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What 'extra strength' on a drug label really means

Plus other over-the-counter drug labels you might wonder about

Published: November 2012

You have a really bad headache, so you go to the drugstore for some super-strength pain medication to make you feel better fast. But what do you buy? Extra strength? Maximum strength? Or should you look for a long-acting or all-day formula? It’s enough to make your headache even worse!

Why is the drug aisle so confusing? Because there are no set definitions for those terms, says Carmen Catizone, executive director of the National Association of Boards of Pharmacy, which works with each state’s regulatory board. In the case of extra, maximum, and ultra-strength, they all mean essentially the same thing: that the formula contains more of its active ingredient than the regular version. Before new products launch, the government doesn’t review terms like these for over-the-counter (OTC) drugs that are already considered safe.

As a result, it can be hard to understand what you’re getting. For example, Extra Strength Tylenol has 54 percent more of its active ingredient, acetaminophen, than regular Tylenol. But that doesn’t mean that other extra-strength products have the same extra amount of active ingredient. It can vary. Continue on to find out more about common label claims. Also, check in with your pharmacist before trying any new OTC drug.

Extra strength

Examples: Extra Strength Tylenol, Alka-Seltzer Extra Strength

What it means: You’ll get an extra dose of the active ingredient vs. the regular version. For example, AlkaSeltzer Extra Strength has 54 percent more of its pain-relieving ingredient; Gas-X Extra Strength has 56 percent more of its active ingredient.

What to watch out for: Always read labels carefully for any drug you take; products with claims like “extra strength” may be a lot stronger than what you’re used to. Also, be sure not to exceed the daily dosage.

Maximum strength

Examples: Maximum Strength Pepcid AC, Maximum Strength Mucinex Expectorant

What it means: You’ll get more of the active ingredient than in the regular version, but you won’t necessarily get the maximum dose you can buy.

What to watch out for: Read directions about dosing carefully or there’s a chance you could overdo it. With Pamprin Max, for example, you can take two pills every 4 to 6 hours. But if you take them every 4 hours, you’ll wind up taking 12 pills in a day when the daily maximum is set at eight pills in a 24-hour period.

Ultra strength

Examples: Ultra Strength Bengay Cream, Gas-X Softgels Ultra Strength

What it means: Technically, ultra can be the same as extra or maximum strength; there’s no set amount of extra active ingredient. For example, Gas-X Ultra Strength Softgels contains 125 percent more than a regular-strength product, and Tums Ultra Strength has 100 percent more.

What to watch out for: With topical products, you still have to worry about using too much. And be especially careful with pills and liquids. (See below for more info.)

Long-acting

Examples: Adult Robitussin Lingering Cold Long-Acting Cough, Sudafed 12-Hour Long-Acting Nasal Decongestant

What it means: The medication should last longer than other drugs of its kind—for example, 8 hours instead of 4 to 6 hours. That’s because the drug’s active ingredient is released differently. For example, it may be an extended-release product.

What to watch out for: Not all long-acting medication lasts for the same amount of time, so it’s important to follow package instructions about when to take it and how much.

All day

Examples: All Day Strong Aleve, All Day Allergy-D

What it means: The medication may last 12 hours or more. So for some meds, one daily dose is all you need. That’s because it’s an extended-release version, so it keeps working over the course of many hours.

What to watch out for: “All day” might refer to the part of the day that you’re awake or to an actual day, meaning a full 24-hour period. Read labels carefully to determine whether you need to take the drug once every 12 hours (then perhaps switch to a nighttime formula) or once every 24 hours.

PM

Examples: Tylenol PM, Motrin PM

What it means: You’ll fall asleep faster and stay asleep. Drugs with “PM” in the name typically contain one of two active ingredients that make you sleepy: diphenhydramine or
doxylamine, which are both antihistamines that affect the central nervous system.

What to watch out for: If you take blood-pressure meds you shouldn’t take PM drugs because together they may cause excessively low blood pressure. Also, don’t drink alcohol when taking PM formulas because they can interfere with each other and may increase the risk of side effects.

Non-drowsy

Examples: Non-Drowsy Claritin Indoor & Outdoor Allergies, Allegra Allergy Original Strength Non-Drowsy

What it means: There are no active ingredients that cause drowsiness.

What to watch out for: Don’t assume that those drugs will help you stay alert; “non-drowsy” drugs don’t necessarily contain stimulating ingredients, they just won’t make you sleepy. But some (including certain decongestants) do contain caffeine or other stimulants that will keep you awake. So read labels and be careful not to have any other caffeine with those medications or you risk restlessness and difficulty falling asleep.

Dual action

Examples: Dual Action Pepcid Complete, Ricola Dual Action

What it means: “Dual-action” implies the drug is designed to relieve symptoms for two different but usually related problems. The drugs either have more than one active ingredient or an active ingredient that works to improve two symptoms.

What to watch out for: Drugs with more than one active ingredient can put you at risk of an accidental overdose if you take other meds with one of those ingredients. Or you could end up taking extra drugs you don’t need.

The risk of combo meds

Store shelves are packed with combo products like Advil Cold & Sinus and NyQuil. Ads make them sound like wonder drugs, relieving your stuffy head, fever, and other nasty symptoms. But if you’re not careful, you could wind up taking too much of certain drugs. Acetaminophen, for example, can damage your liver if you take too much. The drug is found in dozens of products, including cold remedies and sleep aids. With that in mind, the manufacturer of Tylenol, which contains acetaminophen, recently revised the maximum daily dosage for its extra-strength formula from eight pills a day (4,000 milligrams of acetaminophen total) to six pills (3,000 milligrams).

Many combo drugs target colds, flu, allergies, and sinus problems, but there are also laxatives, pain relievers, sleep aids, and stomach soothers that contain more than one active ingredient. We recommend taking single-ingredient drugs whenever you can (such as ibuprofen for muscle aches or loratadine for allergy symptoms). To avoid doubling up on ingredients by mistake, compare drug labels. And if you’re already taking a drug, stop and think before you pop a pill for a seemingly unrelated symptom, such as a headache when all you have is a sore throat.

Editor's Note: These materials are made possible by a grant from the state Attorney General Consumer and Prescriber Education Grant Program, which is funded by the multi-state settlement of consumer-fraud claims regarding the marketing of the prescription drug Neurontin (gabapentin).
   

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