Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen are some of the most commonly used medications, with more than 30 billion doses taken annually in the US alone. Unfortunately, NSAIDs aren&rsquo;t just widely used: they&rsquo;re also widely abused, with nearly one out of seven users going over the daily limit, according to a January 2018 study from the Boston University School of Medicine.

That may not seem like a big deal, but NSAIDs can have serious side effects&mdash;even when taken as prescribed, says <a href="https://www.sharecare.com/doctor/dr-charan-k-cheema">Charan K. Cheema, DO</a>, a family medicine physician with <a href="https://www.sharecare.com/group/saint-joseph-mercy-health-system">Saint Joseph Mercy Health System</a> in Saline, Michigan. And because side effects are dose-related, overdoing it makes them even more likely, leading to bigger problems than the aches, pain and fever you originally took the meds for.

Who overdoses and why 
The recommended daily limit of NSAIDs varies from drug to drug. For ibuprofen, the most popular NSAID, it&rsquo;s 1200 mg for over-the-counter (OTC) drugs and 3200 mg for prescription meds, divided into three or four doses over a 24-hour period. Study participants, who kept a daily diary of their NSAID use for one week, exceeded the limit in several ways:

<ul>
	<li>They took too much of a single NSAID at one time. This was more likely when people used meds calling for a one-pill dose versus the more common two-pill dose.</li>
	<li>They took two different NSAIDs at the same time.</li>
	<li>They failed to wait long enough before taking another dose.</li>
</ul>

Most participants in the study only took OTC meds. But those using prescription NSAIDs complied significantly better with the maximum dosage&mdash;only 2 percent exceeded the daily limit. This highlights the concern about the lack of medical oversight with OTC meds. &ldquo;People often think that these drugs are safe, even at higher doses, because they&rsquo;re available over the counter,&rdquo; says Cheema.

A poor understanding of dosing recommendations was common among study participants who took too much medicine, as were the attitudes that they could choose what dose to take and that it wasn&rsquo;t necessary to start with a low dose to see if it would do the trick. People who exceeded the limit also were more likely to have ongoing pain and poor physical function.

How too many NSAIDs can affect you 
NSAIDs can be hard on the stomach, causing minor troubles, such as indigestion and stomach ache, or more serious problems like irritation of the stomach lining, ulcers and bleeding in the stomach or bowel. Gastrointestinal (GI) issues are more likely if you&rsquo;re older because your stomach lining weakens with age, but even younger people who are predisposed to it can experience irritation with these types of medications, says Dr. Cheema.

Except for aspirin, which is a type of NSAID, these drugs are also linked to a greater risk for heart attacks and strokes. In fact, one 2017 systematic review and meta-analysis found that taking any dose of NSAIDs for one week, one month or more than a month was associated with a 20 to 50 percent increased risk of heart attack compared with not using these drugs&mdash;though the risk was greatest with higher doses and during the first month of use.

&ldquo;You really have to be careful when prescribing these types of medications to people who&rsquo;ve had a heart attack or are at increased risk of heart disease,&rdquo; Cheema cautions. In these cases, she says <a href="https://www.sharecare.com/health/acetaminophen/what-is-acetaminophen">acetaminophen</a>, which works differently than NSAIDs and doesn&rsquo;t increase the risk of heart attacks, may be a safer option.

<a href="https://www.sharecare.com/health/kidney-disease/article/high-blood-pressure-diabetes-watch-out">Kidneys</a> may be affected, as well. &ldquo;Over time, NSAIDs can reduce blood flow to the kidneys,&rdquo; says Cheema. For people with normal kidneys, taking too many NSAIDs for too long can result in chronic interstitial nephritis, a disease contributing to renal failure. Those with kidney function problems should use lower doses or shouldn&#39;t take NSAIDs at all.

Using NSAIDs safely 
To avoid side effects, take the lowest effective dose for the shortest amount of time. &ldquo;The longer you&rsquo;re on them, the higher the risks,&rdquo; says Cheema. While there&rsquo;s no dose that completely avoids all these risks, Cheema advises using NSAIDs no more than two to three times a week.

If you need to take these drugs for long periods, talk to your doctor for advice about how to reduce the risk of side effects. For instance, Cheema sometimes switches things up by having patients substitute a dose of acetaminophen instead of taking ibuprofen or naproxen (another NSAID) every time.

Another option: topical anti-inflammatories, which work well for localized pain near the surface of the skin, like joint pain from arthritis. Compared to pills, only a little of the drug from these creams, gels, liquids and patches makes it into your bloodstream; also, topicals don&#39;t cause GI stress, and may be a safer bet when it comes to heart health. In an October 2017 study published in the Journal of the American Heart Association, people who used topical NSAIDs&mdash;even those who already had heart disease&mdash;had fewer heart attacks and strokes than those who took oral NSAIDs.

Alternatives to NSAIDs 
When it comes to easing pain, medication isn&#39;t the only game in town.

<ul>
	<li>Heat, which relaxes muscles and boosts blood flow, and ice, which reduces swelling, can help. So can wearing a brace or elastic bandage to support the area that&rsquo;s hurting.</li>
	<li>Exercise and physical therapy may improve strength, function and range of motion to reduce pain, and boost energy and mood, as well.</li>
	<li>The <a href="https://www.sharecare.com/health/pain-management/slideshow/natural-ways-manage-pain">mindful breathing</a> done during meditation and yoga are also proven to help alleviate pain.</li>
</ul>

Other potentially effective non-drug therapies include <a href="https://www.sharecare.com/health/acupuncture/how-does-acupuncture-treat-pain">acupuncture</a> and <a href="https://www.sharecare.com/health/mind-body-therapies/how-biofeedback-therapy-works">biofeedback</a>; speak to your doctor if you&#39;re interested in these options for chronic pain.

Medically reviewed in March 2018.

