Nonprescription medications carry the same risks as prescription drugs, but many ... use of these drugs is more common and more difficult ... dose or using OTC medication more frequently than ... Table 1 lists the most common ... Abbreviations used: PPIs, proton pump inhibitors; NSAIDs, nonsteroidal anti-inflammatory drugs.
OTCsection
Appropriate use of nonprescription drugs: How pharmacists can help stefanie ferreri
N
SPECIAL OTC SECTION
onprescription medications carry the same risks as prescription drugs, but many consumers believe that these drugs are safe and don’t proceed with caution before using them. Because of this misconception, misuse of some nonprescription products has led to adverse events and, in some cases, death. For example, the intentional misuse of nonprescription cough syrups has risen, with abusers mixing them into a cocktail with soda and candy for dissociative effects. The health consequences of such abuse can lead to altered mental status and potential brain damage. It is often surprising to hear that nonprescription drugs are being abused or misused.1,2 Misuse of these medications can be intentional or unintentional. Pharmacists are in an ideal position to help deter misuse and abuse. Although intentional misuse of nonprescription drugs makes national headlines with greater frequency, the unintentional use of these drugs is more common and more difficult to identify in patients. Four out of five American adults commonly take OTC medications, most often to treat ailments such as aches and pains, coughs and colds, fever, allergies, skin disorders, and heartburn and other digestive problems. One in five adults who self-medicate admit to taking more than the recommended dose or using OTC medication more frequently than the label indicates. Very few of these adults consult a doctor or a pharmacist about the appropriate use of a nonprescription drug. A consumer poll conducted in 2001 for the National Council on Patient Information and Education (NCPIE)3 found that most American adults read only some of the information on product labels and therefore may miss information essential to the drug’s proper use. The Drug Facts label is a great source of information for patients; we, as pharmacists, still need to be sure patients actually read the label prior to use. According to NCPIE, one-third of survey respondents said they combine medications when treating multiple
48
PharmacyToday • MARCH 2016
symptoms, but only 1 in 10 said they read the entire label of each drug taken. Therefore, most of these individuals are unaware of potentially toxic duplications or harmful interactions. Approximately 40% of nonprescription drugs are consumed by adults aged 65 years and older, who are most likely to have health issues that may contraindicate the use of certain medications. This population faces the greatest risk of adverse effects and drug interactions, including falls, depression, confusion, hallucinations, and malnutrition. People who routinely take prescription drugs or who have underlying health problems such as asthma, clotting disorders, chronic obstructive pulmonary disease, diabetes, enlarged prostate, epilepsy, glaucoma, gout, high blood pressure, immune system disorders, kidney or liver problems, Parkinson disease, and psychiatric or thyroid problems should receive counseling from a pharmacist before taking
any nonprescription medication. Pediatric patients are also at increased risk for unintentional misuse of nonprescription medications. Pediatric dosing errors may be caused by inappropriate measuring devices or medication techniques, the incorrect dosage form, or age-based dosing. Here, too, pharmacists may provide more education about the safe and appropriate use of nonprescription drugs. Pharmacists should know which nonprescription drugs are most commonly misused and abused—intentionally or unintentionally. Table 1 lists the most common nonprescription drug classes/ active ingredients and their potential negative health consequences.4 Taken correctly, nonprescription drugs can be safe and effective. Pharmacists should take the lead on preventing intentional or unintentional misuse by identifying patients at high risk and encouraging safer, smarter use to avoid negative health consequences. References 1. www.drugabuse.gov/drugs-abuse/commonly-abused-drugs-charts 2. www.drugabuse.gov/drugs-abuse 3. www.bemedwise.org/survey/final_survey. pdf 4. J Subst Use. 2013;18(2):82–107
Stefanie Ferreri, PharmD, BCACP, Clinical Associate Professor, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill
Table 1. Nonprescription drug classes and their potential health consequences Drug class/active ingredient Intended use Laxatives
Constipation
Diphenhydramine
Sleeping
Antacids H2 receptor antagonists, PPIs
Heartburn
NSAIDs Acetaminophen
Heartburn Pain and fever reduction Pain and fever reduction
Potential consequences • Electrolyte imbalances • Gastrointestinal complications • Loses effectiveness over time resulting in people taking more than recommended • Dangerous/habit forming when used for more than 2 weeks • Diarrhea or constipation • Block the absorption of certain prescription medications • Bone fractures and magnesium deficiencies that can lead to seizures • Gastrointestinal bleeding/ulceration • Kidney or liver damage • Increased risk of heart attack or stroke • Liver damage
Abbreviations used: PPIs, proton pump inhibitors; NSAIDs, nonsteroidal anti-inflammatory drugs.
www.pharmacytoday.org
