Read the labels, because 'all drugs have side effects'

In an effort to reduce the risk of liver damage resulting from overuse of acetaminophen - the active ingredient in Tylenol - the drugmaker's McNeil division will soon cap the product's daily dose recommendation at 3,000 milligrams (a total of six 500-milligram pills a day) instead of the current 4,000 (eight pills a day).

Some experts say they also worry about overuse of other medications that consumers can purchase off pharmacy shelves without a prescription, such as the pain reliever ibuprofen, Theraflu for colds, and the antihistamine Benadryl.

"It's important for the public to realize all drugs have side effects. It doesn't matter if they're prescription, over-the-counter, herbals or nutritional supplements. If they have active ingredients, they have side effects and can interfere with normal body functions," says Brian Strom, director of the Center for Clinical Epidemiology and Biostatistics at the Perelman School of Medicine at the University of Pennsylvania.

"People don't really read labels," Strom says. He says manufacturers need to make it harder to overdo it with over-the-counter drugs that pose greater overdose risks, for example by packing drugs such as Tylenol in smaller quantities, and doing away with "extra-strength" versions.

Other common, and commonly overused, over-the-counter drugs that concern experts include nonsteroidal anti-inflammatories (NSAIDS) such as naproxen (Aleve) and ibuprofen (Advil and Motrin), says Winston Parris, division chief for pain management at Duke University Medical Center.

"You can have GI (gastrointestinal) problems, especially if you have a history of ulcers and bleeding," Parris says.

Overdosing on NSAIDs also can damage kidneys, says transplant pharmacist Lisa McDevitt, a clinical specialist in organ transplantation at Tufts Medical Center.

"We've seen patients come for kidney transplants who ended up with renal failure because of daily around-the-clock use of naproxen," she says.

Overdoing it on Benadryl, used for allergies, is not uncommon, either, says Sarah Anderson, an assistant professor of clinical pharmacy at the University of Colorado School of Pharmacy.

Though it won't cause organ failure, Anderson says, "the big danger is its sedating side effects."

"People play loose and free with Benadryl," says Ausim Azizi, chair of the department of neurology at Temple University School of Medicine. "There are a lot of side effects. One is loss of memory in the immediate period after taking it, and disorientation in older people," he says.

Anderson says over-the-counter herbals stocked in drugstores are of concern, too, especially what she calls the "G" herbals. Ginkgo biloba and garlic supplements can put a person at risk for increased bleeding, she says, and many people don't realize the herbal drug St. John's wart can decrease the effectiveness of oral contraceptives.

"Herbals are troublesome - there's no quality control," says Strom. "If we're lucky, they're placebos."

If you have a medical condition or you're on other drugs, Anderson says, you need to be vigilant. "Read labels and check things out with your physician and pharmacist," she says.

"All drugs do harm," says Strom. "We've decided for some, though, the toxicity is worth it."

(c) 2011, USA Today.
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