Why over the counter painkillers still require precautions

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As we age, our bodies begin to fail us. We have aches and sores much more frequently and with greater intensity. To manage this pain, we often simply go to our local pharmacy and pick up over the counter (OTC) pain medication, but not all medication is the same. اضافة اعلان

Common OTC pain killers include paracetamol, nonsteroidal anti-inflammatory drugs, and muscle relaxers. Despite these medications being readily available and not requiring a prescription, they are still drugs that require a patient to be knowledgeable in order to avoid adverse effects and abuse. In Jordan, analgesics (painkillers) are the third most sold OTC medication at local pharmacies, with relatively equal usage by both men and women. Their use is so common that one study found that 50.4 percent of all OTC medications used in Jordan were analgesic, followed by supplements in a distant second at 21 percent. 

According to the same study, 89.5 percent of Jordanians like to read the leaflets provided with the medication to educate themselves on potential side effects and contraindications, (conditions in which use of medication should not be allowed). But unfortunately, these leaflets only list the side effects associated with short-term use and do not mention the potential long-term effects.

Conditions not listed under ‘side effects’

Adverse drug effects is a broad term used to describe unintended and often undesired pharmacological effects. The reactions can include predictable or unpredictable adverse events and could be the result of individual intolerance (such as allergies), unseen reactions during testing that are later detected in post marketing surveillance, or inappropriate dosing. 

Side effects fall under this broad umbrella but have a stricter definition. Side effects are undesired effects from medication that are well established, and can occur even when the correct dose is taken. The most important aspect of side effects is that they are reversible, whether that be by discontinuing a medication or continuing a course of treatment until the body has adjusted to the medication. 

These definitions are important because leaflets generally only include information on side effects and not all the possible reactions that may occur. For an individual with other diseases or on other medications, taking OTC analgesics without proper consult can result in serious adverse drug effects or potentially be fatal.

The differences in common painkillers

1. Paracetamol

Paracetamol or acetaminophen is common analgesic in Jordan. Brand names include Panadol, Dolocet, and Panada, and typically come in tablet form but also come in capsules and as liquid. The strength of medication varies depending on the brand and formulation, but tablets commonly come in 250mg or 500mg. 

Two 500mg doses, six times a day is a common regimen taken by those in pain. This is a perfectly acceptable regimen, so long as 4g (4,000mg) is not exceeded in a single day. 

Paracetamol is the preferred choice when it comes to OTC painkillers. It has fewer adverse drug effects compared to other OTC analgesics. The only real drawback is that paracetamol does not combat pain as well as other medication and for those in severe pain, there is no pain relief.

When discussing safety, it is generally safe to take paracetamol for those with renal impairment (such as chronic kidney disease or acute kidney injury), but usage may require monitoring or reduced doses, especially for those with severe renal impairment. 

For those with hepatic (liver) impairment (such as liver disease or cirrhosis) greater care must be taken. In instances of mild to moderate impairment, lowering the total dose may be warranted. 

Australia’s regulatory authority, the Australian Therapeutic Goods Administration (AU-TGA), has designated paracetamol in the A category for those who are pregnant, meaning it has been taken by a large number of pregnant women and women of childbearing age without any proven increase in harmful effects on the fetus having been observed.

2. Nonsteroidal anti-inflammatories 

Nonsteroidal anti-inflammatory drugs are a class of medication that most commonly include ibuprofen, naproxen, and diclofenac. Common ibuprofen medication in Jordan include Advil, Brufen, and Doloraz. Ibuprofen should be given no more than 3.2g (3,200mg) per day in divided doses and need to be taken with food. Naproxen medication includes Nopain, Nexorpan, and Aleve, and should be given in no more than 1.5g (1,500mg) per day, in divided doses, and also need to be taken with food. Diclofenac medication is most commonly found as Voltaren and should be given in no more than 150mg per day with food.

Nonsteroidal anti-inflammatory drugs share many similarities in terms of use, adverse drug effects, and contraindications. All drugs in this category need to be taken with food in order to prevent ulcers. When compared to paracetamol, adverse drug effects are greater, particularly reactions involving the gastrointestinal system. 

Additionally, chronic use of these drugs (typically 3 months of daily use), may cause renal impairment which has the potential to be irreversible. However, these drugs are stronger in fighting pain, but greater care is required when taking these medications, especially if used chronically.

3. Muscle relaxers

Although technically speaking, muscle relaxers are not true analgesics, most formulations include analgesics, particularly paracetamol. Two common muscle relaxers in Jordan are Myogesic and Relaxon. Both of these medications require prescriptions but due to lax oversight, these drugs are sometimes find their way into the hands of those without a prescription. The active ingredient in Myogesic is orphenadrine, which is an anticholinergic drug. Relaxon is formulated with chlorzoxazone, which is a centrally acting skeletal muscle relaxant. However, simply having lower back pain, for example, does not warrant the use of these medications.

Doing your research

Every person should be proactive in their health, especially when it comes to taking medication. It is only natural to be afraid or hesitant when putting something into your body. Fortunately, there are many online tools that can help. Drugs.com is an excellent online source that can provide you with free and reliable information regarding nearly every medication. 

Furthermore, they have tools such as their “Interactions Checker,” which allows you to enter all the medications you are taking and see the possible effects they may have on one another. 

Similarly, “Drugs in Jordan 2020” is an app for smartphones that can be downloaded for free through the Google Play Store. This app was designed by Jordanian doctors and pharmacists and provides its users with information regarding drugs commonly used in Jordan. It can give you quick and accurate summaries of medication without the need for internet. 

With that being said, these sources are only tools to educate yourself, especially on OTC medications. They are not to be used as a way to self-medicate or replace your healthcare professional. If you have any concerns regarding your medication or what can be taken if you have a particular disease, always consult your healthcare professional. 

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