Are OTC Drugs Always OK? Making Sense of Over-the-Counter Medications

Over-the-counter medications comfort us in many ways: They come in a variety of brands and formulations that cater to every symptom, and you can purchase them day or night without a prescription. But do OTC drugs treat the body as effectively as they provide peace of mind? Find out now... While sometimes we must throw ourselves at the mercy of a trusted doctor, at other times we can self-medicate – and, boy, do we. Americans spend $17 billion a year on over-the-counter (OTC) drugs. That’s a lot of cold, flu and pain remedies. Yet many people don’t have a clue what they’re buying and taking, says Timothy W. Cutler, Pharm.D., a pharmacist and associate professor of clinical pharmacy at the University of California, San Francisco. For example, “Do you know that when you’re taking a Tylenol PM, you’re not just taking acetaminophen, but also a whopping dose of Benadryl?” Cutler asks. You should. Especially if you’re allergic to the antihistamine – or giving it to your grandmother. “Benadryl is inappropriate for older adults because it’s so sedating,” Cutler warns. “They could take it, get up in the middle of the night and fall.” Most Americans often make other assumptions: We believe government-approved OTC drugs are 100% safe, that doctors know how a patient will react to them and that we know exactly what we’re taking. Of course, prescription and over-the-counter medications can be safe and do wonders to treat illnesses and keep us healthy. But for drugs to work effectively, people who take them need to be better informed, Cutler says. Ready for the truth about OTC drugs? Read on. Drug Myth #1: OTC drugs are completely safe. The Truth: Definitely not. For example, what could seem more innocuous than aspirin? Although aspirin was the pain reliever of choice in the first half of the 20th century and regained popularity as a preventive treatment for heart attacks and strokes, the drug would never make it through the Food and Drug Administration (FDA) regulatory process today, says Cutler. Or, at least, it couldn’t be sold over the counter, he adds, as it may cause serious gastrointestinal problems and easy bruising. “It’s also potentially dangerous to take before surgery,” Cutler says. It thins blood and may lead to excessive bleeding. He adds that cough and cold remedies, laxatives or anything with acetaminophen or ibuprofen may also promote excessive bleeding during surgery. “Patients think these drugs are safe and not a big deal,” Cutler says. Follow dosing directions with all over-the-counter medications and always check with your doctor or pharmacist before combining. Drug Myth #2: It’s always clear what we’re taking. The Truth: Just like a package of potato chips, OTC drugs also have added ingredients that aren’t necessarily written in bold letters on the label. For example, NyQuil promises a restful night’s sleep, but how? With 18%-20% alcohol. Some people, such as recovering alcoholics and diabetics on certain medications, shouldn’t take alcohol in any form, says Cutler. Read the fine print and find out the medication’s ingredients before you take it. Drug Myth #3: If the FDA approves a drug, it must be safe. The Truth: Not always. The FDA has approved many OTC drugs for children – decongestants, antihistamines, cough suppressants and expectorants. Yet more than 1,500 children were harmed or died after using such remedies during a one-year period, according to a 2005 Centers for Disease Control and Prevention study. Doctors later petitioned the FDA to review the products, and in 2008, the FDA recommended that over-the-counter drugs not be given to children under age 2. Cutler says he rarely recommends these products for children because of the risk of serious side effects, such as rapid heartbeat or seizures. "If your child is having a lot of cold symptoms, talk to your pediatrician or pharmacists about which, if any, of the products could be effective,” he says. Drug Myth #4: You can rely on measuring devices in children’s medications. The Truth: There’s a lot of over- and under-dosing with children’s drugs. It’s no wonder, because manufacturers don’t make it easy, according to a New York University study published in 2009 in the Journal of the American Medical Association. Inconsistencies between dosing directions and markings were found in 146 of 200 top-selling oral liquid children’s medications that researchers looked at. Some devices were missing or had unnecessary markings, or they didn’t use typical units of measurement. Some included abbreviations but didn’t define what they mean. Ask your doctor or pharmacist for the correct dose and a measuring device (spoon, cup or plunger) that you understand. Drug Myth #5: OTC drugs can't be habit forming. The Truth: More than 3 million people ages 12-25 used a cough or cold medication to get high in 2006, according to the National Survey on Drug Use and Health. That’s why many pharmacies now keep NyQuil, Robitussin and other products with alcohol or dextromethorphan (DXM) behind the counter. Abusing these medications may have serious health consequences, including seizures, paranoia, infertility, abdominal cramping, loss of consciousness and even death. However, “somebody who’s well-intentioned and taking the medication as directed won’t get physically addicted to [it],” Cutler says. Drug Myth #6: Generic drugs aren’t as good as brand-names. The Truth: Generic drugs are identical copies of brand-name drugs that are no longer patented. They have the same dosage, safety, strength, quality and performance as brand drugs, according to the FDA. But they’re often cheaper because generic manufacturers don’t have start-up or research costs. “In almost all instances, generic drugs are equal to brand names,” says Candice Garwood, Pharm.D., clinical assistant professor at Wayne State University in Detroit, Mich. “Generics for OTC drugs are also fine, as long as the active ingredient matches the brand name’s active ingredient.” There’s one exception: With medications - taken for epilepsy, for example - even the tiniest formulation change could alter the effectiveness. Don’t switch to a generic unless your doctor approves. Drug Myth #7: Drugs affect everyone the same way. The Truth: Because of people’s individual genetic makeup, a drug can work wonders for one patient and do nothing for the next. Some people can have a bad reaction, or, in FDA-speak, an “adverse event.” In 2009, more than 373,000 serious problems were reported through the FDA Adverse Event Reporting System. Some might have resulted from not managing medication properly, but others were negative reactions that occurred even when over-the-counter medications were taken as directed. Drug Myth #8: Herbal therapies are weak and ineffectual. The Truth: It’s true that complementary and alternative medications aren’t regulated by the FDA, so many of the claims aren’t substantiated. However, they can be very effective, says Cutler. That’s because herbs are derived from plants, as are many prescription drugs, and some even have active ingredients similar to FDA-approved OTC drugs. “For example, red yeast rice is an over-the-counter herbal remedy that contains monacolins, known to inhibit cholesterol,” Cutler says. One of the monacolins – lovastatin – is also in the prescription drug Mevacor, a medication used to treat cholesterol. “The problem is – unlike prescription drugs – we don’t always know how much of the active ingredient is in an herbal product or its potency,” Cutler says. If you’re trying herbal remedies, run them by your doctor first. What’s Your Supplement IQ? You know that taking calcium supplements can help build strong bones when you don't eat enough foods, but do you really know all that you should about supplements? Beyond the world of basic nutrition, there's a different solar system of weird, wacky and wonderful facts about vitamins, minerals and herbs.