How Much is Too Much Ibuprofen?

Has your doctor ever handed you a prescription that you&rsquo;ve been completely unable to read? But when you hand the mystery message over to the pharmacist, she says, &ldquo;No problem. You can pick it up in an hour.&rdquo; How can she possibly know what the doctor ordered, you wonder?

Well, fortunately, most of the time pharmacists get it right. But even when totally legible printed prescriptions are used, mistakes happen&mdash;51 million a year out of 3 billion medications dispensed, says&nbsp;Pharmacy Times. And while that&rsquo;s a small percentage, it&rsquo;s a huge number.

So, when you get a prescription, ask the doctor or his staff member what it says, and then write the info down on a separate piece of paper. This way, you can double check what you know to be correct with what the pharmacist says.&nbsp;<a href="https://www.sharecare.com/health/preventing-medical-errors/medication-error-pharmacy">But don&rsquo;t stop there</a>.

According to one Canadian study, it seems a lot of mistakes get made once the right med with the right dose comes home with you. Labels on medication bottles can be hard to read, so instead of taking one pill every four hours for three days, you may take three pills every four days&mdash;<a href="https://www.sharecare.com/health/health-care-basics/article/pill-refill-anxiety-medication-mixups">or some other mix-up</a>&mdash;and either fail to get the treatment you need or overdose yourself.

To fix this, check that you can easily read and understand the label BEFORE you leave the pharmacy. If you can&rsquo;t, ask for a do-over with clearer, cleaner, bigger type.

Medically reviewed in July 2019.

Your Prescription—Right From the Start

You know bisphenol A (BPA) is nasty stuff. Unfortunately, the bad news about this toxin just keeps on coming. A pair of just-released studies links BPA with heart disease, obesity, and diabetes risk.

BPA is an organic compound that&#39;s used in plastics, such as water bottles, the lining of canned goods, and thermal receipts. Problem is, BPA mimics estrogen in your body and is thought to disrupt hormone function. BPA is linked to a host of potential health problems, from fertility trouble to cancer to developmental delays in kids. <a href="https://www.sharecare.com/health/breast-cancer/how-toxins-contribute-breast-cancer" target="_blank">Learn more about the link between breast cancer, BPA, and other toxins</a>.

Reasons to seek BPA-free products 
A new study from Britain links high urinary concentrations of BPA in healthy men and women to a higher risk of heart disease 10 years later. In another new study, Chinese researchers linked high concentrations of BPA to obesity -- especially belly fat -- and insulin resistance (a forerunner of diabetes) in middle-aged and elderly people. American researchers have found a similar connection between BPA and type 2 diabetes. <a href="https://www.sharecare.com/health/diabetes-complications/prevent-diabetes-high-blood-pressure" target="_blank">Discover ways to help prevent diabetes</a>.

With that kind of news, you certainly don&#39;t want a side order of BPA every time you eat or drink. Simple changes can limit your exposure to BPA and possibly prevent diabetes, heart disease, obesity, and other health-related problems.

<ul>
	<li>Opt for fresh food. One study found that a diet of organic fresh food can reduce urinary levels of BPA and DEHP (a type of phthalate chemical that&#39;s also a hormone disruptor) by more than 50% in just 3 days.</li>
	<li>Look for BPA-free containers. When you do buy packaged foods, choose those in glass jars, aseptic packaging, and BPA-free cans.</li>
	<li>Store food in glass, ceramic, or stainless-steel containers. You can find plastic containers that are free of BPA, but some researchers have found traces of BPA in those, too.</li>
	<li>Shop for dry goods at the bulk bins. Pick up flour, rice, beans, dried fruit, cereal, and pasta at the bulk bins at health-food stores. Sure, you&#39;ll put bulk-bin finds into plastic bags, but you can transfer them to BPA-free containers as soon as you get home.</li>
	<li>Avoid microwaving food in plastic containers. The heat causes BPA and other chemicals to leach into food. Similarly, don&#39;t put plastic containers in the dishwasher.</li>
	<li>Don&#39;t handle thermal receipts. These are those carbonless receipts you collect everywhere you go, from the grocery store to the gas station to the ATM. Yep, they have BPA. Refuse receipts if you have the option. If you don&#39;t, wash your hands after handling them. BPA in thermal receipts can be absorbed through your skin, as well as ingested with food.</li>
</ul>

Medically reviewed in April 2018.

3 Reasons to Worry About Toxic BPA

From lowering cancer risk to boosting your beauty regimen, aspirin&rsquo;s a versatile little pill&mdash;but it&#39;s important to know the potential side effects.

Surprising Reasons to Take Aspirin (And When to Skip It)

If you&rsquo;ve got a fever and you&rsquo;re coughing, congested or battling a sore throat, chances are you&rsquo;re also missing work, losing sleep&mdash;and running out of patience. It&rsquo;s natural to want to feel better as quickly as possible. Many people with flu-like symptoms think antibiotics are a quick-fix for their misery. But in most cases, antibiotics are not the answer.

Antibiotics are powerful drugs, but they aren&rsquo;t a cure-all. They specifically target bacteria, killing these microscopic organisms or preventing them from reproducing. But most chest colds and other illnesses are not caused by bacteria.

&ldquo;The vast majority of respiratory illnesses are viral,&rdquo; explains <a href="https://www.sharecare.com/doctor/dr-r-r-brown">Rush Brown, MD</a>, a primary care physician affiliated with <a href="https://www.sharecare.com/group/memorial-health">Memorial Health</a> in Savannah, Georgia. &ldquo;Antibiotics will not do anything to a virus. They will not help at all.&rdquo;

Bacteria vs. virus: What&rsquo;s the difference? 
Bacteria are ubiquitous. These one-celled microscopic organisms can be found just about everywhere in the environment&mdash;even in the human body. Different types of bacteria live on your skin, inside your mouth and along your digestive tract.

