Overmedication describes the excessive use of

over-the-counter Over-the-counter (OTC) drugs are medicines sold directly to a consumer without a requirement for a prescription from a healthcare professional, as opposed to prescription drugs, which may be supplied only to consumers possessing a valid pres ...

or prescription medicines for a person. Overmedication can have harmful effects, such as non-adherence or interactions with multiple prescription drugs.

Over-the-counter medication overuse

Over-the-counter (OTC) medications are generally first-line therapies that people may choose to treat common acute illnesses, such as fevers, colds, allergies, headaches, or other pain. Many of these medications can be bought in retail pharmacies or grocery stores without a prescription. OTC medication overuse is most prevalent in adolescents and young adults. This overuse is common due to the relatively low cost, widespread availability, low perceived dangers, and internet culture associated with OTC medications. OTC medications may be combination formulations that contain multiple drugs. These combination formulations are often used with other substances, which complicates treatment for these types of overdoses. Furthermore, the easy access to information online can sometimes lead to self-diagnosis and self-medication, contributing to the potential for misuse and overuse.

Acetaminophen

Overuse of acetaminophen is the leading cause of

liver failure Liver failure is the inability of the liver to perform its normal synthetic and metabolic functions as part of normal physiology. Two forms are recognised, acute and chronic (cirrhosis). Recently, a third form of liver failure known as acute- ...

in the

Western world The Western world, also known as the West, primarily refers to various nations and state (polity), states in Western Europe, Northern America, and Australasia; with some debate as to whether those in Eastern Europe and Latin America also const ...

. The maximum daily limit of acetaminophen is 4 grams per day for someone with a healthy liver. It is also highly recommended to not go over the maximum daily limit. Exceeding the maximum daily limit could involve severe

liver toxicity Hepatotoxicity (from ''hepatic toxicity'') implies chemical-driven liver damage. Drug-induced liver injury (DILI) is a cause of acute and chronic liver disease caused specifically by medications and the most common reason for a drug to be withdr ...

, liver failure,

kidney failure Kidney failure, also known as renal failure or end-stage renal disease (ESRD), is a medical condition in which the kidneys can no longer adequately filter waste products from the blood, functioning at less than 15% of normal levels. Kidney fa ...

, or even death. People who have poor liver function or with chronic alcohol use disorder should either limit or not ingest acetaminophen to prevent morbidities. Additionally, acetaminophen is an ingredient in many combination medications, increasing the risk of unintentional overdose. Consumers should read labels carefully and consult healthcare providers to ensure they are not consuming excessive doses. In cases of suspected overdose, immediate medical attention is needed to mitigate potential life-threatening consequences.

Codeine

Codeine Codeine is an opiate and prodrug of morphine mainly used to treat pain, coughing, and diarrhea. It is also commonly used as a recreational drug. It is found naturally in the sap of the opium poppy, ''Papaver somniferum''. It is typically use ...

is an

opioid Opioids are a class of Drug, drugs that derive from, or mimic, natural substances found in the Papaver somniferum, opium poppy plant. Opioids work on opioid receptors in the brain and other organs to produce a variety of morphine-like effects, ...

and shares similarities to other opioid overuse. Many OTC medications for cough have formulations that contain codeine, which people may seek to overuse. The common effects of codeine include

miosis Miosis, or myosis (), is excessive constriction of the pupil.Farlex medical dictionary
citing: ...

respiratory depression Hypoventilation (also known as respiratory depression) occurs when ventilation is inadequate (''hypo'' meaning "below") to perform needed respiratory gas exchange. By definition it causes an increased concentration of carbon dioxide (hypercapni ...

, CNS depression, and decreased bowel motility. Despite the risk of death, dependence is another significant issue related to codeine overuse. Tolerance can cause users to use more opioid, leading to dependence, especially with chronic daily use of codeine. Additionally, the misuse of codeine-containing cough syrups has become a public health concern, as it can serve as a gateway to stronger opioids. Education about the risks and signs of opioid addiction can play a role in prevention and early intervention.

Dextromethorphan

Dextromethorphan Dextromethorphan, sold under the brand name Robitussin among others, is a cough suppressant used in many cough and Common cold, cold medicines. In 2022, the US Food and Drug Administration (FDA) approved the combination dextromethorphan/bupropi ...

, also shortened to DXM, affects the

NMDA receptor The ''N''-methyl-D-aspartate receptor (also known as the NMDA receptor or NMDAR), is a glutamate receptor and predominantly Ca2+ ion channel found in neurons. The NMDA receptor is one of three types of ionotropic glutamate receptors, the other ...

and serotonin receptors which is believed to give its psychoactive effects at high doses. Similarly to codeine, DXM comes primarily in formulations that contain other OTC medications and is not common to find DXM on its own. Moreso, people who use DXM tend to use it concomitantly with other substances such as alcohol,

hallucinogens Hallucinogens, also known as psychedelics, entheogens, or historically as psychotomimetics, are a large and diverse class of psychoactive drugs that can produce altered states of consciousness characterized by major alterations in thought, mo ...

, sedative drugs, and opioids. DXM has dose dependent psychoactive effects with lower dose leading to more restlessness and

euphoria Euphoria ( ) is the experience (or affect) of pleasure or excitement and intense feelings of well-being and happiness. Certain natural rewards and social activities, such as aerobic exercise, laughter, listening to or making music and da ...

and higher doses causing hallucinations, delusional beliefs, paranoia, perceptual distortions,

ataxia Ataxia (from Greek α- negative prefix+ -τάξις rder= "lack of order") is a neurological sign consisting of lack of voluntary coordination of muscle movements that can include gait abnormality, speech changes, and abnormalities in e ...

, and out of body experiences.

