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OTC Drugs, Medicines Safety and You

Many people are still over cautious when buying off the shelf medicines or OTC drugs in pharmacies or supermarkets.
This may be justified since we cannot compare purchasing a medicine or OTC drug to purchasing deodorants, as an example.

Knowledge is an excellent way to conquer fear. The more you know about the subject, the less you fear it and the easier it will be for you to make informative decisions.

Please read this Safety with Medicines web page below with guidelines of how to keep you and your family medicine-safe. The Safety with Medicine page is also categorized to specific community groups including explanations and warnings.

 

Please take the time to read this Safety with Medicine page thoroughly! This information can prevent mistakes and save lives!!!

 

 

 

 

Abbreviations used:

 

OTC
Over The Counter
MD
Medical Doctor (Family Doctor)

 

Definitions section is at the bottom of this Safety with Medicines page.
Where a definition is available, a link option will be available on the specific word when it is encountered for the first time.
At the end of the definition you will find a link to take you back to the same point you left from.

 

Over-the-counter (OTC) Medicines/Drugs

OTC drugs are sold to a customer without prescription.
The term "over-the-counter" is somewhat counter-intuitive, since these items can often be found on the shelves of stores and bought like any other packaged product in some countries in contrast to prescription drugs, which are more likely being literally passed over a counter from the pharmacist to the customer.

Some medicines that are considered safe medicine in general terms, may be available in general stores, supermarkets, gas stations etc.
The rules vary considerably from country to country.

Important to know: In general, OTC drugs for pain relieve and reduction of fever is quite effective, but if after twenty four to forty eight hours there is no improvement than you should see your MD.
Safety with medicines should come first before a medicine use becomes drug abuse!

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Medicine Safety with Pregnant Women

Medicine and OTC drugs taken by the mother during pregnancy may pass through and absorbed in the fetus blood.
Some of the OTC drugs may be safe for a pregnant woman and her fetus.
With others, the side effects are known and with some portion of the drugs, it is unknown yet if the specific OTC drug can be harmful to the fetus.
There are some Medicines and OTC drugs that are not to be used during specific period of the pregnancy.
As a thumb rule, you must consult with your MD (Medical Doctor) and/or the Pharmacist regarding taking any OTC drug or other.

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Medicine Safety with Breast Feeding Women

Medicines and OTC Drugs may pass through the mother’s milk to the baby. With some of the medicines the amount is low and may be negligible.
With other medicines the effect can be noticed and cause side effects.
If you are breast-feeding you must as a minimum precaution, consult with your pharmacist and it is always beneficial to check with your MD regarding an OTC drug or medicine that you plan to use.

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Medicine Safety with Infants and Children

Most of the knowledge and experience on the efficiency, side effects and risks of a medicines and OTC drugs is based mostly on clinical studies on adult volunteers.

The complication is with the difference between adults to children and infants. It is not only the weight factor, but also the body makeup, the body fat distribution, development stage, functionality of different organs as the liver, Kidneys and more.

In other words, children and infants will react differently to medicines and drugs than adults do due to the different way that the medicines and OTC drugs breakdown in their bodies.

This is the reason to be very cautious when administering OTC drugs (or others) to children and infants and to be extra careful when calculating the correct dosage.
Even when you receive the medicine from the pharmacist, you must take into consideration not only the age of the child or infant but also his weight.
Always use an accurate dosage spoon, medicine dropper, dosage cup, or an oral syringe. 

Important to know: Coughing is the body way of clearing the respiratory system’s airways.
Medical Doctors these days do recommend not to try to suppress coughing in toddlers and infants under the age of three.
You should this discuss this issue with your MD
When buying OTC drug, verify with the pharmacist that it does not contain Cough suppressing medication unless otherwise instructed by your MD.

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Medicine Safety with People who use other medicines or OTC drugs

Some times one medicine or OTC drug function can be in conflict with another medicine.
There is also the potential that one medicine will increase the effect of another medicine that you are already using (a risk of double dosage). On the other hand, it may increase the side effects of the medicine you are already using.
If you already taking any other medicines or OTC drugs consistently or even just for a short period, you must consult with your pharmacist or MD so that they can explain to you if there are any conflicts between the different medicines.

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Medicine Safety with People with Chronic Illnesses

Chronic diseases usually cause to one or more organs to behave differently than normal.
This will affect the way their body is breaking down the OTC drugs or medicines and will create potential for additional unnecessary risks to the person.
You must inform your medical situation to the pharmacist or the MD (especially to an MD that does not know your medical history).
With this information, they can better evaluate the risks and decide on the correct OTC drug or medicine for you to use.

