Common Over-the-Counter Drugs

Acetaminophen/Paracetamol
(Tylenol, Panadol) Acetaminophen belongs to a class of drugs called analgesics (pain relievers) and antipyretics (fever reducers).  It is also a nonsteroidal anti-inflammatory drug (NSAIDs)

Dosage:

• Recommended: The oral dose for adults is 325 to 650 mg every 4 to 6 hours. The maximum daily dose is 4000 milligrams.
  
• Acetaminophen shouldn't be taken for more than 10 days continuously without first seeking advice from a doctor as it can cause stomach ulcers and heart problems
  
• Overdose: Acetaminophen is extremely toxic to adults in single large doses of about 7000 mg (or 150 mg per kilogram of body weight), although as little as 4000 mg when taken throughout the day can also be toxic. Also note that the risk of severe liver damage increases acutely when combined with alcohol.
  

Overdose Symptoms

• Liver and kidney damage
  
• Nausea/vomiting/sweating, followed by no other symptoms for 24 hours
  
• As damage sets in between 24-48 hours, liver damage occurs, which can lead to right upper quadrant abdominal pain, jaundice (yellow skin) or icterus (yellow eyes), confusion, coma, and kidney failure
  

Ibuprofen
(Advil, Genpril, Ibu-200, Midol, Motrin, Nuprin) Ibuprofen is in a group of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs), and is used for pain relief and to reduce fevers

Dosage:

• Recommended: The maximum amount of ibuprofen for adults is 800 milligrams per dose or 3200 mg per day (4 maximum doses).
  
• Shouldn't be taken for more than 10 days continuously without first seeking advice from a doctor as it can cause stomach ulcers and heart problems
  
• Overdose:  Severe toxic effects set in at around 400 mg/kg (or 182 mg/lb).
  

Overdose Symptoms

• Blurred vision, ringing in the ears
  
• Diarrhea, heartburn, nausea, stomach pain, vomiting
  
• Little urine production
  
• Difficult or slow breathing
  
• Headache, agitation, confusion, drowsiness, dizziness, seizures
  
• Rashes or sweating
  

Diphenhydramine hydrochloride
(Bendryl, Nytol, Unisom,  Midol, Theraflu, Sominex, etc) Symptomatic relief of perennial and seasonal allergies, runny nose and sneezing caused by common cold; motion sickness (injection only); nighttime sleep aid, etc.

Dosage:

• Recommended: Dosage will vary depending on product.  See packaging.  
  
• Side note:  The drug is sometimes used for recreational purposes, thus dosing may differ based on intent.  More information on this can be found here
  
• Overdose:  400 mg will create a severely delusional state, and is considered an "at risk dose".  Anything above 500mg is dangerous and potentially fatal.
  

Overdose Symptoms:

• Agitation
  
• Blurred vision due to large pupil size
  
• Confusion, delirium, drowsiness, incoherence
  
• Convulsions, movement problems
  
• Diarrhea, nausea, stomach pain
  
• Rapid heart rate
  
• Inability to urinate
  
• Cotton mouth
  
• Flushing of skin
  

Dextromethorphan
(Robitussin, Vicks 44, Benylin, Nyquil, etc) Dextromethorphan is a cough suppressant. It affects the signals in the brain that trigger cough reflex.

Dosages:

• Recommended: Most doses are between 5mg and 25mg.  Follow instructions given on packaging.
  
• Side note:  The drug is sometimes used for recreational purposes.  Additional information can be found here.
  
• Overdose: Over 1000 mg will likely result in very strong psychological effects, as well as physical impairment.  Over 2,500mg begins drastically increasing the risk for permanent damage or death.

Overdose Symptoms:
NOTE: Symptoms may be interpreted differently depending on intent of drug use.

• Drop in blood pressure, rapid heart rate
  
• Slow, labored, shallow breathing
  
• Blurred vision
  
• Blue tint to skin
  
• Stomach/intestinal spasms, nausea, vomiting, constipation
  
• Drowsiness, dizziness, hallucinations, spasms, coma
  

Pseudoephedrine
(Sudafed, Dimetapp, Elixsure, Sudrine) Pseudoephedrine is a decongestant used for temporary relief of nasal congestion caused by hay fever, allergies, the common cold, sinus infections, or other upper respiratory diseases

Dosage

• Recommended:  30-60 mg every 4-6 hours, sustained release: 120 mg every 12 hours; maximum: 240 mg/24 hours
  
• Overdose:  Dosage required for overdose is extremely high.  No exact data is available.  Use symptoms of overdose to determine if emergency action should be taken.
  