Many of these microbes actually help you stay healthy. Only certain species of bacteria, including some that are normally found on the body, have the potential to make people sick, including Streptococcus, Staphylococcus and E. coli. These and other types of bacteria are responsible for some common illnesses, like strep throat, bacterial pneumonia and urinary tract infections (UTIs). The immune system can usually fight harmful bacteria on its own. More serious infections, however, are treated with antibiotics.

Antibiotics often work quickly. Even though these drugs may need to be taken for a week or more, people usually start feeling better and are no longer considered to be contagious after about 24 hours. Although antibiotics are highly effective against bacteria, they are useless against viruses&mdash;the culprits responsible for the common cold, the flu and other viral illnesses that cause similar symptoms.

Unlike bacteria, viruses need a living host to replicate. These tiny germs consist of genetic material wrapped in protein. Antibiotics won&rsquo;t clear a viral infection, help you feel better or prevent you from spreading the illness to others.

In fact, there is no specific treatment for most viral illnesses. If taken right away, some anti-viral medications can reduce the severity and duration of the flu, according to Dr. Brown. But in most cases, people with a cold or other virus must rely on rest, fluids and other supportive care until they recover on their own in about one to two weeks.

&ldquo;The reality of the matter is we cannot make them well overnight,&rdquo; he says. &ldquo;It just takes time.&rdquo;

The risks of antibiotic misuse 
Since the symptoms of flu-like viruses are similar to the warning signs of a bacterial infection, it&rsquo;s often tough to tell the difference. Feeling uncertain or frustrated, some people urge their doctor to prescribe them an antibiotic without knowing whether or not they really need it.

&ldquo;For many years, unfortunately, my colleagues handed them out to make patients happier, maybe before we had as much data and before we were tracking these things as well as we do now,&rdquo; Brown says. &ldquo;We&#39;re certainly trying to reeducate everyone.&rdquo;

Every year in the United States, about 30 percent of antibiotics&mdash;some 47 million prescriptions&mdash;are still prescribed unnecessarily. This is not only unwarranted but also risky for two reasons:

1. The number of drug-resistant germs is increasing as the arsenal of effective antibiotics is dwindling. Before penicillin was discovered in 1928, people more often died of bacterial infections, such as pneumonia and tuberculosis, than from heart disease, cancer and other non-contagious diseases. In the following decades, as more life-saving antibiotics were developed, the average life expectancy of Americans jumped from about 50 years of age to nearly 80.

Every time antibiotics are used, however, bacteria have a chance to adapt and become resistant to them. Overusing or misusing antibiotics (not taking them as prescribed, skipping doses or not completing the entire course of treatment) allows more bacteria to develop resistance, making them stronger and more difficult to kill.

&ldquo;The more you use an antibiotic, the less effective it may become in the future,&rdquo; Brown explains. &ldquo;That certainly holds true for individuals, but also for the community.&rdquo;

With few new antibiotics under development, scientists are concerned that the rise of antibiotic-resistant bacteria will undo progress that has been made against bacterial infections over the past 70 years. Eventually, the increased risk for tough-to-treat infections may complicate common injuries and routine surgeries, like joint replacements.

Each year in the United States, some two million people develop infections that are caused by drug-resistant bacteria. These so-called superbugs claim at least 23,000 lives, the U.S. Centers for Disease Control and Prevention reports. That number is on track to reach 30,000 by 2050, according to a November 2018 report from the Organization for Economic Cooperation and Development (OECD). If left unchecked, it&rsquo;s also estimated that drug-resistant infections could drain $100 trillion from the world economy over the next 32 years.

2. Like all medications, antibiotics may cause allergic reactions or other unwanted side effects. Taking these drugs unnecessarily exposes you to these risks without offering a potential benefit. Side effects from antibiotics may include:

<ul>
	<li>Rash</li>
	<li>Dizziness</li>
	<li>Nausea</li>
	<li>Diarrhea</li>
	<li>Secondary yeast or bacterial infections</li>
	<li>Irregular heartbeat</li>
	<li>Tendonitis, or increased risk for tendon injuries</li>
</ul>

Things you can do 
If you&rsquo;re suffering from a range of symptoms, including a runny nose, cough, low-grade fever, sore throat and other flu-like symptoms, you may have a virus. If so, antibiotics won&rsquo;t help, but there are some things you can do to ease your discomfort, including:

<ul>
	<li>Rest</li>
	<li>Drink plenty of fluids</li>
	<li>Gargle with saltwater for temporary relief of a sore throat</li>
	<li>Ask your doctor about over-the-counter pain and fever reducers, such as acetaminophen or ibuprofen</li>
	<li>Use a cool mist vaporizer or humidifier to reduce congestion</li>
</ul>

You can also try over-the-counter cough remedies or saline nasal sprays to get temporary symptom relief. These should be taken only as directed. Some of these products contain more than one active ingredient. Read all labels to ensure you&rsquo;re not taking too much of any one medication.

Viruses usually clear up in a week or two. If your symptoms persist for more than 10 days without improvement, you could have a bacterial infection or another health issue that may need treatment and you should see your doctor.

Some other warning signs and symptoms that should be evaluated by a doctor:

<ul>
	<li>You have a persistent high fever and chills.</li>
	<li>Your fever or other symptoms gradually worsen over time, or improve initially but then get worse.</li>
	<li>You feel short of breath.</li>
	<li>Your sore throat develops very suddenly, and you have tiny red spots on the roof of your mouth.</li>
</ul>

Your doctor can perform a physical exam and tests to determine if you have a bacterial infection or another health issue that requires treatment. Sometimes a blood or urine test may also be needed to confirm or rule out a diagnosis.

