Over-the-counter (OTC) medications help people cure some simple diseases easily and without seeing a doctor. Some OTC drugs started off as prescription-only, but are now seen as safe for self-medication. Others, such as paracetamol, have always been available over the counter, but are subject to purchase restrictions.
The safe and effective use of all OTCs requires common sense and responsibility. Several commonly used OTC drugs carry a real risk of dependence, misuse or harm when taken in higher-than-recommended doses, for longer than needed, or for the wrong reasons.
One example is codeine, an opioid medicine used to treat mild to moderate pain and, in some formulations, to suppress coughing. Over the counter, it is often combined with either ibuprofen or paracetamol. Once swallowed, the body converts codeine into morphine, which produces its pain-relieving effects.
Common side-effects include drowsiness, constipation, nausea and dizziness. At higher doses, codeine can slow breathing and impair co-ordination. With repeated use, the body can also become tolerant to codeine, meaning the same dose no longer provides the same relief. This process occurs as the brain’s opioid receptors adapt to the drug. People may then increase their dose, raising the risk of physical dependence. Stopping suddenly can cause withdrawal symptoms such as anxiety, restlessness, sweating and sleep problems.
According to a report in the Medical Independent, a recent memorandum from the Health Service Executive (HSE) warned of evidence of high usage of low-dose codeine products and associated harms.
Codeine should be used for the shortest time possible. In general, it is best not to use OTC products for more than three days
The memo from Prof Eamon Keenan, chair of the HSE’s codeine working group, referenced low-dose OTC codeine products, such as codeine with paracetamol (with or without other active ingredients), codeine with ibuprofen, and codeine oral solution. It said there was evidence of harm associated with excessive or prolonged use of low-dose codeine-containing products, including psychological and physical dependence. Serious harms could occur from overexposure to the paracetamol or ibuprofen component of these products when used in excessive doses.
According to the memo, the available evidence indicated that combination products with low-dose codeine and paracetamol or ibuprofen were no more effective than paracetamol or ibuprofen alone for management of pain.
To reduce these risks, codeine should be used for the shortest time possible. In general, it is best not to use OTC products for more than three days.
Other OTC medicines to be careful of include decongestants and sedating antihistamines. Decongestants are available as tablets containing pseudoephedrine or as nasal sprays and drops such as xylometazoline and oxymetazoline. Both work by narrowing blood vessels in the nasal passages, reducing swelling and mucus. Long-term overuse of decongestants can damage the lining of the nose, causing dryness, nosebleeds and, in severe cases, perforation of the nasal wall.
Here are some tips to help you choose OTC products wisely:
Make sure that your self-diagnosis is as accurate as possible. Do not assume the problem is “something that is going around”.Choose a product because the ingredients are appropriate for the condition, not because the product has a familiar brand name.Choose a product with the fewest ingredients. Products that claim to relieve every possible symptom are likely to expose people to unnecessary medications, pose additional risks, and cost more.Read the label carefully to determine the correct dose and take note of any precautions, including which medical conditions could make the medication a poor choice.When in doubt, ask a pharmacist or doctor what the most appropriate product is to treat your symptoms.Ask a pharmacist to check for potential interactions with other medications you are using.Ask a pharmacist to identify possible side effects.Do not take more than the recommended dose.Do not take an OTC medication for longer than the maximum time suggested on the label. Stop taking the medication and call a healthcare professional if your symptoms worsen.