For patients with diabetes, not all over-the-counter drugs are safe
INDIANAPOLIS — The idea that any medication available without a prescription is safe to take can be a dangerous one for those with diabetes, who risk spikes in blood glucose and blood pressure by taking the wrong medication for something as simple as the common cold, according to a speaker here.
Miranda Wilhelm, PharmD , clinical associate professor at Southern Illinois University Edwardsville School of Pharmacy, said that nonprescription medications can have contraindications and drug interactions similar to those posed by prescription medications. A pharmacist, she said, can help recommend a nonprescription medication that will both treat the minor ailment and be safe to take with prescription medications for diabetes.
“Many liquid cough and cold medicines contain carbohydrate and alcohol,” Wilhelm told Endocrine Today before her presentation at the American Association of Diabetes Educators annual meeting. “Sometimes this amount can be significant to affect blood glucose levels. The content of these ingredients is not included on the drug facts label. Sugar-free options are sometimes available, but might not always be required.”
The drug facts label was standardized by the FDA in 1999, Wilhelm said, and includes six required sections: active ingredients, including its strength, class and purpose; uses (indication); warnings (usually divided into several sections); directions for use; other information (oftentimes storage information) and inactive ingredients. The manufacturer determines what warnings and precautions appear on the label, Wilhelm said.
It is the label’s listed, but often ignored, inactive ingredients, Wilhelm said, that should be carefully examined by a patient with diabetes.
“A lot of times the flavorings, the colorings, the pill binders, those are the types of ingredients listed in this section,” Wilhelm said during her presentation. “For us, this is how we can identify whether the product contains sugar or not so we can counsel patients about how that might affect their blood glucose.”
Even nonprescription medicines without added sugar can pose a risk in the setting of diabetes, Wilhelm said. Sudafed, for example, contains the active ingredient suphedrine, a nasal decongestant. The drug is indicated for relieving sinus pressure from a stuffy nose. Under the label’s warning section, there is a note to consult a physician if the user has diabetes.
“So, we have to ask ourselves, why is this on here?” Wilhelm said. “The reason has to do with the mechanism of action. The way that Sudafed works is it is an alpha-adrenergic agonist. This drug binds to alpha receptors throughout the body and causes vasoconstriction, because it releases catecholamines, norepinephrine and epinephrine as it binds to those receptors.”
“In your nose, that’s great, because that helps to reduce that sinus pressure,” Wilhelm said. “But we know systemically that’s going to create a problem. It can raise blood pressure and potentially increase blood glucose.”
If someone has well-controlled diabetes, Wilhelm said, this drug can be an option for the short term.
“If they are controlled, this could potentially be an option, but if they’re not, I’m more concerned about recommending this product,” she said.
Another popular common-cold drug, NyQuil, can pose an even bigger risk for patients with diabetes, Wilhelm said. Active ingredients include the pain reliever acetaminophen, the cough suppressant dextromethorphan and doxylamine, a first-generation antihistamine, which provides the drug’s sedative effect.
What is not listed as an active ingredient — instead noted on the front of the bottle — is the inclusion of 10% alcohol, Wilhelm said.
“The dose of NyQuil is 30 mL, so it’s a shot,” Wilhelm said. “We all know that alcohol can reduce your blood glucose, so we have to be careful with any products containing alcohol.”
In addition, the drug’s inactive ingredients include high fructose corn syrup, Wilhelm said. Concerned, Wilhelm said she contacted the manufacturer to find out how this translated into carbohydrates.
“They stated NyQuil has 20 grams of carb in each dose,” Wilhelm said. “So, this is a snack. The question becomes, how much effect does that alcohol have on a patient or, the glucose part with the 20 grams of carbs. We have to make sure that our patients are aware of this. If you’re reading the back, the alcohol isn’t going to be listed. It’s on the front.”
A careful patient assessment, Wilhelm said, will help a pharmacist or other provider make the safest choice. Typical questions, Wilhelm said, should follow the acronym SCHOLAR-MAC: Symptoms, characteristics, history, onset, location of symptoms, aggravating factors, remitting factors, medications taken, allergies and coexisting medical conditions.
Wilhelm said diabetes educators should encourage patients to understand that nonprescription medicines can have risks similar to those of prescription medications.
“Tell patients to read the drug facts label,” Wilhelm said. “It’s really important for them to read the warnings to know if the products are safe to take or not. Just because you can get it without talking to your doctor doesn’t mean it’s safer. Encourage your patients to tell their health care provider about all the drugs they take. And, ask your pharmacist questions.”– by Regina Schaffer
Wilhelm M. Walking Down the OTC Aisle: Self-Care for Patients with Diabetes. Presented at: American Association of Diabetes Educators; Aug. 4-7, 2017; Indianapolis.
Disclosures: Wilhelm reports no relevant financial disclosures.