&ldquo;I would say a temperature above 100.5 [Fahrenheit] for more than 48 hours that&rsquo;s just not getting better should certainly prompt somebody to get checked out,&rdquo; advises Brown. &ldquo;Let somebody look at you so that we can try and figure out if there&#39;s something else going on or something we need to treat.&rdquo;

Seek immediate medical attention if you&rsquo;re having trouble breathing, are in severe pain or if you&rsquo;re confused or disoriented. These may be symptoms of a life-threatening infection or other medical emergency.

Do I Need an Antibiotic?

Retired NFL defensive lineman Shaun Smith says for nine years he fired up &ldquo;two blunts before every game.&rdquo; He appears with other retired players on a Bleacher Report YouTube video about marijuana use in the NFL that&rsquo;s been viewed 2,773,000 times. And those guys say 80 percent of players and staff smoke marijuana recreationally, if not right before taking the field. Their motive?

&ldquo;We&rsquo;re all big guys and our bodies hurt,&rdquo; says Smith. And they use it as an alternative to opioid pain meds. Bo Sciafe, former tight end for the Titans and the Bengals, says he developed &ldquo;an injury-plagued journey&rdquo; during his career and had been prescribed pain pills&mdash;he then found himself in a dark place. &ldquo;So it was easy for me to receive the benefits of marijuana as a viable option.&rdquo; These days he uses topicals to ease pain and arthritis.

But does smoking marijuana really ease pain and treat chronic diseases? And does cannabidiol or CBD, an active ingredient in marijuana (without the psychoactive effect of THC&mdash;the other much-touted ingredient), really work topically to ease pain? Well, the players would say yes. But the science isn&rsquo;t so clear. So, let&rsquo;s review the reliable findings, good and bad, and offer our suggestions.

A word to the wise 
If it&rsquo;s legal where you live and <a href="https://www.sharecare.com/health/pharmaceuticals/article/what-need-to-know-about-medical-marijuana">marijuana for easing pain</a> (as pill, edible, smokable, or topical) is prescribed by a licensed doc, you want to be sure it&rsquo;s going to be effective. Remember, smoking anything has serious health repercussions, and masking pain instead of alleviating it only prolongs or worsens your discomfort.

What studies suggest 
Pro: A new study published in Neurology has found that THC in marijuana eases neuropathic pain, a complex, chronic condition caused by changes in nerve

function or structure. Diabetes causes about 30 percent of neuropathy cases, but there are hundreds of diseases associated with neuropathic pain. FYI: THC binds to your body&rsquo;s natural endocannabinoid system, which plays a part in regulating everything from digestion to temperature.

Pro: A textbook called Contemporary Health Issues on Marijuana published by Oxford Clinical Psychology lays it out pretty clearly: &ldquo;Medical marijuana in the United States has bypassed the standard process of scientific investigation.&rdquo; But they also say, &ldquo;We conclude that some benefits of marijuana&rsquo;s core elements&mdash;tetrahydrocannabinol and cannabidiol&mdash;are supported by a handful of controlled clinical trials for a very limited number of health problems.&rdquo; Those health problems include two types of <a href="https://www.sharecare.com/health/pharmaceuticals/article/marijuana-extract-treat-anxiety-epilepsy">epileptic syndromes</a>, for which the cannabis-based drug Epidiolex was approved by the FDA in June of 2018.

Pro: The CBD potions available are derived from the hemp plant and CBD does not cause a &ldquo;high.&rdquo; Some studies show it helps reduce intraocular pressure in glaucoma. Others support its use in controlling Parkinson&rsquo;s disease symptoms and easing PTSD-related nightmares.

Con: In July of 2018, The Lancet Public Health published &ldquo;Effect of cannabis use in people with chronic non-cancer pain prescribed opioids: findings from a 4-year prospective cohort study.&rdquo; Their conclusion after tracking more than 1,500 people: &ldquo;We found no evidence of a temporal relationship between <a href="https://www.sharecare.com/health/pharmaceuticals/article/marijuana-curb-opioid-addiction">cannabis use and pain</a> severity or pain interference, and no evidence that cannabis use reduced prescribed opioid use or increased rates of opioid discontinuation.&rdquo;

Con: When it comes to using CBD either orally or topically, the preparations on the market seem pretty unreliable. A 2017 study in JAMA found that almost 43 percent of CBD products contained too little CBD; around 26 percent contained too much, and 20 percent contained the get-you-high chemical THC.

Our suggestion: If you have chronic pain, see a physical therapist and orthopedic doctor for joint and muscle pain. Explore use of ice baths, saunas/whirlpools and massage. Opt for anti-inflammatory food choices (ditch red meats, go for veggies and whole grains) and try stress management using deep breathing or meditation. Acupuncture may also help, as can cognitive behavioral therapy, which can change your response to pain.

Marijuana for Pain: Hype or Hope?

When it comes to a lingering case of the sniffles, your first instinct may still be to run to the family doctor for an antibiotic to knock them out.

The truth is, though, antibiotics aren&rsquo;t a one-size-fits-all solution when you aren&rsquo;t feeling well. And when you take them for the wrong reason, they can actually do more harm than good.

What Happens When I Take an Antibiotic I Don&rsquo;t Need? 
A doctor prescribes an antibiotic when bacteria, rather than a virus, causes the illness in question. This means if you&rsquo;ve got a cold, the flu, or even something like mono, an antibiotic isn&rsquo;t going to make you feel better.

They could also bring on some not-so-pleasant side effects, like an allergic reaction or upset stomach. Overuse and misuse of antibiotics also contribute to <a href="https://www.sharecare.com/health/superbugs/article/have-antibiotics-reached-their-expiration-date" style="line-height: 1.6em;">antibiotic resistance</a>, which is what happens when the bacteria adapt and make the medication ineffective. This means longer, more severe infections.

When Are Antibiotics the Right Choice? 
There are times when an antibiotic is still the best bet for getting you back on your feet, though, and if you have symptoms of these six illnesses, it could be time to head to your doctor for a prescription.

