What Risks Lurk In Your Medicine Cabinet?

By Christine Gorman

It's bad enough when prescription drugs like Vioxx and Celebrex turn out to have secondary effects that can kill you. But when a popular over-the-counter pill like Aleve (also known as naproxen) makes front-page news, linked to a 50% increased risk of heart attack, you've got to wonder what's going on. After all, most of us assume that any drugs sold over the counter--that is to say, without a doctor's prescription--must be pretty darn safe. And in general they are, when taken as directed--usually for just a few days--or in modest doses.

Aleve may yet get a clean bill of health. The National Institutes of Health issued its warning on naproxen based on a study of long-term use that hasn't been completely analyzed--and is contradicted by other findings. But the latest rash of drug scares serves as a timely reminder that even the safest FDA-approved medications can have side effects--some of them serious. (Don't think you're in the clear if you take herbals and other alternative remedies. Much less is known about their safety.)

In the chart that follows we take a closer look at the risks and benefits of some of the most common nonprescription drugs--some of which are probably sitting in your medicine cabinet right now.

NAPROXEN

Aleve, Anaprox, Naprosyn

BENEFITS: Relieves pain, tenderness and swelling. RISKS: Stomach irritation and bleeding. Drowsiness. Unpublished data suggest it may promote heart disease, but other studies indicate a cardioprotective effect. If you experience blurred vision, skin rash, ringing in the ears or signs of internal bleeding, such as bloody vomit or dark stools, contact a physician.

IBUPROFEN

Advil, Motrin

BENEFITS: Relieves pain, tenderness and swelling. RISKS: Stomach irritation and bleeding. May interfere with the cardioprotective benefits of aspirin. There was a report last week of a child who became blind following an allergic reaction. Get immediate medical attention if you experience blurred vision, skin rash, ringing in the ears or signs of internal bleeding.

PSEUDOEPHEDRINE

Sudafed, Dimetapp, Drixoral Nasal Decongestant

BENEFITS: Relieves stuffy nose and opens airways. RISKS: Nervousness, restlessness and difficulty sleeping, particularly if combined with caffeine. Should not be taken by anyone with high blood pressure, glaucoma or kidney disease. Call your doctor immediately if you experience fast or irregular heartbeat, tremors or hallucinations.

OMEPRAZOLE

Prilosec

BENEFITS: Directly inhibits production of

stomach acid. Works best when taken for several days. RISKS: Stomach pain, mild rash, constipation. Can mask more severe problems such as gallstones or a narrowing of the esophagus. Increased the risk of developing pneumonia 89% in a recent study of elderly patients (presumably because the acids in the stomach were no longer strong enough to kill pneumonia-causing germs).

ASPIRIN

Bayer, Bufferin, Ecotrin and others

BENEFITS: Relieves pain, fever, redness and swelling. Can save your life if taken during a heart attack. May lower the risk of a future cardiac attack or stroke. RISKS: Stomach pain and gastrointestinal bleeding. Should not be given to children with fever or viral infections since a rare but serious blood disorder may result. Call your doctor immediately if you experience ringing in the ears, skin rash, difficulty breathing or signs of internal bleeding.

ACETAMINOPHEN

Tylenol

BENEFITS: Relieves pain and fever but not the stiffness, redness or swelling of arthritis. RISKS: Occasional stomach upset. Because so many products contain acetaminophen, it is relatively easy to overdose unintentionally. Administration of an antidote within eight hours provides the best chance for recovery. Although the mixture of any painkiller with alcohol may cause liver damage, doctors believe the combination with acetaminophen may be particularly problematic.

ANTIHISTAMINES

Benadryl, Alavert, Claritin, Chlor-Trimeton

and others

BENEFITS: Relieves itching, sneezing, runny nose and watery eyes. RISKS: Depending on the formulation, dry mouth, irritability, nervousness, irregular heartbeat, increased appetite, weight gain. Older types cause drowsiness (and may even be used as mild sleep aids). Children are at greater risk of suffering seizures. Nightmares, irritability and unusual excitement are also more likely to occur in children.

H2 RECEPTOR ANTAGONISTS

Tagamet, Zantac, Pepcid

BENEFITS: Indirectly reduces production of stomach acid. RISKS: Headache, diarrhea, dizziness. May be less effective when used with antacids. The combination of Tagamet (cimetidine) and Valium can trigger confusion. Use of these drugs increased the risk of developing pneumonia 63% in a recent study.

Note: Many of these products are available under their generic names