Over-the-counter convenience comes with risk

Making a doctor’s appointment simply to obtain a prescription can seem like an unnecessary hassle to an ill patient seeking a specific medication. But physician supervision of drug use increases the likelihood that medications are taken only when truly needed and decreases the chance of serious complications.

Since 1995, however, the Food and Drug Administration has approved more than 70 drugs, or new uses of available drugs, for over-the-counter sale. More are likely to become available.

There’s an argument to be made for making medications available over-the-counter. More people who need them will have access to them, including those without medical insurance and those who don’t have the time to see a doctor. It also allows patients more control over their care and may save them money.

But many physicians argue that consumers are unable to safely self-prescribe medications, and there’s evidence to suggest that they’re right. In a recent survey conducted for the nonprofit National Council on Patient Information and Education, almost half of the respondents reported taking more than the recommended dose of a nonprescription medicine.

Many people also ignored important safety information on the label when buying nonprescription products. A paltry 20% said they actually read labels for dosage instructions or to identify possible side effects; only 40% checked to identify the product’s active ingredient. One in 12 consumers said they don’t read anything on the label at all.

The types of drugs being proposed for over-the-counter use is also worrisome. Until quite recently, most drugs approved for over-the-counter use were for treatment of acute, short-lived conditions with easily recognizable symptoms, such as coughs, colds and headaches. Now nonprescription status has been given to drugs that might be needed long term -- for conditions that are more difficult to accurately diagnose and more complicated to treat. These drugs include omeprazole (Prilosec) for acid reflux disease and loratadine (Claritin) for allergies.

Many drug industry experts see the treatment of chronic conditions such as high cholesterol and hypertension as the next big frontier in the use of over-the-counter medications. This year Merck’s cholesterol-lowering drug Zocor was approved for over-the-counter sale in Britain. Zocor is the first drug of its kind, a statin, to be sold without a prescription anywhere in the world.

Though self-treatment is never completely straightforward, it becomes far more complicated when chronic, potentially life-threatening conditions are being treated. The diagnosis of high cholesterol, for example, requires blood tests that, ideally, are rechecked at regular intervals to determine whether adjustments in treatment need to be made.

Undoubtedly, some people will use over-the-counter products when they don’t need them, exposing themselves to unnecessary risks and leaving untreated the actual cause of their symptoms. Others will substitute over-the-counter drugs for more effective prescription medications simply because it’s easier and less expensive.

But then safety isn’t the driving force behind most drugs’ switch from prescription to over-the-counter status; economics is. Drug manufacturers are looking for a larger market for their products and increased sales; insurance companies are looking for a way to cut expenses.

So while these groups reap the financial benefits, it’s the consumers who assume the responsibility.

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Know the ins and outs of medication

To minimize the chance of dangerous drug interactions when using over-the-counter medications, take these simple precautions:

Make sure that your doctor and pharmacist know about all the medications you are using -- both prescription and over-the-counter.

Carefully read the entire label of every medication you use.

Take all medications exactly as directed. Consuming more than the recommended dose increases your risk of complications and may not increase the effectiveness of the drug. On the other hand, consuming less than the recommended dose decreases the effectiveness of the drug, usually without significantly decreasing the risks.

If you are taking any medication for a prolonged period of time -- even an over-the-counter product -- meet with your physician at regular intervals to determine whether the drug is having its desired effect, the dose needs to be changed or you even need to continue taking the medication.

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Dr. Valerie Ulene is a board-certified specialist in preventive medicine practicing in Los Angeles. She can be reached at [email protected]. The M.D. appears the first Monday of the month.