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Exercises
Hidden Dangers
of Over the Counter Drugs
by
William Fcenbarger
When
the 18-year-old staggered into the emergency room, she was
wild-eyed and gasping for air. Her air passages were swelling
dramatically. Quick-acting doctors in that Midwestern hospital
managed to regulate her breathing with an emergency . She was admitted
to the respiratory intensive-care unit for follow-up treatment
and eventually recovered.
The young woman's nearly fatal experience
was brought on by an allergic reaction to aspirin. She knew
she was allergic to aspirin, but she had taken it .
How?
At the onset of a headache, she had reached
for a common over-the-counter (OTC) drug that she thought
contained .
It did—but had she bothered to read the label closely, she
would have seen the small print that said it also contained
aspirin.
A near-death experience with an OTC drug is,
thankfully, uncommon. But the young woman's mistake─failure
to read the label─is all too common. A survey by the American
Pharmaceutical Association last year found that 47 percent
of adults did not always read the labels on OTC pain relievers,
fewer than 40 percent consulted a pharmacist before taking
these products, and 43 percent were unaware of the potential
risks associated with taking these remedies along with prescription
medicines.
The dangers can be considerable. The remedies
we buy for allergy, headache, upset stomach and other common
ailments are drugs. And they must be used responsibly. If
you are taking prescription medications, be sure to consult
your doctor or pharmacist. Consumers who disregard warnings
on the labels and the package inserts before they swallow,
spray, sip, inhale, insert or smear one of the 100 000 OTC
remedies now on the market are taking a risk.
Here
are some of the pitfalls:
Overdosing
"There is the idea that if one doesn't work,
I'll try two," says Joe Graedon, a pharmacologist and author
of The People's Pharmacy book series. That is not
a good idea.
Earlier this year a 45-year-old truck driver
showed up at the Houston Headache Clinic complaining of
headaches. The
pain would throb and pulsate, waking him out of a sound sleep
and making him nauseated.
It didn't take long to find the problem. The
man had been swallowing about 200 Excedrin Migraine tablets
weekly for nearly a year. The label warns users not to take
more than eight tablets per day and not to use the medication
for more than 48 hours. Each tablet contains 250 grams of
acetaminophen, 250 grams of aspirin and 65 grams of caffeine.
"This
is the classic rebound headache," says Dr. Ninan T. Mathew,
clinic director. "As the pain got worse, he took
more and more painkiller, thinking this was a safe product.
We took him off all daily pain medication, introduced a
relaxation and stress-management program and gave him drugs
to prevent migraines. He is progressing well. "
While no definitive studies have been done,
Mathew estimates that between two and three percent of the
population─as many as eight million Americans─may be overusing
OTC headache remedies.
Many OTC products are merely lower-dose versions
of drugs that can only be obtained with a prescription. For
example, the painkiller Orudis KT is a version of the prescription
drug ketoprofen, which can cause ulcers and severe stomach
bleeding if taken in high doses or for an extended period.
"Habitual and chronic use of pain relievers that have more
than one active ingredient may be risky," warns Dr. William
Henrich, chairman of the National Kidney Foundation's public-policy
committee. "This could lead to kidney damage and a reduction
in kidney function." Some experts, though, say an association
between kidney disease and use of combination analgesics has
not been proved. In any case, these drugs are considered safe
when used as directed.
Interaction
Medical authorities urge anyone taking a prescription
medicine, especially those with a chronic illness, to consult
with a doctor or pharmacist before taking any OTC drug. Millions
of Americans, for example, take Tagamet HB, a popular remedy
for heartburn, acid indigestion and other minor stomach problems.
But if they're also taking the widely prescribed drug Coumadin
(used to prevent blood clots), they're at risk. Tagamet HB
and Coumadin can interact in a way that, in severe cases,
may cause internal hemorrhaging and bleeding from the mouth,
nose, rectum and urinary tract. The warning about this interaction
is present on the Tagamet label, but the reference is to warfarin,
the generic name for Coumadin. (The package insert, though,
refers to both the brand and generic names. )
Anti-depressants are now among the most widely
used drugs in America. Prozac, for example, is America's fifth
most often dispensed drug. "People on medication for depression
have to be careful about using cold remedies," notes Grant
Shetterly, a fellow at the Center for Proper Medication Use
in Philadelphia.
