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Acetaminophen: When to Use Caution

When taken as directed, acetaminophen (Tylenol) is generally considered safe unless you drink three or more alcoholic drinks a day, or take too much (overdose). If you are taking the blood-thinner warfarin (Coumadin), talk to your doctor or pharmacist before taking acetaminophen, because it can increase your risk of bleeding.

"If you keep below the maximum daily dose, this is a pretty safe drug,"  says William Schwab, MD, PhD, chief of geriatrics at Kaiser Permanente and Ohio Permanente Medical Group. Problems can arise when you take combination products such as cold or sleeping preparations or certain prescription pain pills that also contain acetaminophen.

"Pain pills such as Percocet and Vicodin or their generic equivalent also contain acetaminophen and also have to be taken into account when figuring out maximum daily doses," Schwab says. "Read the labels and stay within the safe dose range."

Beware of Antihistamines and Sleep Aids

Diphenhydramine hydrochloride -- the active ingredient in many antihistamines and OTC sleep aids -- can be risky for elderly people, Schwab stresses. It has a prolonged half-life, which means it stays in the body for a long time, and can cause confusion and falls. In men, it may also increase risk of urinary retention. "I don't recommend this for elderly patients -- especially men," he says. Talk to your doctor or pharmacist about other alternatives.

High Blood Pressure and Drug Safety

Cold medicine ingredients may increase blood pressure levels or interfere with how well blood pressure medications work. "Most of the things that are not safe for high blood pressure will state this clearly on the box," Schwab says. He recommends that people with high blood pressure read Drug Safety labels carefully for this warning. Safer alternatives do exist, depending on what ails you. Ask your pharmacist or doctor for guidance on safe choices.

General Tips for OTC Pain Relievers

Some medications need to be taken with food to improve absorption or prevent potential side effects, while others are best taken on an empty stomach. This can be a problem for seniors who may have trouble fixing food for themselves or who may eat little. Talk to your doctor about what you can do to make sure that you are using a medication effectively. For example, drinking a glass of milk before taking an NSAID may help stave off stomach problems.

Memory problems can also be an issue with medication for seniors, raising the risk of accidental overdose if you forget you've already taken as much as recommended. Talk to your doctor before taking any OTC medications on a daily basis. "If your doctor agrees, then there are pill reminder systems and charts to help you keep track of what you take and when,” Perskin says.

Choosing an OTC Pain Reliever

What you need to know to make a safe and effective choice.
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