Over the Counter Drug Dangers & Natural Alternatives€¦ · Natural Health Products Which of the...

Sherry Torkos, B.Sc.Ph., R.Ph. April 2018

Over the Counter Drug Dangers & Natural Alternatives

NaturalHealthProducts

Which of the classes of OTC drugs is the leading cause of hospitalizations and death?

A.  Sleeping pills B.  Laxatives C.  Decongestants D.  Antacids E.  Anti-inflammatory drugs

Ø  Vitamins, minerals, herbs, fatty acids, amino acids and probiotics

Ø  Regulated by Health Canada, NNHPD division

Ø  Products require a license, NPN number Ø  Safety, quality and claims reviewed by HC Ø  Over 100,000 licensed NHPs in Canada Ø  No longer seen as alternative; part of

mainstream approach to health Ø  Over 2/3 of Canadians take NHPs regularly Ø  Benefits for disease prevention, management

and treatment

OTCDrugUseinCanada



Ø  80% of adults use OTC drugs as a first response to minor ailments

Ø  Increasing availability of drugs sold OTC Ø  Wide access to online health information Ø  Rising trend toward self-diagnosis Ø  Few seek professional advice

Drugs:thegood,thebadandtheugly


The good: Ø  Drugs provide life saving treatments, ability to extend

life, and some play a role in disease prevention The bad:

Ø  Risk of side effects, abuse, drug interactions The ugly:

Ø  Thousands of people die each year from taking medications….as prescribed

Ø  Many more die from taking drugs inappropriately, overdose, drug abuse

OTCDrugDangers


Ø  Side effects Ø  Contraindications Ø  Inappropriate use Ø  Dosage concerns Ø  Duplicate ingredients Ø  Risks greater with

age and multiple medication use

OTCCategoriesofConcern



1.  Analgesics 2.  Sedatives 3.  Decongestants 4.  Cough suppressants 5.  Antacids 6.  Laxatives

Analgesics



Ø  Aspirin Ø  Non-steroidal anti-inflammatory drugs

(NSAIDS) Ø  Acetaminophen (Tylenol) Ø  Codeine Ø  Used for headaches, arthritis, menstrual

cramps, minor sports injuries, aches and pain Ø  One in five Canadians suffer chronic pain Ø  Taken by 65 % of seniors

Aspirin

Ø  Acetylsalicylic acid (ASA) Ø  Bayer Aspirin, Robaxisal, numerous generic

brands Ø  Useful for pain, inflammation and fever Ø  Other benefits: decreased risk of blood clots,

heart attack and stroke (in specific populations) Ø  Possible anti-cancer benefits Ø  Adverse effects include: rash, upset stomach,

heartburn, gastric bleeding, nausea, ringing in the ears

NSAIDS


Ø  Ibuprofen (Advil/Motrin) and naproxen (Aleve) Ø  Sold alone and in combination products Ø  Adverse effects include: gastrointestinal

bleeding, ulcers, kidney and liver damage, ringing in the ears, increased BP

Ø  Risks are dose related o  High dose usage associated with 2- to 3-fold

increase in RR of gastric bleeding, perforation and peptic ulcer

Ø  Recent studies show increase risk of heart attack, heart failure and renal failure

Ø  Responsible for over 100,000 hospitalizations and 16,000 deaths per year (US)

NSAIDsandHeartAAack



University of Montreal Hospital Research Centre Ø  Analysis of 450,000 people; 61,460 who suffered

heart attack. Ø  Examined the effect over time of taking three

common NSAIDs – ibuprofen, diclofenac, naproxen, celecoxib and rofecoxib.

Ø  The increased risk of heart attack was between 24 and 58 percent overall when taking the drugs, compared with not using them.

Ø  Taking any dose of NSAIDs for one week, one month, or more than a month was associated with increased risk of myocardial infarction.

BMJ2017;357:j1909

Acetaminophen


Ø  Present in Tylenol, Midol, Robaxact, and many cold and flu formulas (DayQuil)

Ø  Adverse effects include: nausea, stomach pain, rash, headache, liver damage, death

Ø  Leading cause of acute liver failure Ø  Risks greater with high doses and when taken

with alcohol (>3 drinks) Ø  Not a good hangover remedy!

