Pharmaceuticals are a multibillion dollar industry. And the competition to win your drug dollars is intense. All you have to do is turn on the television any evening or flip open just about any magazine and there they are: pills and liquids, drops and sprays, creams and lotions, patches and suppositories, chewable, injectable, extra-strength, fast-acting, long-lasting -- whatever you want for whatever ails you.
Prescription medications are now heavily pitched directly to consumers -- and not just in print with that added page of tiny type, but increasingly on TV as well. And ever more prescription drugs are making the switch to nonprescription status: You can now buy more than 600 over-the-counter drugs that would have required a prescription less than 20 years ago.
There's no question that the vast majority of those heavily advertised, readily available medications can indeed have benefits. But it's also certain that even the most beneficial drugs can pose serious risks -- and many other drugs offer nothing of real benefit to compensate for those risks. You certainly can't figure out which is which from the advertising. And even your doctor or pharmacist may not tell you all you need to know. You've got to do your homework.
Last summer, our magazine, Consumer Reports on Health, quizzed more than 650 readers, selected at random, on the same questions listed here. You'll find the answers and a brief review of each topic beginning on page 12. You'll also have a chance to see how your peers fared. Rest assured that no one aced this exam. In fact, the average score was just nine correct answers out of 16 total questions. So don't get discouraged if you're stumped. The scoring box on page 13 will put your overall performance in perspective.
1. "Shotgun" cold remedies, which contain a combination of ingredients to treat a wide variety of symptoms, such as runny nose, cough, congestion and fever, aren't a good idea because:
a. Some ingredients often do nothing but trigger adverse effects.
b. They lock you in to fixed dosages of the various ingredients.
c. They may contain conflicting ingredients.
d. All of the above.
2. Using nasal decongestant drops or sprays for more than three days may cause "rebound" congestion.
3. For the headache and muscle pains sometimes associated with the common cold, acetaminophen (Tylenol) is generally the best choice since:
a. It's less likely to irritate the stomach.
b. It won't cause "rebound" headaches if you keep taking it.
c. It doesn't interact with alcohol.
d. All of the above.
4. Anti-inflammatory pain relievers, or NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), are usually best for osteoarthritis pain.
5. Antihistamines are usually best for nasal congestion caused by allergies.
6. For occasional heartburn, traditional antacids (such as Alka-Seltzer, Maalox, Rolaids and Tums) are just as effective as the newer "H2 blockers" (Axid AR, Pepcid AC, Tagamet HB, Zantac 75).
7. For high blood pressure, the newer drugs, such as ACE inhibitors and calcium-channel blockers, are generally safer and more effective than the older medications, beta blockers and diuretics.
8. Low-dose aspirin therapy can prevent:
a. An initial heart attack.
b. A repeat heart attack.
c. A stroke.
d. All of the above.
9. Antibiotics can promote the development of drug-resistant bacteria if you:
a. Stop short of the full course of treatment.
b. Take an excessively long course of treatment.
c. Either a or b.
d. Neither a nor b.
10. Medications can:
a. Boost exercise capacity.
b. Impair exercise capacity.
c. Have no effect on exercise capacity.
d. All of the above.
11. If a drug is going to cause a rash or other allergic reaction, that will usually happen the first time you use it.
12. Over-the-counter drugs are safer than prescription drugs because they won't cause side effects if you stay within the recommended dosage.
13. Older people must take a higher dosage of many medications to get the same effect as younger people.
14. Medicine will retain its potency until the expiration date if you store it properly.
15. To save money on medication, it's often a good idea to have your doctor prescribe pills at twice your usual dosage and then split them in half at home.
16. A tableware spoon provides a good measure of a teaspoon for taking liquid medicines.
The Answers: How'd You Do?
Here are the correct answers to the 16 questions--and a look at how many readers got them right.
If you're keeping score, award yourself one point for each right answer; then check the scoring box at the end. (If you think you've been cheated by a trick question, you have permission to count your answer as correct.)
1--"Shotgun" cold remedies, which contain a combination of ingredients, aren't a good idea because:
d. All of the above. (62 percent of the readers tested answered correctly.)
"Shotgun" remedies are loaded with multiple ingredients in order to blast several symptoms at once. That's not just overkill, it's a misfire--for each of the reasons listed:
Of the various active ingredients, some are apt to (a) do nothing but trigger adverse effects. The decongestant phenylpropanolamine can raise blood pressure. Antihistamines, effective against allergies, often do little for a cold and can make you drowsy. And any ingredient targeted at a symptom you're not currently experiencing is obviously a dud.
Moreover, shotgun remedies (b) lock you into fixed dosages of the various ingredients that can't be adjusted to suit the severity--or even the presence--of any particular symptom. As for (c) conflicting ingredients, consider this illogical combination: In many remedies, one ingredient loosens phlegm, making it easier to cough up, while another ingredient in the formula suppresses coughing.
We could go on, but suffice it to say that the best strategy is to decide what's ailing you and seek out the single-ingredient products that effectively address only those symptoms.
2--Using nasal decongestant drops or sprays for more than three days may cause "rebound" congestion.