A common ingredient in many cough suppressants,
dextromethorphan, may interact with an anti-depressant such
as Prozac or Paxil to produce a serious, though infrequently
reported, problem called serotonin syndrome. One 51-year-old
victim was vomiting blood, sweating, shaking, confused and
having trouble breathing. His blood pressure was elevated,
and his pulse was 122 beats per minute. The man, who had a
pre-existing vascular disease, recovered after some time in
intensive care.
Cold remedies also can interact dangerously
with another class of anti-depressants called monoamine oxidase
inhibitors (MAOIs). Most OTC cough and cold products, like
Sudafed, warn specifically against this reaction.
Cancellation
Consumers need to be aware of another potential
pitfall: one drug can cancel or reduce the effects of another.
Because it provides relief from high blood
pressure, Vasotec is one of the most frequently dispensed
drugs in America. It is not unusual for someone with high
blood pressure to be taking ordinary aspirin as a preventive
against heart attacks. "But aspirin may reduce the effectiveness
of Vasotec," says pharmacologist Graedon. The same interaction
could occur with other widely prescribed heart and blood-pressure
drugs─known as ACE inhibitors─such as Accupril, Prinivil
and Monopril. People who take these drugs should not avoid
aspirin, especially if it has been prescribed by a physician,
but should have their blood pressure carefully monitored.
Many people with high blood pressure also
have arthritis. Combining
certain prescription drugs for the former and too much of
an OTC drug for the latter may reduce the effectiveness of
their blood-pressure medication. For example, people
on beta blockers should consult their doctors before taking
nonsteroidal, anti-inflammatory painkillers (known as NSAIDs),
such as aspirin, Advil, Aleve, Motrin and Nuprin.
Grant Shetterly also cautions that the active
ingredients in many antacids, including Rolaids and Tums,
can reduce the absorption of certain antibiotics. In some
cases they can totally negate the effects of the antibiotics
and inhibit the curing of major infections. People should
ask their physicians whether they should take both drugs.
Alcohol When Antonio Benedi caught the flu from his
sons, he relieved his symptoms with Extra-Strength Tylenol,
the No. 1 best-selling OTC product. Later,
when the ambulance came for him at his suburban Washington
home, he was in a coma with liver failure.
Benedi's liver was destroyed by a toxic reaction
to acetaminophen, Tylenol's main ingredient. His habit of
drinking two or three glasses of wine with dinner had made
his liver more sensitive to the drug. A last-minute liver
transplant saved his life.
A study published in 1997 found that overuse
of acetaminophen was the leading cause of admission for acute
liver failure at Parkland Memorial Hospital in Dallas, Texas,
and that heavy drinkers were especially .
The American Liver Foundation recommends that regular drinkers
use less than the normal dosage of OTC acetaminophen products.
Combining alcohol with many popular OTC pain
relievers can be dangerous. Under
a new FDA regulation, all pain-relief and fever-reducing products
will carry labels warning anyone consuming more than three
drinks per day to consult a doctor before taking the product.
Medical and pharmaceutical professionals urge
consumers to read the label of every OTC product they buy
and to ask a doctor or pharmacist about it. They add these
precautions:
* Find out for sure whether taking
the medication will affect your ability to drive.
* Don't assume that all products
under a given brand name are the same. For example, there
are at least 11 different OTC products with the name Sudafed.
Some contain only pseudoephedrine, and others include acetaminophen,
guaifenesin and dextromethorphan. Some contain alcohol; others
contain caffeine.
* Read the label every time you
purchase an OTC product, not just the first time. Companies
can change the ingredients.
* Be extremely cautious if you
crush, chew or break a medication before swallowing it.
Sometimes OTC drugs have a coating that keeps them from dissolving
as they pass through the stomach; sometimes these drugs are
designed to release medications slowly over time—a goal
that can be frustrated by not taking them whole.
Help
for consumers is on the way. New FDA rules approved
earlier this year will make nonprescription drug labels easier
for consumers to read and understand. There will be larger
type, more white space, a standard format and simpler language
to explain side effects, interactions and when to consult
a physician.
Nevertheless, all the warnings in the world
won't help if you don't read them.
(1 531 words)
(From Reader's Digest, June, 1999 )
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