Possible Drug Interactions of OTC Drugs and Preventive Measure

Possible Drug Interactions of OTC Drugs and Preventive Measure

Over-the-counter (OTC) products are medicines you can buy without a doctor’s prescription.In the United States, consumers legally have access to drugs by two mechanisms: access with a prescription provided by a licensed health care professional or access without a prescription, by over-the-counter purchase. Many other countries have a similar classification of drugs. In addition, some countries have a third mechanism, by which certain sales without a prescription require consultation with a pharmacist or in which the marketing of certain drugs is limited to venues where such consultation is available.


States that FDCs should in guidance on the Investigation of Bioavailability general be assessed as to the bioavailability and & Bioequivalence. Bioequivalence of the individual active ingredients either separately (in the case of a new combination) or as an existing combination. Studies should be designed to detect any pharmacokinetic drug-drug interaction.

Drug abuse is the nontherapeutic use of any psychoactive substance, including alcohol, in such a manner as to adversely affect some aspects of the user's life. The substance may be obtained from any number of sources: by prescription, from a friend, over-the-counter, or through the illicit market. The use pattern may be occasional or habitual.

If you use 2 or more drugs at the same time, the way your body processes each drug can change. When this happens, the risk of side effects from each drug increases and each drug may not work the way it should. This is called a "drug-drug interaction." Vitamins and herbal supplements can affect the way your body processes drugs too.

A drug interaction is a change in the effect of a drug caused by some other substance. In some cases, there is a change in the helpful effects of a drug and in other cases there is a change in side effects. It is important to remember that alcohol and tobacco, as well as prescription and nonprescription medicines, can be involved in drug interactions. Vitamins, natural remedies, and certain foods may also interact with drugs.

Many over-the-counter sleeping medications use antihistamines, which cause drowsiness. Diphenhydramine is the most common antihistamine used non-prescription sleep aids. Some drugs contain diphenhydramine alone (Nytol, Sleep-Eez, Sominex) while others contain combinations of diphenhydramine with pain relievers (Anacin P.M., Excedrin P.M., Tylenol P.M.). Doxylamine (Unison) is another antihistamine used in sleep medications. Certain antihistamines indicated only for allergies, such as chlorpheniramine (Chlor-Trimeton), diphenhydramine (Benadryl), or hydroxyzine (Atarax or Vistaril) may also be used as mild sleep-inducers.

Some nutrients can affect the way you metabolize certain drugs by binding with drug ingredients, thus reducing their absorption or speeding their elimination. For example, the acidity of fruit juice may decrease the effectiveness of antibiotics such as penicillin. Dairy products may blunt the infection-fighting effects of tetracycline. Anti-depressants called MAO inhibitors are dangerous when mixed with foods or drinks that contain tyramine (beer, red wine, and some cheeses).

Nonprescription, or over-the-counter (OTC), drugs have a prominent place in the medicine cabinets of most elderly people. Analgesics (painkillers), antacids, cough and cold preparations, and laxatives are among the OTC drug products most frequently used by older people. While many people don't think of these as drugs, OTC drug products can be the cause of adverse side effects in older patients. Aspirin, for instance, can increase the effect of blood thinners, and decrease sodium and chloride excretion--a matter of concern to those with congestive heart failure.

Many OTC products are advertised to relieve heartburn or acid reflux. These include antacids, bismuth subsalicylate, H2 blockers, proton pump inhibitors and combination medicines. Combination medicines may include two or more of the following drugs.Don’t take these drugs if you have an allergy to any of the ingredients. Phenylalanine is an example of an ingredient in some antacids that can cause a problem for certain people. If you have a condition called phenylketonuria, you shouldn’t take a medicine that contains phenylalanine.Medications known to interact with antacids include:

Don’t take bismuth subsalicylate if you’ve ever had an allergy to aspirin or any other product that contains salicylates. Also don’t give bismuth subsalicylate to children who may have the flu or chickenpox because they will have a higher risk of Reye’s Syndrome.

An example of the challenges involved in assessing the safety of an over-the-counter drug is provided by studies of the use of ibuprofen for short-term treatment of fever in children. The proposal to use ibuprofen in children aroused concern about the risks of Reye's syndrome, gastrointestinal bleeding, and renal failure. Renal failure was a particular concern in children who might be dehydrated because of an acute illness. These risks were evaluated in a community-based trial in which 84,192 children with fever were randomly assigned to receive acetaminophen or ibuprofen.

The trial identified no ibuprofen-associated cases of Reye's syndrome or renal failure, and there were no significant differences between the treatment groups in the rates of gastrointestinal bleeding. The results thus provided substantial reassurance that ibuprofen is safe for over-the-counter use in children.Because this drug is available over the counter, the responsibility for recognizing these conditions now rests with the consumer rather than the health care professional.

Other ingredient-related warnings concern your diet while you’re taking an antacid or acid reducer. For example, unless your doctor tells you it’s OK, don’t use products that contain sodium bicarbonate or aluminum hydroxide and magnesium carbonate if you’re on a low-salt diet. Don’t take magnesium hydroxide if you’re following a magnesium-restricted diet.

If you have kidney disease, you shouldn’t use products containing calcium carbonate or aluminum hydroxide and magnesium carbonate without your doctor’s recommendation.Drug-condition interactions may occur when an existing medical condition makes certain drugs potentially harmful. For example, if you have high blood pressure you could experience an unwanted reaction if you take a nasal decongestant.

Herbal products are not rigorously tested and thus cannot be marketed for the diagnosis, treatment, cure or prevention of disease.Ginkgo biloba has potential interactions with garlic, vitamin E and medications with antiplatelet or anticoagulant properties. Patients should be advised not to use ephedrine-containing supplements if they have cardiovascular disease, hyperthyroidism, diabetes mellitus, benign prostatic hypertrophy or glaucoma.

To reduce your risk of drug reactions, follow these guidelines from the American Academy of Family Physicians:

Over-the-counter status offers some clear potential advantages over prescription status.Of course, there are a number of potential disadvantages as well, including risks related to self-treatment by patients — risks of misdiagnosis, delays in obtaining a correct diagnosis, adverse interactions with other medications, reduced opportunities to receive counseling about possible lifestyle therapies (such as exercise and diet), poorer compliance (by patients who view over-the-counter drugs as different from "real" medications), use by patients who are unlikely to benefit from the drug but will nevertheless be exposed to its risks, and patterns of taking medications inappropriately (e.g., "if one is good, two are better").

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