Common OTC Medications: Uses, Side Effects, and Safety Information

Every year, millions of people reach for an OTC medication before calling a doctor. You’ve probably done it too - a headache, a stuffy nose, heartburn after dinner. These pills and liquids are easy to grab off the shelf, but that doesn’t mean they’re harmless. Many people think OTC medications are safe because they don’t need a prescription. That’s a dangerous myth. The truth is, even simple pain relievers can cause serious harm if used wrong.

What Are OTC Medications, Really?

OTC medications are drugs you can buy without a prescription. They’re meant for short-term relief of common issues like pain, fever, coughs, allergies, and heartburn. In the U.S., there are over 800 active ingredients in more than 100,000 different products. That’s a lot of choices. But not all are right for everyone. The FDA and other global regulators require these products to prove safety and effectiveness for self-use. Still, that doesn’t mean they’re risk-free.

What makes an OTC drug different from a prescription one? It’s not just about strength. It’s about how the drug is used. For example, ibuprofen at 200mg is OTC. At 800mg, it’s prescription. Same drug. Different dose. Same risk if misused.

Top Categories of OTC Medications and How They Work

Not all OTC meds are created equal. Here’s a breakdown of the most common types, what they do, and what you need to know.

Pain Relievers: Acetaminophen vs. NSAIDs

Two big names here: acetaminophen (Tylenol) and NSAIDs like ibuprofen (Advil) and naproxen (Aleve).

Acetaminophen works on pain and fever. It’s often the go-to for kids, pregnant women, and people with stomach issues. But it’s not gentle on the liver. Taking more than 4,000mg in a day - even if it’s spread out - can cause liver failure. The FDA reports 15,000 to 18,000 cases of acute liver failure each year linked to acetaminophen. Many of those cases come from people not realizing they’re taking it in multiple products. Cold medicines? Pain patches? Some contain it too.

NSAIDs like ibuprofen and naproxen reduce pain, fever, and inflammation. That’s why they’re better than acetaminophen for sprains or arthritis. But they irritate the stomach lining. People with ulcers, kidney problems, or heart disease should avoid them. A 2021 study found NSAIDs double or even quadruple the risk of gastrointestinal bleeding. And they’re not safe after 20 weeks of pregnancy - they can affect the baby’s kidneys.

Cold and Flu: Decongestants, Cough Suppressants, and Expectorants

These are the most confusing category. Why? Because they’re often mixed together.

Pseudoephedrine (Sudafed) helps with nasal congestion. But it can raise blood pressure and cause jitteriness. In some places, you have to ask the pharmacist for it because it’s used to make meth. Dextromethorphan (Delsym) suppresses coughs. It’s fine at the right dose. But some teens abuse it - taking 10 times the recommended amount for a high. The National Institute on Drug Abuse says over 1.2 million ER visits each year are tied to OTC drug misuse, and dextromethorphan is a big part of that.

Guaifenesin (Mucinex) loosens mucus. It’s harmless if used as directed. But don’t combine it with other cough meds unless you know what’s in them. You could accidentally overdose on dextromethorphan.

Allergy Meds: Old School vs. New School

First-generation antihistamines like diphenhydramine (Benadryl) work fast. But they make you sleepy. Like, really sleepy. Studies show they increase fall risk by 30% in adults over 65. That’s why you shouldn’t use them as a sleep aid - especially if you’re older.

Second-generation options like loratadine (Claritin) and fexofenadine (Allegra) don’t cause drowsiness. They last longer too. In fact, they’re 90% less sedating than Benadryl. If you’re driving, working, or just don’t want to nap all day, these are the better pick.

Gastrointestinal: Heartburn, Diarrhea, and Antacids

Heartburn meds are everywhere. But they’re not all the same.

Antacids like Tums (calcium carbonate) give quick relief. But if you take them daily for weeks, you can get too much calcium. That can lead to kidney stones.

H2 blockers like famotidine (Pepcid AC) reduce acid for up to 12 hours. They’re safe for occasional use.

Proton pump inhibitors (PPIs) like omeprazole (Prilosec OTC) are stronger. They’re great for frequent heartburn. But using them for more than 14 days in a row without a doctor’s advice? That’s risky. A 2023 study in JAMA Internal Medicine linked long-term PPI use to a 20-50% higher chance of chronic kidney disease.

Loperamide (Imodium) stops diarrhea. It’s fine for a quick fix. But if you take too much, it can slow your heart. There have been cases of fatal heart rhythm problems from people taking 20-30 tablets at once.

Who Should Be Extra Careful?

OTC meds aren’t one-size-fits-all. Some groups need to be extra cautious.

• Pregnant women: Only acetaminophen is considered safe for pain. Avoid NSAIDs after 20 weeks. Check labels - some cold meds have ingredients that aren’t pregnancy-safe.
• People over 65: Diphenhydramine increases fall risk. PPIs can affect kidney function. NSAIDs can cause stomach bleeding. Always talk to a pharmacist before starting anything new.
• People with liver or kidney disease: Acetaminophen and NSAIDs can be toxic. Loperamide and some antihistamines need dose adjustments.
• Children under 4: Cough and cold medicines are banned for this age group in the U.S. after over 100 deaths were linked to them between 1969 and 2006.
• Diabetics: Some liquid meds and chewables have sugar. Check the label.

How to Use OTC Meds Safely

Here’s how to avoid common mistakes:

1. Read the Drug Facts label. It’s required by the FDA. It tells you: active ingredients, purpose, uses, warnings, directions, and other info. If you can’t find it, don’t buy it.
2. Don’t double-dose. Many cold and flu products contain acetaminophen. Taking one for a headache and another for a cold? You could hit 6,000mg in a day - way over the safe limit.
3. Check interactions. If you’re on blood pressure meds, antidepressants, or blood thinners, OTC drugs can interfere. Always ask your pharmacist.
4. Don’t use long-term. OTC meds aren’t meant for daily use for months. If your symptoms last more than a week, see a doctor.
5. Store properly. Most OTC meds should be kept below 86°F (30°C). Heat and humidity can break them down. Don’t leave them in the bathroom or car.
6. Check expiration dates. Expired meds lose potency. Some - like liquid antibiotics or insulin - can become dangerous. Most OTC pills last 2-3 years after manufacture.

When to Call a Pharmacist

You don’t need to be a doctor to get good advice. Pharmacists are trained to help you choose the right OTC product. In fact, 93% of Americans live within 5 miles of a pharmacy. That’s not a coincidence.

Ask your pharmacist if:

• You’re unsure which medicine to pick
• You’re taking other medications
• You have a chronic condition like diabetes or high blood pressure
• You’re pregnant or caring for a child
• You’re thinking of using an OTC drug for more than 14 days

Pharmacists can spot hidden risks. For example, someone on blood thinners shouldn’t take ibuprofen. A person with glaucoma should avoid pseudoephedrine. These aren’t obvious unless you know the details.

The Bigger Picture: OTC Medications Are Part of Healthcare

OTC drugs save money and reduce pressure on hospitals. In 2022, the global OTC market hit $135.8 billion. But that doesn’t mean we should treat them like candy.

Companies are now using AI to help people choose safely. CVS launched an app called OTC Advisor that checks your meds and health conditions before recommending anything. That’s a step forward. But the real solution? Education.

The American Pharmacists Association now requires pharmacies to offer mandatory counseling on high-risk OTC products. That’s good. Because the line between self-care and self-harm is thin. Too many people use OTC meds for chronic problems - like daily heartburn or long-term pain - when they should be seeing a doctor.

OTC medications are powerful tools. But like any tool, they can hurt you if you don’t use them right.