Bengay药导致的死亡凸显非处方药的危害

是非处方药不一定就意味着它是无害的。在使用超剂量运动霜剂导致田径明星死亡的事件后，专家发出上述警告。

每日健康6月15日报道——纽约市一个中学田径明星在使用超剂量的肌肉疼痛缓解膏剂后离奇死亡。此事再次引发人们对过量使用非处方药物导致危害的关注。

纽约市药品检查部门裁定，17岁的越野选手Arielle Newman 意外死于超剂量的水杨酸甲酯。这种带有冬绿树气味的成分普遍存在于运动止痛药膏中。

据美联社报道，为了减轻运动相关的不适，在每次跑步比赛前，这位斯塔滕岛青少年把Bengay（奔肌）涂于腿上。她还使用含水杨酸甲酯（有类似阿司匹林的抗炎作用）和其它成分的粘垫。

“多重成分导致剂量超标，”纽约市药品检查部门的发言人Ellen Borakove与美联社说，“所有的成分都能在药房的架子上找到，而且都是非处方药。”

“但是非处方药不意味着‘无害’。”专家警告说。

“在Bengay（奔肌）、Icy Hot（冰热）、Tiger Balm、阿司匹林等膏剂中，水杨酸甲酯或者水杨酸是其活性成分。如超剂量使用，则是有害的。”纽约若斯克运动医学康复研究所的所长Gerard Varlotta博士说。

“水杨酸是抗凝剂，超高剂量能导致内出血、心律失常、肝损伤及各种各样的损伤。”

“但是，多数美国人认为，象Bengay（100多年前已经出现在美国的药房）这种熟悉已久的品牌没有危害，这就诱使他们过量用药。”

“当多数人要大把吃阿司匹林或者其它非处方药之前，他们肯定会三思而行。但他们忘了膏剂也会带来危害。”

“记住，很多不同的药品明确地表明吸收途径是通过皮肤。”Varlotta说。

“对任何药物而言，药量适中是关键。”另一个专家补充说。

“你要按说明书用药，因为中毒剂量已经标明。”华盛顿市美国中毒控制中心协会的专家Elena Juris建议说，“ 这句话适用于膏剂和丸剂。”

在2005年，她的研究组数据显示，14个美国人死于皮肤暴露在某种毒性物质，尽管具体是哪种物质导致这些死亡的统计分析还没得到编辑。

然而，她指出：“事实上，人类暴露于毒性物质的第七大因素是局部外用制剂。仅2005一年，中毒控制中心报道了10.9831万例暴露于局部外用物质的中毒事故。”

Newman的死亡与Bengay相关，这是极个别的事件。而制造此膏剂的Johnson & Johnson药厂告诉美联社说，他们的药品在缓解轻度关节炎疼痛、肌肉紧张和背痛方面是安全和有效的。

与处方药一样，消费者在使用非处方药前认真阅读标签说明书也很重要。但是，Varlotta 认为警告标示应该更醒目点。

“如果查看所有的非处方药，你不能单从外包装上作出区别。”他以Newman所用的Bengay为例说，“没有醒目的大字注明它含有阿司匹林，这个说明在印表中才有。”很多消费者没有意识到，同一种药物会出现多种完全不同的非处方药成分。

“用感冒伤风药就会出现这样的错误。”Juris说，“你可能服用了含对乙酰氨基酚的感冒药来退烧，同时你也会用对乙酰氨基酚来治头痛。因此，你已经过量用药了。所以，不仅仅应该看说明书，你还要确定自己没有重复用药并超出推荐使用量。”

Varlotta关注的非处方药还包括止痛药Advil 或者Motrin（他认为两三片非处方药与一片处方药的危害相同）、许多乱规定剂量的草药、食品添加剂、扶他林软膏（他的很多患者从欧洲带来的一种抗炎的霜剂）。

“扶他林在美国没有批准为非处方药，”Varlotta说，“但它被美国人带回来后会带来问题。”

“患者回到美国，医生又给他们开了消炎药，这就意味着他们同时用了霜剂和消炎药，这可能导致胃肠疾病、出血。”他说，“然后我跟他们说：‘让我看下你用的霜剂。’不必说，它肯定是他们带回来的扶他林软膏或者其它霜剂。”

根据专家的意见，底线是每一种药物——即使是非处方药的霜剂——都有某种程度的风险。

“不能仅仅根据它是非处方药就认为它是完全安全的，非处方药也应按照生产商的说明书指导用药。”Varlotta说，“人们应该知道自己用的是什么药，不管它是口服的还是皮肤外用的。”

Bengay Death Highlights OTC Dangers

Just because it's nonprescription doesn't mean it's harmless, experts caution in wake of teen track star's overdose from sports cream

By E.J. Mundell
HealthDay Reporter


FRIDAY, June 15 (HealthDay News) -- The bizarre death of a New York City high school track star from a muscle pain cream overdose is raising a red flag once again on the hazards of overusing common over-the-counter medications, experts say.

