Overuse of acetaminophen, a common over-the-counter (OTC) painkiller, can result in liver failure and even death. Because of this, the FDA is considering recommendations to place new restrictions on the drug. But this is only the latest in a long string of stories that call the safety of various OTC pain relievers, allergy medicines, and other drugs into question.
How can you be sure that what you are taking is safe or even effective? What’s more, how can you know for sure if the generic you buy is the same medicine as the brand-name drug? And how do all those formerly prescription drugs that are now available without a prescription fit in? With all these concerns and choices, a trip to the local drugstore can be overwhelming.
“The key,” says Norman Tomaka, a certified consultant pharmacist, in Melbourne, Fla., “is to know what you want and need before you go into the store.” Tomaka is also a spokesman for the American Pharmacists Association. “When you’re walking along the medicine aisle is no time to window shop or impulse buy.”
WebMD has assembled a list of shopping tips you can use to make smart, safe choices when you buy over-the-counter medicines.
Tip 1: Read the Medicine's Label -- Carefully
“Reading the label on an over-the-counter drug is the single most important thing,” says Tomaka. The FDA mandates that each OTC drug label must clearly list the active ingredient and the amount of the active ingredient. Labels also need to state what the medicine’s intended use is. “Educate yourself,” Tomaka says, “even if you can’t pronounce the active ingredient’s name. Look at the drug ingredient and look at the indications to find out what it is used for.”
The information on the label can also help you decide between a generic and a brand-name OTC drug product. If you are considering saving money by buying a generic drug, Tomaka says, compare the active ingredient and amounts in the generic vs. the brand name OTC product. “For example, if you are purchasing an antihistamine, read the ingredient and amount. If the store brand or generic brand is identical to the trade brand, it will likely have the same effects on your symptoms.”
If you have known allergies, you should read the inactive ingredients in any over-the-counter drug. “Inactive ingredients,” Tomaka says, “must also be prominently labeled. If you don’t have any allergies to the inactive ingredients, it is likely safe to choose the drug.”
Step 2: Steer Clear of Combination Over-the-Counter Medicines
William J. Calhoun, MD, says you should avoid the use of products that have a combination of ingredients. Calhoun is a professor of medicine and vice chairman of the department of medicine at the University of Texas Medical Branch in Galveston. He says, "Pick the ingredient for the symptom you are trying to mitigate. If you have fever, Tylenol, ibuprofen, or aspirin are pretty good fever reducers. If you have a cough, dextromorphan is a good suppressant, and if you have a runny nose, antihistamines are helpful.”
But if you don’t know what medication will best treat your symptoms, he says, you should ask. “Ask the pharmacist to recommend a single agent product that takes care of the symptoms that you have.” The problem with combination products is that they can increase the risk of an accidental overdose. A combination cold medicine may have acetaminophen (the active ingredient in Tylenol). So taking it along with Tylenol can get you into trouble.
Tomaka also advises that you should keep it simple. “If you need something for sore throat,” he says, “but don’t have a headache or fever or cough, don‘t buy something that treats these problems. If you just have plain diarrhea without gas, you don’t want the product for gas and diarrhea.”
Tip 3: Read and Heed the Warnings on OTC Drug Labels
OTC drug buyer beware if you have high blood pressure, diabetes, Parkinson’s disease, or certain other underlying health conditions. Ingredients in some OTC products may interfere with your disease or medications used to treat it. For example, some decongestants may raise blood pressure levels. “Read the label,” says Megan Berman, MD, “to see if there are any warnings that may pertain to your underlying disease status or current medication regimen.” Berman is an assistant professor of internal medicine at the University of Texas Medical Branch in Galveston. “If you have questions or concerns,” she says, “the pharmacist is an excellent resource.”
Tip 4: Ask the Pharmacist for Help
When in doubt or if an over-the-counter medication looks different to you, ask your pharmacist for clarification. Tomaka tells WebMD that trade names can change and multiple drugs with different indications can have the same trade name. For example, there have been several mix-ups between two common OTC drugs that use the brand name Dulcolax. One has bisacodyl, a laxative, as its main ingredient. The other contains docusate sodium, a stool softener. “Some people have taken the wrong one before a colonoscopy as part of their preparation. As a result, their bowel wasn’t prepared for the procedure,” Tomaka says.
Tip 5: Know When -- and When Not -- to Self Diagnose
Self-diagnosis can be OK in the right circumstances, Tomaka says. “You can trust yourself if you know your symptoms or have had similar problems in the past and self-diagnosed and treated them successfully.” For instance, Tomaka says that if you have some vaginal itching and discharge and it was a warm summer day and you were wearing pantyhose, you can trust your own judgment and treat it with an OTC anti-yeast product. “There are also clues on product labeling,” he says, “that can help tell you if this product will treat your symptoms.”
However, you should see a doctor if you experience repeated episodes of similar symptoms that are not responding to the store-bought therapy. And it’s important to discuss any new symptoms with your doctor before trying to treat them on your own.
A Final Word About the Difference Between OTC and Prescription Versions of a Drug
Many drugs that you could once only buy with a prescription are now available without one. “The dose may have been cut,” says Calhoun, “to increase the safety.” For example, when ibuprofen was a prescription-only drug, it was sold in 400, 600, and 800 milligram doses. But as an OTC pain remedy, it is sold in 200 milligram doses. Some drugs, though, are exactly the same dosage over-the-counter as they were in prescription form. “This means,” Calhoun says, “that the FDA has determined the drug is safe and it is OK to make the choice to use it on your own.”