.
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. Since 1976 the FDA approved that transition for more than 700 products, according to the FDA’s Prescription to OTC Switch List.
Some drugs that have made the switch are well known: the antihistamines Claritin-D and Zyrtec and the acid reducer Prevacid 24 HR. Also, ibuprofen, a common pain killer, got its walking papers 30 years ago.
There’s one catch though. That switch and the resultant ease of access did not necessarily reduce their potency.
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. Taking 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. The current maximum daily dose is 4,000 milligrams, and prolonged excessive use can result in liver damage. Because acetaminophen overdoses have contributed to numerous emergency room visits, hospitalizations and deaths each year, the FDA asked drug manufacturers to limit the strength of acetaminophen in prescription combination drug products to 325 mg per tablet or dosage.
That tackles the problem with prescription drugs, but a similar request was not applied to OTCs. Tylenol especially is tricky because of its many products with varying potencies of acetaminophen. For instance, each pill of Tylenol Extra Strength contains 500 mg of the drug versus 325 mg for regular strength.
In addition, dozens of other non-prescription drugs, such as Coricidin contain acetaminophen. 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 — even on OTC drugs.
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 — could decrease the effectiveness of some medications used for HIV/AIDS 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.
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 and requires monitoring.
The bottom line is that if your physician has not recommended a particular OTC it is advisable to seek advice from a pharmacist who can determine from your symptoms, medical history and current medication, the best option for you.
Doing it on your own can have serious and avoidable consequences.