The New York City medical examiner's office ruled last week that 17-year-old cross-country runner Arielle Newman died from an accidental overdose of methyl salicylate, the wintergreen-scented ingredient found in popular sports balms.

To help ease exercise-related discomfort, the Staten Island teenager reportedly had been putting Bengay on her legs between running meets, while also using adhesive pads with methyl salicylate, an aspirin-like anti-inflammatory, and a third product, according to the Associated Press.

"There were multiple products, used to great excess," Ellen Borakove, a spokeswoman for the NYC medical examiner's office, told the AP. All of the products can be found as nonprescription items on drug store shelves.

But over-the-counter almost never means "harmless," experts warned.

Methyl salicylate, or salicylic acid, is the active ingredient in creams such as Bengay, Icy Hot and Tiger Balm, as well as aspirin, and "is potentially harmful if it is overused," said Dr. Gerard Varlotta, the director of sport rehabilitation at Rusk Institute of Rehabilitation Medicine in New York City.

An anti-clotting agent, salicyclic acid at very high doses "can cause internal bleeding, it can cause arrhythmias of the heart, it can cause problems in the liver -- there are any number of ways it can get to you," Varlotta added.

However, long-familiar brands like Bengay (which first debuted in U.S. drug stores more than 100 years ago) don't set off alarm bells in most Americans' minds, so the temptation to overuse them is there, Varlotta said.

And while most people would definitely think twice about swallowing a fistful of aspirin or other OTC pills, people forget that creams carry dangers, too.

"Remember, there are a whole variety of [medicinal] products that are specifically formulated to be absorbed through the skin," Varlotta said.

As with any drug, moderation is key, another expert added.

"You have to follow the directions, because the poison is in the dose," advised Elena Juris, an education outreach specialist at the American Association of Poison Control Centers in Washington, D.C. And that maxim applies to creams just as much as it does to pills, she said.

Her groups' statistics for 2005 show that 14 Americans died from skin exposures to some kind of toxic substance, although a breakdown on exactly which substances caused those deaths has not yet been compiled, Juris said.

However, she noted that, "the seventh most common substances involved in human exposures from poisoning are, in fact, topical preparations. In 2005, poison control centers reported 109,831 exposures related to topical substances."

Newman's Bengay-linked death was an extremely rare occurrence, however, and Johnson & Johnson, which makes the cream, told AP that their product "is safe and effective when used as directed to provide relief from minor arthritis pain, sore, aching and strained muscles and backaches."

Similar to advice given for prescription drugs, it's crucial that consumers carefully read label instructions and warnings for all OTC products. Varlotta believes that the cautions could be better highlighted, however.

"If you look at all of these [OTC] products, you cannot tell anything from the outside of the box," he said. In the case of the Bengay that Newman used, "there's nothing in big letters that says that it contains aspirin," Varlotta said. "It's in the fine print."

Many consumers also fail to realize that the same drug can pop up in multiple, and very different, OTC products.

"Cough and cold preparations are a common mistake," Juris said. "You might be taking a cold preparation that includes acetaminophen, and you also take acetaminophen [pills] for headache. So, you are overdosing it right there. So, it's not just looking at the label for directions, it's also making sure that you are not combining products and increasing the recommended dosage."

Other OTC products on Varlotta's radar include the painkillers Advil or Motrin (two or three OTC pills equal the dose in one prescription-strength pill, he noted), a host of poorly regulated herbals and dietary supplements, and Voltaren, an anti-inflammatory muscle cream that many of his patients bring back with them from Europe.

Voltaren isn't approved for OTC sale in the United States, Varlotta said, but it can cause real problems for Americans who bring it home.

"People come back, and they are given a prescription by their doctor for another anti-inflammatory, so that means they're now using the cream plus the anti-inflammatory, and they end up getting gastrointestinal problems, bleeding," he said. "And then I tell them: 'Let me see the cream.' And sure enough, it's Voltaren or some other cream they've brought back."

The bottom line, according to the experts, is that every drug -- even a nonprescription cream -- comes with some level of risk.

"Just because it's OTC doesn't mean that it's entirely safe and that it can be used against the directions that are being set out by the makers," Varlotta said. "People should know what they are taking, both orally and on their skin."

http://www.healthday.com/Article.asp?AID=605585


编辑：ache