Overmedication

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Overmedication describes the excessive use of over-the-counter or prescription medicines for a person. Overmedication can have harmful effects, such as non-adherence or interactions with multiple prescription drugs.

Contents

Over-the-counter medication overuse

Over-the-counter (OTC) medications are generally first-line therapies that people may choose to treat common acute illnesses, such as fevers, colds, allergies, headaches, or other pain. Many of these medications can be bought in retail pharmacies or grocery stores without a prescription. OTC medication overuse is most prevalent in adolescents and young adults. [1] This overuse is common due to the relatively low cost, widespread availability, low perceived dangers, and internet culture associated with OTC medications. [2] OTC medications may be combination formulations that contain multiple drugs. These combination formulations are often used with other substances, which complicates treatment for these types of overdoses. Furthermore, the easy access to information online can sometimes lead to self-diagnosis and self-medication, contributing to the potential for misuse and overuse.

Acetaminophen

Overuse of acetaminophen is the leading cause of liver failure in the Western world. [3] The maximum daily limit of acetaminophen is 4 grams per day for someone with a healthy liver. It is also highly recommended to not go over the maximum daily limit. Exceeding the maximum daily limit could involve severe liver toxicity, liver failure, kidney failure, or even death. [4] People who have poor liver function or with chronic alcohol use disorder should either limit or not ingest acetaminophen to prevent morbidities. [5] Additionally, acetaminophen is an ingredient in many combination medications, increasing the risk of unintentional overdose. Consumers should read labels carefully and consult healthcare providers to ensure they are not consuming excessive doses. In cases of suspected overdose, immediate medical attention is needed to mitigate potential life-threatening consequences. [4]

Codeine

Codeine is an opioid and shares similarities to other opioid overuse. Many OTC medications for cough have formulations that contain codeine, which people may seek to overuse. The common effects of codeine include miosis, respiratory depression, CNS depression, and decreased bowel motility. [6] Despite the risk of death, dependence is another significant issue related to codeine overuse. Tolerance can cause users to use more opioid, leading to dependence, especially with chronic daily use of codeine. [1] Additionally, the misuse of codeine-containing cough syrups has become a public health concern, as it can serve as a gateway to stronger opioids.[ citation needed ] Education about the risks and signs of opioid addiction can play a role in prevention and early intervention.

Dextromethorphan

Dextromethorphan, also shortened to DXM, affects the NMDA receptor and serotonin receptors which is believed to give its psychoactive effects at high doses. Similarly to codeine, DXM comes primarily in formulations that contain other OTC medications and is not common to find DXM on its own. Moreso, people who use DXM tend to use it concomitantly with other substances such as alcohol, hallucinogens, sedative drugs, and opioids. [1] DXM has dose dependent psychoactive effects with lower dose leading to more restlessness and euphoria and higher doses causing hallucinations, delusional beliefs, paranoia, perceptual distortions, ataxia, and out of body experiences. [1]

Diphenhydramine

Diphenhydramine is typically used for allergy relief, although it may be used to alleviate sleeping problems, anxiety, and overall restlessness. [7] Effects may include euphoria, hallucinations, or psychosis. [7] The anticholinergic activity of diphenhydramine may lead to tachycardia, dry mouth, blurred vision, mydriasis, depression, and urinary retention. [7]

In 2020, purposeful overmedication with Benadryl (diphenhydramine) was a concern due to use of social media by teenagers in the United States, with the FDA issuing a public warning about the possibility of seizures, hallucinations, breathing difficulty or loss of consciousness. [8]

Pseudoephedrine

Pseudoephedrine, ephedrine or phenylpropanolamine can be overused with the intent for weight loss or improving athletic performance, possibly causing insomnia, diminished sense of fatigue, euphoria, and psychotic behavior. [1] The habitual use of the medication has led to dependence, with symptoms of restlessness, dysphoria, and distorted perceptions on withdrawal. [1]

Elderly

Seniors (65 years old and up) are possible users of overmedication. [9] Seniors are disproportionately affected by not only adverse drug events, but also drug interactions and more hospital admissions.[ medical citation needed ]

The term for individuals taking five or more medications is polypharmacy, which commonly occurs in elderly people, increasing their risk of overmedication. [10] Medical providers are generally hesitant to prescribe polypharmacy in the elderly due to the risk of harmful drug interactions. Concerns with polypharmacy and elderly groups are reduced medication adherence, increased fall risk, cognitive function impairment, and adverse drug reaction. [11] Almost 75% of clinic visits result in people obtaining a written prescription. [12] [13]

More careful prescribing practices could increase medication adherence in elderly people. [14] [15] Single-pill combination formulations make it easier for a person to monitor medications. [15]

