Medicines, or medications, are drugs used to prevent or treat diseases and other health conditions. Drugs are chemical substances that affect the body or mind when they are introduced into the body. They are an important aspect of healthy living for many reasons. They can reduce fever, relieve pain, kill bacteria, and treat the symptoms of minor disorders as well as those of life-threatening illnesses. It is important, however, to use medications—nonprescription as well as prescription drugs—with care. When medications are not used correctly, they can be dangerous and harmful.
Types of Medications
In the United States, medications can be classified in several different ways:
- By legal status: as prescription drugs, controlled substances, nonprescription or over-the-counter drugs (OTCs), or dietary supplements. Controlled substances include illegal drugs as well as certain classes of prescription drugs that carry a risk of abuse. (Prescription drug use is taking a medication as directed to help a medical problem or condition. Prescription drug abuse happens when people take prescription medications more often or in greater amounts than is recommended.) In addition to requiring a prescription, controlled drugs must be placed under additional safeguards for storage, and the number of refills allowed is also restricted by law.
- By route of administration (how the drug is delivered into the body). Drugs can be administered through several routes other than the mouth, including topical treatments like a cream or ointment, patch, or by injections.
- By indication (intended use or purpose) or effect: Is the medication intended to prevent disease, relieve pain, fight infection, lower anxiety, treat acid indigestion, or serve some other specific
purpose? For example, vaccines are medications that help to prevent disease, antibiotics are medications used to combat bacterial infections, and analgesics are medications that help to relieve pain like aspirin and acetaminophen.
Prescription medications are licensed medications. “Licensed” means that they are regulated in the United States (or another country) and can be obtained legally only by receiving a written order from a licensed
physician or other health care professional with the authority to prescribe drugs. The prescription itself is a legal document, so stealing prescription forms or forging a prescription is a crime in all 50 states. Such medications must carry a legend or label prohibiting their sale without a prescription. The usual wording of the legend is: “Caution: Federal law prohibits dispensing without a prescription.” Some pharmacies add a second legend: “Caution: Federal law prohibits the transfer of this
drug to any person other than the patient for whom it was prescribed.” This second legend is intended to reduce the likelihood that prescription drugs will be stolen or resold.
Licensing of Health Care Professionals
Prescription medications can be prescribed and filled only by licensed health care professionals. In the United States, physicians—both doctors of medicine (MDs) and doctors of osteopathy (DOs)—have the widest authority to prescribe medications in all 50 states and the District of Columbia. Every physician in the United States who prescribes controlled substances must be registered with the Drug Enforcement Administration (DEA) and the state in which he or she practices. The physician's DEA number is preprinted at the top of each prescription form, whether the form is filled in by hand or by computer. Veterinarians, dentists, and podiatrists (specialists in foot disorders) also have full authority to prescribe medications in all parts of the United States.
Optometrists have the authority to prescribe medications for certain eye disorders and to write prescriptions for corrective lenses (glasses or contact lenses). Advanced practice nurses (such as nurse-midwives and nurse practitioners) and physician assistants (PAs) are also allowed to prescribe medications; however, some states limit their authority to prescribe controlled substances. A few states have passed legislation to permit clinical psychologists (PhDs or PsyDs) who have undergone advanced training in pharmacology to prescribe medications to treat mental and emotional disorders. Clinical pharmacists (pharmacists holding the PharmD degree) are also allowed to prescribe medications in some states through collaboration agreements. Most registered nurses, most psychologists, most pharmacists, emergency medical technicians, and social workers do not have the authority to prescribe medications.
In addition to licensing specified categories of health care professionals to write prescriptions, state governments in the United States also license and regulate the pharmacists who fill the prescriptions. To become a registered pharmacist (RPh), a person must pass a licensing examination after completing a four-year graduate program in pharmacy and register with the pharmacy board of the state in which he or she practices.
Brand Name and Generic Drugs
Prescription medications can be identified either by their brand name or by their chemical (generic) name.
The brand name, or proprietary name, of a drug is the trade name given to it by the company that first produces it and holds a patent (exclusive right) on its production. Examples of brand or proprietary names are Prozac, the trade name of a chemical called fluoxetine; and Zantac, the trade name of ranitidine, a medication that reduces the level of stomach acid secretion. Generic medications are widely accepted by the general public because they cost less than their proprietary (brand-name) counterparts.
Most drug patents are protected by the Food and Drug Administration (FDA) for 20 years, starting from the date that their clinical trials begin. This period allows the company that first produced the drug time to recover the high costs of researching and developing the drug. After the patent expires, other drug companies can produce generic versions of the formerly patented drug, provided they can demonstrate that their generic versions are bioequivalent to the brand-name product. Bioequivalent means that the generic drug is the same as the brand-name version in its intended use(s), dosage form, safety, strength, method of administration, quality, and effectiveness. For example, when the drug patent on Prozac expired in 2001, 21 other drug companies around the world began producing generic versions. Fluoxetine is still a popular antidepressant, with 24 million prescriptions for its generic equivalents filled in the United States alone in 2010.
Missed Doses and Overdoses
It is a good idea to take a prescription medication at the same time(s) each day as a way to remember to take the drug. People should not panic if they realize that they have forgotten their dose; they should simply take the drug as soon as they remember. If it is almost time for the next dose, however, people should just skip the missed dose and return to their regular dosage schedule. They should generally not take two doses of the medication to make up for the missed dose. When people are unsure about whether to make up the missed dose, they should contact their physicians or pharmacists for advice.
Drug overdoses are more common in children under 5 years of age, teenagers, and young adults but can occur in people in any age group.
Some cases of drug overdose are accidental (particularly in small children and older adults) while others are intentional. Prescription drugs vary in their effects on the body when taken in large quantities; some have only minor effects while others may produce life-threatening symptoms. In addition, individuals vary in their physical reactions to a drug overdose. Since friends and family members cannot be expected to know when a drug overdose will have serious consequences, health care professionals recommend taking the following steps when someone overdoses on a prescription drug:
- Collect any container(s) found near the person who took the overdose. The person's doctor or emergency department personnel will need accurate information about the drug, including its name, the amount of the drug that was taken, and the time when the overdose Page 274 | Top of Articlewas taken. In most cases the label on the container will provide information about the specific drug, the strength of each dose, and the number of doses originally dispensed by the pharmacist.
- Write down the person's age, sex, weight, and general health condition, and watch for any symptoms like confusion, sweating, or nausea that the person may have. Be ready to provide this information when calling for help.
- Do not try to make the person vomit, or give them anything to eat or drink.
- Call the person's doctor; or if he or she is unavailable, call the national poison control center for advice on the specific drug. Make the call even if the person who overdosed does not seem to be having any symptoms. The poison control center can be reached 24/7 from anywhere in the United States at 800-222-1222; staff members are trained to give further instructions.
- If professional advice is unavailable, it is best to take the person to the nearest hospital emergency room, or call 911 and request an ambulance. Be sure to bring the medicine containers to the hospital along with the patient.
Prescription Drug Abuse
Prescription drug abuse is the intentional use of a medication without a prescription; taking drugs in amounts or frequencies other than those prescribed by the doctor; or for the experience or feeling it causes. It also refers to the use of prescription drugs for nonmedical purposes; taking the drug by a method other than the one prescribed (such as injecting the drug rather than taking it by mouth); and the giving or selling of prescription drugs to someone other than the person for whom the drug was prescribed. Prescription drug abuse may also involve the stealing, forging, or selling of prescriptions, or the illegal purchase of prescription drugs over the Internet.
Prescription drug abuse is a growing problem among American teenagers as well as adults. According to the National Institute on Drug Abuse (NIDA; one of the National Institutes of Health) in 2010, prescription medications and OTCs accounted for most of the drugs abused by high school seniors. In 2010, the most recent year for which data are available, one in every 12 twelfth-graders reported abusing Vicodin
(a combination of hydrocodone and acetaminophen); one in every 20 admitted to abusing OxyContin (oxycodone). Both drugs are powerful pain relievers. When asked, 70% of those who admitted to abusing prescription drugs said they had obtained them from a family member or friend; only a few stated that they had bought the drugs over the Internet.
According to NIDA, there are several reasons why prescription drug abuse is growing among teenagers. One reason is that people think that prescription drugs are safe for anyone to use because they are prescribed by doctors (or other licensed health care professionals). This is a dangerous misunderstanding; as noted earlier, when a doctor writes a prescription, he or she selects the most appropriate drug for the individual patient, and prescribes the strength and dosage of the drug that will be most effective for that specific person. The same prescription, however, may be ineffective or even harmful for someone with a different body chemistry, height or weight, age, or health condition.
