treatment after overdoseMany people associate overdose with powerful illicit drugs like cocaine and heroin.
 
However, every year, tens of thousands of Americans overdose on common, everyday over-the-counter medications like Tylenol, Advil, and Benadryl. According to The Journal of Adolescent Health, acetaminophen and ibuprofen are the two most commonly ingested medications in adolescent suicide attempts via overdose. If more than the recommended dosage is taken in a short period of time, the risk of severe and potentially dangerous side effects increases substantially.

It can be difficult to determine the fatal amount of an over-the-counter medication for any particular individual due to the fact that there are so many factors that can affect that limit. These include a person’s body weight, other substances in their system such as alcohol, how much they’ve eaten that day, and how much of a tolerance they’ve build to that particular medication. There also haven’t been as many studies done on overdose from over-the-counter medications due to the fact that it isn’t as common as overdose from illegal or prescription drugs.

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The Most Dangerous Over-the-Counter Drugs

It’s possible to overdose on many different common drugs, but this typically requires an extremely high dose that would likely only be taken by someone attempting to commit suicide. However, there are tens of thousands of calls to poison control centers in the US each year from people concerned that they may have overdosed on an over-the-counter medication. Very few of these individuals die, but they may also experience severely unpleasant effects and sustain damage to vital organs that can cause problems in the future.

The over-the-counter medications most likely to cause overdose include:

  • Acetaminophen: Most commonly found in popular painkillers like Tylenol, but also found in numerous other medications such as cold and flu medicines. The maximum recommended dose for the average adult is 1000 mg every four hours with a maximum daily limit of 4000 mg. Overdose can result in liver damage or acute liver failure, possibly resulting in death.
  • NSAIDS: This is a group of medications that includes aspirin and Ibuprofen. The initial dose for an adult is typically between 81mg and 440mg, with the length of time between doses varying between specific medications. The most common dangerous overdose symptom is intestinal and stomach bleeding.
  • Codeine: Though it’s become more restricted in recent years, codeine is still available over the counter in certain cough medicines. As an opioid, too much codeine can cause dangerous respiratory depression. The maximum adult dose is 60 mg every four hours and 360 mg in a period of 24 hours.
  • Antihistamines: The active ingredient in medications like Benadryl cause significant drowsiness. The most common danger from this comes from people trying to operate heavy machinery, including vehicles, after taking too much of the drug. However, it can also cause irregular heartbeat, delirium, psychosis, seizures, and coma in extreme cases. The maximum safe dose for adults varies greatly depending on the specific medication. For Benadryl, it is generally 50mg every 4-6 hours for adults.

These are all recommendations for taking over-the-counter medications orally. Dosage limits may be different for different types of administration.

The best way to prevent an overdose of an over-the-counter medication is to read the directions and warning labels carefully. It’s also important to consult a medical professional if you’re taking any kind of medication at the same time, including other over-the-counter drugs. Most overdose cases and dangerous side effects from these substances come from mixing them with other drugs that have similar properties or interact badly. Any time an overdose is suspected, a poison control center or emergency services should be contacted immediately.

Dextromethorphan

This drug, commonly called DXM, is found in over-the-counter cough and cold medicines like Robitussin, Nyquil and Dayquil, Theraflu, Tylenol Cold, and more. It is a cough suppressant that has largely replaced codeine in the US, likely due to its availability, effectiveness, and safety when used as directed. However, DXM has also become a subject of abuse, although it is still legal and found in many OTC drugs.

It is possible to overdose on DXM through nonmedical use. Symptoms of DXM overdose include:

  • Breathing problems, including depressed or irregular breathing
  • Blurred vision
  • Constipation
  • Convulsions or seizures
  • Extreme drowsiness
  • Sleepiness; falling unconscious and not waking up
  • Hallucinations
  • Changes in blood pressure, either high or low
  • Muscle twitches
  • Heart palpitations and rapid heart rate
  • Nausea and vomiting
  • Raised body temperature
  • Spasms of the stomach and intestines
  • Coma
  • Death
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    Is an Overdose More Likely if Medications Are Mixed?

    Although over-the-counter medicines are designed to be low-dose and low-impact on the body, mixing them can lead to overdose. Often, people do not think about what goes into OTC medications, which can lead to serious side effects.

    One of the most common types of OTC overdose involves acetaminophen. The painkiller is sold on its own, in sinus drugs, and in cold and flu medications because it is effective in easing pain and reducing fever. However, when a person takes these drugs together, especially in a dose that is higher than recommended, they can accidentally overdose on acetaminophen.

    Antihistamines and motion sickness medications can also lead to overdose. These include medications like Dramamine and Benadryl. Combining these drugs can increase drowsiness, much like mixing alcohol and narcotics. Excessive sleepiness can lead to oversleeping, and it can also lead to coma.

    St. John’s wort, a common herbal supplement, interacts poorly with many medications, both prescription and over the counter. Cough medicine containing dextromethorphan can be extremely dangerous when mixed with this supplement; together, the two can trigger serotonin syndrome, which more often occurs when a person accidentally combines or takes too much of a prescription antidepressant.

    Dangers of Combining OTC Medications with Alcohol

    Most warnings against mixing drugs and alcohol come from prescription medications, like antibiotics or prescription painkillers; however, mixing OTC medicines with alcohol can also be very dangerous.

    For example, cold and flu medications containing acetaminophen can increase the risk of liver damage when combined with alcohol. The combination also increases the risk of ulcers, rapid heartbeat, and stomach upset. DXM in those same medicines increases sedation when mixed with alcohol, which intensifies the risk of depressed breathing, lack of oxygen, coma, and death.

    Some liquid medications, like over-the-counter cough syrups, contain a small amount of alcohol. Some people struggling with alcohol use disorder purchase these drugs in order to abuse the alcohol component, and sometimes they combine the medications with additional alcohol. This practice increases the chance of suffering from alcohol poisoning.

    Heartburn medications mixed with alcohol can cause increased heart-rate and sudden blood pressure changes, as well as increasing the effect of alcohol, which could be very dangerous as people can become much more intoxicated than they would expect based on the amount of alcohol they’ve consumed. Dramamine and other anti-nausea or motion sickness medicines can increase sleepiness or drowsiness, cause dizziness, and cause overdose.

    Mixing many drugs with alcohol increases the risk of dangerous or harmful side effects. This is true for over-the-counter medications as well as prescription medicines.