Introduction

The English physician and educator Peter Mere Latham (1789 – 1875) once stated, “Poisons and medicines are often times the same substance given with different intents.” Though the intent is the same in our discussion, over-the-counter medications can have poisonous effects if misused and/or misunderstood of what adverse effects they may have on different individuals.

The misuse of over-the-counter medications has most recently become more widespread with much more medical information at consumers fingertips via the Internet, magazines, and television. And while it is good that consumers are taking a proactive approach to their health, self-medicating with over-the-counter medications is a responsibility that should be taken seriously.  

During our research into this topic of consumer misuse of over-the-counter medications, we found that the deception of safety regarding these medications, to consumers, is not only due to inadequate warning labels and product information, but also their mass availability. This availability in turn creates a false sense of security on the part of the consumer. Individually or combined these issues have the potential to cause harm, as more than 200 million people in the United States and roughly 50% of the elderly population regularly take some kind of over-the-counter medication. In this blog, we will explore some of the dangers and adverse effects that over-the-counter medications have on idividuals taking and/or misusing them. As more and more people turn to over-the-counter medications to relieve their ailments, both consumers and people in the health care field need to be aware of the potential risks involved and further educate themselves on what to do if adverse reactions occur.

Commonly Misused Over-the-Counter Drugs

When you browse the over-the-counter (OTC) medicine aisle of a store such as Wal-Mart or Walgreens, you may be overwhelmed at the variety of available drug products used to treat similar conditions.  These drugs do not require a prescription to purchase.  In some cases, consumers will buy two different OTC drugs thinking that each has different effect.  But in reality, these two products that are promoted to be used for different conditions may contain the exact same ingredients. Hence, the misuse or abuse of OTC drugs. 

OTC drugs are not perfectly safe.  Similar to prescription drugs, OTC drugs can have negative side effects, including some that can severely damage your overall health.

Here are some of the most commonly misused OTC drugs, that you may even use use, possibly on a daily basis, that you can easily find in a drug store or supermarket:

     1.  Pain relievers –  medications such as acetaminophen (Tylenol) and ibuprofen (Motrin)

     2.  Cough and Cold medications  –  found in any cold medicine with “DM” or “Tuss” in the title or name such as Robitussin, Nyquil, Vicks Formula 44, and Cough/Cold tablets contain a chemical DXM (Dextromethorphan).

     3.  Sleep aids

     4.  Diet pills

A common assumption made by many, is the belief that if 2 or 4 Tylenol do not relieve their symptoms, taking more might work.  The consequence can be acetaminophen toxicity, which is one of the most common causes of acute liver failure.

More on DXM:

Dextromethorphanis the active ingredient and cough suppressant found in many OTC cough and cold medications.  When taken in recommended doses, these medications are safe and effective.  It is taken orally.  When consumed in excessive amounts, people can experience the mind-altering effects. These effects include impaired motor function, numbness, nausea/vomiting, and increased heart rate and blood pressure.  On rare occasions, hypoxic brain damage has occurred due to the combination of DXM with decongestant often found in these medications.

 Here is a newsclip from Today’s Show regarding teens using DXM:

http://www.youtube.com/watch?v=5rrVY4L2XPg

Please feel free to post your comments below.

Resources:

http://www.medem.com/medlb/article_detaillb.cfm?article_ID=ZZZ5A5UFHZD&sub_cat=0

http://www.teenoverthecounterdrugabuse.com/myths-otc-drug-use.html

http://www.drugabuse.gov/drugpages/prescription.html

http://www.youtube.com/watch?v=5rrVY4L2XPg

Over-the-Counter Abuse by Teens

Teen use of over-the-counter drugs has been a rising abuse.  Many parents are oblivious to the fact that their children are buying and overdosing on medications to get “high”.  It is very important for parents to educate themselves about the potential abuse of these products that can be found in the home.  What is more important is to monitor these medications around children.

