By definition, over the counter medications (OTC) are medications available without a prescription. The FDA regulates which medications can be sold as OTC. In order for a medication to be sold OTC, it must be considered "generally safe". However, the FDA recommends these are used under the direction of a healthcare provider. Many OTC medications have side effects or precautions which are important to understand.
Awareness - What Are We Being Sold vs Use Realities
Even the safest of medications can interact with other digested ingredients - vitamins, minerals, supplements, and/or prescription medications. Many times different classes of OTC medications can lead to overuse, increasing dependence or even overdose. Although perceived OTC medications are completely safe, they can and do lead to significant long-term effects with frequent, daily, or prolonged use.
There are multiple OTC medications which carry warnings for individuals ages 65 and over. The cautions are related to increased falls, increased confusion, blurred vision, dry mouth/dehydration. Often times, individuals may not mention to their healthcare team that they are taking these medications.
Medication Classes Potentially Harmful to You
Non-steroidal Anti-inflammatory medications (NSAID)
This class includes aspirin, ibuprofen (motrin), naproxen (aleve). These medications are commonly used for muscle or joint pain, headaches, or fever. The potential concerns with these medications include stomach upset which could lead to - gut ulcers, bleeding and bruising, kidney damage. Use should be limited, unless otherwise recommended by a healthcare provider for a specific reason. When using any of these medications, it is important to not exceed the amount recommended on the bottle. It is also important to drink plenty of water when using any NSAID, to help protect kidney health. Taking the medication with food is also imperative to protect the lining of the gut. Regular use can cause worsening headaches, referred to as rebound headaches. Rebound headaches occur as the medication wears off and are comparable to a mild withdrawal symptom. With continued use, headaches can occur more often and become increasingly severe.
Acetaminophen (Tylenol)
Acetaminophen, commonly known as Tylenol, is typically considered safe. In fact, it is often recommended instead of NSAIDs because it is not as hard on the kidneys or the gastrointestinal system. However, there are still a couple of precautions to consider. Acetaminophen is one of the most common substances involved in poisonings. Like NSAIDs, acetaminophen can also cause rebound symptoms such as worsening headaches. It should not be used daily for headaches. In addition, it can cause damage to the liver if not used correctly. In recent years, the recommended daily amount was decreased to 3000 mg per 24 hours. It is important to check all medications you are taking as many other prescription and over the counter medications contain acetaminophen. Informing your primary healthcare provider if you use acetaminophen is also imperative.
Antacids and heart burn medications
Some heart burn medications, which were commonly prescribed daily for longer periods of time, have now been found to be unsafe to use in that manner. Side effects from prolonged daily use include electrolyte disturbances, B12 deficiency (which can cause anemia), pneumonia, stroke, kidney disease and Clostridium Difficile infection (C-Diff). This family of medications is available over the counter under the brand names of Prevacid, Nexium, and Prilosec. Generic forms may be available under multiple names but would list the ingredients of esomeprazole, lansoprazole or omeprazole.
Another common family of heart burn medication are called H2 blockers and include Zantac, Pepcid and Tagamet. Generic products include the ingredients of ranitidine, famotidine and cimetidine. Within the past year, many of these were hard to find due to product recalls. The recalls were related to concerns of increased cancer risk from one of the ingredients. However, other side effects also exist and include headaches, constipation, muscle pain, dizziness, dry mouth, nausea and vomiting, confusion, and fatigue. With long term use, B12 deficiency (which can cause anemia) is also a concern.
Sleep Aids
Many individuals struggle with sleep difficulties. It can be tempting to use a “sleeping pill” to help. However, there are multiple concerns with these agents. These medications can interact with many other medications and alcohol should be avoided if using any sleep aids. Drowsiness may be prolonged and last into the following day, causing obvious safety issues with driving or work-related activities. Many are listed on the Beer’s list discussed above, and therefore not recommended for those over age 65. Bladder retention, dry mouth, dry eyes, and constipation can occur. Stroke and dementia risk are increased in those age 75 and over. Many sleep medications contain diphenhydramine (benadryl) and therefore are not recommended for people with glaucoma, asthma, chronic obstructive pulmonary disease, sleep apnea, liver disease, or bowel obstruction. Diphenhydramine is also on the Beer’s list.
In addition to side effects, it is common to develop a tolerance to some of the ingredients in OTC sleep aides. This attribute means you may need to take more to get a similar effect. Or you may notice they no longer give any benefit after prolonged use. Dependence or overdose can easily occur.
The FDA has issued warnings regarding sleep aides. The warnings were reportedly spurred by dangerous sleep behaviors, some of which were fatal. Causes of death included carbon monoxide poisoning, falls, drowning, hypothermia, motor vehicle crashes, and suicide. Even when not fatal, there are numerous reports of risky behaviors such as sleep walking and sleep driving, or other potentially dangerous activities while still asleep. Injuries including accidental overdoses, falls, burns, near-drowning, limb loss or near death (some of which were from extreme temperature exposure), self-injuries such as gunshot wounds, and even apparent suicide attempts (WebMD, 2019)
OTC sleep medications should not be used daily. The best option for improving sleep includes lifestyle and sleep hygiene improvements. For example, established bedtime and routine prior to sleep, daily exercise, stress management, avoidance of screen time prior to sleep, and other modifications to daily habits.
Antihistamines
Antihistamines are commonly used for allergies. Similar to other OTC products, they are considered safe but it is important to understand some side effects and precautions. There are 3 classifications of antihistamines, called “generations.” Side effects can vary in intensity between generations of antihistamines, but the list of potential side effects is similar. Side effects include dizziness, dry mouth, dry eyes, drowsiness or fatigue. More severe side effects include mood changes, bladder retention, hallucinations, or blurred vision. This class of medication can also worsen underlying health conditions such as high blood pressure, glaucoma, or breathing abnormalities (such as emphysema, chronic bronchitis, or COPD). Due to the side effects of dizziness and sedation, caution should be used when driving, operating heavy machinery, using any motorized equipment or sharp objects, or any other safety sensitive work. Alcohol or marijuana use while taking antihistamines should be avoided as it can worsen side effects. In addition to the side effects from the antihistamine, some are also mixed with other medications. For example, acetaminophen. Antihistamines can also interact with other medications. Therefore, it is important to read labels closely and alert your health care provider of all products you are using.
Summary
Although over the counter medications are often assumed to be safe, it is clear from our discussion they should not be used lightly. It is important to avoid unnecessary or daily use (unless otherwise instructed by your healthcare provider). If using any over the counter medication, you should be certain to inform your healthcare provider so they can alert you of any concerns or potential interactions. Your healthcare provider may also recommend monitoring certain lab values if you are using any OTC products on a regular basis.
In future posts, we will review some of the common ailments for which OTC products are used in more detail and discuss other options for treating some of those concerns.
** This article is not medical advice, but rather informational and educational. Always consult your Medical Doctor for advice. **
References:
Epocrates drug reference web application. https://www.epocrates.com/
FDA. https://FDA.gov
https://www.mayoclinic.org/healthy-lifestyle/adult-health/in-depth/sleep-aids/art-20047860
OPS Clinics Information:
Mapleton Office: (507) 524-4000
Blue Earth Office: (507) 526-2211
ops@bevcomm.net
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