Stephanie Andrews learned her lesson the hard way. Like most people, the 36-year-old mother of two, who

asked that her real name not be used, underestimated the po-tency and impact of the over-the-counter (OTC) drugs she was taking to relieve her abdominal cramps.

Instead of reducing the pain, the extra doses of pain reliev-ers actually added to her misery.

Her story starts a few years ago when she suffered a mis-carriage. Her doctor offered her two treatment options. One was a surgical procedure; the other allowed nature to take its course

and dispel the tissue. She chose the latter, but that meant a few days of discom-

fort. Andrews’ doctor recommended 800 milligrams (mg) of ibuprofen every four hours.

But Andrews had another idea after her cramps subsided with the help of the fi rst round of ibuprofen pills. She decided to get a head start on her next bout of pain by taking more pills.

“I tried to head it off at the pass,” she said. “I was trying to beat the pain.”

She decided not to wait for four hours as instructed; she took another 800 mg in two hours — double the recommended dose. She continued her “treatment” for two days.

Though she said “it felt good to be without pain,” the plan backfi red. What she didn’t know is that stomach and kidney problems are the two main side effects associated with exces-sive use of ibuprofen.

She knows now. “My stomach was cramping even more,” she said.

Her doctor was a tad furious and had a few choice words after Andrews confessed. “You’re taking way too much,” her doctor warned. “Stop taking it immediately.”

The doctor instead advised her to take acetaminophen, another pain reducer. “But take it as prescribed,” she said.

Andrews says she has learned her lesson. “I still take ibuprofen as needed,” she said. “But I defi nitely watch how I take it.”

Misuse of OTC drugs has not received the amount of at-

tention as prescription drugs but they are far from harmless. Part of the problem is that doctors are taken out of the process. Consumers instead diagnose their own problems, and then self-medicate — all without the benefi t of any medical education.

Indeed, OTC drugs are readily available for all to use, but that does not mean that all should readily use them.

It is a common misperception that OTC drugs are not powerful and do not require the same attention to detail as prescription medications.

Not so. Many OTC drugs were at one time available only through

a provider’s orders. The Food and Drug Administration (FDA) regularly evaluates the safety of prescription drugs and their ability to transition from prescription-only to OTC status. Between 2001 and 2009 the FDA approved that transition for almost 30 medications.

Some drugs that have made the switch are well known: the antihistamines Claritin-D and Zyrtec and the acid reducer Prevacid 24 HR. Ibuprofen, a common pain killer, got its walk-ing papers about 20 years ago.

There’s one catch though. That switch and the resultant ease of access did not reduce their potency.

A practical way of viewing all OTC drugs, including vita-mins and herbal supplements, is that any product that changes the way your body works or treats a condition is a drug.

But how can an untrained person make such an important

Timothy Velasquez, 67, is like a lot of people — rarely, if ever, did he extensively question the details of his prescription drugs.

If questions were few to his doctor, they were even less to his pharmacist. “I trusted those guys,” he said. “They put [the drugs] in a bag and I walked out.”

Velasquez can only shake his head at his past ir-responsible attitude. Especially in light of the fact that he is on 10 different drugs for heart disease, diabetes, high blood pressure and other medical complications. He considers himself fortunate.

Fortunate is right. According to a study published in the Journal of the American Medical Association in 2006, more than 700,000 visits to the emergency depart-ment occur every year due to medication mishaps. And 120,000 of these visits result in hospitalization. Part of the reason is attributable to the virtual explosion in drug usage across America.

Prescription drugs alone constitute the third high-est national health expenditure in this country, trailing only costs for hospital and physician services. The Na-tional Council on Patient Information and Education, a Rockville, Maryland-based nonprofi t organization, estimates that more than 3.5 billion prescriptions were written in 2007.

Some medications in particular have escalated in demand. For instance, the use of antidepressants and antiasthmatic drugs has doubled in the past nine years, while certain medications for high blood pressure and high cholesterol have experienced a fi ve-fold increase.

It’s no wonder then that almost half the population reported using at least one prescription drug during the

preceding month, while roughly one-fourth used three or more prescription drugs.

The elderly are particularly vulnerable. While only 38 percent of those between the ages of 18 and 44 used one

prescription drug, almost 90 percent of those 65 years and older reported the same.

