Overdose: What to do when you take too much of your medicine?

By definition, an overdose is when a person takes more than the normal or recommended amount of a substance, whether it’s a prescription medication, over the counter, legal or illegal.

Whether intentional or accidental, an overdose can result in serious, harmful symptoms or even death. The severity of the overdose depends on the substance taken, the amount, and the physical and medical history of the person affected.

When you live with chronic illness, you may be affected by polypharmacy, or the simultaneous prescription of multiple drugs. Both medication and symptom management can be a challenge, so risk of accidental overdose can be raised in people living with multiple health conditions.

What are the symptoms of a medicine or drug overdose? 

As mentioned above, the symptoms of a medicine or drug overdose vary on the person, the substance, and the amount taken. However, general symptoms may include:

• Drowsiness, dizziness, or weakness 
• Nausea or vomiting 
• Stomach pain 
• Difficulty swallowing (dysphagia) 
• Fever, chills (shivering) 
• Difficulty breathing 
• Excess production of saliva 
• Blue lips and skin (cyanosis) 
• Confusion 
• Double or blurred vision 
• Seizures 
• Loss of consciousness 

Common medicines involved in overdose

Over-the-counter pain-relievers 

Imagine you’re sick with the flu. You’ve taken medicine to reduce your fever, and now you want to relieve your stuffy nose, cough, and your aches and pains. So, you reach for another bottle in your medicine cabinet.

Does this sound familiar? If so, you may accidentally be putting yourself at risk of accidental overdose of over-the-counter (OTC) medication.

Because they are safe and effective when taken as directed, OTC pain and fever reducers like NSAIDs (ibuprofen - Nurofen, Calprofen; naproxen - Stirlescent; aspirin - Caprin, Disprin) and paracetamol (Anadin, Panadol) are often combined with other active ingredients in many medicines.

It is important to be careful not to take more than one medicine with the same active ingredient when you are sick. For example, if you’ve taken ibuprofen to reduce your fever, you shouldn’t take another cold or flu remedy containing ibuprofen, or you’ll get a double dose.

Therefore, it is important to read the labels of every drug, whether OTC or prescription, before you take them. If you have any questions about a medicine or its ingredients, ask your doctor or pharmacist before taking it.

Paracetamol

Paracetamol (Anadin, Panadol, Calpol) is the most widely used pain reliever in the UK and is an active ingredient in over 600 different medications. While safe when used properly, it can be dangerous when you take more than the recommended dose – it can cause liver damage, which can lead to liver failure and even death.

It can be included in medicines for: pain or fever relief, migraines, menstrual pain, allergies, cold or flu symptoms, sinus or headaches, sleep.

Specific symptoms of acetaminophen poisoning include:

• Loss of coordination 
• Yellowing of the skin or whites of the eyes (jaundice) 
• Low blood sugar (hypoglycaemia), which can cause symptoms such as sweating, tremors, and irritability 

Aspirin

Aspirin (Caprin, Disprin) is an NSAID and an anti-platelet medicine that thins the blood and reduces the risk of formation of blood clots (arterial thrombosis). While NSAIDs are safe when taken as directed, they can lead to stomach bleeding and should not be given to children because they can cause Reye’s syndrome, a rare but life-threatening condition.

Specific symptoms of aspirin poisoning include: 

• Rapid breathing 
• Sweating 
• Temporary hearing loss 
• Ringing in the ears (tinnitus) 

Beta blockers 

Beta blockers, or beta-adrenergic blocking agents, are medicines used to treat conditions affecting the heart or blood, such as high blood pressure (hypertension), heart failure, and angina.

Specific symptoms of beta blocker overdose include:

• Slow heartbeat (under 60 beats per minute) 
• Low blood pressure, which can trigger light-headedness and fainting 

Calcium-channel blockers 

Calcium-channel blockers are used to treat high blood pressure and angina, as they prevent calcium from entering the cells of the heart and arteries.

Specific symptoms of calcium-channel blocker overdose include:

• Agitation 
• Slow heartbeat (under 60 beats per minute) 
• Low blood pressure, which can trigger light-headedness and fainting 
• Chest pain 

Tricyclic antidepressants 

Tricyclic antidepressants are some of the earliest antidepressants developed and are today often prescribed when newer antidepressants have failed. They are used in several mental health conditions, such as major depressive disorder, panic disorder, and obsessive-compulsive disorder (OCD).

Specific symptoms of tricyclic antidepressant overdose include:

• Dry mouth
• Enlarged pupils
• Excitability
• Irregular and rapid heartbeat
• Low blood pressure, which can trigger light-headedness and fainting 

Selective serotonin reuptake inhibitors (SSRIs) 

SSRIs are a newer form of antidepressant that are used in the treatment of mental health conditions like generalized anxiety disorder and OCD.

Specific symptoms of SSRI overdose include:

• Agitation 
• Tremors 
• Uncontrolled eye movements (nystagmus) 
• Severe muscle stiffness 

Benzodiazepines 

Benzodiazepines, or “benzos”, are a type of depressant often used on a short-term basis to treat anxiety and insomnia.

Specific symptoms of benzodiazepine poisoning include:

• Shallow breathing 
• Drowsiness 
• Difficulty with coordination and speech 
• Uncontrolled eye movements (nystagmus) 

What should you do if you’ve taken too much medication? How is overdose treated? 

If you experience any of the symptoms described above, you should contact NHS 111 for advice. NHS 111 is open 24 hours a day, 7 days a week, and will connect you with experts in poisoning who will give you further instructions.

If your symptoms are severe or you are advised to do so by NHS 111, you should call 999 to request an ambulance or head to your closest A&E department.

In hospital, an examination will be performed, and the following tests or treatments may be necessary:

• Blood and urine tests – to check the levels of chemicals and glucose in the blood 
• Chest-x-ray, EKG (electrocardiogram or heart tracing) – to check that the heart and lungs are functioning properly 
• Activated charcoal – to bind to the substance and stop it from being further absorbed into the blood 
• Medicines to treat symptoms, including antidotes (if they exist) – to prevent or reverse the effects of substance 
• Sedatives – in the case of agitation 
• Airway support (oxygen, intubation, or ventilation) – in the case of respiratory difficulties or arrest 
• Gastric lavage (stomach pumping) or induced vomiting - to remove the substance from the stomach 
• Laxatives - to remove the substance from the digestive tract

A large overdose can cause a person to stop breathing and can lead to death if not treated right away. If you receive medical attention before serious breathing issues occur, you will likely be fully recovered within 24 hours. However, an overdose can be fatal or can result in permanent brain damage if treatment is delayed.  

Depending on the drug or drugs taken, multiple organs may be affected. In that case, the person may need to be admitted to hospital to continue treatment. 

Conclusion 

Overall, it is important to remember that whether it is a prescription medication, an over-the-counter medicine, or an illicit substance, overdose can have serious consequences on your health.

To prevent potential overdose, here are a few safety tips:

• Read all labels on your prescription and OTC medications 
• Always take your medicines as directed, respecting the dosage and duration indicated by your doctor or listed on the packaging. 
• Talk with your doctor before adding any medications or changing your dosage. 
• If you have any questions about your medicines, talk with your doctor or pharmacist. 

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