Educating the Older Adult in Over-the-Counter Medication Use

Judith Glaser, DO; Lydia Rolita, MD

Disclosures

Geriatrics and Aging. 2009;12(2):103-109. 

In This Article

Abstract and Introduction

Abstract

The number of over-the-counter (OTC) medications is increasing as more prescription medications are being switched to OTC status. Many older adults rely on self-management of medications to treat common medical conditions such as the common cold, pain, diarrhea, and constipation. Although OTC medications are regulated by the U.S. Food and Drug Administration and Health Canada, many people are unaware of proper dosing, side effects, adverse drug reactions, and possible medication interactions that may not be clearly labelled. This article reviews the major side effects of common OTC medications and how to recognize these adverse effects, and provides health care professionals with information to offer to older adults and their caregivers about safe OTC medication use.

Introduction

There are over 100,000 over-the-counter (OTC) medications on the market.[1] Governments view OTC medications as an effective way to shift a greater share of health care costs to the consumer.[2,3] Recently, many prescription medications are being switched to OTC status.[4]

Even though OTC drugs are readily available and are regulated by the U.S. Food and Drug Administration and Health Canada, they may still be harmful. Consumers may not follow directions regarding the dosage, storage and side-effect profiles of nonprescription medications, as well as they do for prescription medications, because they assume that there will be no consequences to their health. Consequently, many people may benefit from having their OTC medications monitored by a health care professional.

Studies in the U.S. have shown that adults over 65 years are the largest users of prescription and OTC medications, accounting for up to 40% of all nonprescription medication use.[5] Twice as many OTC drugs as prescription drugs were being used by older adults.[6] Older adults are two to seven times more likely to experience an adverse drug reaction (ADR) than younger adults,[8] and approximately one third of hospital admissions of older adults are associated with a problem related to prescription medication use.[9] In older adults, the chances of a serious drug reaction are increased because of altered pharmacokinetics, pharmacodynamics, impaired renal function, reduced hepatic blood flow and liver size, increased body fat, decreased lean body mass, changes in receptor sensitivity, and increased number of medical conditions,[1] so the frequent use of OTC drugs makes older adults even more vulnerable to the risks of concurrent or inappropriate medication consumption (Figure 1).[7]

Figure 1.

Many older adults independently manage their prescription and nonprescription (OTC) medications; this is referred to as self-management of medication. The most common self-medication practices that contribute to medication mismanagement are outlined in Table 1.[9,10]

While self-medication can lead to many different problems, ADRs are the most serious. Medication interactions are believed to be the leading cause of ADRs.[9] As the number of medications ingested increases, so does the chance of an ADR occurring and conversely, when one medication is dropped from an eight-medication regimen, the risk of an ADR occurring decreases by more than two thirds.[11] Taking two medications presents a risk of 6%, but the risk increases to 100% when taking eight medications.[9]

The purpose of this article is to review the major side effects of common OTC medications and how to recognize these adverse effects, and to provide health care professionals with information to offer older adults and their caregivers about safe OTC medication use.

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