Bacterial sinus infection - may set in after a cold, but also can be hard to distinguish from a cold

<ul>
	<li>Symptoms: Cloudy or discolored nasal drainage is the big clue, along with headaches, facial tenderness, congestion, bad breath, fever and fatigue. Symptoms that last more than 10 days, or get better then worse again, suggest a bacterial infection.</li>
</ul>

Whooping cough - a serious bacterial respiratory infection that mainly affects infants younger than six months old, kids who haven&rsquo;t been immunized and older children and adults whose immunity is wearing off&nbsp;

<ul>
	<li>Symptoms: Early symptoms include runny nose, mild cough, low-grade fever and sneezing. After one to two weeks, severe coughing fits often appear. They can last over a minute, followed by a &ldquo;whooping&rdquo; sound, vomiting and exhaustion.&nbsp;&nbsp;</li>
</ul>

Strep throat -&nbsp;a contagious sore throat infection caused by Streptococcus bacteria, more common in children than adults

<ul>
	<li>Symptoms: A severe sore throat may be accompanied by a fever of 101&deg;F or above, swollen tonsils (sometimes with white patches), red spots on the roof of the mouth, headache, nausea, vomiting, swollen lymph nodes and a rash.</li>
</ul>

Bacterial ear infection - occurs when germs cause fluid buildup in the middle ear; it can also cause the tubes in the ear to become blocked or swollen

<ul>
	<li>Symptoms: Most ear infections, viral and bacterial, share common symptoms such as fever, headaches, ear pain, pressure in the ear, drainage, reduced hearing and dizziness.&nbsp;</li>
</ul>

Urinary tract infection (UTI) - an infection of the urinary tract&mdash;including the urethra, bladder and kidneys&mdash;most commonly caused by bacteria; affects more women than men.

<ul>
	<li>Symptoms: Symptoms of a UTI vary by age, but most commonly include an intense need to use the restroom, burning or pain during urination and cloudy or dark urine. In older adults, symptoms can be vague and include weakness, fatigue, muscle aches and abdominal pain.&nbsp;</li>
</ul>

Bacterial pneumonia - A serious bacterial infection in the lungs; often a complication of the flu

<ul>
	<li>Symptoms: Bacterial pneumonia often causes very high fever, sweating, increased heart rate and rapid breathing, along with a cough, shortness of breath, sharp chest pain, headache, loss of appetite and, in older adults, confusion.</li>
</ul>

Medically reviewed in March 2018.

6 Ailments That Call for an Antibiotic

In Mel Brooks&rsquo; Young Frankenstein, when Igor (Marty Feldman) steals a brain for Dr. Frankenstein (Gene Wilder), there&rsquo;s a mix-up and the doc gets a brain from someone named Abbey. Abbey Normal. When Dr. Frankenstein realizes he&rsquo;s placed an abnormal brain into his seven-foot tall creation, the mix-up sets up one of the funniest films of all time.

Mixing up brains may make for hilarious comedy, but when it comes to your meds, don&rsquo;t make mistakes that can mix up your brain <a href="https://www.sharecare.com/health/anxiety/article/anti-anxiety-meds-kill-thousands-every-year">or worse</a>. &nbsp;

A study found that people are making more mistakes with their meds than they used to and they&rsquo;re paying a price. Cases of reported medication errors more than doubled from 3,065 in 2000 to 6,855 in 2012. Over 400 people died from those mistakes. The most common medicinal mix-ups that caused serious health problems were with cardiovascular drugs and painkillers such as aspirin and acetaminophen. Most common mistakes: Taking the wrong dose; the wrong drug; or a double dose.

Getting your meds in order 
Eighty-seven percent of Americans 65 or older average four different meds daily! To make sure you <a href="https://www.sharecare.com/health/health-care-basics/how-decrease-chance-medication-errors">get your dosing right</a>, try:

<ul>
	<li>Reading dosage instructions on Rx bottles carefully.</li>
	<li>Making sure each medication is labeled if you move your meds from an Rx bottle to a pillbox.</li>
</ul>

If you need help organizing your medications, ask your doc, neighbor or family member for help.&nbsp;

How to Avoid Mixing Up Your Daily Medications 

The U.S. Food and Drug Administration (FDA) is now requiring stronger warnings on the labels and medication guides for a class of commonly prescribed antibiotics called fluoroquinolones, including Cipro (ciprofloxacin) and Levaquin (levofloxacin).

They&rsquo;ve concluded that for patients with sinusitis, bronchitis or less severe urinary tract infections (UTIs), the risk of serious side effects associated with these drugs generally outweighs their benefits&mdash;especially if other treatments are available.

Why the new warnings? 
After conducting a safety review, the FDA found that this class of antibiotics could cause disabling and potentially permanent side effects involving the tendons, muscles, joints and nervous system.

And it&rsquo;s not the first time questions have been raised about fluoroquinolones&rsquo; safety.

Back in 2008, the FDA linked these antibiotics to tendon rupture and tendinitis in some patients. And in 2013, the FDA issued a follow-up, warning against the drugs&rsquo; potential to cause permanent nerve damage, or <a href="https://www.sharecare.com/health/pain-conditions/what-is-peripheral-neuropathy" style="line-height: 1.6em;">peripheral neuropathy</a>.&nbsp;

Studies have also linked fluoroquinolones to potentially fatal aortic tears and <a href="https://www.sharecare.com/health/aneurysms/is-an-aortic-aneurysm-how-soon-do-i-need-surgery" style="line-height: 1.6em;">aortic aneurysm</a>.

Doctors prescribe these antibiotics to over 26 million Americans each year.