Multiply the drugs and the gap further widens: 63 percent of elderly people versus 11 percent of those 18 to 44 use three or more prescription drugs.

Fortunately, Velasquez didn’t become another major statistic for a medication mishap. But Velasquez did receive a recent wake-up call. He was prescribed a liquid medication to reduce the potassium levels in his blood and was given two bottles at his pharmacy.

There was only one problem. The plastic cup to help measure exact dosages was missing. Reading the label was of little help. And measurements like “CCs” for cubic centimeters merely added to the confusion.

He had no idea what that meant, let alone how to calculate it, and that led to the next problem. Velasquez developed his own regimen.

In fairness, Velasquez was right that he needed to take the medicine twice a day. But without knowing the exact amount, he drank half of the fi rst bottle after breakfast and the remainder before bed.

He repeated this regimen the following day. “The medicine tasted pleasant,” he explained, “so I did not make a big deal of it.”

But it was a big deal. He wound up taking more than four times the recommended dosage — a mishap that could have resulted in kidney damage, according to Dr. Donney John, the clinical pharmacist at South End

Community Health Center.Velasquez realized his error when he spoke to his

pharmacist. Alarmed, the pharmacist immediately called his

Easy access belies over-the-counter drugs’ health risks

Timothy Velasquez took four times the amount of his prescribed medication — fortunately, with no side effects. Velasquez says he now asks questions about his medication before he leaves the pharmacy. (Ernesto Arroyo photo)

Over-the-counter (OTC) drugs can interact with prescrip-tion medications, food, alcohol and other OTC drugs. Read the drug labels carefully before using.

BE Healthy™

Velasquez, continued to page 4

OTC drugs, continued to page 4

VOL. 5 • NO. 1 © October 2010

Sponsored by Boston Public Health Commission

MEDICATION SAFETY:MEDICATION SAFETY:The dos and don’ts of prescription drugs The dos and don’ts of prescription drugs

the drug information sheets that come with your medicine, in case you need to refer to them.

• Take as directed. Not more often, not less often, and on time. If you miss a dose, ask your doctor or pharmacist what to do.

• Set up reminders. Let a daily habit, meals or bedtime for example, be your reminder to take your medication. Or set an alarm on your cell phone. You can also use a pill box with com-partments to help with times of day, or check off daily doses on a simple checklist.

• Expiration dates. Always check expiration dates listed on the bottle before taking medication. Taking medicine after it has expired may cause negative side effects. Throw out any drugs that have expired to prevent medication mix-ups.

• Keep a little list. Tuck a list of medications into your wallet or purse to show to all health care providers (and pharmacists, too, if you use more than one drug store). Keep a copy of the list in your home too, on the refrigerator, so others can access it. In emergencies, this list helps ensure faster, more effective care. Include drug name, doctor, reason for taking, and dosing information. If medications change, make a new list and throw out the old one.

Generic drugs versus brand name drugsPatents on new drugs can last for up to 20 years to allow

manufacturers to recoup their investment in researching, devel-oping and marketing medications. Once patents expire, other

Whether you have a chronic health issue like diabetes, asthma, high blood pressure or a curable illness like the fl u or pneumonia, medicine prescribed by your doctor can be a lifeline. When taken properly, medications can help you live a longer, healthier life. The tips below will help you gain the greatest benefi t from the medicines you need, while helping to stretch your health care dollars.

Taking medications safelyA national health survey shows that the use of prescription

drugs continues to spiral upward. During the past month, 42 percent of African American adults were taking at least one pre-scription drug, according to the Centers for Disease Control and Prevention (CDC). And nearly 40 percent of all Americans over age 60 reported taking fi ve or more medications.

When used properly, these medications can enhance and extend life. To take your medicine safely, follow these tips:

• Tell all. Avoid worrisome drug interactions and side effects by telling your doctor and pharmacist about all the medicines (over-the-counter and prescription), vitamins or other supplements and herbal remedies you use. Also mention allergies and past problems with medications like rashes or dizziness. Using one drug store is also benefi cial, because the pharmacist can track the prescription medications you take.

