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Americans have been fans of over the counter, non-prescription medications since the days of the traveling medicine show in the 1800's. Offering easy relief of symptoms for just a few dollars without any need to see a doctor, over the counter drugs (OTCs) are a $45 billion dollar a year industry in the United States. The concept has been so successful that there are now over 300,000 brands of OTCs for sale in the USA, offering relief from conditions ranging from acne to zinc deficiency.
Many products that once were prescription-only are now offered over the counter. According to the Consumer Healthcare Products Association, over the last 40 years over 100 medications formerly only available with a doctor's prescription are now available on demand, usually at greatly reduced cost (and without the $100 to $500 expense and time spent visiting with a doctor).
Easy treatment with OTCs unfortunately is not without its downside. In the most recent year for which statistics are available at the time this article is being written, 103,000 people in the US were hospitalized for overdoses of OTCs. To be sure, far fewer people die of overdoses of OTCs than from overdoses of prescription drugs (150 deaths per year from Tylenol overdoses compared to 16,000 deaths per year from oxycodone overdoses, for example), but it's possible to get too much of a good thing with many OTCs.
The Young and the Old Are the Most Vulnerable to Overdosing OTCs
While there actually are people who try to commit suicide by taking Aspirin, ibuprofen, or Tylenol (and a few actually succeed in the attempt), problems with overdoses of over the counter medications are usually unintentional. They usually occur in the young and in the elderly. Overdoses are most common in misguided efforts to control fever or pain.
For instance, the emergency services department gets a call from the very anxious mother of a 15-year-old boy. A few days earlier, he broke his leg. He had been spending most of his time resting, taking Tylenol "as needed" for pain. When the ambulance arrives, they find he has a blood pressure of 80/40, a pulse of 130, and he's breathing 32 times a minute. There is a nearly-empty bottle of Tylenol on the table.
Most adults can take up to 4,000 mg of Tylenol a day safely with some margin for error. With children, the appropriate dosing is up to 90 mg of Tylenol for every kilogram of body weight. A teenager who weighs 154 pounds (70 kilograms), for instance, could theoretically take up to 90 mg per kilogram of body weight, or (70 x 90) 6300 mg of Tylenol a day, but most doctors would err on the side of caution and limit the teen to 4,000 mg a day, too. Taking more than 150 mg of Tylenol per kilogram of body weight per day is definitely toxic. This teenager normally would be in trouble taking more than 10,500 mg (21 capsules), and in this scenario it appears he took a great deal more. To prevent permanent damage to his liver and kidneys, he is rushed to the hospital where he is ordered to eat powdered charcoal, and given a liver-protective antioxidant called N-acetylcysteine. His life is saved, but he spends several days in the hospital.
Sometimes Even a "Normal" Dose Is Too Much
In the elderly, the problem is more likely to be an unusual sensitivity to an OTC. An older person with chronic joint pain, for example, may take a variety of pain relievers with a conscious intent to avoid overdosing. However, sometimes the effects of OTC medications are additive, as is the case with Tylenol and Aspirin. An elderly person who takes the recommended dose of one pain reliever, and another, and regular medications, may wind up in the same kind of distress as the teen who over-medicates for an injury.