Illustration by Mark Moran
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ABC’s of OTC’s
By Melissa Gotthardt, September & October 2005
How to avoid common pain-relief pitfalls
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While thousands of patients are denied the prescription pain relief they need by fearful—or misinformed—doctors, those who treat their own pain via drugstore remedies may also run serious risks. Over-the-counter (OTC) pain medications are linked to nearly 130,000 hospitalizations and 19,000 deaths per year. “Used inappropriately, nonprescription pain relievers are as dangerous as any prescription drug on the market today,” says Peter DeMauro, M.D., chief medical officer at Hackensack University Medical Center in New Jersey. To stay on the safe side:
Read ’em, heed ’em
Dosage instructions are printed on labels for a reason. Bypassing them can be disastrous. Case in point: the maximum daily dose for acetaminophen (the generic name for Tylenol) is 4,000 mg per day, or 12 regular-strength 325 mg caps. But switch to extra-strength at 500 mg apiece and take a dozen and you’ll net 6,000 mg per day—a dose that can cause liver failure. With ibuprofen, commonly sold as Advil or Motrin, exceeding the recommended daily dose of 3,200 mg can damage your kidneys. “How long you get away with such a dosage depends a lot on your individual metabolism,” notes Richard Roberts, M.D., J.D., professor of family medicine at the University of Wisconsin Medical School in Madison. “For some, high doses of these drugs can damage the liver or kidneys in a matter of hours.”
Do the math
In a survey conducted by the National Consumer League, 45 percent of those polled considered it okay to take pain relievers, like Advil, along with combination cold and flu products, like NyQuil. But many cold-season remedies already contain pain relievers as active ingredients, so downing pills in addition to your cold medicine may put you at risk of overdose. Bottom line: keep track of your dosages in every form.
Don’t mix
Prescription drugs, including diuretics, blood thinners, and corticosteroids, can interact dangerously with OTC pain relievers such as naproxen (Aleve), ibuprofen, and aspirin. Alcohol is also unsafe: even a three-drink-a-day habit can make taking common pain relievers risky. Alcohol magnifies the internal bleeding risks associated with ibuprofen and aspirin, and makes naproxen and acetaminophen more liver-toxic. Advises Chaim Putterman, M.D., chief of rheumatology at Montefiore Medical Center in New York City: “Reduce your odds of damage while taking pain medications by downsizing your drinking to a single serving per day.”
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