Over the Counter Medicines Hold Hidden Dangers

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.

READ Are Drug Ads on TV Causing Us to Overmedicate?

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.

It's Not Just Tylenol That Can Be Seriously Overdosed

Tylenol poisoning sends 33,000 Americans to the hospital every year. Some need liver transplants. About 150 die. However, it's not just pain relievers that can cause serious OTC overdosing problems. Common allergy medications are also problematic.

An eight-year-old informs his mother, to her horror, he has suddenly gone blind. He had spent the day at home from school because of his allergies. He had taken half a box of Benadryl (diphenhydramine) when suddenly he felt sick. The mother calls EMS.

The emergency medical technician remembers the diagnostic for Diphenhydramine poisoning "Dry as a bone, red as a beet, hot as a hare, mad as a hatter, and blind as a bat." The eight-year-old is understandably upset He's also flushed and feverish but he isn't sweating. When the EMT sees the half-empty box of Benadryl, she understands the situation. The boy is taken to the hospital for emergency treatment.

Catastrophic Overdose of Cough Syrup

Cough syrups are among the most popular of all OTCs. A Consumer Healthcare Products Association survey found that 70 percent of American parents give their children cough syrup as the first line of defense against colds. The survey also found that 66 percent of American adults take cough syrup themselves.

A problem can arise, however, when the anti-tussive (cough-stopping) ingredient is a chemical called dextromethoraphan. In low doses, it stops cough. Take a little more, and there is a sense of awakeness, intense emotion, but euphoria. Take still more, and the user becomes "stoned." There may be a sense of detachment from the outside world along with hallucinations and loss of memory. Keep on taking cough syrup, and there is clearly altered consciousness. The user may not understand what people are saying or doing and express highly "abstract" thinking. If consumption continues, there can be life-like delusions, recall of events buried in the memory, seizures, and even death.

READ Is children's coughing medicine safe?

All of this can happen just from overdosing cough syrup. While there are people who intentionally abuse cough syrup for its psychological effects, the problem is more likely to occur in a child or stressed-out adult who simply needs to stop coughing and get back to school or work. Typically, about 4 ounces (half a bottle) of Robutussin causes symptoms of overdose.

Other problem OTCs include:

• Laxatives. Taking too many laxatives can, paradoxically, make constipation worse, as well as cause serious imbalances in electrolytes
• Sleep aids. Medications that contain Diphenhydramine (mentioned above) and other allergy medications can lose their effectiveness over time so that users take more and more, with increasing risk of side effects.
• Acid blockers. Overuse of Nexium and Pepcid can lead to calcium deficiencies severe enough to cause osteoporosis, and sometimes also to pernicious anemia, which occurs when the body is not able to absorb vitamin B12.

How can you avoid overdosing OTCs? The most important rule to remember is that "More isn't better." If you need more and more of an over the counter medication to get the same effect, you are taking the wrong medication, and it likely won't do you any good.

The second, equally important rule is to read the label and follow directions. Never take more of a medication than is recommended. It will work as well as it is going to work in the dose that the manufacturer tells you that is safe. 

Finally, don't take an entire shelf full of OTCs. In fact, it's even best to avoid combination products, for instance, the "stops your cough so you can sleep medicines." Take just one medication for one problem in just the dosage that you need, and avoid taking multiple OTCs in any dosage.