Codeine


Ø  Currently available in 8mg formulas OTC Ø  Tylenol #1, Mersyndol, Calmylin cough syrup

Ø  OTC products contain 2 other non-narcotic active ingredients (i.e. acetaminophen + caffeine)

Ø  600 million low-dose codeine tablets sold across Canada in 2015

Ø  Adverse effects include: constipation, nausea, dizziness, hallucinations, addiction

Ø  1 in 500 people entering addiction treatment use OTC codeine only

Ø  Lack of evidence for improved efficacy over acetaminophen or ibuprofen alone

NaturalAlternaDves


Ø  Exercise (ROM, stretching) Ø  Hot/cold packs Ø  Arnica

o  For bumps, bruises, minor injuries Ø  Curcumin and Serrapeptase

o  Rheumatoid and osteoarthritis Ø  NEM (natural eggshell membrane)

o  Osteoarthritis Ø  Boswellia

o  Osteoarthritis, sports injuries Ø  Omega-3 Fatty acids

o  Fish oil, Ahi Flower Ø  Anti-inflammatory diet

SedaDves


Ø  2/3 of Canadians have sleep problems Ø  OTC sedatives contain first generation

antihistamines Ø  Marketed for side effects - drowsiness Ø  Examples: Diphenhydramine (Nytol, Unisom)

and doxylamine (NyQuil) Ø  Adverse effects include: drowsiness, dry

eyes/mouth, dizziness, loss of short term memory, poor concentration, urinary retention, loss of appetite

Ø  New research shows link between long term use and dementia o  Taking these products for the equivalent of three

years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less.

SedaDves–NaturalAlternaDves


Ø  Melatonin o  Helpful for shift work, jet lag

Ø  Valerian/Hops o  Sedative properties

Ø  Passion flower o  Helps with insomnia, restlessness, anxiety

Ø  GABA o  Promotes relaxation; improves sleep quality

Ø  5-Hydroxytryptophan (5-HTP) o  Converted to serotonin o  Helps with sleep, stress, depression, anxiety

Ø  CBD oil o  Low/no THC content; requires Rx

NaturalSoluDonsforStress


Ø  Address underlying factors Ø  Exercise, deep breathing, meditation Ø  Adaptogens: Ashwagandha (Sensoril), Holy

Basil, Rhodiola Ø  Passion flower, L-theanine, magnesium

Bio-Strath


Ø  Nutritional yeast; used worldwide for 60+ years Ø  Contains 61 vitamins, minerals and nutrients Ø  Enhances vitamin and mineral absorption from

small intestine Ø  Clinically researched Ø  Benefits:

o  Supporting body during stress o  Improves concentration, memory and focus o  Decreases fatigue o  Enhances energy and stamina

Ø  Safe for people 4 years and above

Takeadeepbreath….


Decongestants


Ø  Pseudoephedrine, phenylephrine, oxymetazoline

Ø  Present in Sudafed, Sinutab and dozens of OTC cold and flu products

Ø  Also used for sports enhancement; stimulant (wake-up pills)

Ø  Adverse effects include: insomnia, anxiety, nervousness, tachycardia, arrhythmia, hypertension

Ø  Rebound congestion with decongestant nasal spray use > 3 days

Ø  Addictive/abuse potential

Decongestants–NaturalAlternaDves


Ø  Neti pot; nasal wash Ø  Saline nasal spray Ø  Essential oils: eucalyptus, wintergreen, menthol Ø  Vaporizer

AnD-histamines


Ø  Benadryl,Clari-n,Reac-ne,Allegra,Aerius,Ø  Providetemporaryrelieffromitching,sneezing,

wateryeyesØ  Sideeffects:drowsinessanddryeyes/mouthØ  Someaffectcogni-vefunc-on(concentra-onand

memory)

Allergies–NaturalOpDons


Ø  Butterbur Ø  Probiotics Ø  Moducare (plant sterols) Ø  Allergy Relief Formula

o  Addresses underlying causes of allergies o  Relieves itching, sneezing, runny nose, red eyes o  Nasal spray for acute treatment o  Tablets for prevention o  Safe for children and use during pregnancy

CoughSuppressants


•  Dextromethorphan (DM) and codeine •  Overdose of DM can cause rapid heart

rate, increased BP, vision, nausea, vomiting, diarrhea, slurred speech, memory loss, hallucinations and coma

