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Over-the-Counter Doesn't Mean Harmless

Misuse of common drugs can cause serious health problems

Please note: This article was published more than one year ago. The facts and conclusions presented may have since changed and may no longer be accurate. And "More information" links may no longer work. Questions about personal health should always be referred to a physician or other health care professional.

HealthDay Reporter

FRIDAY, March 28, 2003 (HealthDayNews) -- A headache. A backache. A bout of tennis elbow, or a pain in your jogger's knees.

If you're like most Americans, you frequently turn to an over-the-counter (OTC) pain reliever to get you through the day or night.

This is particularly true if the drugs you are reaching for are NSAIDs -- nonsteroidal anti-inflammatory medications such as ibuprofen or naproxen -- which are among the most popular over-the-counter drugs on the market today.

While occasional use of these medications can be a big plus in coping with some of life's common aches and pains, what you might not realize is how easy it is to abuse these drugs -- and the alarming consequences that can play out when you do.

"I think many people believe that because something is sold over the counter they can take it as much as they need to, they can use it without checking with their doctor, and that basically, it's harmless medication. And none of these things are true," says New York University internist Dr. Marc Siegel.

More important, Siegel says, what most people don't know is that many over-the-counter medications, particularly NSAIDs, are actually prescription formulas packaged in a much less potent doses.

"But if you are going to increase the dosage, if you are going to take more than what the label recommends, or especially if you are going to use these medications for a lot longer than what is intended, you run the risk of reaching prescription levels. And when you do, you are playing with some potentially very dangerous drugs," Siegel says.

Just how easily that can happen became alarmingly clear in a recent survey of more than 4,200 adults, released by the National Consumer League. The researchers found that of the 84 percent of Americans who acknowledged taking pain relievers in the previous year, more than half also admitted they had knowingly exceeded the recommended dose -- with many reporting they had simply ignored critical label information.

"People read the label and they think, 'Oh, this doesn't apply to me -- I'm healthy, this warning is only for people who have stomach problems or kidney problems,' so they ignore the warnings," says Rebecca Burkholder, director of health policy for the National Consumer League.

Burkholder adds this kind of rationalizing may go on more than people realize. Indeed, statistics show that nearly 17,000 people die every year in the United States due to complications related to NSAIDs. Additionally, another 103,000 people are hospitalized each year due to overuse or abuse of these pain medications.

The problem is considered so serious that last fall, a special advisory committee of the U.S. Food and Drug Administration held a special hearing to address the issue of potential NSAID complications. Those problems include not only gastrointestinal bleeding, but serious damage to the kidney and the liver.

Making sure you never exceed the recommended dosage is one way to protect yourself against problems. But in many instances, that only provides half the protection you will need. That's because you may also fail to realize how many OTC drugs contain the same pain medications.

"In today's market, there are many more multiple ingredient OTC products available than ever before," Burkholder says. "And oftentimes people are not aware that they contain the same pain ingredient they are already taking, so they end up taking more than they realize."

According to the National Consumer League survey, 45 percent of people who took an over-the-counter pain reliever thought it was safe to take another OTC cold or flu medication. And more than one-third believed it was safe to take an OTC pain killer while taking a prescription medication, even though this may not routinely be the case.

Even more worrisome, nearly 20 percent of consumers believed it was OK to drink alcohol while using an over-the-counter pain reliever, even though this is clearly not safe or advised, the survey found.

Siegel also warns that the term "overdose" doesn't just apply to how much medication you take at one time, or even over one 24-hour period. Overdosing can also mean using the right amount of medication for the wrong length of time.

"Most people think that as long as they don't go over the recommended dosage each day that they are in the safety zone," Siegel says. "But in reality, there can be even more dangers involved when you use the correct dose, but you continue to take it for longer than the recommended time frame, without a doctor's recommendation."

Both Burkholder and Siegel say your doctor's advice is ultimately the best way to protect against the abuse of any over-the-counter medication.

"If you are going to take any OTC medication for any reason, for more than occasional or one-time use, then your doctor needs to know about it," Siegel says. "Not after something happens, but, ideally, before you start using it. And certainly once you do."

More information

For the complete National Consumer League survey results and more information on the safe way to use over-the-counter medications, visit The National Consumer League or call toll-free 1-866-216-2316.

You can also find more information on over-the-counter drug safety in this U.S. Food and Drug Administration pamphlet. To read it, you'll need the Adobe Acrobat Reader, which you can download by clicking here.

SOURCES: Marc Siegel, M.D., clinical assistant professor, medicine, New York University Medical Center, New York City; Rebecca Burkholder, director, health policy, National Consumer League, Washington, D.C.

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