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Unexpected Dangers of Over-the-Counter Medicine

otc aspirin

Story at-a-glance -

  • Acetaminophen overdoses are also responsible for more than 150 deaths each year in the U.S.
  • In 2014, 13 deaths occurred after use of over-the-counter saline laxatives
  • The FDA has called on drug makers to strengthen their warning labels on prescription and OTC non-aspirin NSAIDs, to warn of increased risk of heart attack or stroke

By Dr. Mercola

If you have muscle aches, a headache, fever, heartburn, or allergy symptoms, do you reach for an over-the-counter (OTC) medication to help you feel better? If so, you're among good company.

Four out of five U.S. adults often take OTC meds for such complaints, as well as problems like skin disorders and digestive trouble. There are more than 300,000 OTC drugs on the market in the U.S. alone, and in 2014, Americans spent $44 billion buying them.

Many of them contain ingredients that were once available by prescription only; according to The New York Times, industry trade group Consumer Healthcare Products Association reported that more than 100 ingredients, indications, or dosage strengths have transitioned from prescription to OTC status since 1975.1

Many assume that OTC drugs are safe, perhaps even safer than drugs that require a prescription, but just because they're available over the counter doesn't mean they're risk-free.

It's important to be aware of the drug's active ingredients and potential side effects before taking it, but most people don't read all of the information on OTC drug labels. Even acetaminophen, the active ingredient in Tylenol and the most commonly used OTC medication, can be deadly if you're not careful.

Acetaminophen Can Be Deadly

Acetaminophen overdose is the leading cause for calls to Poison Control Centers across the U.S. — more than 100,000 instances per year — and acetaminophen poisoning is responsible for nearly half of all acute liver failure cases in the U.S.2

Acetaminophen overdoses are also responsible for more than 150 deaths each year in the U.S.3 A major problem is that while acetaminophen is considered safe when taken as recommended, the margin between a safe dose and a potentially lethal one is very small.

Taking just 25 percent more than the daily recommended dose — the equivalent of just two extra strength pills per day — can cause liver damage after just a couple of weeks of daily use.4

Previous research has also shown that taking just a little more than the recommended dose over the course of several days or weeks (referred to as "staggered overdosing") can be more risky than taking one large overdose.5 This happens more often than you might think.

It's Surprisingly Easy to Overdose on Acetaminophen

Research published in The Journal of General Internal Medicine showed that nearly 25 percent of people surveyed were at risk of overdosing by using just one OTC acetaminophen product during a 24-hour period.

Close to half of the participants were at risk of over-dosing by taking two acetaminophen-containing products.6 The researchers concluded:

"Misunderstanding of the active ingredient and proper instructions for over-the-counter medications containing acetaminophen is common.

The potential for errors and adverse events associated with unintentional misuse of these products is substantial, particularly among heavy users of acetaminophen and those with limited literacy."

Your risk of severe liver injury and/or death related to acetaminophen increases if you:

  • Take more than one regular strength (325 mg) acetaminophen when combined with a narcotic analgesic like codeine or hydrocodone
  • Take more than the prescribed dose of an acetaminophen-containing product in a 24-hour period
  • Take more than one acetaminophen-containing product at the same time. Make sure to read the list of ingredients on any other over-the-counter (OTC) or prescription drug you take in combination.
  • Drink alcohol while taking an acetaminophen product. Research suggests that acetaminophen significantly increases your risk of kidney dysfunction if taken with alcohol — even if the amount of alcohol is small.7

Combining alcohol with acetaminophen was found to raise the risk of kidney damage by 123 percent, compared to taking either of them individually. Besides alcoholics, young adults are particularly at risk as they're more likely to consume both.8

Unbeknownst to many, acetaminophen may also cause three serious skin reactions, two of which typically require hospitalization and can be fatal.

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NAC Is an Antidote to Acetaminophen Overdose

N-acetyl cysteine (NAC), which is an antidote for acetaminophen toxicity, is well worth knowing about if you ever use acetaminophen. NAC is administered as part of standard care in cases of acetaminophen overdose.

While I generally do not recommend using acetaminophen-containing drugs for minor aches and pains, they are sometimes necessary to temporarily suppress severe pain, such as post-surgical pain. For those instances, I recommend taking it along with NAC.

