The Polypharmacy Network

Polypharmacy Prevention
OTC medications, what’s out there? Risks and benefits
By:Demetra E. Antimisiaris PharmD, CGP, FASCP

Over the Counter (OTC) medications offer self management options for minor health problems. In the current economy, primary care doctor visits are decreasing for the first time in fifty years, the pharmaceutical industry is forecasting a decrease in the level of prescription drug sales. (1,2). This implies that people are likely to self manage health conditions more than ever. Medications have helped prolong human life but there is also evidence that along with increased number of medications taken come the risk of decreased functionality, adverse drug events, hospitalizations and increased risk of mortality. (3,4,5,6, ). This modern day problem is exemplified by the high profile deaths of celebrities from dangerous cocktails of OTC and prescription drugs. This discussion will focus on the most common OTC medications associated with adverse outcomes.

Cough and Cold (C&C) products have high potential to cause harm. Their side effects include psychological activity, cardiovascular-pulmonary effects, interference with diabetes management and more. Because of the multiple systems affected by cough and cold products, it is important to advise your physician use. C&C products often contain same ingredients in multiple products marketed for diverse conditions. For example, separate products labeled to treat: colds, sinus problems, flu, cough, even sleep aids, may each contain the same ingredient, diphenhydramine, known to cause constipation, urinary retention, marked sedation, impaired thinking and reaction time. Consumers are at risk of duplicate dosing of diphenhydramine when unaware of its marketing of for multiple uses. This is especially problematic in seniors with memory problems and chronic diseases. The prescription medications used to improve memory in Alzheimer’s increase acetylcholine, a chemical that helps memory. Over the counter diphenhydramine decreases acetylcholine activity, a prevalent ingredient in C&C products, can severely impair memory and thinking.

Other popular OTC medications for treating pain, stomach problems, diarrhea, and constipation have risks as well. Acetaminophen (Tylenol®) can cause liver toxicity and interfere with blood thinning therapy, while non-steroidal pain relievers such as naproxen (Aleve®) can impair

kidney function, cause blood thinning and make heart failure worse. Antacids such as Rolaids® can cause kidney stones, and worsen heart and kidney failure. Newer stomach agents such as Prilosec® are capable of interactions with multiple prescription drugs to either cause inefficacy or toxicity. OTC diarrhea and constipation medications can cause fluid retention or loss, and interfere with other drug therapy.

How can a person possibly know if an OTC product is safe to use? Never assume that because a medication is OTC that it’s safe. Always let your doctor know about taking OTCs. Your body does not know the difference between an OTC, herb, supplement or prescription drug in terms of safety. Make sure there is an important reason for taking each medication (OTC or not). Familiarize yourself with the active ingredients to help prevent duplicate dosing, and interactions. Remember a different brand name doesn’t always mean a different active ingredient. If you need help obtaining this information, ask your pharmacist, consult the internet, or your doctor. In general, OTC medications are helpful and safe for temporary use and if you find need to take an OTC chronically, make sure to consult your doctor.

1. World Pharma News
2. IMS Health Inc. (RX), Norwalk, Conn: IMS Health Inc.
3. Hilmer, S, et al. A Drug Burden Index to Define the Functional Burden of Medications in Older People. Arch Intern Med/ Vol 167, Apr 23, 2007.
4. Field TS, Gurwitz JH, Avorn J, et al. Risk factors for adverse drug events among nursing home residents. Arch Intern Med. 2001;161:1629-1634.
5. Bath, PA et al. Identification of Risk Factors for 15-year Mortality Among Community-Dwelling Older People Using Cox Regression and a Genetic Algorithm. Journal of Gerontology, 2005. (60A) 8, 1052-1058.
6. Garfinkel D, et al. The war against Polypharmacy: A New Cost-Effective Geriatric-Palliative Approach for Improving Drug Therapy in Disabled Elderly People IMAJ 2007;9:430–434.