What if I&rsquo;m currently taking these drugs? 
&ldquo;It&#39;s important for patients to be aware of side effects and symptoms, and report any to their doctors,&rdquo; says <a href="https://www.sharecare.com/user/dr-darria-longgillespie">Darria Long Gillespie, MD, MBA, FACEP</a>, emergency room physician and senior vice president of clinical strategy at Sharecare. &ldquo;But I also don&rsquo;t want people to stop taking these medications without telling anyone.&rdquo;

That&rsquo;s because while there are serious side effects associated with these antibiotics, taking an incomplete course of any antibiotic &ldquo;is the perfect set-up for an antibiotic-resistant infection,&rdquo; she says.

Talking to your doctor 
If you are taking this type of antibiotic and begin to experience muscle, joint or nerve pain, confusion or cloudy thinking, hallucinations, tingling, prickling or a pins-and-needles feeling in your hands and feet, it&rsquo;s important to talk to your doctor right away, even if you&rsquo;ve stopped taking the medication.

If your doctor does prescribe a fluoroquinolone antibiotic for sinusitis, bronchitis or a UTI, ask about alternative treatment options, and be open about your concerns.

&ldquo;The main lesson here,&rdquo; says Dr. Long Gillespie, &ldquo;is that every medication has side effects, and that includes our most common antibiotics. Antibiotics are wonderful, life-saving medications, but they do not prevent infections and they don&rsquo;t treat viral infections. It&rsquo;s crucial that we only prescribe them when needed.&rdquo;

Medically reviewed in March 2018.

FDA Issues Stronger Warning for Common Antibiotics

When Rosemary Butler belted out the chorus on Jackson Brown&rsquo;s version of&nbsp;Stay (Just a Little Bit Longer)&nbsp;more than four decades ago, a lot of 50- to 60-year-olds apparently decided to take that advice. There are now over 72,000 centenarians in the US!

Advances in chronic disease treatment and prevention are extending your lifespan&mdash;and increasing the number of medications you take. About 75 percent of you, age 65 and up, take drugs for at least two chronic disorders, and almost one-third of you take five or more medications. You also take 35 percent of all over-the-counter (OTC) drugs. No wonder drug interactions are an increasing problem.

One study found combining prescription meds for high blood pressure (HBP) and osteoarthritis is the most common cause of a risky drug interaction. If you add a cox-2 inhibitor for pain on top of a beta blocker for HBP, the cox-2 inhibitor blocks the beta blocker; your blood pressure stays too high. Other combos of prescription and/or OTC meds cause just as much trouble.

To minimize&nbsp;<a href="https://www.sharecare.com/health/health-care-basics/what-is-a-drug-interaction">drug interactions</a>:

<ul>
	<li>Write down each prescription, non-prescription med, and supplement you take.</li>
	<li>Schedule time with your pharmacist to review your list, checking for drug interactions; take notes.</li>
	<li>Take your list and notes to your primary care physician. Create a wellness plan that includes stress management, walking and avoiding the Five Food Felons. This will reduce your need for chronic disease meds. Medicare and most insurance companies cover this visit annually without any co-pay.</li>
</ul>

Here are Dr. Mike&rsquo;s Five Food Felons:

<ol>
	<li>Trans fats&nbsp;raise lousy LDL cholesterol and triglyceride levels, lower your healthy HDL cholesterol level and fuel disease-triggering inflammation.</li>
	<li>Saturated fat&nbsp;in red meats, poultry skin, full-fat dairy products, palm oil and coconut oil fuels cancer risk, coronary artery disease, dementia, obesity and diabetes.</li>
	<li>Added sugars and&hellip;</li>
	<li>Sugar syrups&nbsp;both cause the proteins in your body to be less functional and age your immune system, cardiovascular system and joints. Plus, they disrupt your metabolism and contribute to almost every lifestyle-related malady, including some cancers.</li>
	<li>Refined and processed grains&nbsp;don&rsquo;t contain the fiber or nutrients (contained in 100 percent whole grains) that you need to keep the bacteria in your gut happy, glucose levels regulated, immune system strong and digestion running smoothly.</li>
</ol>

<a href="https://www.sharecare.com/health/healthy-eating-guidelines/foods-avoid-to-stay-healthy" target="_blank">Related: What foods should I avoid to stay healthy?</a>

Medically reviewed in January 2020.

Resolving Prescription Conflicts

Think of the name of an aspirin brand you know. If you thought &ldquo;Bayer,&rdquo; you&rsquo;re probably not alone. But what about the store-brand aspirin that often sits side-by-side with name-brand options on the drugstore shelf? You may be wondering if they&rsquo;re the same.

The short answer to that question is yes.

If a chemist analyzed pills from the two bottles, the results would match up. They&rsquo;d both contain acetylsalicylic acid&mdash;the active ingredient in aspirin&mdash;at the same dose. There might be some differences in inactive ingredients, but these wouldn&rsquo;t have any effect on how the medicine works.

The main difference is in the price: The generic or store-brand version will usually be much cheaper than the name brand.

One study published in 2016 in the Journal of Pharmaceutical Policy and Practice suggests that pharmacists see these options as directly interchangeable&mdash;so much so, in fact, that when it comes to over-the-counter medications, more than 90 percent of the time, they&rsquo;ll pick the generic over the brand for themselves.

Why are they cheaper? 
You may be wondering if &ldquo;cheaper&rdquo; means &ldquo;not as good.&rdquo; Here&rsquo;s why generics tend to be less expensive.

By the time a generic drug hits the pharmacy shelves, the brand version has been around for years. The company that gained approval for the brand-name drug put in years of costly research, testing it in increasingly strict clinical trials. This groundwork and the expense of seeking approval for a new drug increase the costs of brand-name drugs.

A generic doesn&rsquo;t have to go through this process of proving a drug&rsquo;s safety and effectiveness. The active ingredient and how it&rsquo;s formulated have already been tested and approved.

That doesn&rsquo;t mean that generics have no regulation, though. Their manufacturers have to go through their own approval process, showing that their active ingredient and effects are exactly like those of the brand name in everything but name only.