• Go over the basics. Anytime medicine is prescribed, write down the drug name, why you need it, the amount to take, and when to take it and stop. Find out if you need to take the medicine with food and any other important instructions. Remember to save

pharmaceutical companies are permitted to copy brand name drugs by creating chemical counterparts called generic medications. These are often quite inexpensive, can be just as effective and help save you money.

Just like brand name drugs, generic drugs must be approved by the Food and Drug Administration (FDA). This approval ensures that generics are equally safe and effective and have the same active ingredients, strength and form (whether they’re pills or liquid, for example) as brand name drugs.

You can stretch your health care dollars by:• Asking your doctor or pharmacist about generic options.• Checking whether your health plan or local pharmacies

offer generic drugs at low cost. • Buying a 90-day supply of drugs you take regularly through

a mail order pharmacy can also help save money. Check with your health plan to see if this option is available to you.

Taking your medication properly is a vital part of manag-ing your own health. By being a more informed patient you can keep yourself healthy and help bring down your health care costs. Remember to always use antibiotics and medication as directed by a pharmacist, physician, nurse, or according to the bottle. Some medications may be counteracted with the use of alcohol, drugs or other medications like antibiotics, so read the drug label before use. And, work with your doctor to manage your prescriptions, or if you have any questions about your health.

Medicine: A lifeline — when used correctly

Flu facts and tips

Flu season is just around the bend. Staying healthy = keeping your health care expenses down.

Get vaccinated Call your health plan today to fi nd

out when and where you can be vaccinated. Some pharmacy or retail locations may not participate with your health plan — so be sure to ask what providers, pharmacies or retail locations participate in order to save money.

This year’s fl u facts• The CDC and vaccine experts recommend

that everyone 6 months of age and older get a fl u vaccination unless they have a severe allergy to chicken eggs, or have had a severe reaction to a fl u vaccine in the past. Members should always check with their doctor fi rst if they have questions or con-cerns about getting vaccinated.

• Unlike 2009, there will be no need for two separate fl u shots. This year’s shot will protect against the 2009 H1N1 pandemic virus and against two other seasonal fl u strains (the H3N2 virus and an infl uenza B virus).

• Children 6 months to 8 years of age who have never received a fl u vaccination may need two shots. Parents should check with their pediatrician fi rst.

Quick tips for staying healthy this fl u season

You’ve heard it before — the best prevention against the fl u is good hygiene. Below are some quick tips to help you and your family fi ght off the fl u:

• Frequently wash your hands with soap and water. When hand washing is not possible, use anti-septic hand gels that contain alcohol.

• Cover your mouth and nose with a tissue when coughing or sneezing. Throw out the tissue in the nearest waste basket and immediately wash your hands with soap and water.

• Don’t sneeze into your hand if you don’t have a tissue. Instead, use the crook of your arm.

• Stay at least three feet away from people who are coughing or sneezing.

• Immediately wash your hands after contact with an ill person.

• Stay at home when you are sick. • Keep your children at home when they are sick. • Teach your children good hygiene habits. • Ask for a mask when in the doctor’s of-

fi ce or hospital.

BE Healthy • http://behealthy.baystatebanner.com2

1. Since over-the-counter drugs, such as aspirin, are inexpensive and read-ily available, does that mean that they are always safe to take?

Over-the-counter (OTC) medications can be considered safe if taken for the reason intended and at the dose recommended on the label. However, it is important to be aware of one’s medical condition. For example, allergies, diabetes and high blood pressure are conditions that could become worse in patients who take OTC medications without fi rst consulting his or her primary care physician. Also, OTC drugs can interact with each other as well as prescription medications.

2. If a person forgets to take a medication on time, is it best to double the dose the next scheduled time?

That is generally the rule of thumb, but it differs by medica-tion. If you missed one dose, you may be advised to take it as soon as you noticed or with the next dose. If you missed two or more, then it is better to continue taking the regular dose and not to catch up. The risk of overdose is the primary reason for this. Ask your doctor’s recommendations for each medicine you take.

3. Why is exceeding the recommended daily maximum amount of acetaminophen, an active ingredient in Tylenol, dangerous to a person’s health?

