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Tag: Over-the-counter medications

  • More than one in three older adults could be taking inappropriate drugs

    More than one in three older adults could be taking inappropriate drugs

    Should you be taking all the medications you are taking? With medicine, sometimes less is more.  Judith Garber writes for the Lown Institute on a new study in the Journal of the American Geriatrics Society, which finds that more than one in three older adults could be taking inappropriate drugs.

    At least once a year, you should take a bag with all your medicines, prescriptions, over-the-counter medications and supplements, to your doctor’s office to confirm that you should be taking them all. Or, in this time of Covid-19, take photos of all the bottles and share them with your doctor in a telehealth checkup.  Medicare covers telehealth. You might find that your doctor says you no longer need one or more of them or that there are some potentially harmful interactions from taking all of them.

    The data show that older adults often are taking a lot of medications that jeopardize their health. Most older adults take five or more medicines, including supplements and over-the-counter medicines. This increases the likelihood that they will end up in the emergency room or hospitalized.

    Researchers looked at the drug intake of 218 million older adults over a four-year period and found that more than one in three were prescribed a potentially inappropriate drug. There are a large number of possibly inappropriate drugs for older adults, including benzodiazepines, sedative hypnotics, skeletal muscle relaxants, and first generation (sedative) antihistamines.

    The researchers further found that certain types of people were at greater risk of taking potentially inappropriate drugs, including women, people with lower incomes, people with chronic conditions and people with poor mental health.

    Doctors should consider deprescribing certain medicines that can be particularly harmful to older adults. They include anti-cholinergic drugs, benzodiazepines, and proton pump inhibitors. If you are taking any of these medicines, talk to your doctor about whether you should continue to take them.

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  • PPIs found to increase risk of kidney failure

    PPIs found to increase risk of kidney failure

    Routine use of proton pump inhibitors, common over-the-counter medications used to treat acid reflux, can increase the risk of kidney failure four-fold.

    Researchers examined health data on more than 190,000 patients over a 15-year period in a retrospective study. None of the patients had existing kidney disease at the start. Researchers compared patients who were eventually given a PPI and those who weren’t ever given one. Common PPIs include Prevacid (lansoprazole), Prilosec (omeprazole) and Nexium (esomeprazole).

    Results, published in Pharmacotherapy, found that those on a PPI had a 20% increased risk of chronic kidney disease compared with those not on the drug. In addition, those on a PPI were four times as likely to experience kidney failure. The study authors noted that the risks were highest in those 65 and older.

    Although PPIs are only meant for short-term use, overuse of the medications are as high as 70% of patients.

    Lead author David Jacobs, PharmD, PhD, assistant professor of pharmacy practice at the University of Buffalo School of Pharmacy and Pharmaceutical Sciences, noted that doctors need to be educated on the dangers of overuse of PPIs and deprescribing initiatives developed.

    Last month, a study that analyzed adverse events reports sent to the FDA found that PPIs were associated with an increased risk of kidney disease.

    This story first appeared on Medshadow.org.

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  • Six things to know about your over-the-counter medications

    Six things to know about your over-the-counter medications

    Over-the-counter medications are drugs you can buy without a prescription to treat common problems. However, you should still use them with caution. A number of recent studies have revealed worrisome side effects from incorrect use of OTC medicines. Here are six things you should know about over-the-counter medications (OTC) to keep you and your loved ones safe.

    To minimize the risk of harmful drug interactions, always keep a list of all the drugs you are taking in your wallet (both prescription drugs and OTC drugs) and share the list with your doctors and the people you most trust. If you are getting headaches, diarrhea, constipation, or have a dry mouth, it might be a minor side effect of the drugs you’re taking; some side effects can be life-threatening, including severe bleeding or liver or kidney damage.

    1. Just because medicines are OTC does not make them risk-free. Do not assume that because you do not need a prescription for OTC medications that they are always safe to use. Depending upon the other medications you are already taking and your health condition, OTC drugs may be dangerous and can be toxic if overused. While it is generally okay to take the correct dose of an OTC drug for a specific problem (for example, taking ibuprofen to help relieve a headache), all medications carry different risks and benefits. If you have a complex health condition or simply have concerns about an OTC medication, check with your doctor before taking it. People with very bad symptoms, who do not know what is wrong with them, or with long-term medical problems also should check with their doctor before taking an OTC medication.
    2. Our knowledge about the risks and benefits of different OTC drugs is continuously changing. As with other areas of medicine, researchers are constantly learning new things about OTC drugs that change the way they should be used. For example, after receiving numerous reports of severe liver damage associated with the use of acetaminophen (the active ingredient in Tylenol), in 2011 the FDA changed the maximum amount of acetaminophen that could be contained in single OTC dosage to 325 mg. And the risks may differ depending upon your age, weight and medical condition.
    3. OTC drugs may interact with other medications you are taking. Just as two or more prescription medications can interact with one another, creating adverse or unintended side effects, OTC drugs can also change the way a prescribed medication works in your body. If you are taking prescription medications, including opioids, check with your doctor before combining them with an OTC medicine.
    4. OTC drugs may interact with diet or lifestyle factors. OTC medications can be harmful if they interact with alcohol in your system or certain foods in your diet. They can also affect other health conditions. Check with your doctor if you have specific medical or lifestyle considerations that may need to be taken into account when starting an OTC medication. As a general rule, you should not consume alcohol when taking any type of medication, unless your doctor gives you permission to do so.
    5. OTC drugs may affect older people differently. While everyone should be careful when taking medications, older people need to take extra caution. The body changes how it absorbs food and drugs as it ages; and, older people generally take more medications than younger people, putting them at higher risk for adverse interactions.
    6. Your doctor may decide to provide you with different treatments based on the OTC medications you take. Always report your OTC medications to your doctor, whether at check-ups or during hospital visits. Always let healthcare providers know about any medications you are currently taking, including OTC medicines.

