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overdosing is a common problem with OTC |
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).
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