Meanwhile, because several generic manufacturers typically receive approval to sell the same generic drug, the competition between those companies often has the effect of lowering the generic cost further.

Are generics regulated like brand name drugs? 
The U.S. Food and Drug Administration (FDA) has specific requirements for generic drugs. They have to match up with the name-brand versions in several ways. The dose size, how it&rsquo;s taken, dosage level, reasons for use, shelf life and safety all have to be the same. The medicine, says the FDA, has to work just like the brand-name drug does and it has to offer the same clinical benefits.

These requirements are crucial because, according to the FDA, 9 in 10 drug prescriptions that are filled are for generics. So it&rsquo;s vital for consumers that they get what they&rsquo;re supposed to get.

The FDA cautions that any batch of drugs, branded or not, can show some &ldquo;natural variability.&rdquo; From batch to batch, little things can change that don&rsquo;t alter the medical outcome of taking the drug. The FDA has limits on just how much these factors, such as size or purity, can vary.

The process seems to work. One large study published in 2009 in the journal Annals of Pharmacotherapy looked at 12 years of data covering 2,070 studies that compared generic and branded drugs. The authors found no impressive differences between generic and branded drugs in how people absorbed them in their bodies, which is an important factor in how well a drug works.

These comparisons of how the body absorbs the generic and brand versions of a drug are known as &ldquo;bioequivalence studies.&rdquo; Generics can be compared to brand-name versions in other ways. They can be compared for &ldquo;pharmaceutical equivalence,&rdquo; which means how well they match for active ingredient, dose and how they&rsquo;re administered.

Together, bioequivalence (how similarly the body uses the two comparison drugs) and pharmaceutical equivalence (how similar the active ingredient is between the drugs) add up to the &ldquo;therapeutic equivalence.&rdquo; A generic drug that is therapeutically equivalent to its brand-name counterpart will show pharmaceutical equivalence and bioequivalence with it. It will have the same effect and same safety profile as the brand-name drug. FDA-approved generic drugs are expected to show this therapeutic equivalence.

Why doesn&rsquo;t the generic look like my drug? 
One way that branded and generic versions of a drug will definitely differ is in their appearance. Legal rules call for the color or shape of the medications to be different. The active ingredient, however, must be the same.

Are there ever mistakes? 
Like brand-name drugs, generic drugs are monitored on an ongoing basis. The FDA keeps an eye on everything from how a drug is made and packaged to any reports of problems from people taking the drugs.

This post-approval monitoring has helped the agency identify cases in which a generic violates the requirement of therapeutic equivalence. One such example is with an antidepressant called bupropion, also known by the brand name Wellbutrin. After a generic version of this drug was approved, some concerning reports started coming in. People were saying that one specific dose and type of the generic version was not having the usual effects of the drug.

The FDA became concerned enough to conduct its own study of how the body used the two versions of the drug. They found that one of the generics from one of several manufacturers was not therapeutically equivalent to the brand-name version. The manufacturer voluntarily pulled that generic from the market.

Is my drug available as a generic? 
Although an FDA-approved generic drug is anticipated to be functionally the same as a brand-name drug, it&rsquo;s still important to consult with your doctor before switching the manufacturer of any drugs you&rsquo;re taking, such as from a brand-name drug to a generic.

Once you get the green light from your healthcare provider, your pharmacist will be able to help you determine whether your drug is available as a generic. You also can search on the FDA&rsquo;s site through its &ldquo;<a href="https://www.accessdata.fda.gov/scripts/cder/ob/index.cfm" target="_blank">Orange Book</a>&rdquo; database or its <a href="https://www.accessdata.fda.gov/scripts/cder/daf/index.cfm" target="_blank">Drugs@FDA</a> tool. A search on the drug you&rsquo;re looking for will list the manufacturers of the brand name and any generics that are therapeutic equivalents.

5 Essential Facts About Generic Drugs

When you&rsquo;ve been diagnosed with a long-term or chronic condition, you&rsquo;ll often have to take medications long term. But keeping up with your medication schedules can be a struggle.

In fact&mdash;whether because of motivation, costs, lack of understanding about conditions, overly complex prescribing information, honest mistakes like <a href="https://www.sharecare.com/health/healthy-habits/article/easy-ways-remember-take-meds">forgetting to take them</a> or a host of other reasons&mdash;about one out of every two people does not take a prescribed medication according to directions.

But in order to get the maximum benefit from your treatment plan, it&rsquo;s important to follow your prescription as closely as possible.

What is medication adherence? 
<a href="https://www.sharecare.com/health/prescription-drug-medication-adherence/medication-adherence">Adherence</a> is the act of taking a medication as it&rsquo;s prescribed for as long as it&rsquo;s been prescribed. Clinicians used to call this &ldquo;compliance.&rdquo; But with a shift to an understanding that patients are partners in their own care, the term changed. Now, instead of complying with&mdash;or, simply obeying&mdash;what their clinician says to do, patients instead &ldquo;adhere&rdquo; to the plan they&rsquo;ve made with their clinician to ensure their best health.

For some people, adherence simply means that they complete their course of antibiotics as their doctor has recommended. Doing so helps ensure that they get well and stay well after a short-term infection, and using antibiotics as directed can also help tamp down the broader problem of <a href="https://www.sharecare.com/health/patient-drug-education/what-is-antibiotic-resistance">antibiotic resistance</a>.

But for people who have long-term or chronic conditions, adherence is more than a week-long commitment. For many patients, it&rsquo;s a commitment for life.

If you have a chronic condition that requires you to take medication over the long term, knowing the obstacles that can undermine your adherence can help you avoid them&mdash;and understanding the downsides of non-adherence can <a href="https://www.sharecare.com/health/prescription-drug-medication-adherence/article/track-meds-save-money-sharecare">remind you to stay on track</a>.

