Dangerous mix

As we get deeper into the cold and flu season, and with the shortage this year of influenza vaccine, more people may be making a beeline for the nonprescription aisle in their local drugstores.

“People are going to be reaching out for anything they can get” if they come down with a bad cold or nasty case of the flu, said Steven Pray, a pharmacist at the College of Pharmacy at Southwestern Oklahoma State University.

Over-the-counter medications also are taking on extra importance this year for health officials. They are keeping an eye out for a sudden spike in sales in order to pinpoint outbreaks of flu around the country.

We spend a lot on our OTC cold and flu meds – more than $3 billion in 2003, according to the most recent statistics available from the Consumer Healthcare Products Association.

But we consumers don’t always know how to properly use OTC meds.

“This is a clarion call not to just assume over-the-counter medicines are safe because they’re available over the counter,” said Ray Bullman, executive vice president of the National Council on Patient Information and Education.

Improper use of OTC medicines can be dangerous because you can expose yourself to serious overdoses or side effects. Using an OTC drug without enough information can also result in harmful interactions with other medications you may be taking, and can adversely affect health problems such as diabetes or hypertension.

“The most important thing for consumers to do is to read the back of the bottles they buy and be very careful in taking multiple, different products,” said Evelyn Hermes DeSantis, director of drug information for Robert Wood Johnson University Hospital in New Brunswick, N.J.

Virtually all OTC medicines are labeled with the active ingredients that work to relieve symptoms; what type of symptoms the product targets; what medications, foods or circumstances you need to avoid, such as driving, when taking the product; and recommended dosage.

Before you buy anything, consult your pharmacist or physician to be sure the product is the appropriate one for you, DeSantis advised. This is an especially effective way to avoid harmful impacts on chronic conditions or bad interactions with other medications.

For example, DeSantis said, pseudoephedrine is commonly used as a decongestant, but it can increase your blood pressure, which is not good for someone with hypertension. Many cough syrups contain alcohol and sugar, two items that can wreak havoc with the blood-sugar level of a person with diabetes, she said. Other active ingredients can interfere with prescription medications for depression.

Make sure your pharmacist and doctor know about all medications you’re using, as well as dietary or herbal supplements you may be taking.

Understand that OTC products won’t treat the actual virus that caused your cold or flu, DeSantis said. “None of these will cure the common cold or flu. They’re really just trying to make you feel better” by treating symptoms such as fever, aches, stuffiness, sore throat or runny nose, she said.

With that in mind, select products that treat only those symptoms you have, she said.

Be especially careful if you buy a multi-ingredient product designed to simultaneously treat several symptoms. “If it’s a combination product, read the label. If you have every symptom (listed), then it’s OK for you,” said Pray. Otherwise, you’re taking medication you don’t really need.

To avoid that scenario, you could purchase only single-ingredient products and make up your own medicinal “cocktail” to treat your various symptoms, said DeSantis.

Certain active ingredients are commonly used in many OTC products. If you buy several medications, compare the drug labels to make sure you’re not duplicating ingredients.

Follow dosage recommendations to the letter, stressed Pray. “Don’t follow the philosophy that if one dose works, two will be great.” You could be setting yourself up for serious side effects if you overuse a particular ingredient. DeSantis said that acetaminophen, a fever reducer and pain reliever used to ease discomfort from sore throats, headaches and body aches, can lead to liver damage if too much is taken over a prolonged time, say, two or three times the recommended dosage for four or five days.

Many products are designed to treat cold symptoms, while others are geared toward flu symptoms. Still other products claim to treat both flu and cold. What to do? Choose those products that treat only the symptoms you’re feeling, said Fred Eckel, a pharmacist at the University of North Carolina School of Pharmacy and editor of Pharmacy Times. “In reality, there’s really not a lot of symptom differences between the cold and the flu.” Signs that you have the flu instead of a cold are sudden onset of symptoms and a high fever.

You can save money by buying store brand OTC medicines instead of advertised brands, according to Eckel. He and DeSantis said you’re not getting an inferior product with store, or generic, brands because the Food and Drug Administration mandates that they have the same active ingredient in the same amount as advertised brands.

Don’t use OTC medications any longer than the label recommends, said health care experts. Colds typically last about a week and the flu for eight to 10 days, according to Pray. If your symptoms linger, you need to see a doctor to rule out more serious conditions, including pneumonia.