The Hazards of OTC Analgesics

[Kayenneh]

This is my topic for an oral presentation in my English class. It's a topic close to my heart, since every day at work I have at least one customer who wants to buy more OTC painkillers than are allowed. The most common phrase the frustrated ones spit in my face is: "Well, what's the harm?" Do you know, do you read through the package leaflet and are acquainted with the most common side-effects and what's the therapeutic dose? This will be a bit tl;dr, but I thought, if my classmates can benefit from this presentation, so could you.

Let's start with paracetamol (also known as acetaminophen). I won't go into the particulars of how it works or is metabolized, what you need to know is that the liver breaks it down. It hasn't got a wide therapeutic width (the gap from a dose that isn't effective to a toxic dose), so ODing on this particular substance is not hard to do. Many researches show that about 40% of all the ODs that end up in the ER is caused by paracetamol. And remember, this is the only painkiller that is recommended to children and pregnant women. (Actually, I read a disturbing article on how paracetamol can induce infertility in the unborn child, but I haven't found other sources that comfirms it yet.) Paracetamol is especially dangerous when drinking, the lethal dose is around 9 g, if you are a heavy drinker.

Now to move on to NSAIDs, e.g. ibuprofen. NSAID (non-steroidal anti-inflammatory drugs) are COX-enzyme inhibitors. The COX-enzyme is a vital part of the body's own process of making prostaglandins, that have a variety of functions in the body. Prostaglandins basically transmit the pain you feel when having inflamed tissue or a fever, thus NSAID is effective against pain and fever. Now, many know that prostaglandins have affect the stomach by acting in the parietal cells in the stomach wall to inhibit acid secretion. Stop this process and the likelihood of getting an ulcer increases. What people don't know is that NSAIDs can have an adverse effect on your whole cardiovascular system, leaving you vulnerable to heart failure and stroke.

When I tell my customers that I don't sell them more than 30x500mg of paracetamol and/or 30x400mg of ibuprofen (the amount pharmacies in Finland are allow to sell at one transaction by regulation) to ensure that abuse doesn't happen, they usually go monkey shit on my ass. To them abuse of drug is to get high, but abuse is when you use any substance in a way that it was not meant to be used. All (chronic) pain should be examined by a M.D., if ibuprofen or paracetamol is indeed the way to go, you'll get a prescription and get the drugs subsidized by the government.

You don't have to feel alarmed after this, even though OTC painkillers can be tremendously dangerous, when used in the right dosages, they are an effective way of taking care of pains and fever. If you work through a package of painkillers like candy, you are doing a disservice to yourself. So please, use medication with care and thought.

[Jackalope]

(This is based on information from my physician. It is not medical advice.)

In addition to what you say above, it is not necessary to take a large single dose of paracetamol / acetaminophen / Tylenol to cause serious or fatal liver damage. The metabolic half life of paracetamol is in the neighborhood of 4 hours, and while I'm not going to do the math, it's not hard to see the risk in taking more then the recommended maximum daily dose of OTC acetaminophen (4000mg in the U.S.) on a daily basis.

As a chronic pain sufferer, it sucks - the risks and effectiveness of OTC analgesics make them unattractive, and the problems associated with narcotics are obvious. For me, the level of relief that the recommended dosage of OTC stuff provides isn't worth the risks of long-term use, and my physician is extremely stingy with oxycodone (more out of fear of prosecution for over-prescription than for medical reasons). As a result, I medicate the worst pain and do my best to tolerate it otherwise. Oh yeah, and weed - for times when impairment isn't an issue.

Oh yeah, and here's a big "fuck you" to the folks that are in opposition to medicinal marijuana. I don't even particularly like getting high anymore - but that shit works for pain.

When I tell my customers that I don't sell them more than 30x500mg of paracetamol and/or 30x400mg of ibuprofen (the amount pharmacies in Finland are allow to sell at one transaction by regulation) to ensure that abuse doesn't happen

Interesting... acetaminophen is routinely sold in the U.S. in 100x500mg packages, and it's common to see packaging of 300x500mg. OTC NSAIDs (ibuprofen, naproxen sodium) are sold in similar packaging as well.

[Kayenneh]

Oh yeah, and here's a big "fuck you" to the folks that are in opposition to medicinal marijuana. I don't even particularly like getting high anymore - but that shit works for pain.