    Many people take vitamin and herbal supplements to feel better. As a general rule, eating a healthy diet of foods with different vitamins is the best way to make sure you have the vitamins you need. Like over-the-counter drugs, vitamin supplements are not risk-free. Watch John Oliver explain the issues with vitamin supplements. You can learn more from about vitamin supplements on this site from Dr. Salomeh Keyhani, including vitamin C supplements, vitamin E supplements, vitamin B6 supplements, and vitamin B12 supplements.

    Dr. Keyhani’s evidence comes largely from Cochrane.org, which is an independent group that analyzes a range of studies and summarizes the best evidence from research. Also keep in mind that vitamin supplements you buy at the drugstore or other retail stores are not regulated by the Food and Drug Administration, and so they may not be what they appear to be, as the New York Attorney General’s office found. 

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  • Pharma profits from patenting OTC drugs

    Pharma profits from patenting OTC drugs

    Given that taxpayers contribute significantly to both the development of drugs and drug spending, you would think that there would be some federal controls on drug prices. Instead, the US allows drug companies to profit at taxpayer expense in a wide variety of ways, many of which we have described on Just Care. (You can read about Pharma coupons here, Pharma evergreening here, Pharma pay for delay here, Pharma tax breaks here.) Did you know that the US also allows pharmaceutical companies to profit handsomely from patenting OTC (over-the-counter) drugs?

    The FDA has approved brand-name prescription drugs that are simply a combination of over-the-counter medications. Put differently, pharmaceutical companies can combine two over-the-counter medications that can be purchased at little cost at the drug store into one patented brand-name prescription that can cost thousands of dollars. And, because doctors can prescribe virtually any drug they please and insurers often have incentives to pay for most drugs prescribed, pharmaceutical companies need only market these drugs to doctors and patients to reap large rewards.

    Here are just a few examples of drugs doctors should rarely if ever be prescribing. The vast majority of us should be buying their key ingredients over the counter if we need them:

    • Vimovo: A patented drug from Astra Zeneca, which was purchased by Horizon Pharma, that can cost over $3,000 a prescription, even though you can buy naproxen (Aleve) and esomeprazole magnesium (Nexium), its two key ingredients, over the counter for about $40. Marshall Allen reports in The Atlantic that Vimovo’s net sales have exceeded $455 million since 2014.
    • Duexis: A patented drug from Horizon Pharma for arthritis and ulcers that can cost $1,435 a prescription, even though you can buy its two key ingredients, ibuprofen (Advil) and famotidine (Pepsid), over the counter at little cost. Horizon Pharma offers an online coupon, which buys down people’s cost for the drug to as little as $0, to encourage people to use it rather than the low-cost OTC drug alternatives. Allan further reports that Duexis’ net sales have exceeded $465 million.
    • Treximet: A patented drug from GlaxoSmithKline for migraines that can cost $822 a prescription, even though you can buy its two key ingredients sumatriptan and naproxen over the counter at little cost. Glaxo offers an online coupon to encourage people to buy it rather than the low-cost OTC drug alternatives.
    • Zegerid: A patented drug from Santarus for acid reflux that can cost $2,950 a prescription, even though you can buy its two key ingredients omeprazole and sodium bicarbonate over the counter at little cost. The drug company offers an online coupon to encourage people to buy it rather than the low-cost OTC drug alternatives.

    Of course, Pharmacy Benefit Managers (PBMs) and health insurers that want to add value for consumers could refuse to cover these drugs. But, so long as they are getting big rebates from drug makers for making them available to their members, they have a powerful financial incentive to include them on their formularies. In short, so long, as Congress allows PBMs and insurers to collect these rebates, PBMs and insurers likely will make them available, driving up drug spending and adding negative value to our health care system.

    If you want Congress to rein in drug prices, please sign this petition.

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  • Are your drugs delivering good value?

    Are your drugs delivering good value?

    Two out of three adults, 131 million people in the United States, take prescription drugs. Almost half of all Americans have used at least one prescription drug in the last 30 days. But, many drugs we take may be unnecessary or simply not as good as other drugs. Are your drugs delivering good value?

    If you’re an older adult or caring for a loved one, it’s especially important to take a fresh look at the drugs you’re taking on a regular basis. Adults over 65 represent almost 14 percent of the population but use 40 percent of all prescription drugs and 35 percent of all over-the-counter drugs. People between 65 and 69 use an average of 14 drugs a year. People between 80 and 84 use and average of 18 drugs annually. But, as much as 25 percent of drug use by older adults is thought to be unnecessary or inappropriate.

    Consumer Reports offers free advice on “Best Buy” drugs for 23 conditions. It also shares its expertise on ways to help treat your condition apart from taking drugs. Talk to your doctor. You may save money by switching drugs. And you may be better off going off a drug altogether.

    For example, for constipation, Consumer Reports recommends polyethylene glycol as most effective. You can find it in MiraLax. It’s an inexpensive drug that Consumer Reports says is “still the best constipation treatment.” Consumer Reports also recommends eating high fiber foods, such as fruits and vegetables, nuts and whole grains. And fiber supplements, particularly those containing psyllium, may also help.

    For migraine headaches, Consumer Reports recommends triptans. However, Consumer Reports says that some people, including people with coronary artery disease, peripheral artery disease and angina should not take them because they narrow your blood vessels. So, talk to your doctor before taking them. Sumatriptan is a triptan that is available as a generic drug, so likely less expensive than other options.

    Visit Consumer Reports Best Buy Drugs to see which drugs and other treatments Consumer Reports recommends for asthma, allergies, high cholesterol, osteoporosis, rheumatoid arthritis and more.

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