What is the Gut Check: Know Your Medicine campaign?
Gut Check: Know Your Medicine is an educational campaign brought to you by the American Gastroenterological Association (AGA) to motivate and empower individuals to engage in the safe use of pain medication. Medicine labels help adults understand what — if any — medicines share ingredients that could be harmful when doubled. By knowing ingredients, dosing instructions and warnings, individuals can play an important role in protecting their and their own family’s health. The AGA developed this education program with sponsorship support from McNeil Consumer Healthcare.
Where can I go for more information?
We invite you to watch our public service video and download the available materials to practice smarter, safer use of OTC pain medicine. Spread the word and help us minimize side effects and deaths related to OTC pain medicine overdose. Should you have more questions about your medicines, talk to your health-care provider.
Health-care providers are welcome to download materials and display them in their office.
Who funded this initiative?
Why is it important to know what’s in my over-the-counter (OTC) pain medicine?
There may be a misperception that because these medicines are available over-the-counter they are not harmful and that the Drug Facts label is just a guideline. However, the truth is that any medicine can be dangerous if maximum doses are exceeded (overdose) or if the medicine is used longer or more frequently than directed (overuse).
The most common OTC pain meds fall into two categories: nonsteroidal anti-inflammatory drugs (NSAIDs) and acetaminophen. More than 500 OTC and prescription medications (Tylenol®, Dayquil®, Percocet®, etc.) contain acetaminophen and nearly 550 contain an NSAID (aspirin, naproxen, ibuprofen, etc.). These products may have different names but it’s important to remember that they may share the same active ingredients — ingredients that may cause harm when taken together or in excess of a maximum dose.
That’s why it’s important to read all medicine labels and know the active ingredients in your medicines.
- Acetaminophen: On over-the-counter products, identify if the medicine you are taking contains acetaminophen by looking at the “Active Ingredients” section of the Drug Facts label. On prescription labels, acetaminophen is sometimes abbreviated as “APAP,” “acet” or “acetam.”
- NSAIDs: NSAIDs available over the counter include ibuprofen, naproxen sodium and aspirin. It is important to not use more than one NSAID-containing medicine at the same time.
What is acetaminophen?
Acetaminophen is the active ingredient in more than 500 OTC and prescription medications; one of the most commonly used products with acetaminophen is Tylenol®. Acetaminophen acts as a fever reducer and pain reliever. People can use acetaminophen to help address the following symptoms:
- Common cold
- Minor pain of arthritis.
- Muscle ache
- Premenstrual and menstrual cramps
Prescription and OTC medications containing acetaminophen can come in many forms — pills, drops, capsules and liquids.
While acetaminophen is safe when used as directed, it can become harmful when taken in overdose, when taken with other drugs that contain acetaminophen, or when taken if you consume three or more alcoholic drinks every day. The maximum daily dose for acetaminophen is 4,000 mg/daily.
Taking multiple medicines with acetaminophen — even for different issues like a headache or cold — can place you at risk of serious liver damage. Acetaminophen overdose accounts for approximately 56,000 emergency room visits, 26,000 hospitalizations and 458 deaths each yeari.
The signs and symptoms of liver damage are not instantly recognizable. If you’ve taken more than the recommended dose of acetaminophen, contact a poison control center at 1-800-222-1222 immediately, even if you don’t have any symptoms.
What are NSAIDs?
NSAIDs — or nonsteroidal anti-inflammatory drugs — act as pain relievers and fever reducers. Prescription NSAIDs can also work to reduce inflammation. There are currently more than 500 over-the-counter and prescription NSAIDs, including ibuprofen (Advil®, Motrin IB®), naproxen sodium (Aleve®) and aspirin (Bayer®).
Chronic or frequent use of NSAIDs can result in damage to the gastrointestinal tract and kidneys. The risk of stomach ulcers and gastrointestinal bleeding is heightened, when:
- NSAIDs are taken in combination with blood thinning or steroid drugs, low-dose aspirin or other NSAIDs.
- You are age 60 or over.
- You consume three or more alcoholic drinks every day while taking the medicine.
- You have had stomach ulcers or bleeding problems in the past.
- You take the medicine for longer than directed.
The maximum daily dose for NSAIDs varies by ingredient and can be as low as 660 mg/day for naproxen sodium, 1,200 mg/day for ibuprofen, and 4,000 mg/day for aspirini.
Chronic use of OTC NSAIDs has been linked to gastrointestinal bleeding, stomach ulcers, and damage to the esophagus, and small intestine. It is estimated that more than 100,000 hospitalizations and 16,500 deaths a year are due to NSAID-related gastrointestinal complicationsii.