Acetaminophen, a common pain reliever, is one of the safest drugs on the market. However, like most medications, acetamino-phen is metabolized by the liver, and taking more than the recom-mended dose can cause liver problems.

4. Should a person stop taking a drug if he or she begins to feel better before completing the prescribed amount?

NO. You should always consult with your doctor before discontinuing the medication. Antibiotics, for example, should be taken for the duration prescribed. Doing the contrary could lead to bacterial resistance and the surge of “super bugs.” In addition, there are chronic conditions, such as diabetes, hypertension and high cholesterol that require treatment for life — regardless of how good you feel. That’s why it is important to call your doctor’s offi ce to request a refi ll and an appointment before you run out of the medication.

5. If you have bad side effects from a drug prescribed by a doctor, should you stop taking them?

Most medications have side effects, and you should always inquire what they are before starting a new medicine. However, if the side effects are severe and not what you expected, you should call your doctor’s offi ce right away. He or she will know what to do next.

6. Since herbal medications are considered “natural,” are they safe to mix with other medications?

Not always. Even when most herbal supplements have a “natural origin,” they are still drugs with potential interaction with other medications, as well as side effects. One such herbal medication is St. John’s Wort, which is often taken for depression. It has been found, however, that St. John’s Wort interferes with medication for the treat-ment of HIV and other chronic illnesses.

7. Will doubling up on a medication make you feel better more quickly?

NO. Some people think that if one pill is good, two are better. But taking more than prescribed can result in adverse drug reactions. Always take medications as your doctor prescribed.

8. When keeping a list of current medications, should a person include vitamins and herbal supplements as well?

YES. Any drug — including OTC, herbal supplements and vi-tamins — may have potential interactions with each other, food and beverages and prescription medications. Always carry a medica-tion list with you. The following link shows what a medication list should include: http://www.safemedication.com/safemed/MyMedi cineList.aspx.

9. Why is it recommended to have all your prescriptions fi lled at the same pharmacy or pharmacy chain?

When you have all your prescriptions fi lled at one pharmacy, the pharmacist can check for potential drug interactions and side effects. It also helps alert your primary care physician of all the medications prescribed by other doctors.

Pablo Hernandez Itriago, M.D., F.A.A.F.P.Medical DirectorSouth End Community Health Center

Questions & Answers

The information presented in BE HEALTHY is for educational purposes only, and is not intended to take the place of consultation with your private physician. We recommend that you take advantage of screenings appropriate to your age, sex, and risk factors and make timely visits to your primary care physician.

BEFORE YOU LEAVE THE DRUG STORE, GET THE FACTS.Read the drug label to make sure the prescription is yours and matches the one written by your provider.

Name and address of the pharmacy

How and when to take the medicine

Name of the medicine

The number of refi lls allowed

My name and address

The amount of medicine in each pill

The number of pills in the bottle

A closer look

October is Talk About Prescriptions Month

ASK QUESTIONS. YOU’RE THE ONE WHO SUFFERS THE CONSEQUENCES IF YOU DON’T.1. What is the name (brand and generic) of the medicine? What is it for?

2. What’s the dose?

3. How do I take it and how often?

4. What food, drinks or other medicines should I avoid while taking this medicine?

5. What are the possible side effects? What should I do if I have side effects?

6. What should I do if I miss a dose or accidentally take more than the recommended dose?

7. When will the medicine start working?

8. Is there any written information I can take home with me?

BE Healthy • http://behealthy.baystatebanner.com 3

There are checks and balances to prevent prescription errors, but slip ups can occur. Take a second look to make sure you get the right medicine.

doctor who quickly ordered a blood test. “She dropped a dime on me,” he said. The good news is that Velasquez suffered no ill effect. “I got my potassium down all right,” he laughed. “Thank God nothing serious happened. Fortu-nately, it was OK.”

The volume of drugs is just part of the problem. Anoth-er signifi cant part is that people are just not paying attention.

“It can be overwhelm-ing particularly if they are on several different drugs. “It’s hard to keep track,” said John. “Some people double up doses and take more than prescribed. Oth-ers split the pill to make them last longer. Some just completely forget. Others just don’t want to take pills and never follow through.”

