OTC Drugs Have Side Effects, too -- Don't Overdose

OTC is short for over the counter. These are medicines that are available to consumers without a prescription. As a general rule, over-the-counter drugs must be reasonably safe and well-tolerated. But all have side effects that can be life-threatening with abusive over-use.

By definition, non-prescription drugs treat conditions that don’t require direct supervision of a doctor. In effect, consumers self-medicate when they use such products for treatment of pain, allergies, flu or coughs. These medicines have a low risk of side effects when used occasionally by healthy adults.

OTC drug retail sales is big business and growing in the U.S., accounting for $34.3 billion in 2017, compared to $14.7 in 2000, according to Statista.com. These statistics do not include vitamins, minerals or nutritional supplements. https://www.drugs.com/otc/

There are more than 80 classes of OTC pharmaceuticals, ranging from acne medicines to weight loss products. Popular examples include pain relievers like acetaminophen (Tylenol) and ibuprofen (Advil, Motrin), cough suppressants such as dextromethorphan (Robitussin) and antihistamines like laratadine (Claritin 24H). They treat a variety of symptoms due to illness including pain, coughs, colds, diarrhea, heartburn, constipation, acne and others. According to Drugs.com, the top 20 OTC related searches are:

  1. Advil
  2. Aleve
  3. Cepacol Antibacterial
  4. Childrens Dimetapp
  5. Claritin
  6. Colace
  7. Cortaid
  8. Dulcolax
  9. Excedrin
  10. Gaviscon
  11. Lotrimin AF
  12. Maalox Antacid
  13. Midol
  14. Motrin IB
  15. Orajel
  16. Pepto-Bismol
  17. Rolaids
  18. Tagamet HB
  19. Tylenol
  20. Zantac

Extended use, or continuous use such as for chronic pain, can pose risks especially for those 60 and over, those taking more than one medicine, and people with , heart, kidney or liver problems. These consumers have an increased risk of side effects when they take OTC medicines.

National Consumers League: Over the counter NSAID painkillers have great risk potential

Popular non-steroidal anti-inflammatory drugs (NSAIDs), such as Advil or Aleve, commonly used for pain relief have proven to trigger adverse drug events (ADE) when used for extended periods of time or consumed in doses outside label warnings.

Research has demonstrated that more than 16,500 people die each year and 103,000 are hospitalized from serious NSAID-related complications. Additionally, studies have shown that the use of OTC NSAIDs increases the risk of stomach bleeding by two to three times and that most serious side effects can occur without warning symptoms.

The National Consumers League (NCL) in Washington, D.C. announced a campaign in 2002 to educate 30 million consumers who daily take NSAID pain relievers, about the possible danger of these products. They also launched a campaign in October 2013 to alert and warn teens to use OTC medications safely during the school year.

People mistakenly assume non prescription medications are safe

“People mistakenly assume that if a prescription is not required for a medication that is sold in a drugstore or a supermarket, then it must be safe,” said Linda Golodner, president of the NCL, the nation’s oldest consumers advocacy organization. “As a result, consumers who too often self-diagnose and self-treat without seeking a doctor’s advice unwittingly put themselves at risk for potentially deadly consequences.”

A national health survey quoted by the NCL revealed that only 5 percent of respondents discussed the potential risks for serious side effects such as stomach bleeding, ulcers, and kidney and liver problems with their physicians. Only 40% said they’d never talked with a pharmacist or health professional about OTC medications.

“It’s clear that what we’re showing here is just a snapshot of this growing health care management problem,” Golodner added.

Chronic pain and prolonged use of OTC painkillers causes side effects

Many people suffer from chronic pain. There are 100 types of arthritis and nearly all are characterized by symptoms of joint pain, inflammation, swelling and stiffness. Back pain is another chronic problem.

The most common over the counter NSAIDs include aspirin, ibuprofen, and naproxen.

Potential side effects from these OTC drugs and their brands are shown below:

  • Aspirin (Bayer, St. Joseph, Bufferin): Causes stomach and intestinal bleeding, stomach pain, heartburn, dizziness, and constipation. Prolonged use can cause ulcers, kidney and liver damage.

  • Ibuprofen (Advil, Motrin): Causes stomach and intestinal bleeding (especially when combined with alcohol), gas, bloating, stomach pain, heartburn, dizziness, and constipation. Prolonged use increases risk of stroke and cardiac arrest, causes ulcers, elevated blood pressure, kidney, and liver damage and death.