- McNeil Consumer & Specialty Pharmaceuticals briefing packet for the Nonprescription Drugs Advisory Committee (NDAC). Sept. 20, 2002.
- Graumlich, JF. Preventing Gastrointestinal Complications of NSAIDs. Risk Factors, Recent Advances, and Latest Strengths. Postgrad Medicine, May 2001.
How am I supposed to know what to take?
There are many different over-the-counter and prescription fever reducers and pain relievers that contain the same active ingredients. Going into a store or pharmacy, it’s important to realize that there are many options. Set aside the appropriate amount of time to read medicine labels and make a conscious and safe decision for you and your family.
Select a product that you believe will relieve your pain. If it doesn’t work, remember not to take more than directed — because taking more of an OTC pain medicine will not relieve the pain faster and can actually do more harm than good.
Speak with a doctor or health-care provider if your pain isn’t being relieved. He or she can work with you to find a solution that best addresses your pain while also considering other medications that you may be taking or any pre-existing conditions that you may have.
Are people really overdosing on OTC pain medicines?
Unfortunately, yes. People don’t realize that exceeding the recommended dose of acetaminophen can result in serious liver damage — damage that cannot be reversed and is not always recognizable. And, exceeding the recommended dose of NSAIDs can cause gastrointestinal bleeding — a serious and life-threatening condition.
The challenge we face is that the problem is invisible until someone ends up in the hospital. Often times, individuals will continue to exceed the recommended doses until they experience complications. Education is imperative to understanding the risks of using OTC pain relievers.
How can I safely use pain medicines?
With different types of pain medicine available, both over-the-counter and by prescription, it is important for adults and caregivers to read their medicine’s warning label. The best safety measure is to know the active ingredients.
If you are taking multiple medicines, check to see if they share the same ingredients, such as acetaminophen, ibuprofen, naproxen or aspirin.
- Take only one product that contains acetaminophen at a time.
- Take only one product that contains an NSAID at a time (ibuprofen, naproxen and aspirin are all NSAIDs).
If you still have questions or aren’t sure whether a medicine contains acetaminophen or an NSAID, consult your doctor, pharmacist or other health-care provider, like a gastroenterologist, for more information. It’s a great opportunity to discuss what medicines you and your loved ones are taking and the frequency with which they are being taken.
What can I do to prevent overdose of pain medicine?
You can help to prevent overdose or overuse by reading and following your medicine label.
Dosing is different for each product, so it’s important to read medicine labels every time you use a medicine to determine how much to take and how often to take it. For instance, some adults incorrectly believe that recommended dose for OTC pain medicine can be adjusted by weight or height.
Misperceptions like these are common; that’s why it’s important to follow the instructions for every product you use and dose only as directed.
I’ve exceeded the recommended OTC medicine dosage for years — and with no harm. Why stop now?
You should be concerned with exceeding the recommended OTC pain medicine dosage because your next dose could be the one that causes harm. No one is immune to the side effects of exceeded dosages and it only takes one misuse for a complication to occur. Especially as we age, our bodies change and our tolerances toward certain drugs may shift. Health issues that emerge later in adulthood and different combinations of medications and supplements can impact medicine use.
Taking more than the recommended amount of OTC pain meds is never the answer. Often times, side effects from overdose of acetaminophen and chronic use of NSAIDs aren’t immediate.
Know that it’s never too late to practice safe medication habits. You don’t need to give up pain relievers — you just need to take them appropriately. Take a look at your medicine cabinet and re-read all of your product labels. Keep track of those that share active ingredients and remember not to use them at the same time. If you’re given a new prescription, add it to the list and note other products to avoid. Remember, even medicines that you don’t think share active ingredients may. So it’s important to check all prescription and OTC medication labels.
I have chronic pain. Can I take OTC and prescription pain relievers at the same time?
Unless advised by a doctor or health-care provider, do not take OTC and prescription pain relievers at the same time. Prescription medicines can contain NSAIDs or acetaminophen and taking more than one medicine with the same ingredient can increase your risk of health complications.
Chronic pain management is difficult, but it’s important not to risk the serious side effects of ingredient overdose. Talk with your doctor, pharmacist or other health-care provider about options that can safely and effectively relieve your pain.
Are there non-medication alternatives to treat my pain?
Speak with your doctor or other health-care provider about alternative options. If your pain cannot be managed by taking the recommended dose of OTC medication, ask about other options that can best fit into your lifestyle. Physical therapy, biofeedback and acupuncture are all effective forms of pain management.
*When comparing these categories, it is important to clarify that medicines that do not contain an NSAID are not steroids. Many medicines do not have the word “nonsteroidal” (acetaminophen included), however, that does not mean that they contain steroids.
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