Complicating the issue is that each and every medicine has its own characteristics. Medication for diabetes is one example. Insulin and other medications are prescribed according to a person’s lifestyle — what they eat and their level of physical activity. Modifi cations in a diet may require adjust-ments in the prescription, John explained, and those should be made by the health provider. “But some people make adjustments on their own,” he said.

Taking too much insulin can cause blood sugar levels to drop. “People can get very shaky or pass out,” said John. Drowsi-ness, fatigue and rapid heartbeat are other potential consequences.

Another example is blood thinners. Pre-scribed to prevent clots from forming in the blood, blood thinners pose their own set of problems: too much can cause a major bleed; too little can result in a heart attack or stroke.

And like many other medicines, blood thinners are also food sensitive. “A lot of things can affect it,” said John. “Like green leafy vegetables.” Green leafy vegetables are high in vitamin K, which reduces the effectiveness of blood thinners. Other foods, such as grapefruit juice, can also impede the success of medi-

cines. As do alcohol and illicit drugs.Even if a person knows his or her medi-

cation and takes it correctly, there is a chance of multiple drug interactions that diminish or increase the effect of the medication. Patients are not always to blame for medication mishaps; sometimes the medical community does its fair share. A 2003 study published in the New England Journal of Medicine found that of the patients interviewed at four primary care practices, a notable percent-age of adverse drug events was attributed to physicians’ failure to respond to symptoms caused by the medications.

And there’s always the chance that a problem may occur at the pharmacy.

Patricia Link, 59, now knows that checking a prescription before leaving the drug store is a two-step process. She says she checks the label for the correct name, dose

and purpose of the drug. She says she also knows now to actually

look at the individual tablets.Link is on fi ve different types of drugs

that she takes daily for high blood pressure, high cholesterol and a few other ailments.

She also takes pain medication as needed for a complicated orthopedic procedure performed on her spine.

The mishap occurred with her pain medi-cation. The directions were to take one to two pills every six hours. “I take two,” Link said. “That’s my dose.”

But after taking the pills one recent day, she lay down but did not feel any better. Six hours later she took two more.

The next morning she knew something was wrong. “I felt funny in the stomach and tired,” she said. “I usually don’t wake up tired. Something told me to look at the medicine.”

She was surprised at what she discov-ered. “One pill in the bottle looked different from the others,” she explained. “I counted up the pills in the bottle. Five of them were the wrong pills; the rest were mine.”

But they looked very similar. Both were the same color and shape, according to Link, but the “wrong” medication was smaller.

She informed the pharmacy and was told by a nurse at her clinic to go to the emergency room. Fortunately for Link the effects were short-lived and left no permanent damage — at least physically. “It caused me a lot of mental agony,” she said.

What she found out was that the phar-macy inadvertently mixed the drugs and gave Link — in addition to her painkillers — medi-cine for migraines that were also antidepres-sants. The medicine caused diarrhea, exces-sive fatigue and a headache.

Link vows to pay closer attention. “Be-fore I leave that window I check very carefully now,” she said. “I put a few pills in my hand and take a look.”

She hopes other patients check as well. “I was fortunate,” she remarked. “The next person might not be.”

For his part, Velasquez is making sure that he doesn’t make a mistake either. Because he’s not as familiar with his drugs as he should be, he relies heavily on the medicine list that his doctor gives him during each visit.

As a result, Velasquez said, he knows when to take his drugs. He knows which ones have to be taken with food. He also knows which foods to avoid in order to insure the medication’s effectiveness.

More importantly, he fi lls all his pre-scriptions at the same pharmacy, a practice recommended by health practitioners. That allows the pharmacy to have an accurate record of what drugs he is now taking or has taken in the past. The pharmacist can then more easily check for potentially harmful drug interactions, or interactions that may decrease the effectiveness of his medications.

Velasquez says he’s learned his lesson and vows to change his behavior the next time he picks up his meds. “I’ll check to see if everything is there,” he insisted. “I will take the time to ask a few questions,” he said. “I can’t leave everything up to the doc-tor and pharmacist. They’re busy enough.”

medical decision? The FDA weighed in when it mandated in 2002 that all OTC drugs carry a universal “drug facts label” that clearly lists each drug’s active ingredient, uses, warnings, directions for taking, inactive ingredients and other information.