Diphenhydramine

Diphenhydramine Diphenhydramine, sold under the brand name Benadryl among others, is an antihistamine and sedative. Although generally considered sedating, diphenhydramine can cause paradoxical central nervous system stimulation in some individuals, particula ...

is typically used for allergy relief, although it may be used to alleviate sleeping problems, anxiety, and overall restlessness. Effects may include euphoria, hallucinations, or

psychosis In psychopathology, psychosis is a condition in which a person is unable to distinguish, in their experience of life, between what is and is not real. Examples of psychotic symptoms are delusions, hallucinations, and disorganized or inco ...

. The anticholinergic activity of diphenhydramine may lead to

tachycardia Tachycardia, also called tachyarrhythmia, is a heart rate that exceeds the normal resting rate. In general, a resting heart rate over 100 beats per minute is accepted as tachycardia in adults. Heart rates above the resting rate may be normal ...

dry mouth Xerostomia, also known as dry mouth, is a subjective complaint of dryness in the mouth, which may be associated with a change in the composition of saliva, reduced salivary flow, or have no identifiable cause. This symptom is very common and is o ...

, blurred vision,

mydriasis Mydriasis is the Pupillary dilation, dilation of the pupil, usually having a non-physiological cause, or sometimes a physiological pupillary response. Non-physiological causes of mydriasis include disease, Physical trauma, trauma, or the use of c ...

, depression, and urinary retention. In 2020, purposeful overmedication with Benadryl (diphenhydramine) was a concern due to use of social media by teenagers in the United States, with the FDA issuing a public warning about the possibility of seizures, hallucinations, breathing difficulty or loss of consciousness.

Pseudoephedrine

Pseudoephedrine Pseudoephedrine, sold under the brand name Sudafed among others, is a sympathomimetic medication which is used as a decongestant to treat nasal congestion. It has also been used off-label for certain other indications, like treatment of lo ...

ephedrine Ephedrine is a central nervous system (CNS) stimulant and sympathomimetic agent that is often used to prevent hypotension, low blood pressure during anesthesia. It has also been used for asthma, narcolepsy, and obesity but is not the preferred ...

or phenylpropanolamine can be overused with the intent for weight loss or improving athletic performance, possibly causing

insomnia Insomnia, also known as sleeplessness, is a sleep disorder where people have difficulty sleeping. They may have difficulty falling asleep, or staying asleep for as long as desired. Insomnia is typically followed by daytime sleepiness, low ene ...

, diminished sense of fatigue, euphoria, and psychotic behavior. The habitual use of the medication has led to dependence, with symptoms of restlessness, dysphoria, and distorted perceptions on withdrawal.

Elderly

Seniors (65 years old and up) are possible users of overmedication. Seniors are disproportionately affected by not only adverse drug events, but also

drug interaction In pharmaceutical sciences, drug interactions occur when a drug's mechanism of action is affected by the concomitant administration of substances such as foods, beverages, or other drugs. A popular example of drug–food interaction is the effect ...

s and more hospital admissions. The term for individuals taking five or more medications is

polypharmacy Polypharmacy (polypragmasia) is an umbrella term to describe the simultaneous use of multiple medicines by a patient for their conditions. The term polypharmacy is often defined as regularly taking five or more medicines but there is no standard ...

, which commonly occurs in elderly people, increasing their risk of overmedication. Medical providers are generally hesitant to prescribe polypharmacy in the elderly due to the risk of harmful drug interactions. Concerns with polypharmacy and elderly groups are reduced medication adherence, increased fall risk, cognitive function impairment, and adverse drug reaction. Almost 75% of clinic visits result in people obtaining a written prescription. More careful prescribing practices could increase medication adherence in elderly people. Single-pill combination formulations make it easier for a person to monitor medications.

Overprescription

Opioids

Opioids are used for pain management acutely or prescribed after a surgical procedure. While opioids aid in short- and long-term pain management, overprescription or constant opioid-exposure increases the risk for addiction. There is a rise within healthcare systems to manage prescription of opioids. Children prescribed opioids may become susceptible to the harms of addiction. Reducing or withdrawing prescribed opioids, such as for people with chronic non-cancerous pain, using either dose-reduction or stopping opioid prescriptions, may be effective, but standards are absent for managing withdrawal symptoms and deprescribing coprescription of sedatives. Studies found a significant increase in opioid surplus disposal when individuals were provided with the necessary education or disposal kits.

Antibiotics

As antibiotics inhibit bacterial infections, they are a commonly prescribed medication. Overuse of these medications over the years has contributed to reduced efficacy against certain bacteria due to

antimicrobial resistance Antimicrobial resistance (AMR or AR) occurs when microbes evolve mechanisms that protect them from antimicrobials, which are drugs used to treat infections. This resistance affects all classes of microbes, including bacteria (antibiotic resista ...

, a global medical concern. Antibiotic overprescription is a potential problem in acute care, primary hospitals, and dental offices. Antibiotic-resistant bacterial infections are increasing. A systemic review of admitted

COVID-19 Coronavirus disease 2019 (COVID-19) is a contagious disease caused by the coronavirus SARS-CoV-2. In January 2020, the disease spread worldwide, resulting in the COVID-19 pandemic. The symptoms of COVID‑19 can vary but often include fever ...

patients who were prescribed antibiotics showed that 80% of the admitted people were given antibiotics upon admission without confirmed bacterial coinfections. Physicians prescribe antibiotics for non-indicated diagnoses, such as viral infections, possibly contributing to more antibiotic-resistant infections, greater adverse drug events, more drug-drug interactions, and deaths. Dentists may prescribe antibiotics for non-indicated conditions that could otherwise be treated with other interventions, according to clinical guidelines.

References

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