Potential Side Effects of OTC Medicines in Adults by Dr.Mahmoud Pharm
تم كتابةالمقال بواسطة الدكتور محمود فارم
While OTC medicines have a low risk of side effects when used occasionally by healthy adults, they can pose risks for very young children, the elderly, people with kidney problems and people taking more than one medicine. These people have an increased risk of side effects when they take OTC medicines. Potential side effects are described below.
Aspirin and NSAIDs
The main side effect associated with aspirin and other NSAIDs is gastrointestinal (GI) problems. These problems can range from upset stomach to GI bleeding, a serious event that is most likely to occur in older people. The chances of experiencing GI problems from NSAIDs or aspirin increase the larger the dose you take and the longer you take them.
NSAIDs can cause a variety of side effects related to kidney function. These side effects range from reversible inflammation to permanent kidney damage.
Aspirin and NSAIDs may make high blood pressure worse or interfere with blood pressure medicines.
High doses of aspirin pose a risk of liver damage for people who have liver disease, juvenile arthritis or rheumatic fever.
Although safe in the majority of users, long-term use of high doses of acetaminophen, especially in products that also contain caffeine (such as Excedrin) or codeine (such as Tylenol with Codeine), has been shown to cause a form of kidney disease called analgesic nephropathy. This serious condition may develop after years or decades of daily use.
Antihistamines can cause sedation or drowsiness and, therefore, can significantly impair a person’s ability to drive or operate machinery. The sedative effects of antihistamines may increase the risk of falling. Antihistamines can also cause temporary dry mouth or eyes.
Pseudoephedrine can temporarily cause nervousness, dizziness and sleeplessness. It can make you lose your appetite or retain urine. It can also cause heart palpitations, high blood pressure or high blood sugar levels.
Codeine, when used as a cough suppressant, can temporarily cause nausea, sedation and constipation. Dextromethorphan, the medicine in Drixoral, Pertussin CS and Robitussin, has a lower risk of sedation and GI side effects. It can, however, cause feelings of confusion, agitation, nervousness or irritability.
The body processes (metabolizes) every drug differently. If drugs are used together, their metabolism and effect on the body can change. When this happens, the chance that you will have side effects for each drug may become greater.
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Alcohol and OTC Medicines
If you drink more than 1 alcoholic beverage per week and use NSAIDs, including aspirin, you may be at increased risk of GI bleeding. People who consume 3 or more alcoholic beverages each day should consult their physician before using any pain reliever.
Acetaminophen is much less likely than NSAIDs to be associated with GI problems, including bleeding. But to minimize the risk of serious liver injury, you should never take more than the recommended daily dose (4g per day).
Antihistamines, Decongestants and Cough Medicines
The combination of OTC antihistamines and alcohol can increase drowsiness, especially in elderly people. In addition, alcohol makes the drowsiness, sedation and impaired motor skills associated with the cough suppressants dextromethorphan (in products such as Drixoral, Robitussin) and codeine worse.
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Some groups of people may be more likely to experience the side effects associated with OTC medicines. The sections below include tips for using OTC medicines in the following special populations:
Pregnant or breastfeeding women
When used properly, OTC medications pose little risk to children. However, children metabolize drugs differently than adults. You should know how OTC drugs will affect your children before you use them. Talk with your family doctor if you have any questions about giving your child OTC medicines.
Acetaminophen is generally considered the treatment of choice for children’s pain relief.
Do not give ibuprofen to a child younger than 6 months of age.
Do not give aspirin to children under the age of 18 because of the risk of Reye’s syndrome (a drug reaction that can lead to permanent brain injury).
Do not use nasal decongestants, cough medicines and cold medicines in young children, especially those under 2 years of age. These medicines can produce dangerous side effects. In addition, cough and cold medicines are not effective in treating young children.
It can be helpful for parents and other caregivers to keep track of the medicine a child is taking. One way to do that is with a medication log. Using a log can help avoid giving too much medicine or giving it too often. It can also provide important information to your family doctor if there is a problem
The elderly use a number of medications at the same time and therefore need to pay careful attention to drug-drug interactions between OTC medications and prescription medications. Older adults should talk with their doctor about the medicines they take and potential interactions with OTC medicines.
There is a relatively high risk of kidney disease and GI bleeding in elderly patients who use NSAIDs. Discuss this risk with your family doctor.
Pseudoephedrine can increase blood pressure and the pressure in your eye that can lead to glaucoma. It can also make existing blockages in the urinary tract worse. Pseudoephedrine interacts negatively with many other drugs such as beta-blockers, antidepressants, insulin and some medications that treat low blood sugar.
If you use a monoamine oxidase inhibitor (MAOI), a type of prescription antidepressant, or take any medication for a seizure disorder, you should avoid using pseudoephedrine. Pseudoephedrine can change the way these drugs work in your system. Some common MAOIs include Marplan (generic: isocarboxazid), Nardil (generic: phenelzine sulfate) and Parnate (generic: tranylcypromine sulfate).
If you use a MAOI, you should not use dextromethorphan. Dextromethorphan interferes with the way MAOIs work.
Pregnant or Breastfeeding Women
Pregnant or breastfeeding women should talk with their doctor before using any medicine. Some can affect your baby. The following are some general guidelines.
Acetaminophen is generally considered safe for short-term pain relief during pregnancy.
Avoid using aspirin during pregnancy. It can cause birth defects or problems during delivery.
Avoid using other NSAIDs, especially during the third trimester of pregnancy. They can cause heart defects in the baby.
Acetaminophen and NSAIDs such as ibuprofen provide safe pain relief for women who are breastfeeding.
Avoid using aspirin because it is excreted in breast milk and can cause rashes and bleeding problems in nursing infants.
Limit long-term use of antihistamines. Antihistamines are excreted in breast milk, and may cause side effects such as sedation, irritability, crying and sleep disturbances in nursing infants. Antihistamines may also interfere with the production of milk.
These steps can help minimize the risk of side effects during pregnancy and breastfeeding:
Talk to your doctor about possible alternatives to medicine.
Avoid the use of medicines during the first trimester.
Take oral medicines after nursing or before the infant’s longest sleep period.
Avoid the use of extra-strength, maximum-strength or long-acting medicines.
Avoid “combination” products.
Watch your infant for possible side effects, such as a rash, difficulty breathing, headache or other symptoms that your child didn’t have before you took the medicine and then breastfed