The people's pharmacy: Americans have a bizarre relationship with drugs

Web posted January 20, 1998

By Joe and Teresa Graedon
Special Columnist

We Americans have a bizarre relationship with drugs. We believe prescription medications are so powerful that they require years of medical education and postgraduate training to prepare a doctor to use them wisely.

With the stroke of a pen, however, the Food and Drug Adminis-tration can convert a potent prescription drug into an over-the-counter remedy, perceived by most people as simple and safe. Any teen-ager can purchase such a medication from a convenience store grocery or pharmacy with no instruction or education on its proper use.

Over the past two decades there has been a stampede to switch drugs from prescription to over-the-counter status. More than 600 nonprescription products contain ingredients that would have required a doctor's script 20 years ago. Medications such as Actifed, Advil, Aleve, Benadryl, Micatin, Pepcid AC, Tagamet HB and Zantac 75 are now household names.

There is no difference between prescription products and such OTC counterparts except sometimes a dosage reduction. But reducing the dose does not eliminate the risk.

When a doctor prescribes an arthritis drug like ibuprofen, he can find more than two pages of fine print in the Physicians' Desk Reference. It lists contraindications, precautions, warnings, adverse reactions and drug interactions.

In contrast, the box of ibuprofen you can buy at the gas station has very limited information on side effects, and the print is often too small to read comfortably. You won't learn about ringing in the ears, blurred vision, dizziness, depression, rash or nausea.

The warning about digestive complications makes it sounds as if mild heartburn or stomach pain can be alleviated by taking the medicine with food. What many people do not realize, though, is that taking a drug such as ibuprofen, whether prescribed or self-administered, can drastically increase a person's risk of ulcers or gastrointestinal bleeding.

There is not enough room on the box or bottle to provide all the information that is necessary to use over-the-counter products safely. Even the warnings that are provided may be overlooked by complacent consumers.

Cold and allergy remedies can often cause drowsiness or impaired concentration, making driving hazardous. Advertising, however, encourages people to take these medicines to get to work and resume normal activities. Never mind that operating heavy machinery may be a mistake.

Millions of people with blood pressure problems, prostate conditions, diabetes or thyroid disease may not realize how serious the complications of some nonprescription medicines could be. Many over-the-counter pain relievers can counteract the effectiveness of blood pressure pills or make the blood thinner Coumadin far more dangerous.

It is shortsighted for people to assume they can safely use medications without instructions. When you plan to use an over-the-counter remedy, make sure you gather all the information you need to take it wisely.

Q:My mother bought Sudafed for my dad's cold symptoms. Neither of them bothered to read the label warning about prostate problems. What would have happened if I hadn't stopped him from taking these pills?

A:Your father might have suffered from urinary retention, making it difficult or impossible for him to empty his bladder. This can be a medical emergency.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them at Graedon's People's Pharmacy, P.O. Box 52027, Durham, NC 27717-2027, or e-mail them (PHARMACY@mindspring.com).