Other Prescription and Over-the-Counter Drugs

Chapter 14

Overview Drugs that do not fit neatly into other

chapters include:• Birth control pills• Anabolic steroids• Over-the-counter drugs such as analgesics (such

as aspirin), antihistamines and other cold and allergy medications, diet pills, and sleeping aids

• Herbal remedies, hormones, and dietary supplements with psychoactive properties

• GHB• Inhalents

Birth Control Drugs The first birth control pill became available in

the early 1960s and had a profound impact on our culture

About 11.5 million women in the United States use the birth control pill, making it the most widely used form of contraception

The most common form of birth control pill is the combination pill which contains synthetic versions of the two female sex hormones: estrogen and progesterone

When used properly, the combination pill is one of the most reliable forms of birth control available

The birth control pill has been linked to such side effects as increased risk of heart attack and stroke due to blood clots

Mood changes, including severe depression, are often reported

Though the risk is low, other side effects include high blood pressure, benign liver tumors, and gall bladder disease

In an effort to minimize side effects of estrogen, the progestin pill, or minipill, was developed. It contains only progestin, a synthetic progesterone

Newer developments in birth control include the IUD, the vaginal ring, the patch

Such methods may eventually replace the birth control pill as the most popular means of birth control

In 2005, the use of Plan B (emergency contraception pills) was judged safe and effective by an FDA panel that recommended it be made available over the counter. This was controversial and thus not approved until late in 2006 for only women aged 18 and older

Even more controversial is RU-486, the abortion pill, taken during the first 49 days of pregnancy causing the embryo to be aborted

Anabolic Steroids Anabolic steroids are generally synthetic

versions of the male sex hormone testosterone used to promote the development of muscle mass and to enhance athletic performance

Testosterone – The male sex hormone which determines male sexual characteristics such as facial and chest hair (masculinizing effects), and helps build body tissues and repair damaged tissue (anabolic effects).

In 1990 the Anabolic Steroids Act was passed, which made these drugs Schedule III controlled substances

Physical side effects reported are acne, balding, and reduced sexual desire

Men often experience a decline in sperm count and enlargement of the breasts while women experience growth of facial and chest hair, breast shrinkage, deepening of the voice, and menstrual irregularities

Changes cholesterol levels that may increase the risk of heart disease

Damage to liver function with increased risk of liver cancer

In children or adolescents, premature bone fusion causing stunted growth and alteration of normal pubertal development are risks

Psychological effects include mild euphoria, increased energy levels, increased irritability and aggressiveness, mood swings, and even psychotic reactions have been reported

CONTEMPORARY ISSUE BOX 14.2 “BALCO, Bonds and Baseball” Highlights the controversy surrounding BALCO

and Barry Bonds, the implementation of a new steroid-testing policy with escalating penalties for positive tests, and discusses implications of widespread steroid use in sports.

The OTC performance-enhancing drug androstenedione, “Andro”, used by Mark McGwire during his record-breaking home run streak in 1998, was made illegal in 2004 because it was associated with many of the side-effects of anabolic steroids.

Over-the-Counter (OTC) Drugs The Food and Drug Administration (FDA)

divides drugs into two categories: those that require a prescription from a physician to purchase, and those considered safe enough to dispense without a prescription

OTC drugs are evaluated on two criteria: safety and efficacy

(GRAS) – “generally recognized as safe” (GRAE) – “generally recognized as effective”

Analgesics Three major analgesic drugs are available

without prescription: aspirin, acetaminophen, and ibuprofen

Aspirin (Anacin, Bufferin, Excedrin) relieves pain, reduces fever, and is antiinflammatory. Its side effects include stomach irritation and bleeding.

Acetaminophen (Tylenol, Datril) is a potent analgesic drug, but it lacks the antiinflammatory effects of aspirin. It is also less likely to cause stomach irritation.

