COMMENTARY

Using Over-the-Counter Analgesics Safely: What Patients Don't but Should Know

Charles P. Vega, MD

Disclosures

May 04, 2017

Over-the-Counter Analgesics

Over-the-counter (OTC) analgesics are among the most commonly used nonprescription medicines in the United States,[1] yet not every OTC pain reliever is appropriate for every patient. As healthcare professionals, we play an important role in helping patients make the most appropriate choice.

The topic of OTC analgesics can be easily overlooked among the other priorities we face during a clinical exam. Nevertheless, given the scope and impact of these drugs on patients' everyday lives, best practices dictate that we proactively discuss their use at every visit.

Consider this typical scenario: A woman comes to my office for a clinical visit. She tells me she takes seven prescription medications to manage multiple chronic conditions and that she doesn't take any other medications. After more discussion, I discover that she also takes naproxen, ibuprofen, acetaminophen, ibuprofen/diphenhydramine, and acetaminophen/hydrocodone (which was prescribed for her by another physician).

When I asked her why she didn't mention these other medications, she tells me that she doesn't consider these "medicine" because I didn't prescribe them, and she doesn't take them every day. Unfortunately, what she doesn't realize is that, with her heart failure, chronic renal failure, history of stroke, and use of multiple medications with the same active ingredients, she was inadvertently putting her health at risk.

Sound familiar?

A Review of the Risks

To further illustrate why these in-depth conversations with patients about OTC pain-reliever use are important, consider the findings of a recent survey involving 1300 US adults[2] conducted by the US Pain Foundation. The results revealed that 94% of Americans depend on OTC analgesics for pain management and many of them do so without considering factors that could seriously impact their health.

The remainder of the key findings are just as eye-opening. When asked about decisions regarding which OTC pain reliever to use:

  • Nearly half (45%) do not consider the prescription medicines they are currently taking.

  • More than half (58%) do not consider their preexisting health conditions.

  • Two-thirds (65%) do not consider other OTC medicines they are taking.

  • Three out of four (73%) of those aged 60 and older do not consider their age.

  • One in five (20%) do not consider any of these important safety factors.[2]

Healthcare professionals routinely ask patients about their prescription medications. We need to ensure that we are also asking about the use of OTC medications, including OTC pain relievers, to provide appropriate guidance based on each patient's health history or risk/benefit profile. Not having the complete picture can lead to serious consequences.

 
Taking NSAIDs for longer than 3 months has been associated with gastric ulceration rates between 15% and 35%.
 

For example, when taken regularly, nonsteroidal anti-inflammatory drugs (NSAIDs) can elevate a patient's cardiovascular risk, and this risk can be even greater for patients with known cardiovascular disease.[3] Taking NSAIDs for longer than 3 months has been associated with gastric ulceration rates between 15% and 35%,[4] warranting the use of caution when recommending these medicines.

Similarly, it is important to be aware of hepatic risk factors when recommending acetaminophen to a patient. Acetaminophen hepatotoxicity is still the most common cause of acute liver failure in the United States.[5] Many patients who experienced acetaminophen toxicity were not aware that they were misusing the medication.[6] Educating patients on the many medications that contain acetaminophen, as well as the appropriate maximum daily dose, is a key step in ensuring that patients use this medication appropriately.

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