What health risks may be hiding in your medicine cabinet?

Unused or expired medicines

We've all taken a bottle of medication out of the cabinet only to find that it expired months or even years ago. You may wonder, "Can I still take it? Surely a few months won't make a difference?", but this sort of reasoning can pose a risk to your health.

It is important to know that the expiry date on a medicine is the final day that the manufacturer guarantees the full safety and potency of the medicine. With time, medical products can lose their effectiveness and become a risk for consumption due to change in chemical composition or decrease in strength. Plus, certain medications like antibiotics may develop bacterial growth and sub-potent antibiotics can fail to treat infection, leading to antibiotic resistance or exacerbation of the illness.

The bottom line: If your medicine is past its expiry date, do not use it. You can learn more about what to do with unused or expired medications in our article here: Where to dispose of expired or unused medication?

Paracetamol

Paracetamol is one of the most widely used painkillers and fever reducers in the UK. However, when used improperly it can pose a threat to our health. Once ingested, paracetamol is metabolised by the body and one of its metabolites (by-product of metabolism) is active and toxic for the liver. Our body can fight against this toxicity thanks to glutathione, which renders the active metabolite of paracetamol inactive. Unfortunately, glutathione takes a long time to produce and is in short supply in our bodies. This is why it is important to not take more than the maximum dose indicated by your doctor or on the back of the bottle.

Moreover, it is important to note that paracetamol is also present in a number of combination medicines, such as: 

• In combination with tramadol (Tramacet®)
• In combination with caffeine (Paracetamol/Caffeine)
• In combination with aspirin and caffeine (Anadin Extra®) 
• In combination with codeine (Co-Codamol®)

Paracetamol is also present in cold medicines such as: 

• Lemsip Max®, Sudafed Sinus Max®,Beechams Flu Plus® in combination with phenylephrine hydrochloride and caffeine
• Night Nurse Cold and Flu®, in combination with promethazine hydrochloride and dextromethrophan hydrobromide
• Sinutab®, in combination with pseudoephedrine

Care should therefore be taken when taking medicines containing paracetamol so as not to exceed the permitted daily dose. 

Paracetamol poisoning starts with abdominal pain or nausea in the first few hours and then liver damage in the following days. If you experience these symptoms after taking paracetamol, call 999 immediately. 

Aspirin

We all often keep different forms of pain and fever relievers at home, especially aspirin. Though aspirin is safe for most adults, older people who take blood thinners for heart conditions should take caution with it. Taking both aspirin and a blood thinner can cause bleeding in the stomach or intestines.

If you share your medicine cabinet with others or it is easily accessible, it is important to keep aspirin away from children under 2 or children and teens recovering from illnesses with flu-like symptoms. In such cases, aspirin has been known to cause Reye's syndrome, a rare but serious condition which can cause swelling in the brain or liver.

Other NSAIDs

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Nurofen®, Calprofen®) and Naproxen (Stirlescent®, Naprosyn®) are also a common staple of our home pharmacies as they can help with pain and swelling. These medications, however, also thin your blood.

As with aspirin, patients taking prescription blood thinners should use NSAIDs with caution as they can cause severe bleeding. If taken too often, NSAIDs can also increase the likelihood of heart attack or stroke and can damage the kidneys, especially in case of pre-existing kidney problems.

Cotton buds

Cotton buds are useful for a variety of things - applying makeup, doing your nails, crafts, or even helping in certain odd jobs around the house. Despite their utility, it is important to never stick them - or anything else - into your ear canal.

While earwax can sometimes be uncomfortable or unsightly, you may do more harm than good in trying to remove it. Earwax is part of the body's natural defences and not a sign of illness; by poking around with a cotton bud when you can't see you put yourself in danger of irritating, scratching or cutting the ear canal or even damaging the ear drum. If ever your ear hurts, is itchy or you feel like something may be caught in there, make sure to contact your doctor.

Antihistamines

Antihistamines help with allergy symptoms like sneezing, runny nose, cough and itchiness, so it can be handy to keep a box around the house. These drugs, however, can also make you drowsy, lightheaded, anxious or confused, and can affect your appetite, sleep, and libido. Antihistamines have also been known to cause vomiting, diarrhoea, and constipation.

Common antihistamines include:

• Chlorphenamine (Piriton®)
• Acrivastine (Benadryl Allergy Relief®)
• Promethazine hydrochloride (Periactin®)
• Cetirizine (Benadryl Allergy One A Day®, Zirtek®)
• Fexofenadine (Telfast®)
• Loratidine (Clarityn®)

Mouthwash

Mouthwash, also called "oral rinse", usually is made of antibacterial ingredients to clean between the teeth, as well as other ingredients for flavouring. Some forms contain alcohol as an inactive ingredient, while other forms are alcohol-free.

In some people, mouthwash can cause some unpleasant side effects such as nausea, vomiting, xerostomia (dry mouth), and canker sores. Mouthwash can also kill off your healthy oral microbiome (the healthy bacteria that live in your mouth and help break down food and maintain teeth and gums), so it is recommended to use it sparingly.

It is also recommended to store your mouth wash out of reach of children, as kids under the age of 6 are more likely to swallow some by mistake.

Pseudoephedrine

Pseudoephedrine is a vasoconstrictor and decongestant molecule. This means that its action causes blood vessels to constrict. In addition, it can reduce the blood supply to an organ. Pseudoephedrine-based medicines are available over the counter in pharmacies to treat the common cold. 

However, this molecule can cause significant side effects, including cardiovascular and neurological effects that can be potentially fatal. Indeed, vasoconstrictors can increase heart rate, cause heart palpitations and nausea. Pseudoephedrine can also cause serious neurological effects such as seizures, hallucinations and agitation, especially in the case of overdose. 

Therefore, two drugs containing pseudoephedrine should not be combined. Pseudoephedrine should also not be taken by patients with: 

• Liver failure
• Acute angle closure glaucoma 
• A history of seizures 
• A history of stroke 
• Monoamine oxidase inhibitors (MAOIs, a class of antidepressants)
• Severe heart failure

In conclusion, for many of us, our bathroom cabinet has become a true home pharmacy with remedies for every ache, pain, abrasion or sniffle we may encounter. However, this does not mean that these treatments are always safe or used properly. It is important to take care to use all medical products as directed and to not to forget to properly dispose of any products that are past their expiry date.

As always, before taking any medicine, make sure to ask your doctor or pharmacist for advice, specifying your state of health and any treatments you are taking.   

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