One very popular OTC drug that is abused is cough/cold medications.  Many of these medications such as Vicks44, Nyquil, Robitussin, and Coricidin contain Dextromethorphan (DMX).  DMX is a synthetic derivative of morphine.  Teenagers have nicknamed these drugs with names such as Robo, Skittles, and Triple C’s just to name a few.  The main reason OTC drugs appeal to teenagers is the the reasonable price and the fact that the drugs are legal.  Other pills that are abused often by teens include diet pills, sleep aids, and motion sickness medication.  All of these drugs can be extremely dangerous, especially when consumed in large doses. 

Many teenagers do not think about the dangers of abusing OTC drugs as they simply see it as a way to get high.  Some effects include addiction, heart palpitations, blackouts, seizures, and even death.  Long term effects include liver and brain damage.

Resources are available to everyone interested in learning more about OTC drug abuse in teens.  Websites offer ways to identify when a teen is abusing drugs.  Teen abuse is becoming more common and more serious everyday.  It is important that information is made available to the public to help prevent future use by teens.

Please join in this discussion by posting your comments below.

For more information, refer to the following websites:

http://www.freevibe.com/Drug_Facts/prescription_OTC_full_article.asp

http://www.teendrugabuse.us/over_the_counter_drug_abuse.html

http://www.theantidrug.com/DRUG_INFO/drug_info_dxm.asp

http://abcnews.go.com/WNT/Health/story?id=1419151

http://kidshealth.org/research/otc_abuse.html

Over-the-Counter Drug Misuse in Pregnant Women

What can you do if you get sick while you are pregnant? As you can imagine it is not a pleasant experience to be pregnant and have a common cold or a mild fever. You are probably use to getting a cough and fever reduction medication and solve these problems. However, now that you are pregnant it is not as simple as that. Many drugs readily pass through the placenta and can hurt your baby – especially during the first 60 to 90 days of pregnancy. It is best not to administer any drugs (including OTC medications) to pregnant women because of the possible risks to the fetus. Drugs (prescribed and OTC) should only be given to pregnant women when the benefits clearly outweigh any risk and with the approval of your health care provider. Lets go back to the question: What can you do if you get sick while you are pregnant? Before taking any OTC/herbal medication always talk to your health care provider first. Some medications are considered safe during pregnancy while others are considered very dangerous because they can cause fetal malformations and even death. It is required that all medications include pregnancy/breast-feeding warning on their labels.

However, OTC medications do not include a pregnancy category, but they include a Drug Facts label . New moms-to-be always consult your health care provider before taking an over-the-counter medication. Click here to review a chart with common OTC medications and see how they affect pregnancy.

Submit your thoughts and comments below.

Adverse Effects of Over-the-Counter Medications

You may be wondering who is at risk for adverse side effects due to the misuse of over-the-counter (OTC) medications. Well, everyone is potentially at risk.  As reminded in the Merck Manual, safety primarily depends on the consumer using a drug properly. And the first step of proper use for OTC drugs, often relies on consumer self-diagnosis. 

The individuals who pose the highest risk of experiencing adverse effects of the misuse of OTC medications are young children, older adults, women who are or trying to get pregnant, lactating women, people with preexisting health problems, as well as individuals who are also taking prescription drugs. 

OTC drugs are numerous here in the United States, as can be seen in any supermarket and/or drugstore, and they address a variety of aliments.  Some common reasons people take OTC drugs are for cold & cough, heartburn, headaches, sleep aids, and pain relief.  Taking such OTC drugs for their recommended duration of time and in their recommended doses permits safety for most consumers.  However, what happens when these drugs are taken regularly over a longer than recommended time and/or in larger than recommended doses?  

A common OTC drug used in many cold and allergy medications is pseudoephedrine. According to the Fourth Edition of the Poisoning and Toxicology Handbook, some of the adverse effects that can result from its use are headache, tachycardia, palpitations, seizures, nervousness, insomnia, and tremors. Overdosing on pseudoephedrine can cause depression, convulsions, nausea and vomiting. As discussed in the journal U.S. Pharmacist, there is also much research being directed to this drug’s link to strokes.