It is believed the liver damage acetaminophen causes is largely due to the fact that it can deplete glutathione, an antioxidant compound secreted by your liver in response to toxic exposure.

Glutathione also helps protect your cells from free radical damage. If you keep your glutathione levels up, the damage from the acetaminophen may be largely preventable. NAC is the rate-limiting nutrient for the formation of the intracellular antioxidant glutathione, which is why it's such an effective antidote.

Mortality due to acetaminophen toxicity has been shown to be virtually eliminated when NAC is promptly administered in cases of acetaminophen overdose. So whether you are taking Tylenol in prescription or over-the-counter form, I strongly suggest taking NAC along with it.

The Elderly, People Combining Meds May Be Most at Risk

Older adults are among the most heavily medicated populations, and about 40 percent of OTC drugs are used by those who are older than 65.9

With the average adult aged 65 and older taking 28 prescriptions per year,10 this factor alone significantly increases the risks, as combining OTC drugs with prescription drugs can be dangerous.

Seniors process medications differently than younger users and are also more likely to have health issues that contraindicate the use of certain OTC meds. Yet, anyone who is combining multiple medications faces increased risks.

Many OTC meds, in particular, may contain several active ingredients intended to treat multiple symptoms. You may take such a medication even though you only have one of the symptoms listed, and overmedicate yourself unknowingly.

If you then combine that combination product with another combination product, you could be exposing yourself to a seriously dangerous mix of medications.

Laxatives Are the Most Misused OTC Drug

Americans spend more than $700 million a year on over-the-counter (OTC) laxatives to treat constipation.11

However, you must use extreme caution when using such products, as they can have unintended consequences that make your bowel function worse or, as the U.S. Food and Drug Administration (FDA) warned in 2014,12 may even be deadly.

The FDA released the warning following 13 deaths (12 adults and one child) that occurred after use of OTC saline laxatives (including brand name Fleet and others). The products contain the active ingredient sodium phosphate, which draws water into your bowel to help soften your stool, allowing it to pass easier.

However, if too much is taken, the laxatives can lead to dehydration and abnormal levels of electrolytes in your blood, which can cause kidney damage, heart problems, and death.

Another crucial reason why laxatives are NOT a good option is that your body may become dependent on them. This is especially true with stimulant laxatives (such as brand name Exlax), which work by increasing the contraction of muscles in your intestines.

This risk also applies to senna or cassia laxatives, which are frequently marketed as natural. These laxatives may decrease your colon's ability to contract, and over time may damage your large intestine's nerves, muscles, and other tissues. The cumulative lifetime use of commercial laxatives has even been associated with increased risk of colon cancer.13

For these reasons, and because constipation is usually easy to remedy naturally, laxatives should be avoided at all cost and used only as a last resort. If you absolutely must use a laxative, make sure it is used for only a very short period of time.

Sleeping Pills: Another Potentially Dangerous OTC Remedy

When you're desperate for sleep, the idea of popping a pill and falling blissfully fast asleep is a tempting one, but resorting to sleep medications is risky business, even if the drugs are available over the counter. Diphenhydramine, an antihistamine, is a commonly used active ingredient in OTC sleeping pills, as it makes you feel drowsy.

Research involving data from more than 10,500 people who received drugs for poor sleep (hypnotics) showed that "as predicted, patients prescribed any hypnotic had substantially elevated hazards of dying compared to those prescribed no hypnotics" and the association held true even when patients with poor health were taken into account – and even if the patients took fewer than 18 pills in a year.14

The study suggested that those who take such medications are not only at higher risk for certain cancers, but are nearly four times more likely to die than people who don't take them. Sleeping pills linked to these risks included benzodiazepines (such as temazepam), non-benzodiazepines (such as Ambien, Lunesta, and Sonata), barbiturates, and sedative antihistamines (some of which are available over the counter).

Not to mention, antihistamine-containing sleeping pills may lose their effectiveness over time, tempting you to take more of the drugs. Such medications should also not be used for longer than two weeks and may cause side effects like daytime drowsiness and dizziness.

