Avoiding an overdose

Imagine developing a headache, possibly after a night with friends over a few drinks. You walk into a gas station or supermarket and purchase a popular non-aspirin painkiller. You take the amount recommended by the clerk or what it says on the box. The headache does not go as fast as you want, so you continue to take more of the pills, after all the box says four times a day. Sadly, we get the news that you have passed away from of all things liver failure after taking too many tablets of paracetamol, a widely used over the counter medicine.

This was not an intentional overdose – indeed, you did not at any stage take one large dose of the drug. Instead you suffered a ‘staggered overdose’ by taking as your mother stated ‘a few extra tablets’ over the course of a few days to alleviate the splitting headache.

This is a stark reminder of the danger of ignoring the warnings on easily available medicines. Just a few extra tablets were the difference between your life and death. Although a cheap and intrinsically safe analgesic when taken within the recommended daily dose, paracetamol can be highly hepatotoxic after overdose causing liver damage, failure and ultimately death. Aspirin can also be highly toxic when taken inappropriately; leading to potentially fatal stomach bleeds.

In 1998 legislation was introduced in Britain to reduce the pack size of analgesics such as Paracetamol and Aspirin sold over the counter. Persons could now only buy packs of up to 32 tablets in pharmacies and 16 in retail outlets. Within the first year this had a dramatic effect in reducing mortality of Paracetamol overdoses by 20 per cent. Liver unit admissions and transplants were reduced by 30 per cent and non-fatal overdoses by 29 per cent in the four years following the legislation. The effect on reducing large overdoses with aspirin was also significant with a reduction of 34 per cent.

This shows an obvious link between the restriction and regulation of potentially lethal substances and the safe usage of these same substances. Although this data is from the UK, the substances are available here as well, and people are people. How many persons take cold and flu medicines and still use paracetamol at the same time? Everyone likes the convenience of nipping to the automart or supermarket to pick up cold remedies and painkillers. But does that familiarity breed contempt? If a medication is only available either from the pharmacy or under the supervision of the pharmacist, then even if the purchaser

does not read the label properly they understand that there is a potential hazard lurking within the blister pack or bottle.

This issue is not only a problem with these type of medications but there is also an issue with vitamins and some herbs when taken with certain prescription medicines and even some conditions. Thus it is becoming more apparent that specialised help or advice should be available, where and when most over the counter products are carried. While more is being done to promote awareness regarding the importance of the safety and appropriate use of OTC drugs, the pharmacist is still the patient’s best resource in the proper selection of OTC products.

Moreover, while it is important for all patients to properly use OTC products, individuals of advanced age, individuals with pre-existing medical conditions such as diabetes, parents of children, and those currently using prescription drugs should always consult their pharmacist when considering the use of OTC drugs to avoid possible contraindications, drug-drug interactions, food-drug interactions, drug-alcohol interactions, and/or dosing errors.

In assisting patients in the selection of OTC products, pharmacists will assess the patient’s symptoms/condition to determine if self-treatment is appropriate or if medical treatment is warranted, ( in fact local pharmacists presently attend monthly sessions known as “First Contact “, which prepare local pharmacists for possible interventions) as well as evaluating for potential allergies.

When patients are taking multiple OTC products, pharmacists encourage their patients to always check the active ingredients of these products and ensure that a particular ingredient is not in another product they are taking to avoid possible over-dosages, and to use only products that treat their specific symptoms and therefore avoid the unnecessary use of multiple products. As the profession of pharmacy continues to progress, the role of the pharmacist will expand as well. In the midst of these advances, pharmacists will always be considered the drug experts and the fundamental source of drug information for all patients who use these products.

While it is virtually impossible for pharmacists to counsel every patient who uses an OTC product, pharmacists are accessible to patients. When a patient does seek advice regarding these products, the Barbadian pharmacist will also should seize the opportunity to educate the patient about the importance of using these products appropriately. By conducting a thorough evaluation of the patients’ needs, pharmacists can assist patients in making informed decisions regarding OTC selections to optimize therapy and ensure the safe use of these products. When used correctly, OTC products are very effective in treating a variety of common ailments. Recommendations from pharmacists enable patients to make educated choices regarding the use of OTC products.

As stated earlier people are people and it is the opinion of this writer that health legislation should be put in place to protect our consumers. It cannot be left to an unassuming public, to struggle with the warnings and precautions printed in fine scale. Certain products should be pharmacy only, even if we do what the UK did and allow only certain sizes to be allowed in non-pharmacy establishments. I am hearing already the massive outpour of protests from supermarket owners, etc., but the health of our nation cannot be ignored because of tradition and financial might.

The pharmacist is perfectly placed to offer unbiased professional guidance. International studies report that 73 per cent of patients prefer to self-medicate with OTC products, and the majority of patients consider OTC drugs to be safe and effective.

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