Over-the-counter (OTC) drugs can be purchased just as easily as a bottle of shampoo or a box of cereal but that doesn’t mean that they’re harmless.
Few people realize that in some cases, OTC drugs contain the same amount of an active ingredient as that found in prescription medications. Using OTC drugs incorrectly for example, taking them for too long or in excessive doses can cause serious side effects.
Example I: People with arthritis often use OTC painkillers, such as ibuprofen (Advil) or naproxen (Aleve), for months or years even though the label advises against taking these drugs for more than 10 consecutive days without consulting your doctor. The long-term use of such drugs greatly increases the risk for stomach bleeding as well as heart and/or kidney problems.
All OTC medications include a standardized “Drug Facts” label (on the outside of the packaging and also in an insert) that details the approved uses of the drug, active ingredients, how to use it and possible risks. The information is often confusing and printed in such small type that it’s almost impossible to read.
Important: Read the OTC drug label before leaving the store. If you’re purchasing from a drugstore, ask a pharmacist to explain any instructions that you don’t understand.
What to look for…
Active ingredient
This term refers to the medication that relieves symptoms. There might be dozens of drugs that have the same active ingredient.
What you may not know: Manufacturers occasionally change the active ingredients in OTC products.
Example: The antidiarrheal drug Kaopectate once contained attapulgite, a type of clay that is safe for patients taking blood-thinning medication. Kaopectate now contains bismuth subsalicylate, an aspirin-like ingredient that increases the risk for bleeding in patients taking blood thinners.
Inactive ingredients
This term refers to the chemicals that are used as preservatives, binders and colorants/ flavors but have no medical effects.
What you may not know: Some people are allergic to certain inactive ingredients.
Example: Hundreds of products, such as the OTC antihistamine loratadine (Alavert), contain the inactive ingredient lactose, which can trigger reactions in lactose-intolerant people
Uses
Known as “indications” on some labels, this term refers to the list of symptoms that a drug is designed to treat.
The US Food and Drug Administration (FDA) allow drug manufacturers to list only uses for which the medication has been proven to be safe and effective.
What you may not know: It can be risky to take drugs “off-label” for uses other than the indications and/or directions found on the label.
Example: Taking high doses of the OTC B-vitamin niacin to lower cholesterol is an off-label use. Prescription niacin is approved for lowering cholesterol, but taking it without being monitored by your doctor can lead to liver damage.
Warnings
Many patients ignore the warnings on OTC medications because they assume the drugs must be safe or they wouldn’t be sold without a prescription. Not true. OTC drugs can cause side effects that are just as serious as those caused by prescription drugs.
What you may not know: In addition to explaining the main risks of a medication, “warnings” may include information on who should not take the medication, when to consult your doctor if symptoms persist, when to take medications with foods (or when to avoid certain foods and beverages), whether it’s safe to drive, etc.
Even if you’ve taken a particular OTC drug for years, check the warning label each time you purchase it. A drug that was safe when you first started taking it might cause problems if you now take other medications or if the ingredients or your health needs have changed. Always check the expiration date.
