FAMILY MEDICINE® COLUMN
By John C. Wolf, D.O.
Associate Professor of Family Medicine®
Ohio University College of Osteopathic Medicine

ELDERLY SHOULD EXERCISE CAUTION WITH OVER-THE-COUNTER DRUGS

Question: I know that most non-prescription cold and allergy remedies should not be used by those with high blood pressure. Fortunately, I have escaped that health problem, but I have had considerable experience with the tireless march of time. Are there other problems from the uses of these beneficial medications for those of us of retirement age and in good health?

Answer: Most non-prescription cough, cold and allergy medications contain ingredients from the same broad drug category and, therefore, have similar side effects. To answer your question fully, I need first to explain what doctors mean by the term "side effect." This will give you the necessary background to understand what follows.

A side effect is an undesirable response to a medication. It may happen with the first dose of the medication, but more commonly the chance of a side effect increases with the amount of medication that is taken. This is what we doctors call a dose-related response. As an example, most of us can swallow one aspirin tablet without stomach upset, but all people who must take 20 a day for an acute attack of arthritis have stomach trouble as a side effect of the drug. They also, of course, have the benefit of aspirin's main effect relief from the arthritic pain and stiffness.

Unfortunately, non-prescription cold and allergy medications have side effects that are as predictable as their desired effect. Antihistamines are commonly used to reduce the amount of nasal secretion from allergies and colds. Chlorpheniramine, brompheniramine and diphenhydramine are the three most common. These medications generally give satisfactory relief with an acceptable level of side effects; however, as the dose of the antihistamine is increased, the most common side effect drowsiness can present a problem. This is so common that all packages carry a warning about operating a motor vehicle or doing other potentially dangerous activities while taking the drug.

Antihistamines can cause other side effects in addition to sleepiness, and these additional "side effects" are a greater problem for those over 65. Men over 65 are very likely to have enlargement of the prostate gland. The use of an antihistamine can transform a small, annoying prostate-related urinary problem into a serious one. The antihistamine can cause spasm in the muscles that block the flow of urine, making it difficult or impossible to voluntarily relax them to allow urination. Of course, the problem will revert to its previous manageable level once the body has eliminated the antihistamine, but by then the bladder can be uncomfortably full.

Antihistamines in non-prescription medications also pose a risk of worsening narrow-angle glaucoma, a common eye disease that can lead to blindness in those over 65. In addition, they can also cause troubles for individuals with some types of stomach troubles and those with asthma. Fortunately, you can probably safely take antihistamines if you are without any of these health problems, regardless of your age.

Decongestants are often part of the ingredients in cold and allergy medications. Pseudoephedrine and phenylpropanolamine are the most frequently used. They are added to help open a "stopped up" nose and to improve chest congestion, which they do fairly well. However, they too cause side effects. Raising high blood pressure, causing a fast or irregular heart beat, and aggravating diabetes and hyperthyroidism are the most common.

Since side effects to non-prescription drugs are more common in those over 65, it is wise for older individuals to be particularly cautious about using them. I suggest that you should only take these medications with the specific recommendation of your family doctor, particularly if you have any of the conditions I've described.

Family Medicine® is a weekly column. To submit questions, write to John C. Wolf, D.O., Ohio University College of Osteopathic Medicine, Grosvenor Hall, Athens, Ohio 45701.