All substances that alleviate pain and doesn't have too many/bad side effects should be legalized!

Interesting... acetaminophen is routinely sold in the U.S. in 100x500mg packages, and it's common to see packaging of 300x500mg. OTC NSAIDs (ibuprofen, naproxen sodium) are sold in similar packaging as well.

Really?! Fimea (Finnish Medicines Agency) would never allow it. When ibuprofen was finally released as a OTC medicine, 10 was the maximum one could get at once. Obviously they relaxed the regulations just a bit. Here naproxen is a prescription drug only.

[Jackalope]

Here naproxen is a prescription drug only.

It's available by prescription in larger dosages here. The OTC stuff is 220mg BID, I have had RX for 500mg BID. OTC ibuprofen is similar, 200mg OTC, up to 800mg by RX.

It would be interesting to see a comparison of overdose rates in the US vs. Finland (or other countries where it is more heavily regulated). I'm sure that abuse and overdose occurs here, but it's not something that would make the news, so it's not something you hear about.

[Angrboda]

http://www.rocklin.k12.ca.us/staff/avrud...l_dose.pdf

[KichigaiNeko]

Yep ..... knew that.


Analgesics are not first line of defence here in this household. Pain longer than 24 hours? Go see the doctor cos it just might be serious.

[Kayenneh]

Yeah, it's just the attitude of nonchalance I get from so many customers that bug me, especially since they're considering a law to let some OTC drugs be sold in common markets and grocery stores. I cannot imagine what would happen, if the flow of information is already this bad.

As for what Apophenia posted, don't even get me started on ASA..

[KichigaiNeko]

Will check out apophenia's link a bit later but

I have always known of the damage that analgesics can do. Currently have NSAIDS pushed on me to help with a Sinus/ Arthritic/ Asthmatic condition also makes me very wary of their use and abuse.

Here you can get Ibuprofen and Paracetamol from your local grocery chain (Woolworths/ Coles/ Aldi and IGA) mind you I prefer consulting pharmacists for their use.

[Kayenneh]

This whole topic is indeed a double-edged sword, I like that analgesics are readily available for when you need them, but the folly or ignorance of the common man astounds me. What I would like is actually for people to take this more seriously and be educated in the matter, but as long as things are this way, the only solution I see is that as many professional people as possible should be assisting when buying painkillers. If someone still ODs on paracetamol but has heard it from the doctor, a nurse and a pharmacist that you should only eat 3 g/day (4 g in Australia, right?), then the authorities have at least tried to prevent it. I'm scared that many will fall out of the loop if we let drugs be sold in grocery stores. Now, it is impossible to predict and control people's behavior and there's no cure for pure stupidity, but I don't want the bad statistics to go up just because I didn't take my job seriously or tried hard enough, you know?

[KichigaiNeko]

This whole topic is indeed a double-edged sword, I like that analgesics are readily available for when you need them, but the folly or ignorance of the common man astounds me.

Yep. Ignorance is the main factor. Alot like religion and science illiteracy. The stupidity of "the common man" is astounding since ALL the contra-indications are available on the net.

What I would like is actually for people to take this more seriously and be educated in the matter, but as long as things are this way, the only solution I see is that as many professional people as possible should be assisting when buying painkillers.

You know I had a "Marketing Agent" for a business student who advocated that ibuprofen was "Totally Safe and had no side affects" I tried to argue with her but she was full of the company bullshit.

If someone still ODs on paracetamol but has heard it from the doctor, a nurse and a pharmacist that you should only eat 3 g/day (4 g in Australia, right?), then the authorities have at least tried to prevent it.

This is so but as you say..people are stupid

I'm scared that many will fall out of the loop if we let drugs be sold in grocery stores.

Chill mate. They are sold (at reduced rates here in Australia) in the mainstream grocery stores. Anyone with significant medical issues will go and consult a Pharmacist.

Now, it is impossible to predict and control people's behavior and there's no cure for pure stupidity, but I don't want the bad statistics to go up just because I didn't take my job seriously or tried hard enough, you know?

I understand. I am not in the pharmaceutical industry but I at least know what the fuck the drugs I am taking and what they do and how they are metabolised. All you can do is your best.

IF people want to overdose on OTC, you can only chalk that up to evolution in motion.