OTC Drug Safety for Seniors

From the WebMD Archives

You may think that over-the-counter (OTC) medications are always safe. But if you are over 65 and also taking prescription medications, this kind of thinking can get you into some trouble.

"The average number of prescription medications taken by people over 65 is five or six,” says Michael H. Perskin, MD, an assistant professor of medicine and an internist at the New York University Langone Medical Center. “As you get older, it increases and so does the potential for drug interactions."

So how can you find effective and safe relief from arthritis and other pain, and cold or allergy symptoms? "When in doubt, ask your pharmacist," Perskin says. "If you have taken the medication before, it's probably OK. But if it's new or your other medication regimen has changed, check it out."

Here are some other drug safety guidelines for using pain relievers, antihistamines, and cold medications.  

Drug Safety: Use One Pharmacy

If you fill all prescriptions at one pharmacy, all the important information about what you take and when you take it is in a central location. Ask the pharmacist if any OTC or herbal medications will interact with your prescriptions. She can likely tap into a computer, see what else you take, and let you know right then and there.

Learning about interactions with commonly used OTC remedies can also assure smart choices. "Always read the labels and follow the dosing instructions," Perskin says.

Talk to your doctor or pharmacist if you have any medical conditions or take other medications. They can help explain what risks you may have and what precautions to take.

Complications of Using NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) is the blanket name for such OTC medications as aspirin (Bayer, Bufferin, St. Joseph), ibuprofen (Advil, Motrin), and naproxen sodium (Aleve). When your arthritis flares, it may be tempting to reach for an NSAID to curb the joint pain and inflammation and get back in the bridge or golf game. But there are some things you should know first.

NSAIDs also interfere with warfarin (Coumadin), a commonly prescribed blood thinner. In fact, there is a laundry list of medications and herbal supplements that can weaken or strengthen the effects of Coumadin. Your doctor should make it very clear what other medications and herbal preparations to avoid if you’re taking it. "You have to watch really carefully because there are so many drug interactions," Perskin tells WebMD.

Continued

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.

WebMD Feature Reviewed by Louise Chang, MD on September 12, 2011

Sources

SOURCES:

William Schwab, MD, PhD, chief of geriatrics, Kaiser Permanente and Ohio Permanente Medical Group, Willoughby.

Michael H. Perskin, MD, assistant professor of medicine, Langone Medical Center, New York University.

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