Recently in the emergency room, I saw a 35-year-old patient — we’ll call her Jane — who was vomiting blood. The source of the vomiting turned out to be a bleeding ulcer caused by unintentionally overdosing on ibuprofen. Jane was in pain — she was taking prescription ibuprofen for her chronic knee pain — but she was also taking over-the-counter (OTC) Advil® during the previous five days for menstrual cramps. Jane did not know that the active ingredient in Advil is ibuprofen, so she was doubling up on this pain reliever.
I often see patients like Jane — patients who develop medication-related complications due to overuse or overdose of their pain medication, causing sometimes serious, or even fatal, damage to the digestive tract. With a little education, we can prevent many of these cases.
Unfortunately, Jane is not alone. Chronic pain affects more than 100 million Americans. That’s more than the number of people with diabetes, coronary artery disease and cancer — combined. And, chronic pain patients are more likely to exceed the recommended doses of their pain medicine. Some cases, like Jane’s, are unintentional. In other cases, patients believe taking more medication will speed pain relief. As health care providers, we know that it doesn’t work that way. In fact, it can lead to side effects, some of which are life threatening.
These complications from overdose of pain medications are all too common. Every year, it is estimated that more than 126,000 hospitalizations and 17,000 deaths in the U.S. are due to overdose or overuse of acetaminophen or NSAIDs, which are present in many over-the-counter and prescription pain medications.
It’s not difficult to see why this dangerous trend is happening.
Many consumers believe that OTC pain medications are completely safe. While that may be the case at recommended doses, you and I know that’s not the case with excessive use. From 1998 to 2003, acetaminophen was the leading cause of acute liver failure in the U.S., with 48 percent of those cases associated with accidental overdose.
In an effort to educate consumers about the safe use of OTC pain medicines, the American Gastroenterological Association developed Gut Check: Know Your Medicine. Through this campaign, gastroenterologists and hepatologists hope to reduce the amount of preventable health issues that thousands of individuals face every year.
More than 500 over-the-counter and prescription medicines contain acetaminophen and 550 contain NSAIDs, such as ibuprofen, aspirin or naproxen sodium. They address a range of ailments, such as cold and flu, allergy, arthritis, and many more. Even though these medicines may share the same active ingredient, they’re marketed under different brand names, so our patients don’t typically know they may be overdosing.
Even though overuse and overdose of pain medicines — either over-the-counter or prescription — is not a new phenomenon, it’s something that requires attention, because so many of these cases are preventable with the right education. With cold and flu season rapidly approaching, there are a few things we can do the next time we see all our patients:
- Remind patients to read and follow all medicine labels and not to exceed the recommended doses.
- Educate patients to be aware of the active ingredients in their medications and not to double up on the same active ingredient.
- Encourage patients to speak with us if they have any questions about their current medications or believe their treatment regimen needs to be adjusted.
Patients can visit Gut Check to learn more about medication safety and know the dosage limits of common medicines.
Byron Cryer is chair, Gut Check: Know Your Medicine and councilor-at-large, AGA Institute.
Image credit: Shutterstock.com