That means a consumer should be able to determine what the drug contains, if it treats the complaint, how to take it, what to watch out for and even how to store it.

That answers the question for one drug and one illness. Multiple OTC drugs or combining OTC with prescription drugs is another issue.

Take acetaminophen for example. Acetaminophen, a pain and fever reducer, is the active ingredient of several medica-tions, both prescription and OTC. But the current maximum daily dose is 4,000 mg and prolonged excessive use can result in liver damage.

Tylenol especially is tricky because of its many products with varying potencies of acet-aminophen. For instance, each pill of Tylenol for arthritis contains 650 mg versus 325 mg for regular strength. If a person does not keep an

eye on how much he or she is taking, it is easy to surpass the recommended daily maximum.

Cough syrups present another sort of problem. When taken in excess, cough syrup can cause hallucinations and partially explains why teenagers are using it for cheap highs.

Herbal supplements are not without consequences either. Researchers found that St. John’s Wort — used for depression — interacts with drugs that treat HIV and other serious illnesses. Black cohosh, which women take for hot fl ashes, causes some drugs to stay in the system too long or move out too quickly, which reduces their effectiveness.

Dr. Donney John, the clinical pharma-cist at South End Community Health Center, cautions against taking too many pain killers. “People often think ‘one pill is not cutting it’ and double the dose,” he said.

But John cautions against doing this: “You should not take a higher strength than what you need.”

Self-medicating with pain killers can be dangerous. It’s best not to take pain killers too long without seeing a doctor. “It could be masking the symptom of something more serious,” John said.

OTC drugs, continued from page 1

A DOUBLE TAKEVelasquez, continued from page 1

Your doctor prescribed

this

Although the packaging is similar, these drugs are very different. The medicine on the left treats seizures and nerve pain, while the medicine on the right is for high cholesterol.

ILLEGIBLE HANDWRITING The doctor ordered medicine for attention defi cit disorder, but because of illegible handwriting, the prescription was fi lled for methadone, a medication for the treatment of narcotic withdrawal and dependence. That is why you should always ask the pharmacist what the medicine is for.

These three medicines are actually the same — they all are prescribed for manic-de-pression and seizure disorders. However, the looks of drugs can differ by the company that manufactures them. If you’re used to getting the pink pill but get salmon instead, just confi rm the identity of the pill with the pharmacist.

Photo courtesy of Institute for Safe Medication Practices

Is that what you got?

Photo courtesy of the Food and Drug Administration

Your doctor prescribed

this

Is that what you got?

CAN’T JUDGE A BOOK BY ITS COVER

All of these are OK

Since the wrong drugs were accidentally mixed in with her pain medication, Patricia Link now looks at the pills she picks up from the pharmacy. (Tony Irving photo)

THE LOOK-ALIKES

Donney John, Pharm.D. (right), the clinical pharmacist at South End Community Health Center (SECHC), counsels Zenaida Del Valle on proper use of medication for her dia-betes. SECHC participates in Collaborative Drug Therapy Management, which delegates drug therapy management to a pharmacist. (Ernesto Arroyo photo)

Comments on Be Healthy? Contact Health Editor Karen Miller at kmiller@bannerpub.com.

… BUT NOT TOO MUCH OF THIS.Acetaminophen is a common and effective pain reliever and fever reducer. Many people are unaware, however, that acetaminophen is found in many prescription pain relievers as well as numerous over-the-counter products to treat cold and allergy symptoms and menstrual cramps. The maximum daily dose — from all sources — is 4,000 milligrams. Use caution when taking two or more drugs that contain acet-aminophen. Excessive use can result in liver damage.For a detailed list of products that contain acetaminophen, visit http://www.nlm.nih.gov/medlineplus/druginfo/meds/a681004.html.

TAKE ALL OF THIS …Antibiotics are prescribed for bacterial infections, such as pneumonia and strep throat, but are not effective against viruses, like the common cold or the fl u. It is important to fi nish your medicine even if you feel better. If an antibiotic is stopped prematurely, the bacteria may not be completely killed, which can increase their resistance to the antibiotic. This can result in a re-infection of now resistant bacteria.

BE Healthy • http://behealthy.baystatebanner.com4