Be Careful with OTC Heartburn Drugs

One of the most commonly prescribed and OTC drugs for heartburn and acid reflux are proton pump inhibitors (PPIs), which are very effective at blocking acid production in your stomach. While that may sound like an appropriate remedy, considering the fact that stomach acid is creeping up your esophagus, in most cases it's actually the worst approach possible, as a major part of the problem is typically related to your stomach producing too little stomach acid.

Suppressing stomach acid does not address the problem. It only temporarily treats the symptoms. PPI drugs can also cause potentially serious side effects, including pneumonia, bone loss, hip fractures, heart attack, and infection with Clostridium difficile(a harmful intestinal bacteria).

It's also worth noting that you'll also develop both tolerance and dependence on PPI drugs, so you should not stop taking proton pump inhibitors cold turkey. You need to wean yourself off them gradually or else you might experience a severe rebound of your symptoms. In some cases, the problem may end up being worse than before you started taking the medication.

NSAIDS May Lead to Heart Problems or Bleeding Ulcers

NSAIDs, or nonsteroidal anti-inflammatory drugs, include medications like aspirin, ibuprofen, and naproxen. NSAIDs work primarily by inhibiting your body's ability to synthesize prostaglandins, which are hormone-like chemicals made in response to cell injury. Unfortunately, many are completely unaware that these medications can actually cause very serious harm.

Stomach upset, nausea, and vomiting are among the most common side effects, but numerous studies have linked NSAIDs to far more adverse effects, including death.15 All NSAIDs, including OTC aspirin and ibuprofen, are associated with potentially serious side effects such as cardiovascular problems, GI bleeding, kidney problems, and hypertension.

A Dutch study also found that use of NSAIDs may increase your risk for atrial fibrillation, a heart condition characterized by a rapid and irregular heartbeat, which increases your risk for heart failure and stroke.16

In July 2015, the FDA even called for drug makers to strengthen their warning labels on non-aspirin NSAIDs. The FDA stated the labels must now carry language warning of increased risk of heart attack or stroke, including "the risk of heart attack or stroke can occur as early as the first weeks of using an NSAID.

The risk may increase with longer use of the NSAID. The risk appears greater at higher doses."17 The labels must also explain that such risks apply even to people without heart disease, although the risks are increased for heart patients.

If you're in the habit of taking aspirin or acetaminophen when you have a cold, beware that previous research has also found that these drugs suppress production of antibodies and increase cold symptoms, with a trend toward longer infectiousness. For a full run down of the risks of NSAIDs, review the infographic below.

NSAID Infographic Preview

Alternatives to OTC Medications

I strongly recommend exhausting other options before you resort to OTC medications, including even acetaminophen. The health risks associated with these drugs are great, and there are often natural alternatives to help relieve your symptoms.

For instance, exercises, such as strengthening exercises, have been found to decrease pain more than short-term use of acetaminophen for hip or knee osteoarthritis.18 And as Dr. Houman Danesh, director of Integrative Pain Management at Mount Sinai School of Medicine in New York City, told WebMD:19

"This [featured] study does suggest that other methods – such as acupuncture, smoking cessation, weight loss, physical activity, and proper ergonomics at our work stations – may have an equal role to [acetaminophen] in treating back pain."

Below, I list 19 non-drug alternatives for the treatment of pain. I do understand there are times when pain is so severe that medication may be necessary. Even in those instances, the options that follow may be used in addition to such drugs and may allow you to at least reduce your dosage. If you are in pain that is bearable, please try these first, before resorting to medications of any kind.

