Appropriate selection and safe consumption of OTC medications

THE new growth opportunities in the pharmaceutical industry to address access to safe and effective medications for the rising aged population was the genesis for over the counter (OTC) medications. This strategic move to make an OTC version of prescription only medicines (POM) or Rx preparations which contain less milligrams of ingredients, permits acquisition without a prescription or even without a pharmacist watch since they are readily accessible. Hence the Rx to OTC switch puts the consumer in the driver seat where as a responsible driver you are expected to read the label and follow the instructions accordingly for appropriate selection and safe consumption of medications.

Over the last three decades more than 700 individual Rx switched to OTC. In excess of 80 categories of meds for various ailments were deemed safe preparations by the FDA authority ranging from indigestion/reflux preparations to pain killers. Today OTC include wide ranges of tonics, vitamins in various formulations (chewables, gummies and effervescent drinkables), topical acne treatment (presented as gels, foam, washes, soaps), weight loss/mass gainer supplements, antiseptic mouthwashes, hand sanitisers and antibiotic ointment. In all of the examples given these OTCs are less strong than its Rx equivalent. But conversely, the “emergency” contraceptive pill (Plan B or Pill 72) is a high dose of the regular daily oral contraceptive and is available in non-prescription form. Medications, especially like Pill 72 have the potential for risks outweighing the benefits if it is not used according to the directions given. You are not expected to have “an emergency” daily or weekly. So what are the implications if such products are abused either knowingly or unknowingly?

The repercussions are becoming more alarming since some patients are presented with more compromised organ function and even irreversible damage mainly to the kidneys and the heart. This was highlighted in the case when the teenage girl went into cardiac arrest in the US and died at the coffee shop having consumed excessive caffeinated products at a fast rate. Highly caffeinated products are readily available in the form of energy drinks and ‘stay awake’ pills in Guyana. In recent times, prior to COVID-19, there was a trend of abuse of cough syrups to attain a “euphoric high”, a universal problem associated either with DXM (dextromethorphan) or codeine (a restricted ingredient). Abused dosages of DXM ranges from breathing problems, rapid heart rate (palpitations), muscle twitching and brain damage. So as a parent if you see this in the bags of your children you should be very concerned.

Similarly, medications such as aspirin and paracetamol can potentially escalate a crisis in patients with a pre-existing liver disease such as cirrhosis or the genetic Wilson disease since they are metabolised by the liver. In sickle cell patients overload with iron tonic can lead to a hospital admission. Some mothers give their kids diphenhydramine found in cold medicines or cyproheptadine present in appetite stimulants for the sedative side effects which can lead to temporary memory loss or in extreme cases impairment of the brain functions over time.

Cough “syrups” found on the shelves of a supermarket, patent shop or gas station are not a one size fit all, and it is highly unlikely that a clerk or cashier with no pharmaceutical knowledge can be able to best advise you on the most suitable choice. For example, diabetics cannot use syrup or lintus, they should only use products labelled “sugar free”. A multi-symptom product provide the “shot gun” effect of treatment and may not be the best option since you will experience the side effects from the unwanted ingredient(s). So taking a flu medication when there is no fever is unnecessarily working your liver to breakdown an extra drug for which you have no symptom. A hypertensive or heart patient should not select a product with pseudoephedrine or ephedrine.

As asthmatic should not use any product with NSAIDs (non-steroidal anti-inflammatory drugs) like Advil, Motrin (generic is ibuprofen). And as a rule of thumb, NO child or any teenager below 18 years of age should be given aspirin because of Reye’s syndrome.

For further advice consult the pharmacist at Medicine Express PHARMACY located at 223 Camp Street, between Lamaha and New Market Streets. If you have any queries, comments or further information on the above topic kindly forward them to medicine.express@gmail.com or send them to 223 Camp Street, N/burg.
Tel #225-5142.

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