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When physicians prescribe medications to you, we have a duty to provide sufficient information for you to make an informed decision.
For any drug, you need to know (1) what it is intended to do (or what condition it is treating), (2) the common side effects, (3) any potential serious side effects, (4) possible significant interactions with food or other drugs you are taking, and finally, (5) any treatment alternatives.
In recent years, drugs that were once available only by prescription can now be bought without seeing your doctor. As a consequence, many consumers are taking potent medications with potential serious risks without informed consent.
In my last column, I discussed the risks of two common drugs you can purchase without a prescription, ibuprofen and ASA. Today, I’ll share what you should know about the risks of four more categories of non-prescription drugs.
1. Topical Decongestants. Topical refers to medications that are used on the surface, such as on the skin or in the nose, ears or eyes. Decongestant nose sprays such as Otrivin or Dristan are effective at rapidly reducing nasal and sinus congestion, but if overused (more than three times a day or for longer than 5 days), they can cause rebound congestion – and dependence on the drug to reduce that extra congestion.
An alternative for allergic rhinitis are nasal steroids, such as Flonase or Nasacort. Though they don’t cause rebound nasal congestion, these too have their own side effects. They can increase nose bleeds and should not be used by children or alone without antibiotics in the case of bacterial sinus infections.
Decongestant eye drops, such as Visine, are very effective at getting the red out – but only temporarily. Daily use can cause rebound redness and many university students become dependent on them to manage their red eyes.
2. Steroid Creams. Steroids are anti-inflammatory and immune suppressants. In the past, only 0.5% hydrocortisone creams to treat eczema or itchy skin were available without a prescription; however, you can now get the 1% strength over the counter. Steroid creams should never be used on broken or infected skin. They can exacerbate a bacterial infection. If large amounts are used on babies, sufficient steroid could be absorbed and cause systemic effects. Overuse of topical steroid creams can cause skin atrophy, manifested by thinning of the skin and appearance of surface capillaries or dilated blood vessels.
3. Nicotine Replacement. Nicotine replacement in the form of lozenges, gum, patches and inhalers can be helpful aids in quitting smoking. Though they do not contain the toxins associated with smoking cigarettes and vaping, the addictive ingredient – nicotine – can result in dependence and addiction to nicotine replacement.
I’ve seen a number of non-smoking patients who have become addicted to nicotine gum. That’s why these drugs are not sold to children. Nicotine can increase your heart rate and blood pressure and contribute to insomnia.
4. Sedatives. Though non-prescription sleeping pills are not as potent as what a physician may prescribe, they can also reduce driving safety and increase your risk for falls. Because of the sedative effects, you shouldn’t drive, operate heavy machinery, work on the roof or send an email to your boss.
The active ingredients are usually antihistamines or dimenhydrinate. The latter, Gravol is not used in the US, and when we ask for it in American pharmacies and ERs, they think Canadians are crazy to be eating small rocks to treat nausea.
Just because a medication is available without a prescription, don’t assume it’s safe. Be well informed. Read the labels (For those over 40, this may require the reading glasses you can also buy in the pharmacy without a prescription). Speak to the pharmacist for clarification.
Let your physicians know if you are taking any regular non-prescription drugs, including ASA and ibuprofen. They may or may not be appropriate for you and they could interact with what you may be prescribed.
Last week, a patient with allergies reported that his blood pressure was better controlled when he changed from Reactine Complete to Reactine. The former contained the decongestant, pseudoephedrine – a decongestant that stimulates the heart and raises blood pressure.
Dr. Davidicus Wong is a family physician. His Healthwise Column appears regularly in this paper. For more on achieving your positive potential in life, read his blog at davidicuswong.wordpress.com.