Over-the-Counter Medications and Herbal Remedies

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Q: Can ibuprofen or other over-the-counter pain relievers affect blood sugar? Is it safer to take herbal supplements because they are a more "natural" way to improve health without affecting other medical conditions?

A: Ibuprofen by itself is not known to affect blood sugar levels. However, this and other over-the-counter pain relievers have the potential to interact with medications used in the treatment of diabetes, thus indirectly affecting this condition. Also, liquid formulations containing ibuprofen, acetaminophen and aspirin might contain added sugar (including dextrose and fructose) and can temporarily affect blood sugar. As for "natural" herbal supplements, they too have the potential to negatively impact current health conditions or interact with over-the-counter and prescription medications. That said, it's important to speak with your physician or pharmacist prior to taking any of these products.

The over-the-counter buffet of medications

Look down any isle in the pharmacy or supermarket and you will find many non-prescription medications available to treat a variety of medical conditions. Whether it's heartburn, gas, diarrhea, pain, headache, sinus ache, stuffy nose or sore throat, there's something to potentially help relieve the symptoms. And, while most are safe when used as directed, remember that medications have the potential to interact with other medications or supplements you take.

Imagine this scenario: You have a cough and cold and take a medication to help with those symptoms. You also have a headache, so you take a product to decrease your pain. Sounds harmless enough, unless both formulations contain acetaminophen. Then, you've likely exceeded the maximum recommended daily amount for that particular ingredient. If you decided to have a few too many alcoholic drinks while taking these medicines, you could potentially do great harm to your liver.

Let's change the scenario. Suppose you hurt your back and take ibuprofen for pain. You figure it's safe enough to take because it's an over-the-counter product. Weeks go by and you continue to take this medication on a regular basis. Finally, you visit your doctor because the symptoms persist. During the examination, your high blood pressure is found to be out of control and blood tests determine your chronic kidney disease has taken a turn for the worse. Had you known those medical conditions could be made worse by the use of ibuprofen, your physician could have helped you select a different pain reliever.

Take a look at some other examples of common and potentially dangerous combinations of over-the-counter meds, prescription drugs, and supplements:

Combining ginkgo with aspirin may increase the risk for bleeding, especially in those currently taking the clot-fighting drug known as warfarin.
Taking supplemental doses of niacin (one of the B vitamins) while using a prescription product of the cholesterol-lowering class of drugs known as statins might increase the risk for muscle pain and, potentially, kidney damage.
Drinking energy products containing high-octane stimulants (like guarana, kola or bitter orange) while using decongestants can increase your heart rate and blood pressure.
Taking antidepressant medications known as selective serotonin reuptake inhibitors (SSRIs such as Prozac and Zoloft) in combination with the over-the-counter supplement known as St. John's wort may increase the risk for a potentially dangerous condition known as serotonin syndrome. Its symptoms include nausea, vomiting, and marked fluctuations in blood pressure.
Using non-steroidal anti-inflammatory medications, such as ibuprofen, in combination with herbal supplements such as ginkgo, ginseng, feverfew, ginger or clove oil may increase the risk for bleeding.

As you can see, it's important to know the potential risks for drug-to-drug or drug-to-herbal product interactions before taking them.

Herbal supplements and health

Just because a product is touted as "natural" doesn't ensure it is safe for you. That's because dietary or herbal supplements can act as medications since they contain powerful ingredients in doses large enough to impact your health. This is especially true if you have pre-existing conditions including the following:

Diabetes—Be cautious with ginseng, hawthorn and nettle as they may affect your blood sugar control.
High blood pressure—Licorice (the black "natural" non-candy product), ginseng, goldenseal, bitter orange, yohimbe and devil's claw may increase your blood pressure.
Depression—Kava and valerian may further deepen the depression.
Allergies—If you are allergic to ragweed, daisy, aster or chrysanthemum, the following herbs may make your allergies worse: echinacea, feverfew, chamomile and yarrow.
If you are pregnant or nursing, do not take any herbal supplement unless approved by your physician or health-care provider.

It is also important to know that dietary supplements cannot be assumed to be safe, effective or of high quality. The National Center for Complementary and Alternative Medicine provides information on this topic.

Lastly, as a person ages, he or she is more likely to have chronic health conditions (such as diabetes, heart disease, high blood pressure and glaucoma) that require one or more prescription medications to keep those diseases under control. When monitored by a physician there is usually a margin for safety. However, when taking one or more over the counter drug or herbal supplements without that oversight, unnecessary risks and side effects are more likely to occur.

For further information, speak with your physician and pharmacist. More information is also available from the Food and Drug Administration and the American Academy of Family Physicians.

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Robert Danoff, D.O., M.S., is a family physician and program director of The Family Practice Residency, as well as the combined Family Practice/Emergency Medicine Residency programs at Frankford Hospitals, Jefferson Health System, Philadelphia, Pa. He is the medical correspondent for CN8, The Comcast Network, a regular contributor to Discovery Health Online and a contributing writer to The New York Times Special Features. (Read his full bio.)