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Use OTC Medicines Cautiously

The article below appeared in the December 29  issue of Health with Perdana, a regular column in The Star by Perdana University faculty members. This week’s article is contributed by Dr. Amuthaganesh Mathialagan, Senior Lecturer in Pharmacology, Perdana University Royal College of Surgeons in Ireland.


Frequent use of the over-the-counter medicines can be harmful to health.

Over the counter (OTC) medications are drugs which have been found to be safe and appropriate for use without the supervision of a health care professional such as a physician, and they can be purchased by consumers without a prescription [1].  Studies have shown that utilization of OTC drugs have increased in Malaysia with at least 60% of the population reported to have used OTC drugs at least once a year. The most commonly used OTC drugs are analgesics, antipyretics, antibiotics, cough remedies and supplements and these medications are very frequently being obtained from the pharmacies. As expected, in many studies, time saving has been quoted as one of the significant benefits to self-medication, as these drugs are conveniently available in many supermarkets and retail stores and, does not require making appointments with doctors to obtain these drugs. In addition to saving consumers time and money, OTCs also give many people a sense of self-control over their health and well-being.

However, frequent use of OTC drugs without proper consultations can be impact general well being as well. The dangers that can be associated with OTC drugs roughly falls into two categories; adverse effects (side effects) and drug interactions.


Adverse effects of OTC drugs

 Some OTC drugs should not be taken by people with certain health conditions, or be combined with other drugs — prescribed or over the counter — because of the possibility of adverse interactions. For example, acetaminophen or paracetamol or its brand name Panadol, is one of the most widely used OTC drug, commonly taken to relieve pain or fever. But acetaminophen is also a frequent ingredient in other often-used OTC products, including many cough and cold products. In excessive amounts, acetaminophen can cause severe liver damage and other unwanted effects

An important consideration that should be remembered is that just because a drug is sold over the counter does not mean its harmless. Laxatives, for example, are said to be among the most popular OTC medication. Contact laxatives, such as Dulcolax, are known to cause excessive bowel movement when taken in high amounts. This excessive use of laxatives can cause chronic dehydration that in turn will cause fatigue, weakness and dizziness to the patient. Individuals with chronic heartburn might resolve to take antacids (OTC drug) that counter the effects of stomach acid. But these can also cause diarrhea or constipation, and block the absorption of certain prescription medications.

So, OTC medications are quite capable of causing adverse events that will impact the well-being of the individual.


Drug Interactions and Tolerance

Risk of OTC hazards are more pronounced in the elderly population, who are most likely to have health issues that may contraindicate the use of certain over-the-counter medications. Because of chronic health problems, age-related changes in how well the body processes drugs, and the sheer number of prescription medications many older people tend to take, they face the greatest risk of adverse side effects and drug interaction. Drug interactions mostly will involve either decrease or increase in activity of concomitant drugs. For instance, elderly individuals who take aspirin on daily basis need to be cautioned in taking Non- Steroidal Anti-inflammatory Drugs (NSAIDs) such naproxen and diclofenac sodium as it could increase the risk of bleeding ulcers.

Similarly, some OTC drugs like Piriton or Chlorpheniramine have tendency to develop tolerance if frequently used. Tolerance is a process where the effectiveness of the drug is reduced due to consistent use of the drug. So invariably, you may need to take 3 pills of Piriton to achieve the same effect as opposed to one earlier. This invariably causes the patient to have higher doses to achieve the same degree of disease relief which invariably can lead to increased adverse events.


Sensible use of OTC

OTC use should not be restricted but education on sensible use should be advocated.  Malaysians should know that OTC drugs are generally safe when used occasionally and correctly by healthy adults but in those with chronic health problems it can risk causing potentially serious adverse reactions. People who have underlying health problems or who routinely take one or more prescription drugs would be wise to consult their doctors before taking an OTC drug. At the very least, it should be counter checked with the attending pharmacist. If you fill all your prescriptions at the same pharmacy, potential adverse drug interactions are easier to pick up. Failing that, carry with you a list of all the prescription and O.T.C. medications you take to show the pharmacist or the doctor during your visit which will an important safety measure. Additionally always read the drug label and be aware of medication intake timing, influence of alcohol and additional warnings.