May 2002 • Volume 8 • Number 5 |
Think you have a handle on your patients' self-prescribing habits? This might surprise you: More than 70 percent of American adults and about 50 percent of children take over-the-counter medications in any given week, according to a study in the Jan. 16 Journal of the American Medical Association.
If you're concerned, it's with good reason. Considerable evidence indicates that many patients do not read labels or heed warnings about possible drug interactions or side effects of OTC products. And because there is a general perception that these drugs are safe, patients may not seek the necessary information before making a selection. The danger is only increasing, says one FP.
"In the last five years, there's been an incredible burst of new pharmaceuticals, and with it an awareness among physicians of interaction problems," says Susan Montauk, M.D., who co-wrote a new AAFP monograph on the subject (see story "AAFP's OTC monograph can help").
In fact, more than 100,000 drugs are available without a prescription, according to recent data reported in JAMA. "There's no way you can know about 100,000 medicines, so you have to educate your patients on how to assess and use OTCs," says Montauk, professor of clinical family medicine at the University of Cincinnati College of Medicine.
To be sure, OTC medicines can be beneficial. Patients who study the choices can treat themselves appropriately for minor conditions without the inconvenience of visiting or calling their physicians.
But physicians should impress on patients the need to read labels carefully -- especially the small print -- and ask questions if they're uncertain of what's appropriate for their ailment. Assuming that all OTCs are benign can prove disastrous, especially if a patient already is taking another medicine or several others.
EASY TO OVERDOSE
Catherine Little, 67, of Cincinnati, used to pride herself on the fact that she never caught cold. Until February. Already taking blood pressure medicine and a nonsteroidal anti-inflammatory drug, Little was struggling with a cold when she started taking an OTC cold medicine. But a wracking cough persisted, so she also took a cough medicine she had on hand. She didn't have a measuring spoon handy, so she estimated her dose. "And that's about all I remember," she says. She woke up in the hospital.
At first, ER doctors weren't sure what was causing Little's dementia. Tests for stroke, masses and metabolic events were negative. Only after she became more lucid was she able to say what she had taken. Hospital workers determined that she overdosed on OTC medicines, says Montauk, her physician.
Montauk says it is common for medicine to have different effects in patients over age 65. Even if there is no concern about drug interactions, older patients should start with the OTC drug's dose.
Another common mistake patients make is to take OTC drugs for longer than recommended. This information is on the label, often in tiny print.
Polypharmacy presents another potential danger. For instance, naproxen and ibuprofen are safe and effective, but many patients experience problems if they take both at the same time, says Montauk. And these days, many people take an aspirin a day for cardiac benefits. However, aspirin mixed with non-steroidal anti-inflammatory drugs can increase the risk of gastrointestinal problems. Mixing caffeine or tobacco -- agents that already increase blood pressure -- with any medicine that raises blood pressure can cause disaster as well.
BRING THEM IN
It's not enough to ask patients what OTC medicines they are taking. "You must ask what they have in their cabinets," Montauk says. "Better yet, have them bring them in." Anything that's in their cabinet could be used when a patient is ill and perhaps not thinking clearly.
But the biggest danger may well be unfamiliarity.
Sometimes a patient doesn't know what they're taking, says Montauk. "It's not uncommon for people to tell me they're taking an antihistamine and then tell me that the 'antihistamine' they're taking is Sudafed.
"And when you hear, 'Oh I just take a vitamin,' you have to ask for more specifics; it could be a diet drug containing ephedra or an inappropriately high dose of a fat-soluble vitamin."
FP Report is published by the
AAFP News Department.
Copyright © 2002 by
American Academy of Family Physicians.