February 21, 2011
In the last few years, more and more medications are being sold over the counter (OTC) at your local pharmacy and grocer. When originally released, these medications came with lengthy descriptions of their indications, benefits and risks, as well as their potential side effects. Physicians prescribed these medications and patients took them, sometimes reluctantly, as they had concerns about the potential for problems caused by the medication.
Once the FDA decides to make a medication OTC, several things happen. The first thing that happens is the public forgets all of its concerns about safety and starts to self-medicate. One of my patients believes OTC stands for “Out of The physician Control” drugs. The second thing that happens is insurers refuse to pay for the prescription strength equivalent of the OTC, transferring the cost of the medication from the insurer directly to the patient.
On December 21, 2010, I published “Medications vs. Drugs,” an article discussing the value of “medications” prescribed for a specific cause and the risk of “drugs” taken for all the wrong reasons. OTC products often fall in the “drug” category, as they are often taken for the wrong reasons and often taken in inappropriate amounts and for inappropriate lengths of time. OTCs are not safe when taken inappropriately.
There are many OTCs used for indigestion and gastric upset. These medications are potent and can cover up underlying, serious illnesses. Not long ago, I saw a patient who had been taking multiple, OTC, acid relievers for years. He had not seen any doctor and only came to see me because large doses of these OTC products no longer relieved his “indigestion”. Testing revealed he had late stage esophageal cancer.
Three weeks ago, I treated a patient who had been taking a nasal decongestant for months. His nose congested if he did not use the “12 hours of relief” product on an every 2 hour basis. He had “rhinitis medicamentosum”, a physical dependency/addiction to his medication. There were clear warnings on the back of every bottle he used, yet he ignored them as he thought an OTC product must be safe. He also did not want to pay a “co-pay” to see his doctor.
On a regular basis, I treat patients for ulcers, anemia and kidney problems due to the abuse of ibuprofen and other OTC anti-inflammatory medications. We live in a society where, if a little is good, a lot is better. Patients take 3 to 6 times the recommended dose of this class of drugs in hopes of relieving pain. In doing so, they cause pain!
There are many such stories in my practice. The take home lecture is that OTCs should be used according to the instructions that come with the product and with your doctor’s knowledge. They are not meant to take the place of medical care. They can cover up significant underlying conditions. They can adversely interact with the prescription medications you are taking. They are more costly than you know. They should be respected and taken only for the indication listed on the box they come in and only in complete accordance with the instructions on the box.