  • Naproxen (Aleve): Causes stomach and intestinal bleeding, stomach pain, heartburn, dizziness, and constipation. Prolonged use increases risk of stroke and heart attack, ulcers, elevated blood pressure, kidney and liver damage, and death. Aleve has the same side effect as Advil or Motrin.

Acetaminophen (Tylenol) is another OTC painkiller causing side effects

Another popular counter-sold painkiller is acetaminophen with several preparations sold under the brand name Tylenol. Acetaminophen is not an NSAID. It’s a widely-used analgesic and antipyretic medication derived from coal tar.

Acetaminophen relieves mild pain and reduces fever. It is not completely understood the way acetaminophen relieves pain. It is known that unlike aspirin and NSAIDs (which work in the skin, muscles and joints), acetaminophen blocks painful sensation in the brain and the spinal cord. However, it has no therapeutic affect on the symptoms of stiffness and inflammation or moderate-to-extreme pain found in arthritis.

The side effects, when used appropriately, are rare. The most serious side effect is liver damage due to large doses, chronic use or concomitant use with alcohol or other drugs that also damage the liver. Chronic alcohol use may also increase the risk of stomach bleeding.

Caution: Keep in mind that it's easy to excess-dose on acetaminophen by taking two or more medicines that contain it, like Tylenol Plus, NyQuil, or Benadryl Allergy/Cold, and prescriptions like Vicodin or Percocet.

Other common OTC products

In addition to painkillers, three of the most common other types of over-the-counter products include antihistamines, decongestants and cough medicines.

Antihistamines block the receptors that cause itching, nasal irritation, sneezing and mucus production. Antihistamines consist of three types:

  1. Diphenhydramine, in products such as Benadryl Allergy, Banophen and Diphenhist

  2. Brompheniramine, in products such as Dimetapp Allergy

  3. Chlorpheniramine, in products such as Chlor-Trimeton Allergy, Aller-Chlor, Chlo-Amine

Antihistamine side effects include sedation or drowsiness and can significantly impair a person's ability to drive or operate machinery. The sedative effects of antihistamines may increase the risk of falling. Antihistamines can also cause temporary dry mouth or dry eyes.

Decongestants narrow blood vessels in the nose lining, restricting blood flow through the nasal area causing swollen tissue in the nose to shrink. The only active substance in OTC decongestants is pseudoephedrine, found in brand names such as Sudafed, Allermed and Genaphed.

Decongestant side effects include tempory nervousness, dizziness and sleeplessness. It can cause loss of appetite or urine retention. It can also cause heart palpitations, high blood pressure or high blood sugar levels.

Cough Medicines are separated into two types, antitussives and expectorants:

  1. Antitussives (cough suppressants) block the cough reflex. Dextromenthorphan is a common antitussive contained in brand names such as Robitussin Pediatric, Pertussin CS, Delsym and Drixoral.

    Side effects of dextromethorphan include feelings of confusion, agitation, nervousness or irritability. It has a lower risk of sedation and GI side effects.

  2. Expectorants clear mucus from the airway by thinning mucus to make coughing more productive. Guaifenesin is the only expectorant used in OTC products, found in brand names such as Robitussin, Tusibron and Guiatuss.

    Side Effects of Guaifenesin include feeling jittery, cervical mucus, mental confusion, and occasional fatigue.

Alcohol and OTC medicines

Alcohol and over-the-counter pain relievers, antihistamines, decongestants and cough medicines do not mix.

You may be at increased risk of GI bleeding if you use NSAID painkillers and drink more than one alcoholic beverage per week. If you consume 3 or more alcoholic beverages each day, you should consult your physician before using any pain reliever.

The combination of non-prescription antihistamines and alcohol can increase drowsiness, especially in elderly people. Alcohol also makes the drowsiness, sedation and impaired motor skills associated with cough suppressant dextromethorphan worse.

The bottom line is that occasional consumption of OTC medicines within maximum dosage warnings is not likely to cause serious side effects, even with painkillers. However, there is a significant population in the U.S. that depends upon daily intake of these non prescription medicines.

Prolonged and continuous use of any of these counter-sold drugs, especially pain relievers, increases the potential for adverse health reactions, some of which without noticeable warning symptom, including fatalities.

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