A second reason for the increase in prescription drug abuse is the growing availability of prescription medications in general. In 1991, for example, doctors in the United States wrote 5 million prescriptions for stimulants; by 2010, they were writing 45 million prescriptions for
these drugs each year. Similarly, prescriptions for opioid pain relievers rose from 75.5 million in 1991 to 209.5 million per year by 2010. This increase in the number of prescriptions means that there are more prescription-only drugs in people's family or friendship networks that can be stolen, sold, or used improperly.
The third reason for abusing prescription drugs is emotional issues. Teenagers as well as adults may use these drugs to get high, to relieve anxiety, to help them sleep, to do what their friends are doing, or simply because they are bored and want to try a new experience. The problem is that there are significant dangers associated with the abuse of prescription drugs. One is the possibility of becoming dependent on or addicted to the drug. A second danger is accidental overdose, particularly with opioid pain relievers; the number of accidental deaths from opioid overdose has increased fourfold in the United States since 1999, and is now larger than the number of accidental deaths from heroin and cocaine combined. The third danger is the possibility of contracting HIV or other infections from shared needles when injecting the drug.
What to Do If Prescription Drug Abuse Is Suspected
The first thing to do if a friend or family member might be abusing prescription or OTC medications is to observe the person's behavior. Is the person using a medication without following directions or using a medication prescribed for someone else? Is the medication being used when it is not needed or for purposes other than medical treatment? When a friend or family member may be abusing medication, a first step may be to ask them about it and express concern. It might be as simple as expressing the concerns to the person and offering help without accusing or blaming the person. Very often a person who is abusing drugs will make excuses for his or her drug use such as “I'm just trying to lose weight,” or “I need it to stay awake and study at night after my part-time job,” or “I have a big game next week.” Be prepared to give examples of the
friend or family member's behavior that are issues of concern.
If a person believes they may have a problem with prescription or OTC drug abuse, it's important to seek help immediately. Ask a friend, family member, or other trusted adult for help. Parents, teachers, other family members, friends, counselors, and healthcare providers can help find the necessary help. Admitting the problem is the first step on the road to recovery. It takes courage and strength to recognize one's own problems; it also may take support to seek the help needed to solve them. There are many resources available to help people with prescription or OTC drug problems. Health professionals, self-help groups, counselors and therapists, and self-directed treatment programs can help people overcome their drug problems.
When people are ill, often times they are able to seek relief from medications available at their local pharmacy without having to visit a physician for prescription medicine. Typically, the conditions are minor and not life threatening. People use nonprescription, or over-the-counter (OTC), drugs to treat less serious conditions that are either transient (will pass relatively quickly), such as the common cold, or chronic (lasting for a long time or recurring frequently), such as allergies.
OTCs are an additional large category of medications regulated by the FDA's Center for Drug Evaluation and Research. According to the Consumer Healthcare Products Association (CHPA), there are over 100,000 OTCs available for purchase in the United States and Canada as of 2012. Most of these OTCs are used to maintain good nutrition or to treat minor illnesses or conditions that do not require a doctor's attention. OTCs include all medications that do not require a prescription, although some have age restrictions or quantity limitations on purchase as noted below. One major difference between prescription drugs and OTCs is federal oversight of advertising: while the FDA regulates the
advertising of prescription medications, OTC advertising is regulated by the Federal Trade Commission or FTC.
Over-the-counter medications represent a large portion of the money spent on health care in the United States; sales of OTCs for minor health complaints amount to more than $20 billion per year, with dietary supplements accounting for another $12 billion. Nonprescription drugs are also widely available for purchase over the Internet as well as in supermarkets and other retail stores that do not have pharmacies. As of 2012, OTCs can be purchased in over 750,000 locations in the United States.
Common Types of OTCs
Some of the most common OTC drugs, from pain relievers such as acetaminophen and aspirin to cold and flu remedies to more controversial remedies like sleep aids and weight loss aids, are presented below, followed by side effects and recommendations for general usage of such medications. OTCs generally can be grouped into the following large categories:
Medications Related to Digestion
Over-the-counter drugs in this category include antiemetic preparations to relieve nausea and vomiting; laxatives to treat serious constipation; antidiarrheal preparations to stop diarrhea; antacids to relieve acid indigestion by neutralizing stomach acid; and acid reducers that work to relieve heartburn or acid reflux by neutralizing (opposing it to create better balance) acid produced by the stomach. Some preparations in this category can serve more than one function; for example, bismuth subsalicylate, a liquid preparation sold under the trade name Pepto-Bismol, may be used to treat nausea, heartburn, and diarrhea.
The stomach stores food, mixes food with gastric secretions, and empties food into the small intestine for digestion and absorption. Gastric acid helps with digestion and absorption of food, and it also kills bacteria found in the stomach. Acidity is measured using a pH value. The pH of gastric acid is extremely high, approximately 3 million times more acidic than the pH of blood. The stomach has a lining to protect it from this acid. The lining secretes mucus and bicarbonate, which form a barrier against the acid.
Many substances interfere with the lining's ability to protect the stomach, so it may become irritated by the acid. These substances include medications, alcohol, and caffeine. Smoking and certain diseases
affect the lining as well. When acid irritates the stomach, the resulting symptoms may include heartburn, gas, indigestion, and even ulcers, which are tears or breaks in the lining. There are two main types of antacids to treat these problems: H2-antagonists and non-H2-antagonists. (H2 is a type of acid.)
Non-H2-antagonists were the first antacids available without a prescription. They work by neutralizing the gastric acid in the stomach. This makes it easier for the lining to protect the stomach. These antacids contain calcium carbonate, sodium bicarbonate, aluminum salts, or magnesium salts as their main ingredients.
Calcium carbonate takes longer to dissolve than the other ingredients but is more effective at neutralizing the acid. Calcium carbonate antacids are intended for short-term use only. Some people believe that the calcium in antacids can be used as a dietary supplement, but the amount of calcium that is absorbed, and therefore usable by the body, is actually very small.
Antacids that use sodium bicarbonate offer almost instant relief, but should not be taken by people who are on a low-sodium diet, have congestive heart failure, high blood pressure, cirrhosis, swelling, or kidney failure because of the sodium (salt) that the body absorbs from these antacids.
Aluminum salts dissolve very slowly and take longer to work. These antacids can cause constipation. They are often combined with magnesium salts, which cause diarrhea. Magnesium salts neutralize acid better than aluminum salts, but not as well as calcium carbonate or sodium bicarbonate, and they don't provide long-term relief. People with kidney failure should not use aluminum salt or magnesium salt antacids.
Some antacids have other ingredients such as aspirin or a chemical called simethicone, which relieves gas. Sometimes sodium bicarbonate antacids also contain alginic acid. This acid reacts to the sodium bicarbonate and makes a foam that treats heartburn.
H2-antagonist antacids also are available without prescription. Originally designed to treat ulcers, they work well for heartburn, acid relief, and sour stomachs. These antacids work by blocking the formation of excess acid in the stomach. They do not neutralize the acid that is already there. These antacids should not be taken for more than two consecutive weeks.
Antacids in liquid form absorb faster than the other varieties, so they provide faster relief. Chewable tablets should be chewed thoroughly and work best when taken with water. Some interactions with other drugs may occur because the other drugs can bind to the antacids and will not get fully absorbed. Pregnant women should not use antacids unless recommended by their doctor.
When the digestive tract is functioning normally, food and fluid pass from the stomach into the small intestine and colon. Cells that line the small intestine and colon absorb nutrients and water then pass the waste along. If these cells become irritated, they cannot absorb the nutrients and water as they should. The food and fluids then move through the colon too fast, which results in a watery stool called diarrhea.
There are a number of things that can irritate the cells lining the small intestine and colon. The most common culprits are viruses, which people often call “stomach flu,” but which actually is an illness called viral gastroenteritis. Allergies or reactions to certain foods and parasites or bacteria found in food and water, stressful situations, poisons, blood pressure drugs, and drinking too much alcohol may also cause diarrhea.
OTC antidiarrhea drugs, such as Imodium and Kaopectate, do not cure diarrhea; rather they only control its symptoms. People who have diarrhea should try to rest, eat small amounts of food at a time, and avoid dehydration by drinking plenty of fluids. The best diet for diarrhea is known by the acronym BRAT, which stands for bananas, rice, applesauce, and toast. Antidiarrhea drugs should not be used for more than two days.
When people's bowels do not move as often as usual and waste becomes hard and difficult to pass, they suffer from constipation. Other symptoms of constipation may include lower back pain, a distended stomach, or a headache. Constipation is usually the result of inadequate (not enough) water intake or a diet that is lacking in fiber. Fiber naturally provides bulk, which makes the waste soft and easy to pass. A diet that includes more fruits, vegetables, and whole grains provides more fiber. Also, certain diseases and drugs such as narcotic analgesics, antidepressants, and antacids that contain aluminum may cause constipation. Lack of exercise may be a contributing factor as well.
Constipation that does not improve with dietary changes is commonly treated with OTC drugs called laxatives that stimulate bowel muscles or soften waste. Laxatives may also used to prevent pain for people with hemorrhoids. Laxatives should only be used for short-term therapy (no longer than a week) and should not be used to achieve weight loss. Overuse of laxatives is dangerous and can lead to severe deficiencies in vitamins and minerals. People can also develop a dependency on laxatives if they are used for too long; this can lead to chronic constipation.
There are two main types of OTC laxatives, and both affect the large intestine. Bulk-forming laxatives absorb water, increasing the volume of waste in the bowel and making it softer and easier to pass. These laxatives produce results within 12 to 72 hours. Stimulant laxatives use senna to make the bowel muscle contract, which speeds the passage of waste through the intestine. Overuse of stimulant laxatives can cause dehydration, severe cramping, and loss of protein and potassium. Some products contain both a stimulant laxative and stool softener.
Laxative users should contact their doctors if they experience nausea, vomiting, bleeding, dizziness, or weakness while using OTC laxatives. Children under six should not use laxatives unless they have been so advised by their doctor.
Analgesics (Pain Relievers)
Pain relievers, or analgesics, are familiar products found in most medicine cabinets. These OTC products are intended to relieve mild pain from conditions such as headaches, muscle or menstrual cramps, toothache, arthritis (painful inflammation of the joints), fevers, and other pain-related symptoms. Though there are many brand name products and different strengths and formulas, and today's consumer has a variety of pain relieving products from which to choose, there are two major categories of over-the-counter pain relievers: those containing acetaminophen (e.g., Tylenol); and nonsteroidal anti-inflammatory drugs or NSAIDs. NSAIDs include such drugs as aspirin, ibuprofen (e.g., Advil), and naproxen (e.g., Aleve). Descriptions of the various pain-relieving agents available as OTC drugs follow.
Acetylsalicylic acid is known by a much more familiar name—aspirin. It is a common analgesic, or drug that alleviates pain without affecting consciousness. In the fifth century BC, Greek
physician Hippocrates used powder extracted from willow tree bark to treat pain and reduce fever. The active ingredient, sodium salicylate, was discovered centuries later. This ingredient was the predecessor to aspirin.
Aspirin works by inhibiting the release of hormone-like substances called prostaglandins. Prostaglandins affect blood vessels and the functions of blood platelets and sensitize nerve endings to pain. By limiting prostaglandins, aspirin affects blood clotting, eases inflammation, and prevents nerve endings at the site of the pain from becoming stimulated. It is used to relieve pain from headaches, muscle strain, arthritis, and to reduce fevers.
Like all drugs, aspirin has risks as well as benefits. It can irritate the stomach lining, causing heartburn, pain, or nausea. Coating aspirin capsules helps to reduce the risk of irritation by preventing the release of the aspirin until it has passed through the stomach and into the small intestine; however, coating also slows the absorption of aspirin and increases the amount of time it takes before it starts to work. Buffered aspirin reduces the acidity of the stomach's contents to lessen irritation. Taking aspirin with an antacid or after a meal also reduces stomach irritation. Because of these possible side effects, people should not take aspirin if they have a bleeding disorder, stomach ulcer, or gout (a painful disease of the joints, especially legs, hands, and feet).
Acetaminophen is the generic (non-trademarked) name for the pain reliever found in brand name products such as Tylenol and Excedrin. It is also used to treat fever, headaches, and minor aches and pains. Like aspirin, acetaminophen limits the production of prostaglandin in the brain. Aspirin affects prostaglandin production in the rest of the body as well, but acetaminophen only affects the brain. For this reason, acetaminophen does not reduce inflammation. It cannot affect swelling from arthritis, sprains, or muscle pain. It has fewer side effects than either aspirin or ibuprofen (see below). Many people with blood clots, ulcers, chicken pox, influenza, or gout can safely take acetaminophen instead of aspirin.
Originally available only by prescription, this drug has been available in lower strength as an OTC pain reliever since 1984. Ibuprofen may be used to treat headaches, muscle aches, arthritis, swelling, menstrual pain, and to reduce fevers. Like aspirin and acetaminophen, it works by inhibiting production of prostaglandins, which aids blood clotting and makes nerve endings sensitive. Ibuprofen is a stronger analgesic than either aspirin or acetaminophen and a better anti-inflammatory than aspirin. It can be found in brand name products such as Advil, Motrin IB, and Nuprin.
Premenstrual syndrome (PMS) is the name given to a group of physical and emotional symptoms that females who are menstruating may experience just before the start of menstruation each month. It is estimated that more than 40 percent of women experience some symptoms of PMS. The symptoms usually begin seven to 14 days before the onset of menstruation and can last until 24 hours after menstruation ends. The symptoms and their intensity can vary. Physical symptoms include headache, cramps, backache, bloating, constipation, and diarrhea. The emotional symptoms may include irritability, lethargy or tiredness, and quick mood swings.
OTC drugs for PMS treat the physical symptoms using analgesics to help relieve pain and diuretics to reduce water retention and bloating. The best way for women to treat PMS is to avoid stress, exercise regularly, and watch their diets. A diet high in protein, complex carbohydrates, and vitamin B may help lessen the symptoms of PMS. It also helps to avoid salt (which may cause the body retain water), coffee, tea, chocolate, and cola (which contain caffeine and can contribute to headaches).
Topical is a term that refers to products applied to the skin and other surface tissues of the body, such as the eyes, nails, hair, or lining of the mouth. Topical OTCs include such medications as moisturizing or redness-relieving eye drops; anti-itch creams or lotions to relieve discomfort from sunburn, poison ivy, or other minor skin irritations; soaps, creams, scrubs, toners, and cleansers for treating acne; sunscreens to reduce the risks of prolonged sun exposure; liniments and gels to relieve the pain of arthritis; local anesthetic gels or liquids to treat mouth ulcers; rubbing alcohol and hydrogen peroxide solutions to cleanse and disinfect minor cuts and scrapes; and anti-cavity, dental sensitivity, tartar control, and tooth-whitening toothpastes.
Topical Antibacterial Agents
Antibacterial agents work by various mechanisms to kill or slow the growth of bacteria that are causing infection. OTC topical antibacterial agents such as Neosporin are intended to treat minor cuts and scrapes, and they usually contain one or more of three different antibiotics designed to combat specific types of microorganisms. Some antibacterial drugs also contain local anesthetics to alleviate the pain that can accompany infections. Other antibacterial drugs include antiseptics to prevent or slow down bacteria growth in the infected area. Mineral oil or lanolin may also be found in these drugs to speed the medication's absorption.
To further promote the effectiveness of antibacterial drugs, it is important to keep infected areas clean, cool, and dry, and drink plenty of water (topical medicines are poorly absorbed by the skin if it is dehydrated). Antibacterial agents may cause allergic reactions such as rashes and fever. These problems can often be resolved by changing to a different drug. Like many OTC drugs, topical antibacterial agents should not be used for more than seven days.
Cortisone is an organic (naturally occurring) compound from the steroid family (a group of fat-soluble organic compounds). It is a hormone that originates in the adrenal cortex (part of the adrenal glands, which are located one above each kidney), and is known for its anti-inflammatory properties. It was first introduced in 1948 as a treatment for rheumatoid arthritis. It is now available as
a synthetic compound called hydrocortisone, which is found in many OTC creams and ointments, such as Cortaid, to provide relief from certain skin conditions such as eczema; itching caused by allergies, rashes, poison ivy/oak, and bug bites; arthritis; and hemorrhoids. Cortisone can cause problems with sodium, potassium, and nitrogen imbalances and may sometimes cause swelling and further inflammation. It should not be used for more than seven days at a time.
Acne is an inflammatory disease of the oil glands of the skin. Both superficial (surface) acne and deep (cystic) acne are caused by a combination of bacteria, hormones, and inherited tendencies. Certain drugs, industrial chemicals, oily cosmetics, or hot, humid conditions can also cause or worsen the condition.
During puberty, an increase in hormones stimulates oil glands on the face, neck, back, and chest. The glands produce large amounts of sebum, a fatty substance. Sebum normally flows out of the skin along the hair follicles. However, too much sebum, combined with skin debris, can form a plug in the hair follicle called a blackhead. Once the hair follicle becomes plugged, bacteria grow in it. This bacterial infection is called acne. In severe cases of deep acne, inflamed cysts may form; in the most severe cases of cystic acne the cysts can cause permanent scars.
Mild cases of acne do not necessarily need to be treated with drugs. Regular washing and moderate exposure to sunlight will usually control the acne. Antibacterial soaps can be somewhat helpful, although they may cause irritation. Moderate to severe acne is usually treated with OTC topical (applied on the body) drugs such as salicylic acid or benzoyl peroxide, contained in products such as Clearasil and Stridex medicated pads. In addition, some people may use products that contain retinoids. Unfortunately, the ingredients that make these products effective may cause discomfort or redness, especially during the first few uses. In addition, these same ingredients can dry the skin and make skin extremely sensitive to the sun. It is advisable to avoid unnecessary sun exposure and use sunscreen regularly when treating acne with topical medications.
It is best to see a dermatologist (doctor who specializes in skin conditions) before starting any new acne treatment. If none of the OTC treatments seem to be working, people with severe or cystic acne may need prescription agents—powerful topical or oral medications—to help clear the skin.
Yeast Infection Medicine
A yeast infection is a common infection of a woman's vagina caused by overgrowth of the fungus Candida albicans. Candida is naturally present on the skin and in the vagina, but it multiplies rapidly when there is a change in the pH or hormone balance. This rapid growth may be caused by antibiotic or steroid therapy. Women with diabetes often experience yeast infections because the yeast grows quickly when blood sugar levels are high. Using douches or vaginal hygiene sprays may also alter pH and cause yeast infections. The symptoms of a yeast infection in women are itching, burning, a vaginal discharge, and redness in the pubic area.
There are many OTC medications for treating yeast infections. However, the symptoms of a yeast infection are similar to those of other vaginal infections, so for women who have not experienced a yeast infection or are not sure they have a yeast infection, checking with a doctor first is advisable. If it is a yeast infection, OTC antifungal yeast infection drugs, available in creams or suppository form, may be used. These drugs may interact with oral contraceptives (birth control pills) and antacids and should not be used by pregnant women. If the symptoms do not go away after the recommended treatment, women should see a doctor immediately.
Men can also have yeast infections, and it is possible, though rare, that they can be transmitted sexually. In men, a yeast infection may cause itching and irritation of the penis. Most doctors agree that men do not generally need to be treated if symptoms clear quickly, however, if symptoms continue, they should see a doctor.
Hemorrhoids are a form of varicose (swollen or knotted) veins that occur when the veins around the anus become inflamed or irritated. This usually results from pregnancy or prolonged sitting for long hours at a time. Hemorrhoids may cause itching, burning, pain, swelling, irritation, or bleeding around the anus, and constipation can make hemorrhoids worse.
There are two ways to treat hemorrhoids using OTC drugs. There are creams and suppositories that relieve most symptoms. These drugs usually consist of a soothing agent that contains an antiseptic, an astringent (such as bismuth, witch hazel, and zinc oxide), or a vasoconstrictor (shrinks blood vessels). These ingredients reduce swelling, burning, and itching, and restrict blood supply to the area. Some also contain a local anesthetic (pain blocker). These drugs may cause irritation or a
rash. The second method of treatment is to relieve constipation by using laxatives, which may aggravate hemorrhoids in the short term. Laxatives soften waste to ease its passage.
Neither treatment actually shrinks the hemorrhoids. They simply provide symptom relief while over time the problem corrects itself naturally. OTC hemorrhoid drugs are available in ointments, suppositories, and medicated pads with witch hazel. Severe or persistent hemorrhoids may need to be removed surgically.
Medications for Symptoms of Flu, Colds, and Allergies
These OTCs are intended to treat the coughing, sneezing, and watery eyes associated with colds and seasonal allergies. There are two different types of OTC cough medicines. One is designed to help people cough up mucus (expectorants) and the other helps people stop coughing (antitussives); some cough medicines contain both types of ingredients. Allergy medications and cold medications contain antihistamines to stop sneezing and decongestants to clear stuffy nasal passages. Decongestant OTCs are also available as nasal sprays. Some cold medications also include aspirin or another pain reliever to treat the muscle aches and low-grade fever associated with colds and flu.
Antihistamines and Allergy Drugs
The immune system protects the body from sickness and infection. To do so it must recognize and
respond to any foreign substance it encounters. Histamine is an organic substance that plays an important role in the human body's response to injury or invasion. When an injury or allergic reaction occurs, the body releases histamine in response. An allergic reaction occurs when the immune system responds aggressively to a foreign substance. There are two main types of allergies; each is triggered by different substances. Perennial (year-round) allergies are usually reactions to animal dander, paint fumes, certain foods, drugs, dyes, or chemicals. Seasonal (occurring at certain times of the year) allergies are generally environmental. They are reactions to pollens, trees, grass, ragweed, and mold spores.
Antihistamine drugs used to treat allergies are called H1 blockers because they only block histamine on H1 receptors. H1 receptors are found mostly in the small blood vessels in the skin, nose, and eyes. High levels of histamine in these receptors cause an allergic reaction, usually a runny or stuffy nose or sneezing. Allergic reactions also may include itching or swelling skin such as hives, eczema, itching from insect bites, or irritation of the eyes. Antihistamines are synthetic (manmade) drugs that block the action of histamine by replacing it at one of two sites where it binds to the receptor, which prevents reactions from occurring. This reduces irritation in the eyes and nose, congestion and breathlessness in the lungs, and redness, itching, or swelling of the skin.
Antihistamines also pass from the blood to the brain where they may cause general sedation (drowsiness) and depression (lessening) of certain brain functions, such as the vomiting and coughing mechanisms. Since most antihistamines have this sedative effect on the brain, they are often used in sleep aid drugs (see section on sleep aids). They also may be used to control nausea and motion sickness.
Some experts believe that antihistamines should not be available over the counter because of the drowsiness and sluggishness that is associated with their use. Other side effects include blurred vision, dry mouth, constipation, and light-headedness. Older adults are especially likely to experience these side effects, which may increase their risk of falling. Pregnant women and people with chronic bronchitis, emphysema, and glaucoma should avoid antihistamines. Like many drugs, most antihistamines must not be taken with alcohol, antidepressants, or sedatives.
Antihistamines are not usually helpful for treating the common cold. These drugs should not be used for longer than seven days or by
children under age of six. Whenever possible, prevention—avoiding the substances that cause allergic reactions—is the best solution. If OTC allergy drugs do not help alleviate symptoms, allergy shots administered by a physician may be a viable alternative.
The lining of the nasal (nose) passages is a mucous membrane. When infection, such as a cold or an allergic reaction, occurs, the blood vessels that supply the mucous membranes become enlarged and the mucous membranes swell. Fluid accumulates in nearby body tissue and mucus (the sticky substance secreted by the mucous membrane) is produced in larger amounts than usual. The result is a stuffy nose. Decongestants relieve a stuffy nose by limiting production of mucus and reducing swelling in the mucous membrane by constricting the blood vessels in the nose. This opens the airways and promotes drainage of nasal passages.
There are two types of decongestants: topical (applied to the mucous membranes directly) and oral (taken by mouth). Topical decongestants are sprays or drops that are used directly in the nose. There are short-and long-acting topical decongestants that can provide relief from four to 12 hours; they usually start to work within a few minutes.
Oral decongestants are taken through the mouth. Their effects are usually longer lasting than those of topical decongestants but they also take longer to produce noticeable relief. They are also more likely to cause side effects, such as increased heart rate and trembling, than topical decongestants. Both topical and oral decongestants should be used only by adults or children over age 12 unless advised by a doctor.
People with high blood pressure, diabetes, heart disease, or an overactive thyroid should only use decongestants with their physician's approval. If people use decongestants too frequently, they may develop problems, such as nervousness, insomnia, dizziness, headaches, or palpitations.
Cold/Flu and Cough Medicines
Contrary to popular belief, going outside on a cold day with wet hair does not cause a person to catch the common cold. Viruses are the culprits. Viruses are easily transferred from person to person via the air (when a person sneezes, for example) or via objects such as door knobs and telephones. (That is why washing one's hands often helps cut down on the transmission of viruses and viral illnesses.) The symptoms of a cold are a runny or stuffy nose, coughing, sneezing, and a sore throat. These symptoms usually last about seven
days. If the symptoms persist for seven to 10 days and include fever, tiredness, and headache, the illness might be influenza (flu).
There is no cure for a cold or flu; the only medical option available is the treatment of the symptoms to provide some relief. OTC cold and flu medicines usually contain analgesics such as aspirin or ibuprofen, to reduce fever and aches, as well as antihistamines and decongestants.
There are several products that may help reduce coughing related to colds and flu. There are two types of cough—productive and non-productive. Productive coughs bring up phlegm (mucus produced by the mucous membranes in chest and lungs) and can often be relieved by inhaling steam, which makes it easier to cough up the phlegm. If steam doesn't work, expectorants may help clear the phlegm from the chest and lungs. Nonproductive coughs are dry and hacking. This kind of coughing is treated with antitussives, which calm the part of the brain that controls the coughing reflex. Antitussives have a sedating effect on the brain and nervous system, so drowsiness and other side effects are common.
Most cough medicines are made up of active ingredients and flavorings added to a syrupy base. Some cough medicines contain active ingredients that work against each other, such as expectorants that produce phlegm and antitussives to suppress the body's ability to cough it up. It is important to carefully read the label and choose a cough medicine to treat the correct kind of cough. Using the wrong type of cough medicine could cause the cough to worsen. If a cough lasts longer than two days or symptoms such as fever or blood in the phlegm are present, a physician should be consulted immediately.
Because many cough and cold remedies contain antihistamines, users should be certain that they are not taking another product containing antihistamines at the same time. Furthermore, cough and cold medicines should not be taken with tranquilizers or sedatives or for more than seven days. People with asthma, emphysema, glaucoma, heart disease, high blood pressure, or thyroid disease should avoid using these drugs. People with diabetes need to choose sugar-free products. Most cold and cough remedies offer specific formulas for adults and children.
First Aid-Related Products
Adhesive bandages, gauze pads, liquid bandages, and similar products for a home or travel first aid kit are an important category of OTCs even though they are not medications in the strict sense.
Other OTC Drugs
There are certain OTC drugs that are controversial because they are known to be addictive (habit-forming) or because they have been linked to abuse and misuse, such as sleep aids and diet pills. There are other OTC substances that people might not naturally recognize as “drugs,” such as caffeine, which is a drug that, when misused, can have dangerous effects.
Caffeine and Caffeine-Based Stimulants
Caffeine is classified as a drug by the FDA. An organic (naturally occurring) compound, caffeine has a stimulating (speeds up or excites) effect on the central nervous system, heart, blood vessels, and kidneys. Caffeine can also make a person feel more alert and less tired. It can also cause irritability, nervousness, jitters, headaches, anxiety, and insomnia (sleeplessness). Consumed in excess, caffeine can cause heart palpitations, diarrhea, and vomiting. Some research studies have suggested that caffeine may play a role in the development of birth defects, ulcers, breast disease, diabetes, heart disease, osteoporosis, and high blood pressure. Girls, in particular, should avoid consuming caffeine if they are experiencing PMS as it may make the symptoms worse.
Because caffeine is found in many common products, it can be easy to consume too much of it. Coffee, tea, many soft drinks, chocolate, and many medications, such as pain relievers and weight loss aids, all contain caffeine. To help maintain alertness and prevent sleep, people often use OTC stimulant products containing caffeine. However, because of the side effects that accompany the excessive use of caffeine or any kind of stimulant, these products are intended for short-term use only.
Nicotine and Nicotine-Replacement Products
OTC smoking cessation products help people quit smoking. They include chewing gum and lozenges that contain small amounts of nicotine to reduce the craving for tobacco as well as transdermal patches that release small amounts of
nicotine through the skin. Like caffeine, nicotine is also considered a drug. Nicotine is an organic compound found in tobacco leaves. These leaves are used to make cigarettes, chewing tobacco, and other tobacco-based products. Since nicotine is addictive, regular smokers become addicted to nicotine. And, despite the fact that many people use tobacco regularly, nicotine is highly toxic (poisonous) in large doses, which can cause vomiting, nausea, headaches, stomach pains, convulsions, paralysis, and even death. In fact, nicotine is toxic enough that it is a component in some insecticides.
The very substance that causes smokers to become addicted to smoking, however, can be used to help them quit. Smoking provides a steady supply of nicotine, which causes smokers' bodies and brains to crave nicotine when they stop smoking. Often these cravings are so strong they make smokers very likely to start smoking again after they attempt to quit. Ironically, nicotine is used in nicotine replacement therapy (NRT) products. NRT products are temporary aids that are used on a regular schedule; they provide the body with nicotine but do so without requiring the user to smoke. Over time, these products, which are available in many forms, including patches, pills, and chewing gum, help lessen nicotine cravings and also help smokers move away from the actual habit of lighting up a cigarette or chewing tobacco. All of this contributes to the diminishment of withdrawal symptoms. In many of the products, the dosage of nicotine is gradually decreased to help smokers wean themselves off nicotine.
When people don't get enough sleep, they often feel tired, overwhelmed, and stressed. In fact, too much stress could even be the reason they aren't getting enough sleep. There are several different types of sleep disturbances and sleep disorders. Insomnia, which is a difficulty falling or staying asleep, is a sleep disturbance that causes people to feel as though they did not get an adequate amount of sleep. Transient insomnia usually lasts only a few days and doesn't require treatment. It is usually the result of a temporary worry or discomfort from a minor illness. If people have chronic, or long lasting, sleep disturbances then they should see their doctors instead of trying to treat the problem themselves. Chronic sleeplessness could be caused by psychological (mind-related) problems, such as severe anxiety or depression, or by a physical disorder.
Transient insomnia that lasts less than three weeks is treatable with OTC sleep aids, however, they should be used only when lack of sleep is affecting a person's general health. The purpose of the sleep aids is to reestablish the habit of sleeping, and the medication's effectiveness is reduced rapidly after the first few nights; this means that the OTC sleep aids work best for a limited time. OTC sleep aids should not be used for more than seven to 10 days or by children under the age of 12.
Most OTC sleep aids work by interfering with the chemical activity in the brain and nervous system by limiting communication between the nerve cells. This reduction in brain activity allows a person to fall asleep more easily. Many sleep aids use the antihistamines diphenhydr-amine and doxylamine to depress brain function. With this in mind, anyone taking antihistamines should not be taking sleep aids containing the same ingredient and vice versa.
Sleep aids, by virtue of their purpose, may cause drowsiness, slowed reactions, and slurred speech. Most people who use them are asleep within an hour of taking them. However, the sleep induced by sleep aids is not the same as the sleep one experiences when falling asleep naturally. Because of this, then, people taking sleep aids often feel less rested than if they had fallen asleep naturally. One reason for this may be that these drugs suppress rapid eye movement (REM) sleep, the stage of sleep during which people have dreams. All stages of sleep are important to awakening in the morning feeling rested.
Weight Loss Aids
With obesity rates in the United States rising, many people are looking for an easy alternative to diet and exercise to lose extra pounds. For decades, there have been companies offering OTC products
that claim to be the “miracle drugs” that can help people lose weight effortlessly. Most traditional OTC weight loss drugs are designed to suppress (reduce) the appetite or cause feelings of fullness so that the person taking them does not feel tempted to overeat. More recently, OTC diet pills use a mechanism to reduce the amount of fat absorbed by the body. However, most OTC diet aids have not proven to be effective in the long term, and they often have negative side effects. Though looking for an easy route to weight loss is natural, the only long term solution for healthy weight loss is through diet and exercise.
How to Read an OTC Label
It is very important to read the label of an over-the-counter drug carefully in order to use it safely and wisely. The FDA requires all OTCs sold in the United States to carry a “Drug Facts” label on the product's container or external packaging. The label must conform to a standard format and be written in easy-to-understand language. A Drug Facts label has seven parts:
- Active ingredient(s) and purpose. The active ingredient is the chemical substance or compound that treats or relieves the symptoms of a specific disorder or condition. There may be more than one active ingredient in the OTC, and the different ingredients may have different purposes. The purpose refers to the type of activity that the active ingredient performs, such as “antacid,” “topical analgesic,” “lubricant,” “fever reducer,” “pain reliever,” “nasal decongestant,” or others.
- Uses. The “Uses” section of an OTC label lists the symptoms or conditions that the drug may be used to treat, such as “relieves itching,” “relieves sour stomach,” “temporary relief of dryness of the eyes,” or “prevention of infection in minor scrapes or cuts.” Some Drug Facts labels may use the term “Indications” instead of “Uses.”
- Warnings. The “Warnings” section gives safety information about the product, such as possible side effects, interactions with other medications, parts of the body to avoid when using the product, groups of people (such as children, pregnant women, or persons with specific health conditions) who should not use the product, and similar safety notices. Examples might be “Do not use if you have kidney disease” or “Do not use in children under 12 years of age.” The Warnings section will also advise people to ask a doctor Page 296 | Top of Articleor pharmacist before using the medication if they have certain medical conditions.
- Directions. This section of the Drug Facts label contains basic instructions for proper use of the OTC, such as how and where to apply it (if it is a topical preparation); how often to take it (if it is taken by mouth); how much to take; and how long the product may be safely used or taken.
- Other information. This section of the label usually includes storage instructions, such as keeping the product away from extreme temperatures, sunlight, or moisture; storing it at room temperature; or refrigerating the product after the first use.
- Inactive ingredients. The inactive ingredients in an OTC do not treat symptoms. They include chemicals used to preserve the active ingredients, food coloring to improve the appearance of the medication, binders that hold the ingredients together, coatings on tablets, sweeteners or flavoring to mask the unpleasant taste of some active ingredients, and fillers that add bulk to the product so that people can measure doses more easily. The list of inactive ingredients is useful for people who know they are allergic to certain food colorings, sweeteners, or other specific inactive ingredients, and must avoid products that contain them.
- Questions or comments for the manufacturer. This section of the label usually includes a toll-free telephone number for contacting the manufacturer of the OTC.
Prescription Drugs Switched to OTCs
The FDA has the authority to decide that drugs formerly available only with a prescription can be safely sold directly to consumers without a doctor's prescription. This change, which the FDA calls an Rx-to-OTC switch, has made about 700 new drugs available as OTCs since 1980. Drugs that reduce the secretion of stomach acid, nicotine substitutes used to help people quit smoking, certain antihistamines, and antifun-gal vaginal creams are examples of the Rx-to-OTC switch. Most former Rx-only drugs that have been switched to OTC status were studied for several years before the FDA approved the change. Some medications have a dual status, with a lower dosage of the active ingredient(s) in the product available as an OTC and a higher dosage available as Rx-only.
It is likely that the FDA will continue to switch prescription drugs to OTC status for two reasons. The first is cost: some OTCs cost only half as much as the prescription-only version of the drug. A second reason is the general public's growing interest in self-care and self-treatment. Many people prefer being able to treat such common conditions as allergies, minor skin disorders, or heartburn with effective OTCs rather than having to visit their doctors to get prescriptions for the medication.
OTCs Requiring Extra Caution
There are some OTC medications that should be used with caution because of possible side effects.
Aspirin, also known by its chemical name acetylsalicylic acid or ASA, is a familiar household analgesic for minor aches and pains. It is also used as a blood thinner in low doses to lower an older adult's risk of heart attack or stroke. Aspirin is the most widely used OTC worldwide, with 40,000 tons of it used each year. Its common name was originally the trade name given to it by Bayer, the German company that first marketed it in 1897. Unlike acetaminophen, aspirin has anti-inflammatory as well as pain-relieving and fever-reducing effects. It is, however, also more likely to irritate the stomach, particularly when adults take it together with an alcoholic drink. Allergy sufferers should also watch their aspirin intake. People with an allergy to aspirin may have difficulty breathing or develop hives, itching, or swelling. Also, aspirin should never be given to someone directly before or after surgery because it decreases the blood's ability to clot, which may cause excessive bleeding. Additionally, aspirin should not be given to children under age 12 or to pregnant women, especially during the last three months of pregnancy since it could cause complications during delivery.
The most important possible side effect of aspirin, however, is its association with Reye's syndrome. Reye's syndrome is a potentially fatal (deadly) childhood disorder named for the Australian physician who first described it in 1963. Although the exact connection between Reye's syndrome and aspirin is not yet known as of 2012, the syndrome appears to be triggered in a small percentage of children under 18 who are given aspirin to treat fever associated with chickenpox or other viral illnesses. The FDA presently requires all OTCs containing aspirin to carry warnings about Reye's syndrome on their labels, while the Centers for Disease Control and Prevention (CDC) recommend that children under age 19 should not be given aspirin or combination drugs containing aspirin during episodes of fever-causing illnesses.
Acetaminophen, sold under such common brand names as Excedrin, Anacin-3, and Tylenol, is a widely used pain reliever (analgesic) and fever reducer (antipyretic) that some people prefer to aspirin because it is less likely to irritate the stomach. Acetaminophen is also safer for children than aspirin. Acetaminophen does, however, cause liver damage in large doses; in fact, it is the single most common cause of liver failure in the United States. The risk of an acetaminophen overdose is increased by the fact that many cough and cold medications contain acetaminophen in combination with other active ingredients; so people taking acetaminophen could take an accidental overdose of the drug by using the cough medicine in addition to taking acetaminophen in tablet form. In addition, drinking alcohol intensifies the side effects of acetaminophen. Although it was previously thought that adults could safely take as much as 1,000 mg of acetaminophen per dose up to a maximum of four doses per day, the FDA decided in 2009 to lower the maximum single safe dose for adults to 650 mg. In 2011 the FDA asked manufacturers of combination products containing acetaminophen to limit the content of the drug to no more than 325 mg per dose, and to include a warning about the risk of liver failure on the product's label or package.
The overuse of certain topical nasal decon-gestants, particularly those that contain oxymetazoline or phenyleph-rine, can lead to a condition called rhinitis medicamentosa, in which the congestion in the nasal passages increases in a rebound effect. Found in such common OTC nasal sprays as Afrin, Dristan, and Vicks Sinex, oxymetazoline works by constricting the blood vessels in the tissues that line the nasal passages. When a person stops using a topical
decongestant after using it for longer than recommended, the blood vessels in the mucous membrane suddenly widen because they are no longer constricted by the drug. This causes congestion to occur all over again. To reduce the risk of rebound congestion, people should not use nasal decongestant sprays for longer than three days in a row without consulting their doctor, and they should not use the spray more often than recommended on the label. Rebound congestion can be treated by discontinuing use of the spray that contains oxymetazoline and using an OTC saline solution instead to keep the nasal passages open until the rebound effect wears off.
Decongestant (Anti-Red) Eye Drops
Decongestant eye drops, also known as anti-red or whitening eye drops, are OTC eye preparations that work in a way similar to decongestant nasal sprays; some contain phenylephrine, a common ingredient in nasal sprays. Decongestant eye drops reduce redness in the eyes by shrinking the tiny blood vessels that give the white of the eye a bloodshot appearance. While occasional use of decongestant eye drops is safe for relief of itching or redness in the eyes caused by seasonal allergies, overuse of this type of eye drops can worsen the very redness they are intended to relieve. This rebound effect is similar to that caused by overuse of nasal decongestant sprays. In addition, the use of decongestant eye drops can mask redness caused by potentially serious underlying eye disorders. It is better to use lubricant eye drops to relieve redness caused by pollen or other irritants, lack of sleep, or general tiredness, and to consult a doctor if redness or irritation persists.
Laxatives are OTC preparations that are used to relieve serious constipation or to cleanse the bowel before a medical examination. Constipation is defined as having a bowel movement fewer than three times per week. When people are constipated their stools may be hard, dry, small in size, and difficult to eliminate. Some people who are constipated find it painful to have a bowel movement and may feel bloated. It is important to remember that constipation is a symptom, not a disease. Almost everyone experiences constipation at some point, and a diet that doesn't include enough fiber or water is often the cause of the problem. Temporary, mild, or occasional constipation generally does not require the use of laxatives. In fact, many people find that adding more fiber to their diets in the form of fruits, vegetables, beans, whole grains, and bran cereals, drinking plenty of water and other liquids, and daily exercise help to relieve constipation.
A doctor should decide when people need laxatives and which type is needed. Laxatives taken by mouth are available in liquid, tablet, powder, and granule forms.
There are five main types of laxatives: stool softeners, bulk-producing agents, emollients (which make the stool slippery), osmotics (which hold water within the stool), and stimulant or irritant laxatives. Bulk-forming laxatives, also known as fiber supplements, are considered the safest to use. They work by absorbing water in the intestine, which makes stool softer. Metamucil and Citrucel are common bulk-forming laxatives. The stimulant category is the most powerful and should be used with great care. Stimulant laxatives include castor oil, buckthorn, cascara, and senna extract. Ex-Lax is a common OTC laxative that contains senna. Stimulant laxatives are generally safe for occasional use, but should not be used for more than a few days.
Laxative abuse is common among people with eating disorders, who mistakenly believe that they can lose weight by speeding up the passage of food through the lower intestinal tract. In actual fact, most of the calories in food have been absorbed by the time that the food reaches the large intestine, which is where laxatives have their effect. What is lost is mostly water and waste products. The person may feel thinner or lighter but has actually lost only water weight. Long-term laxative abuse is dangerous to health because it can lead to dehydration; the loss of vitamins and minerals that are needed for good health; damage to the tissues of the colon and possibly the liver; and dependency on laxatives to have any bowel movements at all. Laxative abuse also may increase risk of developing colon cancer.
Caffeine-based stimulants are tablets or capsules intended to help people stay awake and alert when they are feeling drowsy or tired. Common names include No-Doz, Vivarin, and Stay Awake. Students preparing for examinations and long-haul truck drivers, as well as others who must work or drive for long hours, often use these oral medications to stay awake. Caffeine tablets are safe for most people when used for only a day or two, without increasing the dosage or taking the product more frequently than directed. Some people, however, may experience nervousness or jittery feelings even at the recommended dosage level. In addition, people who take caffeine tablets for long periods of time may become dependent on them and develop withdrawal symptoms (most often headaches, nausea, and mood changes) when they stop taking them.
Non-antihistamine sleep aids can be addictive if taken regularly for more than a few weeks or in large doses. This is a danger, as the effects of all OTC sleep aids will diminish after a few nights' use. This may prompt a user to take more than the recommended dose. When people who exceed the recommended dose stop taking these drugs after becoming dependent upon them, they may experience sleeplessness, anxiety, seizures, or hallucinations. They may also have nightmares or vivid dreams because the amount of REM sleep suddenly increases again.
Some analgesic (pain-relieving) or anti-fever drugs can also induce sleep. These are most effective if pain is keeping a person from falling asleep. People should avoid these drugs if they have are allergic to aspirin or acetaminophen.
Weight Loss Aids
The side effects of weight loss aids range from dizziness, nausea, vitamin loss, insomnia, irritability, agitation, mood swings, and hard-to-control bowel movements to depression, high blood pressure, increased risk for stroke, and death. Some ingredients formerly used in diet pills, such as ephedra and phenylpropanolamine, were banned for use in diet aids by the FDA in the 2000s because of deaths linked to their use.
Dietary Supplements and Herbal Remedies
The FDA defines dietary supplements as products intended to supplement (complete) the diet that contain one or more of the following: a vitamin; mineral; herb or other plant (except tobacco); amino acid; a concentrate, combination, or extract of any of these substances; or substances historically used by humans to complete the diet. The FDA requires dietary supplements to be labeled as such and to be formulated so they may be taken by mouth in pill, capsule, tablet, powder, or liquid form. The FDA regulates dietary supplements as food products rather than as medications. Although the FDA regulates dietary supplements as foods rather than medications, it forbids manufacturers from labeling these products as ordinary foods or as the sole item of a meal or diet. Manufacturers are not permitted to claim that the dietary supplement can treat or cure any disease. They can, however, legally state that the product will contribute to supporting and maintaining good health and well-being.
Manufacturers of dietary supplements are not required to file applications with the FDA for approval before marketing their products. Instead they are required to notify the FDA that the product is safe and to wait 75 days for the agency to review the information provided in
the notification. Fifteen days after the review is completed, the FDA posts a notice on its Web site permitting the product to be sold. In addition, since 2006 manufacturers of dietary supplements have been required by law to notify the FDA of any serious side effects reported by people who have used the product. Side effects are any reactions to a medication other than the intended reaction. Examples of common medication side effects are drowsiness, dizziness, and upset stomach. One of the reasons many medications advise against operating machinery or driving after taking them is because they are known to cause drowsiness or dizziness.
Types of Dietary Supplements
The most familiar types of dietary supplements are multivitamin and single-vitamin tablets; calcium supplements to maintain or build bone strength; products that come from a natural source (such as omega-3 fatty acids); and herbal preparations (sometimes called botanicals). Other types of dietary supplements that can be purchased in most supermarkets as well as health food stores and online include:
- Meal supplements. Usually sold in liquid form, these products are not intended to replace a normal diet completely but are sometimes used to replace one meal a day for weight management or to supplement regular food for people who are ill. They include products like Ensure and Boost.
- Sports nutrition supplements. These products consist of drinks, powders, tablets, and “power bars” intended to help athletes improve performance, control their weight, or replace fatty tissue with muscle. They include protein supplements, amino acids, creatine, and sports drinks containing caffeine.
- Supplements to maintain joint health. More often used by older adults than teenagers, these products include glucosamine, a substance used in the body to repair cartilage in the joints; and chon-droitin, a complex sugar molecule that also helps to maintain and repair cartilage.
According to the National Center for Complementary and Alternative Medicine (NCCAM), more than half of all Americans (52%) take some form of vitamin supplement on a regular basis, with multivitamins, vitamins E and C, calcium supplements, and B-complex vitamins being the most widely used. A recent survey found that nearly 20 percent of adults age 18 and older and 12 percent of children and teens in the United States reported using such products as fish oil, glucosamine, and herbal products within the past month.
Herbs and various products made from them are also categorized by the FDA as dietary supplements. Some herbs, like pepper, licorice, sage, cinnamon, thyme, peppermint, and rosemary, are used in cooking to flavor foods or beverages. Others, like lavender and lemongrass, are used in perfumes. Herbs used as dietary supplements, however, are usually those that have a noticeable effect on the digestive tract or nervous system as well as having a pleasant taste or scent. These herbs may be used alone or in various combinations to make teas, decoctions (liquids produced by boiling the herbs in water), or tinctures (alcohol-based extracts). Some herbal products are also available as dried powders, tablets, or capsules. Herbs that are frequently used as dietary supplements in the United States include ginger to relieve nausea, peppermint to ease digestion, echinacea to treat colds and sore throat, ginseng to strengthen the immune system, and valerian for relaxation and sleep.
Using Medications Safely
The safe use of medications, whether prescription or over-the-counter, includes careful attention to the doctor or pharmacist's instructions as well as proper storage and disposal.
Following instructions for the safe use of a medication begins with reading the label on the container. If the drug is a prescription medication, the signatura portion of the label will include specific instructions about the amount, frequency, and timing of each dose, and usually the purpose of the drug as well. An example might be “Take one tablet by mouth once a day in the morning for control of high blood pressure.” If the medication is an OTC, its packaging or container
will have a Drug Facts label as described above, with information about the purpose of the drug and its proper dosage. The FDA recommends reading OTC labels carefully each time the medication is purchased, as Drug Facts labels are changed or updated whenever there is new information about the drug.
It is important to keep in mind that the doctor's instructions on the label of a prescription drug are intended only for the person for whom the drug was prescribed and for no one else. People should never “borrow” another person's prescription medication or offer their own prescription drug to someone else. In the first place, a medication that works well at a specified dosage for one person may not be effective for another person or may cause unexpected side effects, because each person's body is unique and responds to medications in its own way. Second, as noted earlier, a prescription is a legal document; it is therefore illegal to give a prescription drug to another person, and both people could face legal penalties.
In addition, people should never give either prescription medications or OTCs to household pets without direct instructions from a veterinarian. Prescription drugs and OTCs are developed for and tested in humans, and are not intended for use in animals. Some common OTCs, including acetaminophen and aspirin, are poisonous to cats; while sedatives that help people sleep have the opposite effect on dogs. In fact, 50% of all cases of poisoning in pets involve human medications. In case of accidental pet poisoning: call the 24/7 Animal Poison Control Center Helpline at 800-213-6680.
Proper storage of OTCs begins with taking a few precautions before purchase. People should check the outer package of an OTC medication for evidence of tampering before purchase, and check any other tamper-evident packaging (TEP) features before using the product. TEPs are safety features that were mandated by the FDA in 1983 following a still-unsolved crime in which seven people in Chicago died after taking a pain reliever that had been poisoned with potassium cyanide. TEPs include outer shrink wrapping over the caps and necks of bottles; plastic seals over the ends of cardboard boxes; inner foil seals
over the opening of tablet containers; blister packaging of tablets and capsules; and similar devices. If any of these feature look damaged or are not intact, it alerts customers that an OTC may have been intentionally altered or contaminated in some way. If the package or the contents look suspicious in any way, the customer should return the OTC to the store or pharmacy where it was purchased.
All medications that do not require refrigeration should be stored in a childproof cabinet or medicine chest and kept there when not in use. OTCs and prescription drugs should never be left on kitchen countertops or tables where curious children can open and use them, or pets can jump up and pull them to the floor. In addition, medications should always be kept in their original containers so that no one in the household can take the wrong drug by accident.
To protect pets and children, people should keep pet medications in a separate storage chest or area away from drugs for humans; there have been many cases in which a cat or dog has eaten a pet owner's pills or capsules. In addition, human medications should never be left in purses or backpacks where children or pets can reach them and pull out the medication container.
Drug interactions can make a medication less effective, reinforce its activity, damage health directly, cause unpleasant side effects, or increase the risk of preventable accidents. Most drug interactions occur in one of three ways:
- Drug/drug interactions. These occur when a person takes two (or more) drugs that react with each other. Some drugs strengthen or reinforce the effect of another drug; for example, the effects of diazepam (Valium) on the central nervous system are intensified if the drug is taken together with certain pain relievers. In other cases, the second drug reduces the effectiveness of the first drug; for example, insulin used to treat diabetes loses part of its effectiveness when it is taken together with thyroid medications. Drug/drug interactions also can occur between prescription or Page 306 | Top of ArticleOTC medications and herbal remedies as well as between two or more different prescription medications.
- Drug/beverage or food interactions. This type of interaction occurs when the active ingredient in some medications reacts with substances in certain foods or drinks. Alcohol is a common culprit, as it intensifies the effects of tranquilizers and sleeping medications, and is often involved in falls, automobile collisions, or accidental deaths from these interactions. Alcoholic drinks also reduce the effectiveness of some antibiotics in treating infections. With regard to foods, people who are taking a type of antidepressant known as monoamine oxidase inhibitors or MAOIs must avoid eating foods that are rich in an amino acid called tyramine. These foods include certain cheeses, meats, and pickled foods as well as beer and wine.
- Drug/physical condition interactions. People with certain medical conditions or health problems may have them made worse by some medications. For example, nasal decongestants can raise blood pressure, and this unintended effect may produce such symptoms as nausea, sweating, or anxiety in people who already have high blood pressure, particularly if their high blood pressure is poorly controlled.
To lower the risk of drug interactions, people should give their doctor a list of all medications that they take on a regular basis, including OTCs, vitamin supplements, and herbal remedies as well as prescription drugs. They should also talk with their pharmacist as well as their doctor about possible drug interactions. Many pharmacists will provide printouts or handouts of possible drug interactions on request when they dispense a prescription drug.
Using Dietary Supplements Safely
As with prescription and OTC medications, people using herbal preparations and other dietary supplements should be aware that they can also have side effects and interact with other medications, particularly if the supplement is taken in large quantities. For example, vitamin C in large doses may cause nausea or diarrhea, and long-term use of valerian may cause users to feel dizzy or mildly depressed. People should not assume that dietary supplements are safe just because they may be “natural” products. They should consult their doctors or pharmacist about possible side effects or interactions before taking dietary supplements.
Another caution to note when using plant-based dietary supplements is that the strength or potency of the same plant may vary widely depending on its country of origin and the weather conditions under which it was grown. How well the supplement works or any side effects it may cause can vary from brand to brand or even between different shipments of the same brand. Moreover, although the FDA expects American manufacturers of dietary supplements to conform to good manufacturing practices (GMPs), it cannot guarantee the purity or effectiveness of herbal products. It is not unusual for herbal remedies to contain portions of plants other than those listed on the label or to be contaminated by heavy metals or pesticides. The FDA is, however, authorized to take legal action against the manufacturers of products that are unsafe, contaminated, or promoted by false advertising claims. People who use dietary supplements can protect themselves by using only products made by reputable manufacturers; consulting their doctors or pharmacists about the products; and checking the FDA website for the most recent information about product recalls and other safety alerts.
Herbs to Avoid or Use with Caution
In addition to gathering information about the recommended use and side effects of any herbal product before using it, people should be aware that the FDA has issued warnings about several popular herbs since the early 2000s:
- Comfrey (Symphytum officinale): In 2001 the FDA advised manufacturers of herbal products to remove comfrey from herbal teas and other products intended to be taken by mouth because the herb has been found to be harmful to the liver. Comfrey is still permitted to be used in some skin creams and other topical products to treat mild skin inflammation.
- Ephedra (Ephedra sinica): Known as ma huang in China, ephedra was long used in traditional Chinese medicine to treat low blood pressure, asthma, and the symptoms of influenza and the common cold. In the United States, it was used more recently in weight loss supplements and products to increase athletic performance; however, there were many reports of adverse effects from ephedra ranging from heat stroke to heart attacks from the 1990s onward. It was not until the death of a major league baseball pitcher who had used ephedra during spring training in 2003 that the FDA finally succeeded in banning the sale of the herb in the Page 308 | Top of ArticleUnited States due to its potentially fatal side effects and its use in the production of methamphetamine.
- Ginseng (Panax ginseng): Although ginseng is one of two herbs most commonly used in the United States (because of its popularity in traditional Chinese medicine and recent claims that it boosts the immune system), the FDA has found pesticide contamination in shipments of ginseng imported from Canada and China. In addition, the agency found that some products advertised as containing ginseng actually contained little or none of the herb.
- Kava (Piper methysticum): Kava (sometimes called kava-kava) is a plant native to the islands of the South Pacific that has been used traditionally to brew a sedative or relaxing drink. In the West, the drink is usually prepared from the dried root of the kava plant. Kava is also available in tablet form as a dietary supplement. Since 2002, however, both the FDA and the CDC have warned Americans that kava can cause liver damage, particularly when it is consumed together with alcohol. Kava has also been shown to interact in dangerous ways with benzodiazepine tranquilizers, an-tiseizure medications, and diuretics.
- St. John's wort (Hypericum perforatum): St. John's wort is a flowering plant native to Europe, commonly used in teas, tinctures, tablets, or capsule form to treat mild depression and premen-strual tension. Like kava, St. John's wort is potentially dangerous because of its interactions with prescription drugs, although it interacts with many more categories of prescription drugs than kava. St. John's wort has been reported to interact with antidepressants and opioid pain relievers, as well as such illegal drugs as cocaine, LSD, and methamphetamine. St. John's wort also reduces the effectiveness of birth control pills, benzodiazepine tranquilizers, and drugs given to treat HIV infection.
It is just as important to discard old unused medications as it is to store current ones properly. People should check the expiration dates on both prescription medications
and OTCs from time to time—including those in the home first aid kit—and throw out drugs that are past their expiration date. There are, however, additional precautions that should be taken for the safe disposal of unused or expired drugs. The FDA recommends the following steps:
- Find out whether the local town or city government has a take-back program that allows people to bring back unused drugs to a specific location for proper disposal. The DEA presently sponsors National Prescription Drug Take-Back Days across the United States.
- Read the label on the drug container for instructions about safe disposal. Most drugs can be safely placed in the trash, but a few should be flushed down the toilet. People should not, however, flush drugs unless the label specifically states that they should be disposed of in this way.
- If there is no local take-back program and if the container label has no specific disposal instructions, remove the drugs from the container and mix them with an unappealing substance, such as coffee grounds or cat litter. This precaution will prevent the possibility that a child or pet will find the drugs and accidentally eat them. It will also disguise the drugs from people who may rummage through trash bags placed outside the home for collection. The mixture should then be placed in a sealable plastic bag or empty jar with a lid, and then put in the trash. The bag or jar will prevent the medication mixture from leaking or spilling out of the outer garbage bag.
- Before discarding the container itself, scratch out or cover all identifying information on the label, including the name of the drug, the prescribing physician, and the patient's name and address. This precaution will protect the person's identity and their private health information.
For More Information
Hyde, Margaret O. Drugs 101: An Overview for Teens. Brookfield, CT: Twenty-First Century Books, 2003.
KidsPeace, and Martha Radev, ed. I've Got this Friend Who: Advice for Teens and Their Friends on Alcohol, Drugs, Eating Disorders, Risky Behaviors, and More. Center City, MN: Hazelden, 2007.
Magill, Elizabeth, ed. Drug Information for Teens: Health Tips about the Physical and Mental Effects of Substance Abuse Including Information about Alcohol, Tobacco, Marijuana, Prescription and Over-the-counter Drugs, Club Drugs, Hallucinogens, Stimulants, Opiates, Steroids, and More, 3rd ed. Detroit, MI: Omnigraphics, 2011.
Pampel, Fred C. Prescription Drugs. New York: Facts On File, 2010.
Sayler, Mary Harwell. Prescription Pain Relievers. New York: Chelsea House, 2011.
Tuttle, Cheryl Gerson. Medications: The Ultimate Teen Guide. Lanham, MD: Scarecrow Press, 2005.
American Association of Poison Control Centers (AAPCC). Emergency Poisoning Hotline: 800-222-1222. http://www.aapcc.org/ (accessed November 19, 2012).
National Center for Complementary and Alternative Medicine (NCCAM). “Using Dietary Supplements Wisely.” http://nccam.nih.gov/health/supplements/wiseuse.htm (accessed November 22, 2012).
“TeensHealth: Prescription Drug Abuse.” KidsHealth.org . http://kidshealth.org/teen/drug_alcohol/drugs/prescription_drug_abuse.html (accessed November 22, 2012).
U.S. Drug Enforcement Administration (DEA) Home Page. http://www.justice.gov/dea/ (accessed November 19, 2012).
U.S. Food and Drug Administration (FDA). “Dietary Supplements Alerts.” http://www.fda.gov/Food/DietarySupplements/Alerts/ (accessed August 15, 2012).
U.S. Food and Drug Administration (FDA). “Drugs.” http://www.fda.gov/Drugs/default.htm (accessed August 15, 2012).
U.S. National Institute on Drug Abuse (NIDA). “NIDA for Teens.” http://teens.drugabuse.gov/ (accessed November 21, 2012).