Over-the-Counter Medications: Are They Really Safe? (Issue #1)
With that in mind, we are starting a new blog series focusing on the safety of over-the-counter medications and supplements.
It is now estimated there are 100,000-300,000 over-the-counter drugs marketed in the United States. These are commonly used to treat allergies, pain, fever, cough, motion sickness, indigestion and many other maladies. So how do you know what to take and when? What brand and dose? And is it safe in combination with prescription medication?
Aspirin
Well, let’s start with an oldie but a goodie, and one that we’ve probably all taken at one time or another….aspirin.
Since the 1800’s aspirin use has been widespread due to its ability to reduce pain, fever and inflammation. However, even long before this, over 2,000 years ago, a precursor to aspirin found in the bark of the willow tree was used for medicinal purposes. Aspirin has also been shown to reduce clot formation so in recent decades, it has been widely recommended for prevention of heart attacks and strokes. Millions of patients have taken a baby aspirin a day in hopes of protecting themselves.
In this blog we are discussing the use of aspirin in primary prevention. If you ALREADY HAVE a history of heart disease, stroke or vascular disease, aspirin is likely part of your treatment plan and should never be discontinued without consulting with your physician first.
It’s just a baby aspirin; harmless, right?
Unfortunately, recent studies have shown us that it’s significantly more complicated than that. So complicated that the US Preventive Services Task Force, the American Diabetes Association, and the American College of Cardiology cannot agree on what to recommend, and to whom, even in 2023.
Why is this?
Aspirin, like all other medications, does have potential side effects and risks. Common adverse side effects include stomach upset, stomach ulcers, and worsening of one’s asthma. However, taking aspirin regularly can also have more serious consequences. We know that even a low dose baby aspirin can increase an individual's risk of bleeding, and on occasion this causes significant gastrointestinal bleeding or bleeding in the brain. Bleeding risk is greater in older patients, those who smoke or drink alcohol regularly, have hypertension, and take other blood thinners. So, before we can recommend a daily aspirin, we need to decide if the predicted benefit of aspirin (preventing a cardiac event or stroke) is significantly greater than the predicted risk (causing a significant bleeding complication).
Thankfully, there are standardized algorithms your physician can use to help predict the risk-benefit ratio of starting a daily baby aspirin, and using shared decision-making, we can make this decision together at your appointment. In Direct Primary Care, we have the time to review this as a team and help you decide what is best for your health. We look forward to discussing this and much more at your upcoming appointment with us.
Stay tuned for our next installment. Proton pump inhibitors (prilosec, nexium, protonix, prevacid) were prescription medications for years but are now widely available over the counter. Are they safe? What precautions should you be aware of?