Mouthwash and over-the-counter medications can harm workers, who may not be aware of the risks.

Taking Hazards From the Home to the Workplace

Over-the-counter remedies and prescription drugs may affect the health of your workers and at the same time may carry over into the work environment.

If you are the director of an environmental health and safety office, you need to be aware of the negative impacts of some commonly used medicines in the work environment. For example, the use of many of the statin drugs may actually cause slow but steady muscle weakness that will result in workplace injury. As far as executives are concerned, the use of mouthwashes containing alcohol may result in recurring mouth infections due to their dehydrating effects. Similarly, the chronic use of aspirin and other anti-inflammatory therapy may also create excess bleeding events from relatively minor wounds or permanent liver or kidney damage.

This article is intended to provide information about a few of these issues that may affect the health of your workers and at the same time may carry over into the work environment. If you have experienced muscle weakness, progressive vision impairment, frequent bleeding episodes, or liver-related symptoms, you may be the victim of your own home medicine cabinet. The root cause of many of the above ailments can be found in both the over-the-counter remedies and the prescriptions that you're taking. Seldom are these negative outcomes made clear to the individual using the remedies until after the damage has been done, and often not even then. The culprits causing these problems may be as simple as the medicine you take for pain relief or may even be nothing more than a cosmetic lotion rubbed on your skin. The results of these remedies can be as mild as causing you to have upset stomach and nausea or serious enough to ruin your vision or cause organ damage.

We realize that we're likely to make your life a lot more complex by reading this article, but we hope we also will keep you from having some of the more serious manifestations of the unintended impacts of these materials. We will be discussing in this article the negative impacts of aspirins, nonsteroid anti-inflammatory drugs (NSAIDs), mouthwashes, as well as cholesterol reduction medicines.

Aspirin
Do you take aspirin? Is taking a daily aspirin good for you? What will happen to you if you have too much aspirin in your system? Aspirin is one of the most common medications, found in almost everyone's medicine cabinet and used as a regular medicine to relieve pain and reduce fever. It is mainly used as a secondary preventive measure to reduce the risk of having a pathological condition such as cardiovascular diseases (e.g., heart attack or stroke) or to manage rheumatoid arthritis (inflammation of the joints) or osteoarthritis (deterioration of the joint’s cartilage). However, one must be aware of the fact that although aspirin therapy may be beneficial for these conditions, daily aspirin therapy isn't for everyone and can become at the expense of its takers if used with exaggeration and without medical advice.

Aspirin is a drug that interferes with the body's ability to form a blood clot by inhibiting the function of the blood's clotting cells (platelets), the key players in the human hemostatic system that provides the balance between bleeding and clotting forces. When one bleeds for some reason or another, platelets build up and form a stable plug that seals and ceases bleeding. However, if platelets keep on building up in the vascular system, then clotting episodes may emerge, causing heart attacks or possibly strokes. There are many conditions that have been shown to increase the risk of blood clot formation due to the increased clumping action of platelets; these mainly are seen in individuals with cardiovascular diseases and in individuals who suffer from abnormal blood flows (stagnation of blood flow), such as immobile or elderly individuals.

People with cardiovascular diseases are very susceptible to blood vessel injury or rupture because of atherosclerosis -- hardening of blood vessels due to the buildup of cholesterol-rich substances (plaques). Although no bleeding is actually happening, platelets will bind to the blood vessel to cease bleeding as would occur with any normal injury. Instead of sealing the cut, platelets will build up inside the blood vessel, slowing down and blocking blood supply (mainly oxygen) to the heart, eventually causing injury and damage to the heart muscles (heart attack). Therefore, aspirin therapy is recommended by many clinicians for patients at high risk for cardiovascular diseases to prevent and reduce the clumping action of platelets.

Although taking an occasional aspirin is safe for most adults to use for headaches, body aches, or fevers, daily use of aspirin therapy can have serious adverse effects. Several recent studies have shown that taking a daily low dose of aspirin (≤ 300 mg) increases the risk of having a major gastrointestinal (GI) and intracranial hemorrhage (brain bleeding), and the risk significantly increases with age.1,2 In comparison with other studies, De Berardis, G and colleagues followed the subjects for a period of up to six years and demonstrated a significant increase in hospitalizations due to major bleeding episodes among aspirin takers compared to non-aspirin takers.

Regular aspirin therapy also has been shown to be associated with blindness. A recent study by Liew and colleagues investigated the association between a regular aspirin therapy and the risk of developing age-related macular degeneration (AMD), one of the leading causes of blindness in adults age 50 and older.3 The researchers compared regular to non-regular-aspirin takers during a 15-year period and found a direct association between aspirin takers and AMD, and the risk significantly increased over time. The study suggested the accumulative dose of aspirin is a key player in the pathogenesis of this disease via different mechanisms, such as increased lipid metabolism.

In short, aspirin can be very beneficial for individuals with cardiovascular diseases, rheumatoid arthritis, or osteoarthritis, but if the risks of bleeding offset any beneficial effect of aspirin, one must think twice before taking a regular aspirin therapy.

Nonsteroid Anti-Inflammatory Drugs
Are you using nonsteroid anti-inflammatory drugs (NSAIDs) on a daily basis to relief a pain or to control a fever? If you do, then be aware of their serious side effects. NSAIDs are considered to be among the most widely used over-the-counter medications found in almost everyone’s medicine cabinet. Although they are mainly used as anti-inflammatory and pain relievers for a variety of conditions, some still use NSAIDs as a regular therapy for fever and flu-like symptoms.

