How Safe are Over-The-Counter Medicines for Older Adults?

Over-The-Counter medicines, also known as OTC's!



Up to 46% of older adults take an OTC medicine with their prescription medicines.

If you are an older adult, think twice about using an OTC medication. Consider the safety of these medications including the risks and their benefits. The way our bodies process medicine changes as we age, this includes the way a medicine is absorbed, how it travels to where it needs to be processed, how it is processed through the body and how it is cleared from the body.

In this post I want to discuss OTC medicines, safety, and how they may interact with commonly taken medicines by older adults.

Nonsteroidal anti-inflammatory medicines also called NSAIDs


NSAIDs can increase the risk of bleeding, ulcers, increase blood pressure, risk of stroke, cause kidney damage, worsen heart failure symptoms and interact with blood thinners. Some common NSAIDs include, Motrin/Advil (ibuprofen), Aleve (naproxen), Celebrex (celecoxib), Cataflam (diclofenac), etc. Although NSAIDs are great at relieving pain, especially for arthritis pain, they should only be taken if a health care provider has advised their use.


NSAIDs can decrease the effectiveness of most blood pressure medications causing potentially high blood pressures. NSAIDs can cause kidney damage when used with some blood pressure medications like lisinopril or other medicines in its class, the diabetic medicine metformin and a medicine called methotrexate which is used for multiple conditions, in older adults it is generally used for rheumatoid arthritis. When NSAIDs are taken with aspirin they can decrease the effectiveness of aspirin increasing the risk for a heart attack.


Aspirin is also considered to be an NSAID. Aspirin is a great medication to use only when a health care provider recommends it. It is generally used to prevent and treat diseases of the heart or stroke. Aspirin can increase the risk of bleeding, cause headaches, and dizziness. The general recommendation is not to use aspirin if a person is over the age of 70, and if they don't have a history of heart disease or stroke.

Allergy and sleep medicines also called antihistamines


Some of the medications used for sleep, and allergies can cause confusion, drowsiness, dizziness, dry eyes, decreased appetite, increased sweating, sensitivity to changes in motion. Some of the more common medications in this class include Benadryl (diphenhydramine), Dimetapp (bromepheniramine), Chlor-Trimeton (chlorpheniramine). Geriatricians consider these medications to be some of the most dangerous for older adults. There is also some evidence that prolonged usage can increase the risk of dementia.


Cough medicines


Older adults can experience confusion, dizziness, drowsiness, feeling tired, nausea, stomach pain when taking cough medicines. Some common OTC cough medicines include Robitussin (dextromethorphan), Mucinex (guaifenesin) , Mucinex DM (dextromethorphan/guaifenesin).


Cough medicines interact with many medicines, including medicines taken for seizures, anxiety, depression, pain medicines. It is important to discuss the use of cough medicines with your health care provider to ensure you are not taking a combination that can harm you.


Although rare, there can be a very dangerous interaction between Robitussin and Trazodone. This combination can increase the risk for a condition called serotonin syndrome causing symptoms of confusion, seizure, hallucinations, changes in blood pressure, sweating, blurred vision, stomach cramps, nausea, stiffness and can be life threatening.


Medicines used for stuffy nose


Medicines used for a stuffy nose are called decongestants. They can cause a person to feel restless, feel their heart beating fast, difficulty sleeping, and increase blood pressure. Common decongestants include Sudafed (pseudoephedrine and phenylephrine ), Afrin (oxymetazoline). The best solution to a stuffy nose is regular spray saline.


When decongestants are taken with medicines like Klonopin (clonazepam), Xanax (alprazolam), Ultram (tramadol), Zoloft (sertraline), Neurontin (gabapentin), Desyrel (trazodone) or Zyrtec (cetirizine) they can cause increased dizziness, confusion and difficulty concentrating. Diphenhydramine can interact with the blood pressure medicine lisinopril causing lower blood pressures. Sudafed can decrease the effectiveness of the diabetic medicine, Metformin. The combination of these medicines can be very dangerous for older adults because it significantly increases their risk of falling.


Heart burn medicines


Let me start by saying, when used appropriately these medicines are great, but they should only be used under the direction of a health care professional. For some conditions these medications need to be used for a long time. Usually they are indicated to use for a shorter period of time. If using these medications just for the purpose of heartburn, there are some non-medicine and dietary approaches that can help with symptoms of heart burn. These medicines can interfere with how other medicines that are processed in the body.


Medications like Tagamet (cimetidine), Pepcid (famotidine), Zantac (ranitidine) are called H2 blockers. Main side effects of H2 blockers include constipation, dizziness, stomach pain, dry mouth, and confusion. These medicines can decrease the bodies ability to take up vitamin B12, Vitamin D, folate and some other nutrients that are very important. Tagamet can interact with Coumadin (Warfarin) increasing the risk of bleeding.


Medicines like Prilosec (omeprazole), Nexium (esomeprazole), Prevacid (lansoprazole), Protonix (pantoprazole) are called proton pump inhibitors (PPIs). These medicines can cause stomach pain, diarrhea, nausea, and a bacterial infection called clostridium difficile colitis (C-diff). Prolonged use can cause osteoporosis. There is some evidence suggesting that long term use of PPIs can increase the risk of dementia. These medicines can interact with other medicines such as the blood thinner Plavix (clopidogrel) making the blood thinner less effective. PPIs can increase the levels of medicines like Coumadin (warfarin) a blood thinner, Diazepam (valium) used for anxiety and as a muscle relaxer, Celexa (citalopram) used for depression, and Dilantin (phenytoin) used for seizures.


Summary


OTC medicines can be helpful for certain problems, however their safety needs to be considered. See the chart below for a brief summary of common OTC medicines and their side effects.


Common Over-The-Counter Medicines and Side Effects

I hope you enjoyed this blog post on over the counter medications and safety. Our goal at Golden Oak Medicine is to educate our patients and the public on aging related topics. We are board certified Geriatricians providing primary care services for adults 55 years and older in Asheville, NC.



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