Americans spend $5-billion a year on more than 100,000 varieties of over-the-counter drugs. The FDA estimates there are 178,000 hospitalizations each year as a result of their misuse —and yet recent surveys suggest that almost 50% of us regularly exceed maximum daily dosage recommendations.

“As a culture, we have a tendency to think that taking a drug for whatever ails you is the answer…All drugs have side effects and all have the potential for toxicity. They shouldn’t be taken lightly and they should be taken with an expectation and knowledge of what can happen…Advertising clearly increases drug use and sales. It feeds the overuse of drugs and the cavalier attitude that exists with some of the public. I don’t see the advertising, especially the direct-to-consumer advertising for prescription drugs, as being a benefit to anyone but the pharmaceutical company,” says Dr. James O’ Donnell, assistant professor of pharmacology at Rush Medical College.

ASA and acetaminophen are two of the most commonly administered drugs in the world and form the active ingredient in a number of common over-the-counter analgesics and cold remedies

Among analgesics, acetaminophen is the most popular OTC (over-the-counter) painkiller in the US. According to a recent major study, however, acetaminophen overdose is the leading cause of liver failure in America and accounts for almost 57,000 emergency room visits annually.

“Acetaminophen can certainly be dangerous at doses exceeding four grams (4,000mgs) per day, which can easily be exceeded when taking extra strength OTC drugs,” says Dr. O’Donnell. “Acetaminophen is the non-narcotic component of a number of combination opiate/non-opiate analgesics and when taken in high doses for chronic pain, there’s a risk of exceeding the four-gram threshold.”

Alcohol and fasting increase the potential toxicity of excessive acetaminophen intake, even at doses lower than the four-gram recommendation. Because acetaminophen is also present in approximately 200 other products, it’s easy for unwitting consumers to exceed daily limits without knowing it.

“Stronger warnings need to be given to patients using prescription drugs containing acetaminophen and OTC products should have strong and clear warnings as well,” says Dr. O’Donnell.

Dangerous side effects are not restricted to acetaminophen misuse: ASA can cause stomach distress and bleeding and inhibits blood clotting; ibuprofen can damage the stomach lining and may exacerbate liver or kidney problems; and naproxen sodium can irritate the gastrointestinal system.

Protect Yourself:

• Advise doctors and pharmacists concerning allergies.
• Question the pharmacist before you buy OTC medications — provide all the pertinent information, including the names of other drugs and health food products you may be taking. Never combine drugs without medical approval.
• Read the labels thoroughly; adhere to recommended daily dosages and respect expiration dates.
• Seniors, diabetics, heart patients and children need to practice special caution.

“The ultimate responsibility is the patient’s,” says Dr. O’Donnell. “An educated patient is a better patient. Some errors are made in prescribing and filling out medications. If the pill looks different, ask why. If the pharmacist responds, ‘you got a different or generic manufacturer,’ make sure you give the doctor the precise markings and color and description of the pill. Ask what the drug’s name is and what it’s for. Expect the pharmacist to ask you why you’re taking the drug and what you were told about it. These interactions can identify an error if the wrong drug is prescribed or an error occurs. Don’t be bashful — ask, ask, ask and expect to get answers!”