Over the Counter Medicines: Making Safe Choices
Thursday, January 31, 2013

Dr. Jacqueline Riedel

When seeking pain relief or fever reduction, patients are faced with many over-the-counter (OTC) options. The array of choices can be overwhelming, especially when also trying factor in any potential interactions with other medications, or health issues the patient may face. Here are some tips from your family doctor to help reduce confusion and increase the safety of use of over-the-counter medications.

Non-steroidal anti-inflammatory drugs (also known as NSAIDs) are a class of readily available over-the-counter medications; included in this group of drugs are ibuprofen, naproxen, and aspirin. These medications work well to reduce inflammation, pain, and fever; they are often used to treat minor joint pain, headaches, swelling associated with injury or fever associated with illness. However, they can have some not-so-healthy side effects, especially if used in high doses over a long period of time.

The unhealthy side effects of NSAIDs occur because of the way the medications work in the body. This group of drugs functions by reducing the amount of a naturally occurring chemical called cyclooxygenase, or COX for short. There are a few different versions of COX that our body produces, each working at a different location. Over-the-counter NSAIDs block or reduce the functionality of all COX molecules indiscriminately.  Reducing one version of COX will treat pain and lower fevers; unfortunately, this can also leave the lining of the stomach susceptible to inflammation. With long-term use, NSAIDs can lead to gastric ulcers and bleeding within the gastrointestinal tract.

In addition, NSAIDs can decrease blood flow to the kidneys through a second chemical pathway. This leads to elevated blood pressure, especially in patients already taking medications for high blood pressure. NSAIDs can also further reduce kidney function in those with chronic kidney disease. Thinning of the blood is known to occur as a side effect of NSAID medications, so use of these drugs should be avoided in anyone taking daily aspirin, Coumadin, or other blood thinners.

Acetaminophen (Tylenol®) is another type of commonly used over-the-counter medication. It is often used as a pain reliever and fever reducer, although it remains unclear exactly how the drug works. Acetaminophen is known to cause liver and kidney damage at doses in excess of 3000 mg per day (equal to six extra strength tablets in 24 hours). Complicating matters is the fact that acetaminophen is found in combination with many prescription pain relievers; if you are using a prescription pain medication, be sure it does not contain acetaminophen prior to using Tylenol® as an adjunct therapy.

When used properly, over-the-counter medications can be safe and effective in the treatment of everyday pain and fevers. Be sure to check with your family physician regarding your own medical problems and prescription medications prior to initiation of any supplemental medication regimen.

Dr. Jacqueline Riedel is a Family Medicine physician and a member of the Kennedy Health Alliance. She practices in West Deptford, NJ, and can be reached by calling 856-384-0210.