Another drug found in many OTC sleep aids and allergy medications, such as Unisom and Benadryl, is diphenhydramine. The adverse effects of taking this particular OTC drug include hypotension, blurred vision,  and angioedema. It is also noted in the handbook, an overdose of a drug containing diphenhydramine may result in coma, tachycardia, toxic psychosis, and even death in infants and children.

In examining the label of a commonly used OTC drug, NyQuil, it states the warnings for the possibility of overdosing. It reads: “Taking more than the recommended dose can cause serious health problems, including liver damage.”  Visit the following link to read more about the possible dangers of NyQuil: http://www.vicks.com/nyquil-cold-flu.php

It is important to know that each OTC drug class, including those listed above, have different adverse effects on different individuals.  And always be careful when taking any kind of drug. Make sure to read the product label thoroughly to know if it is a safe OTC drug for you to take. Finally, know the recommended dosage, duration of use, common side effects, as well as any warnings pertaining to the particular drug. Please offer your thoughts and/or personal stories relating to this discussion below. To learn more, please visit these websites: 

http://gwired.gwu.edu/cms2/index.gw/Site_ID/5157/Page_ID/13632

http://familydoctor.org/online/famdocen/home/otc-center/basics/853.html

http://www.uspharmacist.com/index.asp?show=article&page=8_1302.htm

http://www.merck.com/mmhe/sec02/ch018/ch018a.html

Misuse of Over-the-Counter Medications Containing Acetaminophen

Acetaminophen is a widely used pain-killer and fever-reducer that can be found in many over-the-counter (OTC) medications, including numerous pain relievers, sleep aids, as well as cold, cough, and flu remedies. For most consumers, medications containing acetaminophen can be taken safely, following the recommended usage, dosage, and duration. But in a recent study published in InterScience, acetaminophen-associated overdoses account for about 56,000 emergency room visits yearly, causing 458 deaths, many of which were accidental.

Such accidental overdosing on medications containing acetaminophen, has been caused by not only some individuals hypersensitivity to acetaminophen, but also by individuals taking such medications for more days than recommended, and/or by interactions with other drugs, and/or by taking acetaminophen-containing medications with alcohol.

In another recent publication, by the U.S. Food and Drug Administration, it was stated that taking more than the recommended dose of acetaminophen can lead to serious liver damage. As listed in the Poisoning and Toxicology Handbook, acetaminophen can cause adverse reactions to the liver including, but not limited to, hepatic encephalopathy, hepatitis, jaundice, and cirrhosis. Thus, taking over-the-counter medications that include acetaminophen should be taken with care due to its risk of toxicity and to the potentially severe, even fatal, liver damage.

In another article published recently in the journal of Infectious Diseases Society of America, is was stated that acetaminophen is one of the few drugs currently in clinical use that is associated with predictable dose-related liver toxicity. And, according to the same above referenced study in InterScience, acetaminophen toxicity is the foremost cause of acute liver failure in the United States.

These facts and figures have astounded me as a regular consumer of acetaminophen pain-relievers and cold remedies. Both consumers and individuals in the health care field need to realize how far reaching OTC acetaminophen misuse is and the potential dangers inherient in the misuse of this or any OTC drug.

I would like to end by reminding you as with any drug product, over-the-counter medications containing acetaminophen should be taken with great caution. There are potential risks involved, though rarely when taken according to the recommendations printed on the product packaging. Minor oversights or lack of understanding or knowledge can have serious consequences to the consumer.

Please feel free to join in this discussion and offer your thoughts and opinions by posting a comment below. And if you have questions or concerns about the medications you are taking or plan to take you should always speak to your doctor or pharmacist. For additional information about acetaminophen and its dangers, please view the following websites:

http://www3.interscience.wiley.com/journal/112149032/abstract

http://www.fda.gov/fdac/features/2003/103_pain.html

http://www.journals.uchicago.edu/doi/full/10.1086/381446

http://query.nytimes.com/gst/fullpage.html?res=9C06EFDF1431F934A25750C0A9629C8B63&scp=1&sq=acetaminophen+misuse&st=nyt