a pharmacist helps a customer asses a box of medicine in the aisle

Over the Counter Medications and the Liver

As a community pharmacist, I often witness customers self-selecting over the counter (OTC) medications to help various ailments. Many of us are aware of two offenders, that when consumed in excess, can harm the liver: acetaminophen and alcohol. It is very daunting to select the right product, especially given the abundance of options in drugstores. While your doctor is the best person to ask about what medications are safe for you, here are some tips to help navigate the OTC aisle at the drugstore:

Tip #1: Scan labels for the word “ethanol”

Alcohol is a large component of some OTC medications and functions as a preservative and commonly used for its drowsiness effect. For example, the alcohol content in some cough and cold products ranges from 0.5 – 70%. Cough and cold medications are particularly notorious for containing alcohol. While we don’t know the exact amount of alcohol that will start to impact the liver, total alcohol intake can add up easily from various sources. Read the labels found at the back of OTC medications, or look for alcohol-free formulations, if available.

Tip #2: Combine all your acetaminophen sources

Acetaminophen is used for headaches, cramps, fever, and various other aches and pains. The maximum daily dose of acetaminophen for most people is 4 grams (4,000 mg). This is equivalent to 8 tablets of regular strength (500 mg) acetaminophen. Check your maximum daily dose of acetaminophen with your doctor or pharmacist. Some people on certain drugs or with certain medical conditions have a lower daily maximum. Acetaminophen is found in many cough and cold products to help with aches and fever.  Remember that these sources also count within the daily acetaminophen limit! Some prescription pain medications also come formulated as a combination with acetaminophen. It is difficult to identify exactly the amount of acetaminophen that will start to negatively impact the liver, so it is recommended to reduce intake when possible.

Tip #3: Not all herbal products are safe

There are many herbal products that can affect the liver; These include, but are not limited to, valerian, niacin, and black cohosh. While some herbal products may seem safe because they are natural, herbals may also harm the liver. I would recommend avoiding the use of herbals unless you have been instructed by your doctor to take them. Be cautious of concentrated herbal teas, especially if they are consumed on a daily basis.

Tip #4: Avoid these OTC products if you are undergoing treatment for hepatitis C

St. John’s Wort and acid-reducing agents such as ranitidine and esomeprazole are not recommended if you are undergoing treatment for hepatitis C. These OTC drugs can reduce the effectiveness of your treatment.

It can be overwhelming to keep track of all the drugs that can harm the liver. Do not hesitate to ask the pharmacist involved in your care when starting new OTC medications – we are always happy to help! Your pharmacist can sit down with you and go over all your medications. Finally, it is a good idea to keep a list of all your medications, including OTC products, to share with your circle of care.

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