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overdosing
is a common problem with OTC
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There
is an Arabic public T.V announcement that reminds viewers that good health
cannot be purchased. However, the billion-dollar market of
over-the-counter-drugs (OTCs) around the world shows that most people do not
believe this. OTCs are convenient and most people consider them harmless.
However, medical professionals have been concerned about the range and potential
hazards that lie waiting in a bottle of medicine. Experts are worried that OTCs
allow people to ignore serious symptoms until it is too late. Although OTCs can
save the expense and time of going to the doctor, many ailments should not be
treated at home but are because of the availability of
over-the-counter-remedies. The greatest dangers of OTCs, however, are the
problems of overdosing, side-effects or mixing medications.
Side
effects of OTCs range from the uncomfortable to the deadly. A vast array of OTC
treatments available face unassuming customers at the local pharmacy offering to
eliminate the problem ascertained through self-diagnosis. Without guidance from
the pharmacist the customer is in danger of choosing inappropriately. Even a
medication as innocent sounding as a cough-cold remedy can produce undesirable
side effects such as drowsiness, inattentiveness and increased blood pressure.
Decongestants applied directly to mucous membranes in the nose lose
effectiveness over a period of time and taken for too long can result in rebound
congestion and mucosal damage (commoncold, p.4).
Antihistamines
can cause dryness of the eyes, mouth and nose, urinary retention, blurred
vision, irritability and nervousness. In addition, antihistamines can be deadly
if combined with alcohol, tranquilizers or any activity that demands
concentration. The path of antihistamines involves the reduction of blood supply
to the nose. They prevent the body’s histamine from attaching to cellular
receptor H – preventing histamine activity: stimulation of sneezing, runny
nose, coughing, blocked noses during colds (commoncold p.1). First generation
antihistamine H-blockers have a sedative affect and may cause anticholinergic
syndrome, tachycardia, dry skin, urinary retention and agitated delirium. They
can also disrupt neurotransmission in the cortex. First generation
antihistamines include: chlorpheniramine, hydroxyzine, diphenhydramine. In 1990,
the greatest number of toxic antihistamine exposures, 22,854, took place amongst
patients under six-years of age (Roth p.1, 5).
Combining
medications is another problem doctors encounter with
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more
drugs are available without a prescription every day |
users
of OTCs. In fact, the problem is so widespread that in September 2001, the Food
and Drug Administration (FDA) issued a final ruling banning OTC combination and
drug products that combine a bronchodilators with an analgesic, antipyretic,
anticholinergic, antihistamine, anti-tussive or acts as a stimulant (Reuters #1
p.1). These products, however, still exist in some countries. The FDA ruling
followed a series of reported incidents in 1999 when 3884 cases of antihistamine
exposure were reported to US poison control centers. The reports ranged from
moderate to major toxicity. From the 3884 cases, 28 resulted in fatalities and
many of those fatalities were associated with diphenhydramine. Diphenhydramine
can be found in combination with phenylpropanolamine (PPA) and aspirin in
products such as: NightTime Effervescent Cold, and in combination with PPA,
acetamininophen and caffeine in products such as Oradrine-2 (nlm, p.1 –4).
Amongst 136 patients with diphenhydramine overdose there was extreme lethargy
and coma was found in 55% of reported cases (Roth, p.7).
In
the interest of profit, the OTC industry continues to propagate the idea that
OTCs are completely safe, however more and more doctors are speaking out against
their widespread usage. Dr. Ralph Horowitz of Yale University School of
Medicine in Connecticut, U.S. stated, “Case reports have linked PPA to the
occurrence of hemorrhagic stroke”. Those who use PPA in cough-cold combination
remedies have a 23% greater chance of stroke. In addition, there is a 16-fold
risk increase for those using appetite suppressants containing PPA. PPA can be
found in: Acutrim, Alka-Seltzer Plus Cold Medicine Original, Contact 12-Hour
Cold Capsules, Robitussin CF (Chemical p.1), Sinutab SA, Triamninian, Norel
Plus, Oradine-2 (nlm, p.1-3). PPA as a decongestant, reduces the blood supply in
the nasal blood vessels and in so doing, clears nasal congestion. This action
actually increases blood pressure in patients who have high blood pressure. One
medical report warned of serious gastrointestinal bleeding, a rare but possible
kidney disease arising from heavy use of anti-inflammatory pain relievers, liver
damage from high doses of acetaminophen, and rebound congestion and dangerously
high blood pressure from weight-loss drugs with PPA in products such as Dexatrim
and Acutrim (Drug p.1). Additionally, antihistamines in general are known to
increase eletroencephalograhic, EEG, abnormalities in the brain (Roth p.7).
Although
the more recent second-generation antihistamines are
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OTCs
are not as safe as people think |
non-sedating
they do not come without their own dangers. They include fexofenadine,
loratidine (clarityn) and astermizole and cetirizine (Zyrtec, Zirtec), which are
more popular due to the reduced side-effects (Roth p.3). Second generation
antihistamines are more selective in the binding of histamine and interfere less
with the central nervous system, as they do not cross the blood-brain barrier.
They can be found in combination in Coricidin D, Dristan Sinapils, Histagesic
Modified, Dristan Cold Multi-Symptom Formula, Covangesic, Alumadrine Aclophen (nlm
1-3).
Second
generation antihistamines are not without their side effects however. They can
cause ulcers and inflammation in the stomach and duodenum (Stern p.17) and
patients with liver disease should avoid loratidine as it can lead to arrhythmia
(Leung p.10). Despite this, Schering-Plough Corporation recently succeeded in
obtaining FDA backing for their product loratidine as an OTC drug. This would
make loratidine the first non-prescriptive oral antihistamine in the US for the
treatment of chronic hives and nettlerash. Loratidine (clarityn) would also be
marketed as a seasonal allergy treatment with or without prescription (Reuters
p.1). While the FDA regards clarityn as safe, the European Medicines Evaluation
Agency, EMEA, view it otherwise. In response to the large number of birth
defects that have transpired from mothers who have used the drug while pregnant
(Reuters #3 p.1).
Sources:
