Physicians are urging the public to become educated on daily limits for OTC Medications and healthcare professionals can help.
Just about all of us have brushed off a headache or mild orthopedic-type injury with a shrug and an assurance that ‘I’ll be fine once I take a few [insert name of over-the-counter (OTC) pain reliever here.]”
But how many is a few? Usually, this means two pills… but for a manual laborer, athlete, or anyone else who has to repeatedly utilize the inured body part, that number can climb higher. The end result is a study published at the beginning of this year indicating that nearly one in five ibuprofen users regularly exceed the maximum recommended daily dose over a one-week period.
The FDA is now issuing a series of countermeasures, such as the inclusion of a warning on all OTC medications related to the increased risk of heart attack, heart failure, and stroke with use of anti-inflammatories—and the increase of said risk by exceeding daily dosage guidelines.
But it’s not enough. Nurses and physicians on the ‘front lines’ of healthcare can have more of an effect than any federal guideline by learning their patients’ OTC medication routines, identifying risk factors, and educating each individual on avoiding long-term damage.
Education in the Doctor’s Office
Charles Vega, MD, is a family physician in Santa Ana, CA and serves as clinical professor and associate dean at University of California-Irvine. In his practice, Dr. Vega takes the responsibility of educating patients on the use of OTC medications quite seriously—largely because some people don’t take these medications very seriously at all.
“A core issue is that many patients don’t necessarily think of OTC analgesics as drugs,” he said. “I’ve had some tell me in the clinic ‘I just take the pills you’ve given me when I have really bad pain—otherwise, I’ll just take the pain pills I have at home.’”
When Dr. Vega asks for more information about those pills at home, patients are often vague, nonspecific, or at times even unaware of what they’ve been taking. The potential benefits—and harms—of these products are lost on the patients until Dr. Vega offers them further information. In fact, many people are completely taken aback when they learn there are potentially harmful side effects to OTC medications.
“I see them in my practice all the time,” confirmed Dr. Vega. “These drugs are so ubiquitous—and they do a lot of good. You get a headache, you strain your back—it’s great, it’s very convenient to have these analgesics available for fast relief. You don’t need to make an appointment, or call in a prescription. They’ve very effective.
“But on the back end, especially with more chronic use, it’s very important to understand the differences between some of these products.”
For this purpose, Dr. Vega utilizes a simple brown paper bag in his practice, and has patients bring in everything they are using—including older medications they may not be actively using, but keep around the house regardless. “What was healthy several years ago for a patient may be harmful today,” he explained.
While the FDA has given daily recommended and maximum intakes for a number of products, it’s not as simple as it sounds. With so many active ingredients, the danger comes when people take one drug in the morning, another in the afternoon, and perhaps a third at night. “It comes down to reading the product label, and understanding the active ingredients,” said Dr. Vega. “The dosing instructions are right there—read them, follow them, and you shouldn’t go wrong.”
But just in case…
“Sticking to one product from each drug class is critical,” he added. “You can’t use combination pills—keep it simple. Sometimes when I advise patients on adding up milligrams, it can be very confusing when combining multiple products.”
Another important point is differentiating between the maximum daily intake and the recommendation. FDA guidelines call for 4 grams of acetaminophen per day as a maximum—but current guidelines limit the amount of acetaminophen in a prescription tablet to 325 mg. If you do the math, that would be 12 capsules in a day—obviously not a great idea.
“Use the minimum amount of the drug that’s needed, for the shortest amount of time possible,” Dr. Vega simplified.
The Opioid Factor
The ongoing crisis in the United States attributed to the prescription and use of opioid-based pain medications has effects both positive and negative when it comes to over-the-counter medications. People are more ware of opioid-related risks, and thus more likely to attempt to avoid usage of these drugs—but in turn, that underlines the importance of educating patients about the dangerous side effects of excessive use of OTC medications.
In other words, OTC medications are often seen as the safe alternative to opioids—and while they are certainly preferable for the treatment of orthopedic pain, that doesn’t mean they come without considerations of their own.
“About 30 percent of U.S. adults have some form of pain that’s gone on for more than six months,” said Dr. Vega. “The fact that we’re trying to fight the opioid epidemic doesn’t always account for the fact that millions of individuals are dealing with this [pain].”
Johnson & Johnson Consumer Inc. has created a handy, one-stop shop for professionals looking to educate their patients on use of OTC medications. You can access the relevant information and share with your patients at www.getreliefresponsiblyprofessional.com