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Medicine Safety with the Elderly

The ageing processes and the physical changes related to them are affecting the way the medicines and OTC drugs are broken down by the body and the way the drugs are influencing the body.

The liver and kidneys functions are reduced and at the same time, the brain and the nervous systems are more susceptible to the medicines.

Usually older people are taking already a range of different drugs and this is the main cause for this age group to suffer more than others from side effects. Even “safe” OTC drugs may be risky for the elderly group.

When buying medicines for the elderly, you must inform the Pharmacist or the MD the patient medical situation and list the other medicines or OTC drugs he/she already taking.
With this information, the pharmacist/MD can better evaluate the risks and decide on the correct medicine/drug for the patient to use.

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In What form should you take the Medicine or OTC Drug?

Some of the Medicines and OTC drugs are available in different forms.
The usual and known forms are Tablet, Capsule, Gel Capsule, suppository, syrup and drops.

Image of medicine in tablet pills formTablets (pills) – Are in small circle or oval disc-shape form. The drug is compressed in the tablet. The tablets (pills) come in assorted colours and sizes. After the tablet is swallowed, the tablet breaks down slowly and the drug is released into the body.

 

 

image of medicie in capsule formCapsules – The medicine is encapsulated in a cylindrical shaped hollow body made mostly of a Gelatine base. After swallowing the capsule, the Gelatine melts away and the Drug/Medicine is released.
There are two main types of capsules. One has dry powdered medicine and the other has the medicine in Gel form.

 

image of medicine in suppository formSuppository – Solid “Torpedo” shaped delivery system made of greasy compound (usually based on Glycerine or Polyethylene Glycol or Cocoa butter) mixed with the Medicine.
The suppository is inserted to the Rectum or Vagina and the body heat melts the suppository slowly while releasing the medicine gradually into the body. 
In this way, any contact with the stomach and the digestion system is avoided.
This is an advantage for people suffering from digestion problems or from vomiting.

image of medicine in drops image of medicine in syrup formSyrup and Drops– Are medicines in liquid form that include the medicine, artificial flavouring, colouring and preservatives.





Medicine Safe handling:

Do Not Crush Tablet or open capsules - Some people do have problems swallowing tablets and they are used to crash the tablets and then swallow the powder with a liquid of some sort.
You must be aware and warned that a crushed tablet or opening the capsule of a medicine or OTC drug may lead to two opposite reactions (depends on the medicine).
One reaction can be non-effectiveness of the medicine since it is passing faster through your system and does not have time to be absorbed in your body and take effect.
On the other hand, some tablets are constructed in a tablet form so that they will dissolve and release the drug slowly in your body. If crushed you may suffer from an overdose with increased chance for severe side effects.
If you have trouble-taking pills, talk to the pharmacist for a suitable alternative.

Do Not Split the suppository to two or more smaller parts – This action may cause for uneven distribution of the medicine's active ingredient and ineffectiveness of the drug.

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What is the most effective form of Medicine or OTC drug?


They are all similarly effective and there is no major difference between them while taking into consideration that we are comparing the same dosage per form.

The difference is in the efficiency of delivering the medicine into the body. The liquid forms are always absorbed faster into the body and will react faster.
This was the idea behind the creation of the Gel form capsules. Before you get too excited, you should know that usually the effect of Gel capsules would be just a few minutes faster then tablets while their price will be much more expensive.
You should be the judge if this few minutes worth the price.



Important points to verify while purchasing OTC drugs or prescribed medicine:

  1. Find out how to store the medicine (refrigerated, in the cupboard etc.)
  2. Check the expiry date on the case and verify that it has not expired or close to the expiry date

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Seven Questions you should ask your Pharmacist before buying Medicines or OTC Drugs

  1. Does the OTC drug you picked conflicts with any other Medicines/Drugs and/or other supplements you are taking (i.e. Vitamins)?
  2. Re Confirm the use/purpose of the Medicine or OTC drug and advise the Pharmacist on any of the conditions mentioned above or any other health issues you may have.
  3. Ask about any side effects that may appear (nausea, vomiting etc.) when using the medicine or OTC drug and what should you do if they do appear?
  4. Does the Medicine or OTC drug cause drowsiness? If it does, you must avoid driving or any other operation/function that require you to be fully alert!
  5. What is the maximum period of use? Some medicines and OTC drugs are addictive and with others the body become used to the drug and increase in dosage may be required.
  6. Does the Medicine or OTC drug conflicts with any types of drinks or foods (i.e. Alcohol)? Some types of foods or drinks may reduce the effect of the drug.
    Some OTC drugs and/or medicines are dangerous when combined with Alcohol (more details further on).
  7. Ask about the maximum frequency, maximum dosage and when (time of day, before or after meals etc.) to take the medicine or OTC drug.

