Posted: Aug 10, 2011 2:41 PM
It's been a hard day, and Joe's back is killing him.
His wife has some Percocet left over from a trip to the dentist, and there's that big bottle of Tylenol under the sink, so Joe grabs a couple of each and washes them down with a slug of beer.
Luckily for Joe, he's a fictional character invented for this article. But there are a lot of real-life Joes out there making big mistakes with over-the-counter and prescription pain pills.
Can you spot Joe's mistakes? Joe didn't make every mistake in the book. But he made quite a few.
Here's WebMD's list of common pain pill mistakes, compiled with the help of pharmacist Kristen A. Binaso, RPh, spokeswoman for the American Pharmacists Association; and pain specialist Eric R. Haynes, MD, founder of Comprehensive Pain Management Partners in Trinity, Fla.
Doctors prescribe pain pills at the doses they believe will offer the greatest benefit at the least risk. Doubling or tripling that dose won't speed relief. But it can easily speed the onset of harmful side effects.
"The first dose of a pain medication may not work in five minutes the way you want. But this does not mean you should take five more," Binaso says. "With some pain drugs, if you take additional doses, it makes the first dose not work as well. And with others, you end up in the emergency room."
If you've given your pain medication time to work, and it still does not control your pain, don't double down. See your doctor about why you're still hurting.
"This 'one is good so two must be better' thing is a common problem," Haynes says. "Patients should follow the instructions their doctor gives. Ask before leaving the office: Can I take an extra pill if I still hurt? What is the upper limit for this medication?"
Another bad idea is trying to boost the effect of one kind of pain pill by taking another.
"There may be Advil, Tylenol, Aleve, and ibuprofen in the house, and a person may take them all," Binaso says.
This can escalate into a very bad situation, Haynes says.
People often take over-the-counter pain drugs -- and even prescription pain drugs -- without reading the label. That means they often don't know which drugs they're taking. That's never a good idea.
And if they take another over-the-counter drug -- either for extra pain relief or for other reasons -- they may be getting an overdose. That's because many OTC drugs are combination pills that carry a full dose of pain pill ingredients.
In Joe's case, he's taken a prescription pain pill that contains acetaminophen along with a second full dose of acetaminophen from Tylenol, putting him at risk of injury.
Pain medications and alcohol generally enhance each other's effect. That's why many of these prescription medications carry a "no alcohol" sticker.
That sticker shows a martini glass covered by the international "No" sign of a circle with a slash. But it applies to wine and beer just as much as it does to spirits.
"A common misperception is people see that sticker and think, 'I'm OK as long as I don't drink liquor -- I can have a beer.' But no alcohol means no alcohol," Binaso says.
"The patient should heed that alcohol warning, because it can be a major problem if they do not," Haynes says. "Alcohol can make you inebriated, and some pain medications can make you have that feeling as well. You can easily get yourself into trouble."
Drinking alcohol can be a problem even with over-the-counter pain drugs.
Before taking any pain pill, think about what other medicines, herbal remedies, and supplements you are taking. Some of these drugs and supplements may interact with pain medications or increase the risk of side effects.
For example, aspirin can affect the action of some non-insulin diabetes drugs; codeine and oxycodone can interfere with antidepressants.
You should give your doctor a complete list of all the drugs, herbs, and supplements you take -- before getting any prescription.
If buying over-the-counter medications, Binaso recommends showing a list of everything else you're taking to the pharmacist.
Pain medications can make you drowsy. Different people react differently to different drugs.
"How I react to a pain medication is different from how you react," Binaso says. "It may not make me drowsy, but may make you drowsy. So I recommend trying it at home first, and see how you feel. Don't take two pills and go out driving."
Unfortunately, it's very common for people to share prescription medications with friends, relatives, and co-workers. Not smart, Haynes and Binaso say -- particularly when it comes to pain medications.
"If a fairly healthy person is taking a medicine because she is in pain, and wants to give some pills to Uncle Joe because he is hurting -- well, this is a potential problem," Haynes says. "Uncle Joe may have a problem that keeps his body from eliminating the drug, or he may have an allergic reaction, or the drug may interact with a medication he is taking, with life-threatening results."
It's not easy to read drug labels, even if you can make out the small print. If you have a question about either a prescription or OTC drug, ask the pharmacist.
"That's why I'm in the store," Binaso says. "You may have to wait a couple of minutes for me to finish what I'm doing. But you'll get the information you need to take the right medicine the right way. Just say, 'Tell me about this medicine; what should I be on the lookout for?'"
Joe's wife is actually to blame for one of his mistakes. She should have disposed of those extra pain pills once she was over her dental pain.
Why? One reason is that pills stored at home start breaking down soon after their expiration date. That's especially true of drugs kept in the moist environment of the bathroom medicine cabinet.
"People say, "That drug is only a year past its expiration date; isn't it good?" But if you take a pill that's broken down, it may not work -- or you may end up in the emergency room because of reaction to a breakdown product. That is really common," Binaso says.
Another reason that it's dangerous to hoard is that the drugs may tempt someone else into making a very bad choice.
"Teen drug abuse is really up, especially with pain medications," Binaso says. "It is not uncommon for kids to go to their parents' or grandparents' medicine cabinet and then go to a party and put the drugs in a bowl."
Pills are actually little drug-delivery machines. They don't work the way they're supposed to when taken apart the wrong way.
Scored pills should be cut only across the line, Binaso says. Those without scoring should not be cut at all, unless you're specifically instructed to do so.
"When you start chopping up pills like that, the pill may not work," she says. "We find more and more people are doing this. And then they say, "Oh, that pill had a really bad taste. That is because they cut away the coating."