Every day millions of us snap off the top of a medicine bottle with the hopes that it will prevent, treat or cure each of our many ills. Every time we swallow, inject or rub on a medication that prolongs or improves our life, we trust that it will do more good then harm. But all medicines, even the ones that have withstood the test of time, have some degree of risk, especially when taken with other medicines.
Adverse drug reactions are responsible for millions of emergency room visits. A drug's side effects, an accidental overdose, drug abuse and misuse can do irrevocable damage. One area of particular concern is the combining of prescription and over-the-counter (OTC) medicines, drugs bought off the shelf without a prescription. A study examining the medication use in older adults, an age group that is most likely to be taking medications routinely, found that 1 in 25 are at risk for a major potential drug-drug interactions, sometimes with grave consequences. A majority will be caused by non-prescription therapies.
Consumers can unknowingly put themselves in harms way when they mistakenly believe that because an over-the-counter medicine or dietary supplement doesn't require a prescription, it carries no risk. Nothing can be further than the truth. OTC remedies contain many powerful ingredients. Even seemingly harmless herbs such as ginkgo, and foods and beverages such as alcohol and grapefruit juice, can pose a danger when combined with certain prescription medications.
So how will you know a safe combo from a worrisome one? Sometimes a warning is listed on the label if there is a known problem or your pharmacist will include an informational insert with your prescription outlining what to avoid while taking this medication. Still, pharmacists and doctors are not always aware what OTC medications or supplements patients are taking, which would otherwise trigger an alert if it were known. Consumers that are not forthcoming about all the medicines and supplements they take risk an adverse event, maybe even death.
Minding Menacing Mixtures
There are many prescription and OTC combinations that should put people on high alert. The rule of thumb is to not introduce any new prescription or OTC medicine, vitamin or herbal supplement that will interfere with the action of one you are already taking. Anything that can increase, decrease or cancel the effectiveness of medications, cause a brand new side effect, or get in the way of how the drug is processed in the body can have grave consequences.
Here are just a few bad combinations.
- OTC pain reducers and prescription blood thinners - Certain anti-inflammatory pain medications called NSAIDs (aspirin, ibuprofen, naproxen) reduce body chemicals called prostaglandins that are involved in pain pathways. But these chemicals also protect the stomach lining. They also tend to add to the anticoagulant power of blood thinners by further reducing platelets, the blood cells involved in clotting. The combo can cause massive gastrointestinal bleeding.
- OTC migraine treatments with prescription diet pills - Diet pills that contain phenylpropanolamine increase the risk of bleeding in the brain (hemorrhagic stroke). The symptom is severe headache. If you mistake that headache as a migraine and combine the diet pill with OTC migraine medicine, that risk is increased further. Also, both have a stimulating effect and behave similarly to raise blood pressure. The combo can cause hypertension and stroke.
- OTC calcium supplements and prescription thyroid medication - When taken together, calcium found in dietary supplements and antacids interfere with the absorption of prescription thyroid hormone. The combo can cause an inadequate amount of thyroid hormone circulating in the blood.
- OTC decongestants and prescription diabetes drugs - Decongestants found in cough and cold remedies not only have added sugar, but they raise blood pressure, a common problem for people with diabetes who may also be taking medications to lower high blood pressure. The combo can cause hypertension, high blood sugar and increase the risk for stroke and poor glucose control.
To safeguard you from a drug-drug interaction you will need to be a substance sleuth. There are potentially harmful ingredients hidden within many OTC products, but you may have to dig deep to find them. If you are not careful you can even find the same ingredient in a pain reliever, fever reducer, cold remedy and cough suppressant.
Here's what you can do to help avoid a dangerous prescription and OTC combo.
- Keep a detailed record of all prescriptions, OTC, herbal and dietary supplements you are taking
- Know what each medicine you have been prescribed is used for and the side effects, interactions, precautions and warnings
- Confer with your doctor, health practitioner and pharmacist before taking any new prescriptions, OTC remedies, dietary supplements and herbs
- Read the label carefully
- Learn the purpose of each active ingredient in OTC medicines and be certain to match the remedy to the symptom
- Fill all prescriptions at a single pharmacy so that they can routinely check for interactions
- Make sure you understand how to take the drug before you leave the pharmacy and ask the pharmacist (not the cashier) questions if you don't
- Report any symptoms that might be related to the use of a drug to your doctor or pharmacist
- Make each of your doctors aware of medications prescribed by others
- Do not remove medicines from their original containers or remove the label
- Periodically review your list of medications with all your doctors and healthcare providers
- Let someone else in your family know all your prescription and OTC products you are taking in case you become ill
To find more information about drugs, supplements and herbal products visit the National Institute of Health drug look up. To download Food and Drug Administration approved medication package inserts, visit the Daily Med.