 

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Mixing OTC Drugs or prescribed Medicines with food and/or Drinks

You have now purchased a medicine or OTC drug; you must know that responsibility is the key for safety with medicines! Some foods and drinks may interact strongly with medicines or OTC drugs and reduce the effect of the drug or in some cases lead to severe side effects.
Following are the main drinks that may interact with medicines. Make sure you read the information about taking the medicine or OTC drug on full or empty stomach later on this page.


image of glass with red wineAlcohol – Avoid drinking Alcohol with any OTC drugs containing Paracetamol or Ibuprofen.
The combination between alcohol and Ibuprofen can increase the chance for bleeding in the digestion system and reduce concentration (alertness).
The combination between alcohol and Paracetamol can lead to liver damage.


image of a grapefruit Grapefruit (as a fruit or Juice) – Grapefruit has a chemical that slows down the functionality of Enzyme CYP3A4. This Enzyme is responsible for the body metabolism and for the absorption of the medicines in the body.
This slow-down can cause high concentration of the medicine or OTC drug in the blood and may lead to poisoning.
This interaction can happen with many drugs but in the case of OTC drugs, it is recommended not to mix grapefruit with medicines containing Paracetamol or Ibuprofen.


image of fizzy drinksFizzy Drinks – All fizzy drinks can cause change in the acidity of the stomach. They can reduce and change the effect of the medicine or OTC drug you are taking.
Refrain from drinking fizzy drinks when taking OTC drug or other prescribed medicine.

Note: You must consult the pharmacist or MD concerning any other medicine or OTC drug you use and its combinations or reaction with different type of drinks.

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Should I take the OTC Drug or
prescribed Medicine after or Before a Meal?

In order to get the maximum effect of a medicine or OTC drug, it is important to pay attention to the timing for taking a medicine in relation to meals.
You read about the preferred method in the leaflet that comes with the medicine and/or OTC drug. If there is no leaflet or you are still not sure than ask your Pharmacist or MD.
There are drugs that are better to take with food to reduce their irritation on the digestive system.
Other drugs are better taken on empty stomach to increase and speed up their effect.

On Empty Stomach – It should be safe to take OTC drugs from the Paracetamol family and Medicines or OTC drugs intended to reduce heartburn.

With food – The recommendation is to take OTC drugs from the Ibuprofen family with food. In this context, food does not mean a full meal. A slice of bread or a cookie will suffice.

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Twelve things you must know when administering medicines
to Infants and Children

 

  1. Consult with your Pharmacist or MD regarding any new medicine or OTC drug you did not use before even if it is regarding “Natural” products. In some cases “Natural” products can be more dangerous than regular medicines.
  2. Avoid administering adult’s medicines or OTC drugs to infants and children even in small dosages unless you MD approved or directed you to do so.
  3. Accurately measure dosages using dosage spoon, medicine dropper, dosage cup, or an oral syringe. Never estimate!
  4. The weight of the infant or child is important for calculation of the required dosage. Always be sure you know their latest weight.
  5. Raise the infant to a vertical position when administering medicine that requires swallowing. Never administer it when the infant is lying down and definitely not when they are sleeping.
  6. Administer liquid medicine in drops slowly aiming to the inside of the cheek. This way you will avoid choking the infant and it is also be harder for the infant to spit it out.
    Drip few drops at a time and let the infant calm down and stop crying before you continue.
  7. Don’t mix food or drinks with the medicine or OTC medicine. Yes, it is not easy to administer a medicine to an infant or a young child, but mixing it with food or drinks make it harder to accurately evaluate how much of the medicine dosage was already swallowed.
  8. Keep a safe distance and height between the medicine cabinet and children and infants. Make they understand that this cabinet is out of scope for them! Do not let them play even with empty medicine bottles so they would not relate games with medicines.
  9. Take your own medicine or OTC drug in private. Children and infants will imitate the adults and will try and take a medicine by them selves.
  10. Explain to the child about the function of the medicine, its name and the difference to other foods, sweets and drinks.
  11. Emphasize to the child that a specific medicine is intended for one ill person in the family and is not to be used by other family members even if they are also ill.
  12. Verify that the medicines and OTC drugs are out of the child reach in other places/locations where the child/infant spends his time. Most of child/infant’s medicine related poisoning cases happen usually at the grandparent’s house or other close relatives. 