•  Can be fatal, particularly when combined with other drugs

•  Codeine causes upset stomach, constipation, nausea, dizziness, addiction

CoughSuppressants–NaturalAlternaDves


DigesDveHealthinCanada


Ø  Digestive disease affect 2/3 of Canadians Ø  IBD, IBS, celiac, dyspepsia, ulcers, GERD,

diverticulitis, colon cancer, constipation, and diarrhea

Ø  Annual cost of $18 billion in health care and lost productivity

Ø  Widespread overuse of OTC drugs to treat gas, bloating, heartburn, diarrhea, and constipation

Antacids


Ø  H2-blockers (ranitidine, famotidine, cimetidine)

Ø  Proton pump inhibitors o  OTC: omeprazole o  Rx: Pantoprazole, lansoprazole, esomeprazole

Ø  Side effects: o  Gas, bloating, nausea, diarrhea, constipation o  Headaches, dizziness o  Irregular heart rate o  Reduced absorption of calcium, magnesium and

vitamin D and B12 o  Impaired kidney and liver function o  Increased risk of heart attack and osteoporosis

with long term use

Inthenews…


British Medical Journal, July 2017 “Long-term use of a class of drugs that treat heartburn

may be linked to a shortened lifespan” Ø  Proton pump inhibitors used for heartburn, GERD,

ulcers and GI disorders Ø  Considered safe when used for 2 months or less Ø  Long term use associated with 25% increased risk of

death Ø  Recommendations by study authors, “addressing the

root cause of heartburn, such as by losing weight, reducing alcohol, quitting smoking and making diet changes, can quell or reduce symptoms before jumping to medications.”

Ø  Previous studies estimate that between half to 69 per cent of PPI prescriptions are for "inappropriate indications”

LaxaDves


•  Used for constipation and weight loss •  Chronic constipation affects 15 to 30 percent of

Canadians •  Laxative types:

•  Stimulants (bisacodyl) •  Bulk forming agents (Metamucil/Psylium) •  Stool softeners (Docusate)

•  Adverse effects include: cramps, diarrhea, electrolyte imbalance, lazy colon

•  Reduced absorption of nutrients with long term use

WhytheBand-aidapproachfails


Proper digestion requires healthy function of stomach, intestine, liver, gallbladder and pancreas

FactorsaffecDngdigesDon


Ø  Poor diet (fast/processed food), big meals Ø  Excessive alcohol Ø  Exposure to pesticides, environmental

toxins Ø  Imbalance of microflora Ø  Lack of exercise Ø  Stress Ø  Smoking Ø  Drugs (antibiotics, antacids, cholesterol and

BP drugs, NSAIDS, opioids)

ToxicOverload


Signsofliverdistress


Ø  Acid reflux, indigestion Ø  Gas, bloating Ø  Constipation Ø  Diarrhea Ø  Headaches, dizzy spells Ø  Coated tongue, bad breath Ø  Yellow complexion, brown spots on the skin Ø  Poor sleep Ø  Lack of energy Ø  Abdominal and lower back pain

DigesDveHealth-NaturalopDons


Ø  Consumer smaller meals Ø  Maintain healthy body weight Ø  Regular exercise Ø  Eat foods in natural form Ø  Increase intake of soluble fibre & water Ø  Increase intake of beneficial bacteria

o  Fermented dairy (yogurt, kefir), Kambucha, probiotics

Ø  Liver/digestive health supplements

BoldocynaraLiverComplex


Ø  Artichoke, Dandelion, Boldo leaf and Milk Thistle

Ø  Stimulates bile secretion Ø  Facilitates digestion of fats Ø  Supports detoxification and regeneration

of liver Ø  Aids digestive Ø  Reduces symptoms of heartburn, acid

reflux, bloating, gas

My perspective!Which of the classes of OTC drugs is the leading cause

of hospitalizations and death?


Ø  Many of the chronic health issues we face today are rooted in lifestyle

Ø  Important to address underlying cause Ø  Holistic approach to health and wellness play

a valuable role in disease prevention and treatment

Ø  Integrate of conventional and complementary medicine when appropriate

Ø  Ask questions, seek advice Ø  Trust your gut instinct Ø  Knowledge is power

Sherry Torkos, B.Sc.Ph., R.Ph. Web Site: sherrytorkos.com

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