Overdose Symptoms

• Seizures
  
• Nausea, vomiting
  
• Cardiac cardiac arrhythmias, hypertension
  
• Agitation, hallucinations
  

Pharmaceuticals

I.  Narcotic Opiates
Narcotics are drugs that alleviate physical pain, suppress coughing, alleviate diarrhea, and induce anesthesia. Natural narcotics are derived from the Opium poppy and synthetic narcotics are made to act like Opium.

1.Codeine
Dosage:

• Common doses: Most codeine products contain anywhere from 8mg-60mg of codeine, accompanied by 325mg of acetaminophen.  Other products may contain aspirin or caffeine.  See above information of toxicology of these drugs.
  
• Recommended: Codeine is available only by prescription in the United States.  Take the dose recommended by your doctor/pharmacist.  In other countries, low doses are available over the counter.  Follow packaging instructions.
  
• Overdose:  Because codeine is a narcotic, the exact dosage for overdose varies from person to person based on body weight and tolerance to the drug.  Pay attention to potential codeine AND acetaminophen overdose.   100mg-500mg doses of codeine have shown to cause early side effects of overdose.  Doses between 500-800mg can cause serious and prolonged symptoms of overdose, and doses over 800mg are very dangerous.
  

2. Hydrocodone (Vicodin, Lortab, etc)
Dosage:

• Common doses:  Most hydrocodone products come in one of three ratios (of hydrocodone to acetaminophen).  Those are 5mg:500mg (Vicodin), 7.5mg:750mg (Vicodin ES) and 10mg:660mg (Vicodin HP).  
  
• Follow the instructions of your doctor or pharmacist.  
  
• Overdose:  Due to the nature of the drug, exact dosage for an overdose varies by user's tolerance and body weight.  Users with no tolerance should not exceed 40mg in one day, however heavy users have been reported to take 100-200mg per day with little side effects.  Because of this, instructions should be followed, and symptoms of overdose should be monitored.  REMEMBER that this product also contains acetaminophen.  See above for toxicology.
  

Overdose Symptoms
*Symptoms for both drugs are very similar, and are listed together.

• Depressed, slow, shallow breathing
  
• Pupil contraction
  
• Loss of consciousness/altered state of consciousness
  
• Flushed skin
  
• Itchiness
  
• Agitation, confusion
  
• Drowsiness
  

SSRI's
(Celexa, Lexapro, Provac, Paxil, Zoloft, etc) Selective serotonin reuptake inhibitors are a class of antidepressants used in the treatment of depression, anxiety disorders, and some personality disorders.

Dosage

• Recommended: SSRI's are available by prescription.  Take what is recommended by your doctor or pharmacist
  
• Overdose: SSRI overdose is relatively rare, in comparison to other types of antidepressants.  Studies show that a dose of over 75x the normal dose is likely to lead to potentially long-term damage or fatality.
  

Psychostimulants
(Aderrall, Ritalin, etc) The drug is used primarily to treat attention-deficit hyperactivity disorder and narcolepsy, which are its only two approved indications

Dosage:

• Recommended: Available by prescription only.  Do not exceed dose recommended by doctor or pharmacist.  Average dose ranges from 20-60mg daily.
  
• Overdose:  Do not exceed 100mg in one day.

Overdose Symptoms:

• Overstimulation of the nervous system resulting in twitching, agitation, tremors, shaking, convulsions and an increased heart rate.
  
• Cotton mouth
  
• Nausea, loss of appetite, vomiting
  
• Confusion, delirium, hallucinations
  
• Sweating, change in body temperature
  

-----------------------------------------------
End notes:
*This does not advocate the misuse or abuse of any of the above drugs.
*Corrections and additions are welcome

If you believe you are experiencing an overdose:
Call 911, or an emergency number immediately.

National Poison Control Hotlines
United States: 1-800-222-1222
United Kingdom: 0870 600 6266
Ireland: 353 1 8379966

Global Poison Control Hotlines from the World Health Organization

Sticky on Course of Action for Suspected Overdose