Overprescription

Opioids

Opioids are used for pain management acutely or prescribed after a surgical procedure. While opioids aid in short- and long-term pain management, overprescription or constant opioid-exposure increases the risk for addiction. [16] There is a rise within healthcare systems to manage prescription of opioids. [16] Children prescribed opioids may become susceptible to the harms of addiction. [17] [18]

Reducing or withdrawing prescribed opioids, such as for people with chronic non-cancerous pain, using either dose-reduction or stopping opioid prescriptions, may be effective, but standards are absent for managing withdrawal symptoms and deprescribing coprescription of sedatives. [19] [20] Studies found a significant increase in opioid surplus disposal when individuals were provided with the necessary education or disposal kits. [21] [22]

Antibiotics

As antibiotics inhibit bacterial infections, they are a commonly prescribed medication. Overuse of these medications over the years has contributed to reduced efficacy against certain bacteria due to antimicrobial resistance, [23] a global medical concern. [24] Antibiotic overprescription is a potential problem in acute care, primary hospitals, and dental offices. [24]

Antibiotic-resistant bacterial infections are increasing. [23] A systemic review of admitted COVID-19 patients who were prescribed antibiotics showed that 80% of the admitted people were given antibiotics upon admission without confirmed bacterial coinfections. [25]

Physicians prescribe antibiotics for non-indicated diagnoses, such as viral infections, possibly cntributing to more antibiotic-resistant infections, greater adverse drug events, more drug-drug interactions, and deaths. [26] Dentists may prescribe antibiotics for non-indicated conditions that could otherwise be treated with other interventions, according to clinical guidelines. [27]

Related Research Articles

<span class="mw-page-title-main">Hydrocodone</span> Opioid drug used in pain relief

Hydrocodone, also known as dihydrocodeinone, is a semi-synthetic opioid used to treat pain and as a cough suppressant. It is taken by mouth. Typically it is dispensed as the combination acetaminophen/hydrocodone or ibuprofen/hydrocodone for pain severe enough to require an opioid and in combination with homatropine methylbromide to relieve cough. It is also available by itself in a long-acting form sold under the brand name Zohydro ER, among others, to treat severe pain of a prolonged duration. Hydrocodone is a controlled drug: in the United States a Schedule II Controlled Substance.

<span class="mw-page-title-main">Paracetamol</span> Common medication for pain and fever

Paracetamol (acetaminophen) is a non-opioid analgesic and antipyretic agent used to treat fever and mild to moderate pain. It is a widely used over-the-counter medication. Common brand names include Tylenol and Panadol.

<span class="mw-page-title-main">Over-the-counter drug</span> Medication available without a prescription

Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid prescription. In many countries, OTC drugs are selected by a regulatory agency to ensure that they contain ingredients that are safe and effective when used without a physician's care. OTC drugs are usually regulated according to their active pharmaceutical ingredient (API) and strengths of final products.

<span class="mw-page-title-main">Cold medicine</span> Medication taken to relieve cold symptoms

Cold medicines are a group of medications taken individually or in combination as a treatment for the symptoms of the common cold and similar conditions of the upper respiratory tract. The term encompasses a broad array of drugs, including analgesics, antihistamines and decongestants, among many others. It also includes drugs which are marketed as cough suppressants or antitussives, but their effectiveness in reducing cough symptoms is unclear or minimal.

<span class="mw-page-title-main">Diphenhydramine</span> Antihistamine medication

Diphenhydramine (DPH) is an antihistamine and sedative first developed by George Rieveschl and put into commercial use in 1946. it is available as a generic medication, and also sold under the brand name Benadryl, among others. In 2021, it was the 242nd most commonly prescribed medication in the United States, with more than 1 million prescriptions.

<span class="mw-page-title-main">Opioid</span> Psychoactive chemical

Opioids are a class of drugs that derive from, or mimic, natural substances found in the opium poppy plant. Opioids work in the brain to produce a variety of effects, including pain relief. As a class of substances, they act on opioid receptors to produce morphine-like effects.

Self-medication, sometime called do-it-yourself (DIY) medicine, is a human behavior in which an individual uses a substance or any exogenous influence to self-administer treatment for physical or psychological conditions, for example headaches or fatigue.

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Vicks DayQuil is an over-the-counter combination medication product used for the temporary relief of common cold and flu symptoms. DayQuil is available in several formulations.

<span class="mw-page-title-main">Dihydrocodeine</span> Opioid

Dihydrocodeine is a semi-synthetic opioid analgesic prescribed for pain or severe dyspnea, or as an antitussive, either alone or compounded with paracetamol (acetaminophen) or aspirin. It was developed in Germany in 1908 and first marketed in 1911.