Similar to aspirin, NSAIDs also interfere and inhibit normal platelet function, yet their effect is rather milder and shorter. Likewise, NSAIDs also can cause serious adverse effects, some of which may become permanent if used with exaggeration. Several studies have shown that chronic use of NSAIDs therapy may increase the risk of GI bleeding and, more seriously, liver damage, cardiovascular complications, and impaired renal function.4 NSAIDs also have been reported to cause increased skin and eye photosensitivity and phototoxicity, thus posing a higher risk from sun and arc welding exposure. Increasing the incidence of eye damage and skin cancer is very likely.5 The mechanism(s) by which NSAIDs induce such conditions is unclear; however, it may involve a multi-factorial process, such as production and accumulation of toxic byproduct(s) and/or free radical(s) within these vital organs. For this reason, acetaminophens are sometimes preferred over NSAIDs, especially for individuals with liver problems (e.g., hepatitis or cirrhosis), because they impose fewer complications on the liver, where blood’s clotting factors are produced. Therefore, individuals with liver problems have an impaired coagulation process (impaired ability of the blood to clot), and NSAIDs increase the risk of bleeding by further inhibiting the normal function of platelets. If acetaminophens are taken over a long period of time or in excessive dosage, however, they can be very toxic to the liver, and the toxicity is exacerbated in individuals who drink alcohol even if they were taking the recommended dosages of acetaminophen. One must be cautious and aware of the threats of such medications because the danger does not come from taking an occasional pill or two, but instead from overusing over-the-counter medications or mixing them.

Statins
Have you ever thought that what might help to lower your high cholesterol can also affect your ability to move around? Are you taking statins and feeling a little inactive? Although these are not over-the-counter medications, statins are among the most commonly prescribed drugs for individuals with elevated serum cholesterol or elevated Low-density lipoprotein (LDL), both of which are strong predictors of coronary artery disease.

Even though they are very efficient in lowering serum levels of cholesterol and LDL, a recent study has shown that statins may cause a variety of side effects, such as muscle pain and weakness.6 With chronic statin therapy, these symptoms may progress into a more severe muscle-wasting condition called rhabomyolysis that could also lead to severe kidney complications. These symptoms are unpredictable, dose dependent, and may become irreversible if not recognized and addressed. The Food and Drug Administration has released safety information regarding to the use of statin therapy. The recent statement is intended to inform (not to scare) consumers about the possibility these cholesterol-lowering medications may cause cognitive impairments, confusion, and possible memory loss,7 -- symptoms that are reversible upon stopping the use of statins.

In an occupational setting, is it necessary to do a complete medical assessment for the statin effects prior to making any rash decision about an associate's lack of enthusiasm or faltering abilities.

For the consumer, the most important consideration in the decision to use statins is to weigh the benefits versus the potential harmful effects.

Mouthwash
As we continue to examine your medicine cabinet, we notice the standard model of mouthwash, typically used after brushing your teeth. It appears to be the type that has an alcohol base, which is intended to provide disinfection of those malodorous microorganisms. Of course, you may be using one of the more recent varieties that has no alcohol content at all. For those of you using alcohol varieties, several research studies8-10 have reported finding an association between long-term use and oral cancer. In a recent study conducted by Wynder and colleagues, they found a significant association between mouthwash use and oral cancer. A bigger multi-site study by Guha and colleagues comparing participants who reported having used mouthwash to those who reported never having used it found that individuals who reported using the product more than twice a day were nearly six times more likely to develop oral squamous cell carcinoma compared to those who reported never having used mouthwash.

It is believed that the alcohol in the mouthwash causes dehydration in the sensitive tissue of the mouth, allowing bacteria to infiltrate in the gums. The resultant effect is to actually increase bad breath, the potential for infection, and may actually be a carcinogen. Our tentative recommendation would be to use non-alcoholic varieties, checking the label for anything that might be considered a carcinogen.

This article has been written not to change your use patterns of your over-the-counter medications, but to alert you to the seldom spoken of potential long-range consequences of their use, thus allowing you to make informed decisions.

References
1. Nadatani, Y., et al., Incidence and risk factors of gastrointestinal bleeding in patients on low-dose aspirin therapy after percutaneous coronary intervention in Japan. Scand J Gastroenterol, 2013.
2. De Berardis, G., et al., Association of aspirin use with major bleeding in patients with and without diabetes. JAMA, 2012. 307(21): p. 2286-94.
3. Liew, G., et al., The Association of Aspirin Use With Age-Related Macular Degeneration. JAMA Intern Med, 2013: p. 1-7.
4. Risser, A., et al., NSAID prescribing precautions. Am Fam Physician, 2009. 80(12): p. 1371-8.
5. Kocheva, I.E., Phototoxicity of nonsteroidal inflammatory drugs. Coincidence or specific mechanism? Arch Dermatol, 1989. 125(6): p. 824-6.
6. Di Stasi, S.L., et al., Effects of statins on skeletal muscle: a perspective for physical therapists. Phys Ther, 2010. 90(10): p. 1530-42.
7. Wagstaff, L.R., et al., Statin-associated memory loss: analysis of 60 case reports and review of the literature. Pharmacotherapy, 2003. 23(7): p. 871-80.
8. Weaver, A., S.M. Fleming, and D.B. Smith, Mouthwash and oral cancer: carcinogen or coincidence? J Oral Surg, 1979. 37(4): p. 250-3.
9. Wynder, E.L., et al., Oral cancer and mouthwash use. J Natl Cancer Inst, 1983. 70(2): p. 255-60.
10. Guha, N., et al., Oral health and risk of squamous cell carcinoma of the head and neck and esophagus: results of two multicentric case-control studies. Am J Epidemiol, 2007. 166(10): p. 1159-73.

This article originally appeared in the October 2013 issue of Occupational Health & Safety.

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