OTC analgesics and drug interactions: clinical implications

A Mark Fendrick,Grace E Johnson,Deborah E Pan

doi:10.1186/1750-4732-2-2

A Mark Fendrick, Grace E Johnson + Show 1 more

Open Access

https://doi.org/10.1186/1750-4732-2-2

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Abstract

The risk of drug interactions with concurrent use of multiple medications is a clinically relevant issue. Many patients are unaware that over-the-counter (OTC) analgesics can cause potentially serious adverse effects when used in combination with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents. Of particular significance is the increased risk of upper abdominal gastrointestinal adverse events in patients who take traditional nonsteroidal anti-inflammatory drugs (NSAIDs). This risk is dose dependent and further increased in patients who take more than one NSAID or use NSAIDs in combination with certain other medications. Some NSAIDs may also mitigate the antiplatelet benefits of aspirin and may increase blood pressure in patients with hypertension. Clinicians should be aware of potential drug interactions with OTC analgesics when prescribing new medications. Additionally, patients should be properly counseled on the appropriate and safe use of OTC analgesics.

Highlights

A survey of medication use patterns in the United States has found that more than 80% of American adults used at least one over-the-counter (OTC) or prescription drug each week, and that 25% used at least 5 [1]
Many patients are unaware of the potential for toxicity and adverse drug interactions associated with the long-term and inappropriate use of OTC analgesics
OTC analgesics are associated with adverse effects in only a small percentage of people, the widespread use of these drugs makes even a small increase in population risk a clinically relevant issue [4]

Summary

Introduction

A survey of medication use patterns in the United States has found that more than 80% of American adults used at least one over-the-counter (OTC) or prescription drug each week, and that 25% used at least 5 [1]. There is wide reporting in the literature of a dramatic increase in the risk of adverse GI effects, including ulceration and hemorrhage, with concomitant current use of corticosteroids and NSAIDs (OR range, 2.2 – 14.6, in various studies) [11,13,22]. Recent studies have shown that traditional NSAIDs may interfere with the antiplatelet effects of aspirin by providing competition for the platelet COX-1 binding site [26-28]. This may limit the utility of aspirin as a cardioprotective agent in patients who require certain NSAIDs to manage pain effectively. All patients should be educated on potential drug interactions that may occur with OTC analgesics and prescription medications

Fendrick AM

Findings

31. Beilin LJ