Over-the-Counter Medication Overuse and Bowel Obstruction
Over-the-Counter Medication Overuse and Bowel Obstruction
Acute kidney injury (AKI), often due to prerenal causes (volume depletion), is a frequent basis for hospital admission, accounting for as much as 10% of individuals admitted to the inpatient ward and 15% of those admitted to the intensive care unit; however, this is usually from urinary and not bowel obstruction, and the latter has limited description in the literature as a cause of AKI. To the knowledge of the authors of the current letter, it has never been described as secondary to a nonprescription medication such as loperamide for diarrhea.
This case depicts the drastic consequences that can occur from overuse of OTC medications in the elderly population. OTC medications are responsible in all age groups for a considerable percentage of overdose presentations to emergency departments. This is of particular concern in elderly adults because they represent the majority of admissions for adverse drug reactions. Although this has been attributed to such factors as age-related decrease in renal and hepatic metabolism, high body mass, and comorbidities, a lack of representation in many of the studies that drive drug dosing has exacerbated it. Drug–drug interactions due to polypharmacy are also a significant factor in elderly adults, with the average elderly adult taking six to nine medications concurrently, with potentially more than half available without a prescription. In addition, because of lack of pharmacy involvement, OTC medications can be absent from the medical record, often because of forgetfulness or an individual's belief in lack of risk based on the medication's nonprescription status.
In conclusion, although this is a dramatic and unusual presentation of bowel obstruction, the underlying cause, overuse of an OTC medication, is not; this emphasizes the importance of discussing and documenting all medication use in older adults—with patients and caregivers.
Discussion
Acute kidney injury (AKI), often due to prerenal causes (volume depletion), is a frequent basis for hospital admission, accounting for as much as 10% of individuals admitted to the inpatient ward and 15% of those admitted to the intensive care unit; however, this is usually from urinary and not bowel obstruction, and the latter has limited description in the literature as a cause of AKI. To the knowledge of the authors of the current letter, it has never been described as secondary to a nonprescription medication such as loperamide for diarrhea.
This case depicts the drastic consequences that can occur from overuse of OTC medications in the elderly population. OTC medications are responsible in all age groups for a considerable percentage of overdose presentations to emergency departments. This is of particular concern in elderly adults because they represent the majority of admissions for adverse drug reactions. Although this has been attributed to such factors as age-related decrease in renal and hepatic metabolism, high body mass, and comorbidities, a lack of representation in many of the studies that drive drug dosing has exacerbated it. Drug–drug interactions due to polypharmacy are also a significant factor in elderly adults, with the average elderly adult taking six to nine medications concurrently, with potentially more than half available without a prescription. In addition, because of lack of pharmacy involvement, OTC medications can be absent from the medical record, often because of forgetfulness or an individual's belief in lack of risk based on the medication's nonprescription status.
In conclusion, although this is a dramatic and unusual presentation of bowel obstruction, the underlying cause, overuse of an OTC medication, is not; this emphasizes the importance of discussing and documenting all medication use in older adults—with patients and caregivers.
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