True. (91 percent of the readers tested answered correctly.)
The vast majority of readers surveyed recognized this time limitation (or guessed correctly). Nasal drops or sprays, or "topical" decongestants, have several advantages over oral varieties: They're highly effective, fast-acting and unlikely to cause side effects. However, they can indeed cause stuffiness worse than before if used for more than three days in a row.
3--For headache and muscle pains sometimes associated with the common cold, acetaminophen (Tylenol) is generally the best choice since:
a. It's less likely to irritate the stomach. (81 percent of the readers tested answered correctly.)
Everyone seems to have gotten the message that acetaminophen is least likely to upset the stomach. But roughly one in five readers were mistaken about two drawbacks that acetaminophen does share with the other over-the-counter pain relievers--including aspirin, ibuprofen (Advil, Motrin-IB), ketoprofen (Actron, Orudis KT) and naproxen (Aleve). Any of them can lead to rebound headaches if used too frequently. And each product poses an alcohol interaction risk in heavy drinkers: For acetaminophen, it's liver damage; for the others, stomach bleeding.
4--Anti-inflammatory pain relievers, or NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn), are usually best for osteoarthritis pain.
False. (17 percent of the readers tested answered correctly.)
The standard therapy for osteoarthritis used to be prescription-strength NSAIDs. But osteoarthritis pain, even when accompanied by inflammation, is often not caused by inflammation. Thus, reducing the swelling is not key to relieving the pain in those cases. So acetaminophen is generally the best first choice since it's gentlest on the stomach. If acetaminophen fails, relief may be found with any one of the other over-the-counter pain relievers, all of which have anti-inflammatory effects.
5--Antihistamines are usually best for nasal congestion caused by allergies.
False. (26 percent of the readers tested answered correctly.)
Antihistamines can often effectively relieve various allergy symptoms, including sneezing, runny nose and itchy eyes. But--with one recent exception--they can't unstuff the stuffed nose that troubles many allergy sufferers. Some products, such as Actifed and Seldane-D, attempt to overcome that handicap by adding a decongestant. But that's not the best strategy for long-term use, since decongestants can cause agitation, insomnia and increased blood pressure.
The exception is the prescription drug azelastine (Astelin), the first antihistamine nasal spray, which does indeed relieve stuffed nose. Other options that eliminate stuffiness as well as other allergy symptoms include cromolyn nasal spray (Nasalcrom) and prescription steroid sprays such as beclomesthasone (Beconase AQ, Vancenase AQ) and fluticasone (Flonase), though those drugs can take anywhere from three days to three weeks of regular use to have full effect.
6--For occasional heartburn, traditional antacids (such as Alka-Seltzer, Maalox, Rolaids and Tums) are just as effective as the newer "H2 blockers" (Axid AR, Pepcid AC, Tagamet HB, Zantac 75).
True. (72 percent of the readers tested answered correctly.)
Antacids neutralize stomach acid; H2 blockers suppress production of the acid. Both types of remedies can effectively eliminate heartburn pain--in different scenarios.
7--For high blood pressure, the newer drugs, such as ACE inhibitors and calcium channel blockers, are generally safer and more effective than the older medications, beta blockers and diuretics.
False. (49 percent of the readers tested answered correctly.)
Most doctors start treating hypertensive patients with either ACE inhibitors, such as enalapril (Vasotec) and lisinopril (Prinivil, Zestril), or long-acting calcium-channel blockers, such as diltiazem (Cardizem CD) and verapamil (Calan SR, Isoptin SR). But for most patients, the National Institutes of Health and most blood-pressure researchers recommend starting with the older, best-studied classes: diuretics, such as chlorothiazide (Diuril) or hydrochlorothiazide (Esidrix, Hydro-Diuril), and beta blockers, such as atenolol (Tenormin), metroprolol (Lopressor) and propranolol (Inderal LA).
Studies have clearly shown that the older drugs reduce the risk of hypertensive complications, including coronary disease and stroke; whether the newer drugs cut that risk is less clear. Diuretics and beta blockers are also less expensive and have a longer safety record. In general, ACE inhibitors, long-acting calcium channel blockers and various other classes of antihypertensives should be reserved for cases where there's a compelling medical reason or where the top choices don't do the trick.
8--Low-dose aspirin therapy can prevent:
d. All of the above. (79 percent of the readers tested answered correctly.)
For many people, aspirin is an inexpensive and powerful defense against (a and b) an initial or repeat heart attack, as well as (c) a thrombotic, or clot-related, stroke.
9--Antibiotics can promote the development of drug-resistant bacteria if you:
c. Stop short of the full course or take an excessively long course of treatment. (31 percent of the readers tested answered correctly.)
Either way you misuse antibiotics, you run the risk of breeding drug-resistant bacteria. If you stop too soon, you spare the bugs that can hang on the longest--and then only the toughest survive and multiply. On the other hand, overly long treatment may give any surviving bacteria time to develop new defenses.