 

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Disclaimer

This Safety with Medicine web page was created to enrich your knowledge concerning medicines and their use. If we managed to save one life by people using this extended knowledge and prevent an accident with the wrong use of medicines and OTC drugs, than all this work was worthwhile. 
As was repeated many times above, if you are unsure regarding the use of a medicine or OTC drug, you must consult your pharmacist and/or Medical Doctor.

The information presented on this web site is intended for educational purposes only and are not to be used for diagnosis and treatment, or a substitute for professional medical advice.

If you have a problem or specific medical condition, we always recommend that you see your doctor for diagnosis, treatment, and continuing care. Information provided by these web pages or any links to other web pages does not constitute a doctor-patient relationship between you and the author of this web site

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Definitions:

MD - Medical Doctor

The Doctor of Medicine (MD, from the Latin Medicine Doctor meaning "Teacher of Medicine") is a doctoral degree for physicians (medical doctors). The degree is granted by medical schools.
It is a first professional degree (qualifying degree) in some countries, including the United States and Canada, although training is entered after obtaining at least 90 hours of university level work.
In other countries, such as United Kingdom and Australia, the MD is a higher doctoral academic research degree resembling a PhD.
In Britain and many Commonwealth nations, the qualifying medical degree is instead the Bachelor of Medicine, Bachelor of Surgery (MBBS or BMBS or MBChB).

ref: Wikipedia

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PhD - Doctor of Philosophy

Doctor of Philosophy abbreviated Ph.D. or PhD for the Latin philosophy doctor, meaning "teacher of philosophy".
It is an advanced academic degree awarded by universities. In many, but not all countries in the English-speaking world, it has become the highest degree one can earn and applies to graduates in a wide array of disciplines in the sciences and humanities.

ref: Wikipedia

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Drugs

Legal definition of drugs - Some governments define the term drug by law.
In the United States, the Federal Food, Drug, and Cosmetic Act definition of "drug" includes "articles intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease in man or other animals" and "articles (other than food) intended to affect the structure or any function of the body of man or other animals.
Consistent with that definition, the U.S. separately defines narcotic drugs and controlled substances, which may include non-drugs, and explicitly excludes tobacco, caffeine and alcoholic beverages.

ref: Wikipedia
dictionary.reference.com

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Ibuprofen

Ibuprofen is a non-steroidal anti-inflammatory OTC drug originally marketed as Brufen, and since then under various other trademarks, most notably Nurofen, Advil and Motrin. It is used for relief of symptoms of arthritis, primary dysmenorrhea, fever, and as an analgesic, especially where there is an inflammatory component.
Ibuprofen is known to have an antiplatelet effect, though it is relatively mild and short-lived when compared with that of aspirin or other better-known antiplatelet drugs. Ibuprofen is a core medicine in the World Health Organization's "Essential Drugs List", which is a list of minimum medical needs for a basic health care system.

ref: Wikipedia
Journal of Clinical Pharamcology

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Paracetamol

Paracetamol is a widely used OTC drug analgesic (pain reliever) and antipyretic (fever reducer). It is commonly used for the relief of fever, headaches, and other minor aches and pains, and is a major ingredient in numerous cold and flu remedies.

In combination with non-steroidal anti-inflammatory drugs and opioid analgesics, paracetamol is used also in the management of more severe pain (such as cancer or postoperative pain).
While generally safe for human use at recommended doses, acute overdoses of paracetamol can cause potentially fatal liver damage and, in rare individuals, a normal dose can do the same; the risk is heightened by alcohol consumption.
Paracetamol toxicity is the foremost cause of acute liver failure in the Western world, and accounts for most drug overdoses in the United States, the United Kingdom, Australia and New Zealand.

ref: Wikipedia


Journal of Clinical Pharamcology

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Enzyme CYP3A4

Cytochrome P450 3A4 (abbreviated CYP3A4), a member of the cytochrome P450 mixed-function oxidase system, is one of the most important enzymes involved in the metabolism of xenobiotics in the body.
CYP3A4 is involved in the oxidation of the largest range of substrates of all the CYPs. CYP3A4 is also, correspondingly, present in the largest quantity of all the CYPs in the liver.

ref: Wikipedia

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