USE IN GENERAL AND SPECIAL POPULATIONS, THERAPEUTIC ERRORS, MISUSE, STORAGE AND DISPOSAL
A Resource from the American College of Preventive Medicine
A TIME TOOL FOR CLINICIANS
ACPM's Time Tools provide an executive summary of the most up-to-date information on delivering preventive services to patients in the context of a clinical visit. Information presented is based on evidence presented in peer-reviewed journals and other relevant sources, such as national surveys and recommendations by governmental agencies. Please refer to the Over-the-Counter (OTC) Medications Clinical Reference for more information.
Use of Over-The-Counter (OTC) Medications Is Trending Upwards
There is a broad range of oral and topical OTC preparations used frequently by the general public to treat common health problems ranging from headache to tinea pedis (Athlete’s foot). In fact, OTC medications such as analgesics, decongestants, and antihistamines are among the most frequently used of all medications in the United States.
- Currently, 35% of adult Americans use OTC medications on a regular basis.
- OTC medication use in children is twice that of prescription medication.
- Retail sales of OTC medications are over $17 billion. Cough/cold and allergy remedies, analgesics, and antacids/anti-gas products are the most common preparations for oral ingestion purchased. Toothpastes, oral antiseptics/rinses, and first aid treatments are the most common topical preparations purchased.
- OTC use will increase as more prescription drugs move to OTC status.
OTC Benefits Outweigh Their Risks
FDA’s Center for Drug Evaluation and Research (CDER) regulates OTC medications to ensure that they are properly labeled and that their benefits outweigh their risks.
- The public perceives OTC drugs to be safe and many individuals take them without medical supervision.
- They have a low potential for risk.
- They are economical and convenient.
- OTC use allows self-care providing a sense of autonomy for the consumer.
OTC Medications Are Safe But Not Risk-Free
As with all medications, there can be risks with use. The risks of OTC use include:
- Delay in seeking medical advice for a serious illness (including masked diagnosis)
- Risk of drug-drug/herbal/dietary supplement interactions
- Risk of adverse events
- Potential for dependence, misuse and abuse
The Challenge For Physicians Is To Openly Discuss OTC Use With Their Patients
Misuse refers to the intentional use of a product in higher doses or for longer than recommended, or for inappropriate purpose (other than "getting high”). Abuse refers to intentional use to "get high.” Physicians are challenged to identify incorrect use of medications they did not prescribe. Learning how to counsel patients about the appropriate use and storage of OTC medication is a proficiency needed by all healthcare providers if we expect to change statistics like the following:
- Therapeutic errors and unsupervised medication ingestions result in emergency department visits of over 70,000 children each year. In more than 26,000 of these cases, OTC medications are implicated.
- Unsupervised ingestions alone result in emergency department visits of over 58,000 children each year (prescription and OTC drugs).
- One third (33%) of Americans admit that they have taken more than the recommended dose of an OTC medicine.
- Only half (51%) of Americans say they seek out the label for usage information when they plan to take an OTC medication for the first time.
- One-quarter of physicians do not ask their patients about OTC drug use.
- Only 18% of physicians educate their patients about safe drug taking, storing, and disposal practices.
Of particular concern are adolescents who abuse OTC cough medicines containing dextromethorphan.
Older Adults May Not Be Aware That They Are at Increased Risk Of Experiencing Adverse Events
The elderly represent a high proportion of OTC users who are not inclined to discuss OTC use with their physicians. Polypharmacy is common in this group, including use of multiple OTC preparations and prescription drugs.
- Physicians should actively seek a conversation with older patients about the OTC medications they are using and, where applicable, tell them about increased risks when our bodies get older.
- Physicians are encouraged to refer to the Beers List (See Table 3) of drugs potentially inappropriate for the older adults.
Storage And Disposal
All drugs (prescription and OTC) should be kept out of reach and sight of children after every use and stored at one well-controlled location such as a locked drawer or cabinet. Child-resistant caps must be correctly replaced after every use.
For proper disposal, the Environmental Protection Agency recommends that drugs be taken out of their containers, mixed with undesirable substances, (e.g., cat litter, used coffee grounds) and put into a disposable container with a lid or into a sealed bag before putting in the trash. Environmentally, it is irresponsible to "flush” OTC medications.
Changing Practice Patterns Will Make A Difference
By intensifying patient communications about the correct use of OTC drugs as well as the risks of their incorrect use, physicians can provide a better patient outcome.
A Final Thought
OTC medications play a vital role in the health of Americans. Their use is high and warrants awareness by both physicians and consumers of the safety hazards. Incorrect use of OTC medicines is "risky business” and physicians have a role in prevention efforts to thwart unhealthy practices. Improved patient education and continued communication about the proper use of OTC medications will help minimize the potential for harm. Consumers should learn the specifics about their OTC medications and report use to their physicians; as a safeguard, physicians should routinely ask "What OTC medicines do you take daily, on occasion, never, and why?”
Taking medication as directed to prevent
misuse and abuse is addressed in other ACPM Time Tools. To read more go to Use, Abuse, Misuse and Disposal of
Prescription Pain Medication and Medication Adherence.
Supporting references and additional information:
Over-the-Counter (OTC) Medications Clinical Reference
Over-the-Counter(OTC)Medications: A Guide for Patients
Download printable versions of these resources:
Over-the-Counter (OTC) Medications Time Tool
Over-the-Counter (OTC) Medications Clinical Reference
Over-the-Counter (OTC) Medications: A Guide for Patients
For other information and useful links, visit the American College of Preventive Medicine website at www.acpm.org.
ACPM recommends using the following citation when referencing this educational program.
Excerpted with permission from the American College of Preventive Medicine. Over-the-counter Medications: Use in General
and Special Populations, Therapeutic Errors, Misuse, Storage and Disposal Time
Tool: A Resource from the
American College of Preventive Medicine. 2011. Retrieved from http://www.acpm.org/?OTCMeds_clinicians.
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Copyright 2011. American College of Preventive Medicine. All Rights Reserved.