In high doses, acetaminophen may cause liver problems and as few as 10 Extra-Strength Tylenol can be lethal to a child

Other widely used OTC painkillers are ibuprofen and naproxen. Ibuprofen was a prescription drug (Motrin) until 1984 and is now marketed as Advil and Nuprin

Naproxen was approved as an OTC drug in 1994 and is marketed as Aleve and Naprosyn. They have effects similar to aspirin but are better tolerated

Cold and Allergy Medication Cold sufferers spend $1.3 billion on OTC

cold remedies in the united States every year Common ingredients are aspirin or

acetaminophen for aches, pain, and fever Other ingredients of nonprescription cold and

allergy medications include the decongestant pseudoephedrine, an expectorant such as guaifenesin, and an antitussive (cough suppressant) such as dextromethorphan.

Antihistamine are also common ingredients in OTC cold and allergy preparations .

Side effects such as drowsiness and fatigue limit their use for that reason yet the antihistamine diphenhydramine is the major ingredient in nonprescription sleeping pills.

Other side effects include thickening of mucus secretions, blurred vision, dizziness, dry mouth and nose, and sweating

OTC Stimulants and Sedatives The main ingredient in OTC stimulants is

caffeine Phenylpropanolamine (PPA) was a common

ingredient until 2000 when the FDA withdrew OTC approval because it was found to increase the rsik of stroke

Popular brands are No-Doz and Vivarin No-Doz contains the equivalent of one or two

cups of coffee

Herbal Products, Hormones, and Dietary Supplements The Dietary Supplement Health and

Education Act was passed in 1994 reducing the authority of the FDA to regulate herbal and other biological products that often contain psychoactive drugs

Many herbal drugs, amino acids, and hormones are marketed as dietary supplements. They include androstenedione, areca, DHEA, ephedra, ginkgo biloba, kava, melatonin, SAM or SAMe, St. John’s wort, and valerian

Androstenedione (“Andro”) is marketed as an alternative to steroids to enhance strength and performance

Areca is a palm tree cultivated in Southeast Asia , India, and Africa. The nuts of the palm, referred to as betel nuts, are chewed for a mildly stimulating effect much the way tobacco is chewed in the United States

Users develop a nicotine-like dependence

DHEA claims that it prevents heart disease, cancer, obesity, and diabetes. It is also said to be an “antiaging” hormone. There is no evidence for such claims but it does produce acne, premature baldness, and other side effects noted with anabolic steroids

The main psychoactive ingredient in ephedra is ephedrine, a potent stimulant which has been associated with many side effects and some deaths due to heart attack and stroke

Ginkgo Biloba is touted as a “smart drug” that enhances memory and concentration. Some studies have supported this claim in Alzheimer’s disease

Kava appears to produce a sedating or relaxing effect similar to alcohol or other depressant drugs. Supplement preparations sold in the U.S. imply it can relieve stress and anxiety

Melatonin is thought to regulate biological rhythms and sleep. It can reduce the time it takes for people to fall asleep, lengthen sleep time, and prevent “jet lag”

SAM or SAMe claims to promote “emotional well-being” and is hyped as a treatment for depression

St. John’s Wort is the poster child for the herbal alternatives movement due to its antidepressant effects

Valerain is used to treat insomnia and anxiety and some studies support its claims

GHB is a naturally occurring neurotransmitter that has the properties of a depressant drug. It began as a supplement but due to abuse problems is now tightly regulated as a Schedule I drug.

It has been approved for medical use in the treatment of cataplexy, a form of narcolepsy where there is a sudden loss of muscle control

Salvia Salvia divinorum, a potent hallucinogenic drug used

by the Mazatec people in religious ceremonies for centuries, is growing in popularity in the U.S.

It is not a scheduled drug and thus can be sold legally in most states but is most often purchased on the web or in smoke shops.

Though effects are short in duration (about an hour) they are often intense and produce a trance-like state

After a suicide in 2006 attributed to salvia, the DEA has begun to review it for scheduling in the future

Inhalants A large group of volatile compounds that can

alter consciousness when taken into the lungs. Many are organic solvents that can damage the brain

Other side effects and hazards include headache, rapid heart beat, eye problems, numbness of the extremities, permanent peripheral nerve damage, psychotic behavior, movement disorders, kidney failure, and death from cardiovascular collapse or suffocation