Be Smart About OTC Medicines

You really can have too much of a good thing. Over-the-counter (OTC) medicines are a case in point. Some people don’t take these medicines as seriously as prescription ones. As a result, they might feel free to use more than the recommended dose.

“If the box says to take one pill, some people think two must be better," says Linda Garrelts MacLean, R.Ph., spokeswoman for the American Pharmacists Association. "Or, if it says to take the medicine every four to six hours, they may feel every two to three hours is fine."

Yet OTC products are strong medicine. In fact, many of today’s most popular OTCs were sold only by prescription not long ago. And when you overuse OTC medications, you risk doing more harm than good. That’s why it’s so important to use them with care.

Too much pain relief

It’s easy to slip into the habit of taking OTC medicines often. They’re easy to buy, and they offer much relief. Consider pain relievers, including aspirin, acetaminophen (Tylenol), ibuprofen (Advil, Motrin), and naproxen (Aleve).

A 2006 study published in the Annals of Emergency Medicine looked at how people use these medications. Of 546 people seeking care in an emergency room, about 6 percent said they had taken more than the recommended daily dose of an OTC pain reliever within the past three days. Many were also getting a double dose—or more—by taking not only an OTC pain reliever, but also a combination product such as a cold-and-flu preparation that contained the same active ingredient.

“OTC medications like pain relievers are considered safe and effective at the recommended dose, but when you go over that dose, they’re not always as safe as you might think,” says Kennon Heard, M.D., study author and assistant professor of surgery at the University of Colorado School of Medicine.

Used in excess, pain relievers can cause serious side effects. For example, taking too much ibuprofen or naproxen increases the risk for ulcers. Combining these drugs with aspirin adds to the risk for bleeding in the digestive tract. In addition, heavy use of acetaminophen can lead to liver damage. The risk is especially high with products containing a mix of painkilling ingredients, such as acetaminophen plus aspirin.

Overdoing other OTCs

Overuse of many other OTC medicines can also lead to side effects or mask more serious health problems:

• Laxatives. Some people overuse laxatives because they think it’s vital to have a bowel movement every day. Others abuse these medicines in an effort to lose weight. Over time, they can become dependent on laxatives, with ever-larger doses needed to stimulate a bowel movement. Eventually, the intestine may stop working properly on its own. Laxatives are meant to be used for only a short while. If you have constipation often, talk with your health care provider. It could be a side effect of another medication or a symptom of a condition such as irritable bowel syndrome, a hormonal disorder, or nerve damage.

• Nasal decongestant sprays. They can help relieve a stuffy nose caused by a cold, the flu, allergies, or sinusitis. They shouldn’t be used for more than three to four days in a row, however. When used beyond that, a rebound effect may occur, making congestion worse. If your nose is still stuffy after a few days, stop using the spray and talk with your health care provider. You may need treatment for an underlying condition.

• Heartburn remedies. OTC antacids and acid reducers can help relieve the discomfort of occasional heartburn. But people with severe or frequent symptoms may have a more serious problem that could get worse if not properly treated. Talk with your health care provider if you’re using an OTC medication for heartburn more than twice a week. Also, stop the treatment and call your provider if you have stomach pain that stays the same or gets worse after you take the medicine.

• Sleep aids. OTC sleep aids are meant to help with only an occasional sleepless night. Side effects may include daytime drowsiness, reduced alertness, headaches, and dizziness. “For older people in particular, they can increase the risk for falls,” says MacLean. If you often have trouble getting the rest you need, talk with your health care provider. He or she may suggest other ways to improve your sleep, such as cutting out caffeine, following a regular sleep schedule, and exercising regularly.

A dose of caution

Be sure to give OTC medicines the respect they deserve. Always read product labels completely and follow the instructions exactly. When in doubt about whether a product is right for you or safe to take with your other medicines, talk with your health care provider or pharmacist.