  1. Eliminate or radically reduce most grains and sugars from your diet. Avoiding grains and sugars will lower your insulin and leptin levels and decrease insulin and leptin resistance, which is one of the most important reasons why inflammatory prostaglandins are produced. That is why stopping sugar and sweets is so important to controlling your pain and other types of chronic illnesses.
  2. Take a high-quality, animal-based omega-3 fat. My personal favorite is krill oil. Omega-3 fats are precursors to mediators of inflammation called prostaglandins. (In fact, that is how anti-inflammatory painkillers work, they manipulate prostaglandins.)
  3. Optimize your production of vitamin D by getting regular, appropriate sun exposure, which will work through a variety of different mechanisms to reduce your pain.
  4. Emotional Freedom Techniques (EFT) is a drug-free approach for pain management of all kinds. EFT borrows from the principles of acupuncture, in that it helps you balance out your subtle energy system. It helps resolve underlying, often subconscious, and negative emotions that may be exacerbating your physical pain. By stimulating (tapping) well-established acupuncture points with your fingertips, you rebalance your energy system, which tends to dissipate pain.
  5. K-Laser Class 4 Laser Therapy. If you suffer pain from an injury, arthritis, or other inflammation-based pain, I'd strongly encourage you to try out K-Laser therapy. It can be an excellent choice for many painful conditions, including acute injuries. By addressing the underlying cause of the pain, you will no longer need to rely on painkillers.
  6. The infrared wavelengths used in the K-Laser allow for targeting specific areas of your body, and can penetrate deeply into the body to reach areas such as your spine and hip. For more information about this groundbreaking technology, and how it can help heal chronic pain, please listen to my previous interview with Dr. Harrington.

  7. Chiropractic. Many studies have confirmed that chiropractic management is much safer and less expensive than allopathic medical treatments, especially when used for pain, such as low-back pain. Qualified chiropractic, osteopathic, and naturopathic physicians are reliable, as they have received extensive training in the management of musculoskeletal disorders during their course of graduate healthcare training, which lasts between four to six years.
  8. These health experts have comprehensive training in musculoskeletal management.

  9. Acupuncture can also effectively treat many kinds of pain. Research has discovered a "clear and robust" effect of acupuncture in the treatment of: back, neck, and shoulder pain, osteoarthritis, and headaches.
  10. Physical and massage therapy has been shown to be as good as surgery for painful conditions such as torn cartilage and arthritis.
  11. Astaxanthin is one of the most effective fat-soluble antioxidants known. It has very potent anti-inflammatory properties and in many cases works far more effectively than anti-inflammatory drugs. Higher doses are typically required and you may need 8 mg or more per day to achieve this benefit.
  12. Ginger: This herb has potent anti-inflammatory activity and offers pain relief and stomach-settling properties. Fresh ginger works well steeped in boiling water as a tea or grated into vegetable juice.
  13. Curcumin: In a study of osteoarthritis patients, those who added 200 mg of curcumin a day to their treatment plan had reduced pain and increased mobility. A past study also found that a turmeric extract composed of curcuminoids blocked inflammatory pathways, effectively preventing the overproduction of a protein that triggers swelling and pain.20
  14. Boswellia: Also known as boswellin or "Indian frankincense," this herb contains specific active anti-inflammatory ingredients. This is one of my personal favorites as I have seen it work well with many rheumatoid arthritis patients.
  15. Bromelain: This enzyme, found in pineapples, is a natural anti-inflammatory. It can be taken in supplement form but eating fresh pineapple, including some of the bromelain-rich stem, may also be helpful.
  16. Cetyl Myristoleate (CMO): This oil, found in fish and dairy butter, acts as a "joint lubricant" and an anti-inflammatory. I have used this for myself to relieve ganglion cysts and a mild annoying carpal tunnel syndrome that pops up when I type too much on non-ergonomic keyboards. I used a topical preparation for this.
  17. Evening Primrose, Black Currant, and Borage Oils: These contain the essential fatty acid gamma linolenic acid (GLA), which is useful for treating arthritic pain.
  18. Cayenne Cream: Also called capsaicin cream, this spice comes from dried hot peppers. It alleviates pain by depleting the body's supply of substance P, a chemical component of nerve cells that transmits pain signals to your brain.
  19. Medical cannabis has a long history as a natural analgesic21 Its medicinal qualities are due to high amounts (about 10 to 20 percent) of cannabidiol (CBD), medicinal terpenes, and flavanoids. Varieties of cannabis exist that are very low in tetrahydrocannabinol (THC) — the psychoactive component of marijuana that makes you feel "stoned" — and high in medicinal CBD.
  20. The Journal of Pain,22 a publication by the American Pain Society, has a long list of studies on the pain-relieving effects of cannabis.

  21. Methods such as yoga, acupuncture, meditation, hot and cold packs, and other mind-body techniques can also result in astonishing pain relief without any drugs.
  22. Grounding, or walking barefoot on the earth, may also provide a certain measure of pain relief by combating inflammation.