<span class="mw-page-title-main">Dextropropoxyphene</span> Withdrawn opioid medication

Dextropropoxyphene is an analgesic in the opioid category, patented in 1955 and manufactured by Eli Lilly and Company. It is an optical isomer of levopropoxyphene. It is intended to treat mild pain and also has antitussive and local anaesthetic effects. The drug has been taken off the market in Europe and the US due to concerns of fatal overdoses and heart arrhythmias. It is still available in Australia, albeit with restrictions after an application by its manufacturer to review its proposed banning. Its onset of analgesia is said to be 20–30 minutes and peak effects are seen about 1.5–2.0 hours after oral administration.

<span class="mw-page-title-main">Polypharmacy</span> Use of five or more medications daily

Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard definition and the term has also been used in the context of when a person is prescribed 2 or more medications at the same time. Polypharmacy may be the consequence of having multiple long-term conditions, also known as multimorbidity and is more common in people who are older. In some cases, an excessive number of medications at the same time is worrisome, especially for people who are older with many chronic health conditions, because this increases the risk of an adverse event in that population. In many cases, polypharmacy cannot be avoided, but 'appropriate polypharmacy' practices are encouraged to decrease the risk of adverse effects. Appropriate polypharmacy is defined as the practice of prescribing for a person who has multiple conditions or complex health needs by ensuring that medications prescribed are optimized and follow 'best evidence' practices.

<span class="mw-page-title-main">Doxylamine</span> First-generation antihistamine used as a short-term sedative and hypnotic (sleep aid)

Doxylamine is an antihistamine medication used to treat insomnia and allergies, and—in combination with pyridoxine (vitamin B6)—to treat morning sickness in pregnant women. It is available over-the-counter and is typically sold under such brand names as Equate, Unisom, or ZzzQuil, among others; and it is used in nighttime cold medicines (e.g., NyQuil) and pain medications containing acetaminophen and/or codeine to help with sleep. The medication is delivered chemically by the salt doxylamine succinate and is taken by mouth. Doxylamine and other first-generation antihistamines are the most widely used sleep medications in the world. Typical side effects of doxylamine (at recommended doses) include dizziness, drowsiness, grogginess, and dry mouth, among others.

<span class="mw-page-title-main">Methocarbamol</span> Medication for musculoskeletal pain

Methocarbamol, sold under the brand name Robaxin among others, is a medication used for short-term musculoskeletal pain. It may be used together with rest, physical therapy, and pain medication. It is less preferred in low back pain. It has limited use for rheumatoid arthritis and cerebral palsy. Effects generally begin within half an hour. It is taken by mouth or injection into a vein.

<span class="mw-page-title-main">Dextromethorphan</span> Cough suppressant, antidepressant, and dissociative drug

Dextromethorphan (DXM), sold under the trade name Robitussin among others, is a cough suppressant used in many cough and cold medicines. In 2022, the FDA approved the combination dextromethorphan/bupropion to serve as a rapid acting antidepressant in patients with major depressive disorder.

<span class="mw-page-title-main">Hydrocodone/paracetamol</span> Combination pain relief drug

Hydrocodone/paracetamol is the combination of the pain medications hydrocodone and paracetamol (acetaminophen). It is used to treat moderate to severe pain. It is taken by mouth. Recreational use is common in the United States.

<span class="mw-page-title-main">Codeine</span> Opiate and prodrug of morphine used to treat pain

Codeine is an opiate and prodrug of morphine mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. It is found naturally in the sap of the opium poppy, Papaver somniferum. It is typically used to treat mild to moderate degrees of pain. Greater benefit may occur when combined with paracetamol (acetaminophen) or a nonsteroidal anti-inflammatory drug (NSAID) such as aspirin or ibuprofen. Evidence does not support its use for acute cough suppression in children. In Europe, it is not recommended as a cough medicine in those under 12 years of age. It is generally taken by mouth. It typically starts working after half an hour, with maximum effect at two hours. Its effects last for about four to six hours. Codeine exhibits abuse potential similar to other opioid medications, including a risk of habituation and overdose.

An equianalgesic chart is a conversion chart that lists equivalent doses of analgesics. Equianalgesic charts are used for calculation of an equivalent dose between different analgesics. Tables of this general type are also available for NSAIDs, benzodiazepines, depressants, stimulants, anticholinergics and others.

<span class="mw-page-title-main">Opiate</span> Substance derived from opium

An opiate is an alkaloid substance derived from opium. It differs from the similar term opioid in that the latter is used to designate all substances, both natural and synthetic, that bind to opioid receptors in the brain. Opiates are alkaloid compounds naturally found in the opium poppy plant Papaver somniferum. The psychoactive compounds found in the opium plant include morphine, codeine, and thebaine. Opiates have long been used for a variety of medical conditions, with evidence of opiate trade and use for pain relief as early as the eighth century AD. Most opiates are considered drugs with moderate to high abuse potential and are listed on various "Substance-Control Schedules" under the Uniform Controlled Substances Act of the United States of America.

<span class="mw-page-title-main">Pain management in children</span> Medical condition

Pain management in children is the assessment and treatment of pain in infants and children.

References

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