Understand your condition 
People who struggle with adherence do so for different reasons, some of them specific to the medication or to the condition that they have. But generally, there are some common factors that you can foresee and possibly control.

One main reason people stop taking medications prematurely or take them incorrectly is because they don&rsquo;t understand why they&rsquo;re taking them in the first place. They may not fully grasp the dimensions of their condition and how it can be treated with medication. In the case of conditions that have no symptoms&mdash;such as high cholesterol or high blood pressure&mdash;they may not realize that taking medication can improve a condition even if they don&rsquo;t &ldquo;feel&rdquo; better outwardly.

In many healthcare situations, patients often feel as if the burden is on them to seek the information. But improving understanding of the need for a prescription is a two-way street. Doctors can work on explaining things to patients so that they understand the importance of taking their medications correctly, and patients should seek information from their doctors until they do understand.

Ask the right questions about your prescription 
When it&rsquo;s time for your appointment or when you&rsquo;re picking up a prescription from your pharmacist, make sure you have your questions ready. You might want to ask any or all of the following:

<ul>
	<li>What condition do I have that requires this medication?</li>
	<li>What will the medication do for my condition?</li>
	<li>What is the name of the active ingredient in my drug, in addition to the brand name?</li>
	<li>What are the best timing and conditions for taking it (Mornings? With food?)</li>
	<li>Will the drug begin working immediately or take longer?</li>
	<li>Are there special storage requirements?</li>
	<li>Are there drug interactions with other medications or supplements I already take?</li>
	<li>Should I avoid any specific food, alcohol or activities when taking this drug?</li>
	<li>If I want to stop the medication, what should I do?</li>
</ul>

Getting answers you need goes a long way toward resolving many of the obstacles in the way of achieving your adherence goals.

Stick with your prescription when your condition improves 
Sometimes, when a medication produces improvement, you might be inclined to stop taking it because you feel better or you begin to see progress toward improving your condition. The problem with that, especially with chronic conditions, is that stopping the medication can reverse progress.

Take statins, for example. Statins are drugs that help reduce levels of &ldquo;bad&rdquo; cholesterol (called low-density lipoprotein, or LDL) and other fats in the blood. These drugs can reduce the risk for stroke, heart attacks and death among people who have hardening of the arteries or increased risk for heart disease.

The hitch is that statins will work only if you take them as prescribed&mdash;if you &ldquo;adhere&rdquo; to your treatment plan. You might start a prescription for a statin and learn at a doctor&rsquo;s visit that your cholesterol values have temporarily moved into a healthy range. But if you stop taking the drug, your values will likely climb again, setting you back on the path toward more serious heart disease.

In fact, people with heart risk factors who quit taking their statins may see an increased risk for mortality. Yet according to some research, half or fewer of patients who take these drugs don&rsquo;t take them as prescribed or even quit them altogether. What&rsquo;s more, as many as four out of five don&rsquo;t end up hitting their target cholesterol levels, in part because these highly effective drugs go underused. The patterns are similar for people who take medications for high blood pressure.

It&rsquo;s crucial to continue to stick with your medication as prescribed, even if your symptoms or numbers improve.

Stay the course when you feel worse 
The other side of the coin is when your medication makes you feel bad, or you&rsquo;ve taken a medication like it that previously produced bad side effects. The reality is that many drugs involve side effects, some worse or more significant than others.

When you start taking your medication, you should have a discussion with your healthcare provider about side effects. In particular, find out which ones are most common, which ones usually go away with time and which ones warrant a call to the doctor.

If you feel that the side effects simply outweigh the benefits the drug is supposed to offer, don&rsquo;t stop taking it without first talking with your doctor. With some medications&mdash;such as corticosteroids, antidepressants and beta-blockers&mdash;stopping cold turkey can be dangerous.

Lower drug costs when you can 
Drugs can be costly. If you find that you are becoming nonadherent because of drug costs, don&rsquo;t give up. You have some options.

Your first step should be to ask your doctor whether your prescribed drug is in your insurance plan&rsquo;s formulary, its list of covered drugs. If it&rsquo;s not, switching to an appropriate drug that&rsquo;s covered by insurance can help you save money.

You can also ask about potentially less-expensive alternatives, including generics. <a href="https://www.sharecare.com/health/pharmaceuticals/article/essential-facts-generic-drugs">Generic drugs</a> are regulated and established as direct substitutes for brand-name drugs. Check with your insurance company to see if you get more coverage for specific generics.

The companies that manufacture these drugs sometimes offer patient-assistance programs. These programs subsidize drug costs for patients who qualify based on income and other factors. You can also look into cheaper options for obtaining prescriptions: Some mail-based pharmacies offer a price break and ship a 90-day supply of some drugs for less per unit.

Automate your prescription to save time 
Getting your prescriptions delivered by mail in 90-day supplies helps solve another issue with adherence: time.

It takes time to refill and pick up medications at the pharmacy. And you have to remember your refill and make sure you have refills available or you&rsquo;ll risk missing doses while you wait for your doctor&rsquo;s approval. Many major pharmacies offer auto-reminders for refills, by text, phone or email and will contact your doctor&rsquo;s office for you to handle refill requests.

Living with&mdash;and treating&mdash;a chronic condition presents a host of challenges. If you encounter any of these stumbling blocks, don&rsquo;t hesitate to reach out to your healthcare provider. Your doctor can answer any questions you have about your condition&mdash;and remind you of the myriad of benefits that come from following your treatment plan.

6 Prescription Drug Challenges—And How to Overcome Them

A U.S.&nbsp;health guidelines&nbsp;panel recently issued new&nbsp;preliminary&nbsp;recommendations advising people 60 and older&nbsp;not to&nbsp;begin taking aspirin as prevention against&nbsp;a first stroke or heart attack. Here&rsquo;s what this news means for you.

Drug Information