Because of the the widespread misuse of antibiotics, many illnesses that had previously been readily cured can now be difficult to treat. Public health officials are trying hard to preserve the world's antibiotic arsenal by establishing guidelines for appropriate use. If your doctor prescribes an antibiotic, ask whether a briefer course might eradicate your infection--and then complete the full course prescribed, even if you feel better before it's over. And don't demand antibiotics for a cold or flu; antibiotics don't work against viral infections.
d. All of the above. (54 percent of the readers tested answered correctly.)
Some drugs--such as pain relievers for arthritis, oral sprays for asthma and ACE inhibitors for congestive heart failure--can (a) boost exercise capacity by controlling the disease symptoms or the underlying disease itself.
Many other drugs--ranging from prescription tranquilizers to over-the-counter decongestants--can (b) impair performance by sapping energy; depleting fluids; unsettling the nerves, stomach or gut; or dulling coordination, reflexes or judgment. (Naturally, still others would (c) have no effect on exercise capacity.)
If you suspect that a drug you're taking may be hampering your workouts, talk with your doctor. You may be able to resolve the problem by lowering the dosage, switching to a different drug or changing the timing of either your medication or your workout.
11--If a drug is going to cause a rash or other allergic reaction, that will usually happen the first time you use it.
False. (65 percent of the readers tested answered correctly.)
The fact is, a drug can't cause an allergic reaction the very first time you take it. That's because the body must become sensitized to the medication--which means a rash might break out after you've been taking the drug for days, or when you take it the second time, or the hundredth time.
Virtually any drug can provoke an allergic rash. Some common culprits: antibiotics, anticonvulsants, ACE inhibitors, sleep medications and tranquilizers. Substitute medications can usually be found.
Since a drug that causes a rash one time might cause a more serious reaction the next, be sure to carry a card in your wallet stating your allergies.
12--Over-the-counter drugs are safer than prescription drugs because they won't cause side effects if you stay within the recommended dosage.
False. (91 percent of the readers tested answered correctly.)
While over-the-counter drugs are generally safer than prescription drugs, it's not because they don't cause side effects at recommended dosages.
All medications cause problems in some users. It's just that the side effects of OTC drugs are usually less serious than those of prescription drugs. That's one of two criteria that must be met before the Food and Drug Administration will allow a medication to be sold without a prescription. (The other is that users typically don't need a doctor's help to diagnose the symptom being treated.)
Still, even an ordinarily mild side effect--such as drowsiness or stomach irritation--can be disastrous in some people or at certain times. So you need to be cautious with over-the-counter drugs, especially since you're responsible for monitoring yourself.
Be sure to read and follow label directions closely.
13--Older people must take a higher dosage of many medications to get the same effect as younger people.
False. (94 percent of the readers tested answered correctly.)
It's actually the other way around: Older people often need lower dosages. That's because, as the liver and kidneys age, they become less efficient at eliminating drugs from the bloodstream. So drugs can reach higher levels in the body and remain there longer. That makes them more potent--and more toxic--in older people.
Recommended "adult" dosages don't always take that difference into account, since they're typically based on trials involving young or middle-aged adults. If you're over 65, make sure your physician practices this benevolent form of age discrimination.
14--Medicine will retain its potency until the expiration date if you store it properly.
False. (5 percent of the readers tested answered correctly.)
The expiration date marked on drug packages is just an estimate of how long the unopened medication is likely to stay potent.
Once the container is opened, you can probably count on full potency for only about a year, if the medication is stored properly. Keep it in a cool, dry place--which probably rules out the bathroom "medicine cabinet"--and throw away the cotton packing, which actually draws moisture into the container. Mark the date the package was opened and, regardless of the printed expiration date, discard any remaining medication after a year.
15--To save money on medication, it's often a good idea to have your doctor prescribe pills at twice your usual dosage and then split them in half at home.
True. (16 percent of the readers tested answered correctly.)
Too bad so many consumers appear to be missing out on this cost-saving strategy. (Could it be that drug companies have discouraged the practice?)
If you take medication regularly, ask your doctor about a double-dose prescription. Then use a pill splitter (sold in pharmacies) to divide each tablet in half. However, don't attempt to split capsules or special long-acting pills; that could result in too much or too little medication reaching the bloodstream at once.
16--A tableware spoon provides a good measure of a teaspoon for taking liquid medicines.
False. (79 percent of the readers tested answered correctly.)
Common tableware "teaspoons" may hold anywhere from half as much to twice as much as an actual measured teaspoon. So for an accurate dose, use a standard measuring spoon.
Also, be sure to read the markings carefully when using dose-measuring cups included with some liquid medications.
Excerpted with permission from the January 1999 issue of Consumer Reports on Health.
SCORE YOUR ANSWERS
None of the 665 Consumer Reports on Health readers who took the quiz last summer earned more than 13 points; most earned nine points or less.
Here's a guide to your score:
0-6 points: Beware of adverse effects! (11 percent of readers)
7-8 points: Watch what you swallow. (30 percent of readers)
9-10 points: Good safety profile. (40 percent of readers)
11-13 points: Are you a pharmacist? (19 percent of readers)
14-16 points: Next time, don't peek! (0 readers)