A well-stocked medicine cabinet is key to getting quick relief when you have an illness or injury. Knowing what to take and why is important to ensure that you get relief safely. There are a lot of different medications available for purchase “over the counter” (OTC) that can be used to treat many common conditions. But just because you can purchase a medication without a prescription does not mean you shouldn’t be cautious with how you take it.
First, know that over-the-counter medications are required to have a label on it with “Drug Facts”. Look under “Active Ingredients” on the label to find out exactly what it contains, and then look under “Purpose” so you know what the medication is supposed to do. The FDA has required that every medication has one of these labels so that you will know just what you are taking.
Many medications - especially things like cold medicines and pain relievers- actually contain several different drugs, so knowing precisely what they contain is key to making sure you do not accidentally take too much of one specific component. Following dosage recommendations on the packaging and not mixing two different types of medications containing the same ingredients is critical.
Below is a guide to some of the medications that may be in your medicine cabinet, and some things to be aware of when reaching for them.
Over-the-Counter Medications: Pain Relievers/Fever Reducers
These are very common types of medications to have in your medicine cabinet- but also one of the most common accidental overdoses! Many over-the-counter cough/cold medications include acetaminophen or ibuprofen as well, so be vigilant in checking labels:
- Acetaminophen (Tylenol, “non-aspirin pain reliever”): When used as directed, this is a safe and effective medication that can be used for both pain and fever control. Acetaminophen is sold on its own as Tylenol, APAP, and “non-aspirin pain reliever”, and is also a common ingredient in many other OTC and prescription medications. Cold/flu medications, “arthritis pain relief”, Percocet, and Vicodin are just some of the products that contain acetaminophen. Because of this, it can be easy to accidentally take too much acetaminophen, which in extreme cases can lead to liver failure and even death. Make sure you read the labels on your pill bottles and do not take more than is recommended on the label. Do not mix over-the-counter medications containing acetaminophen. In addition, if you drink alcohol regularly or have a history of problems with your liver, call your doctor to determine if acetaminophen is safe for you.
- NSAIDS (aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn)): NSAID is an abbreviation for non-steroidal anti-inflammatory medication. These are medications that can be taken for pain and fever control, just like acetaminophen, though they work differently in the body. There are also prescription-strength NSAIDs, such as diclofenac and celecoxib, to name a few. These can sometimes be upsetting to the stomach, so they should be taken with food. They also are common ingredients in combination medications like cough/cold meds and pain relievers, so again, check the labels of any of these combo meds so you don’t accidentally take too much. It is not a good idea to take different NSAIDs at the same time- for example, if your doctor prescribes diclofenac for your arthritis pain, do not also take ibuprofen if you get a headache. Too many NSAIDs can be damaging to your kidneys or lead to ulcers from irritation of your stomach lining. Finally, never give aspirin to a child or teenager with a fever as this can result in a rare but dangerous condition known as Reye’s Syndrome.
- Headache medicine (Excedrin): This deserves special mention, as many medications marketed for headaches actually contain multiple drugs. For example, Excedrin contains aspirin, acetaminophen, and caffeine. While this can provide good relief for some headache sufferers, caffeine can cause palpitations or insomnia for some people.
Over-the-Counter Medications: Cold/Cough Medicine
When you get a cold or flu, you can get many different symptoms- congestion, fever, cough, or sore throat and runny nose for example. Because of this, cough and cold medicines typically contain several different drugs. It is critical that you read the label to understand exactly what you are taking- try to take a medication that treats only the most bothersome of your symptoms and not symptoms that you don’t even have!
Remember too that many of these combination over-the-counter medications contain drugs that can make you feel sleepy- make sure you look for “non-drowsy” on the label if this is something you want to avoid. Some of the more common ingredients in cold/cough/flu medications include:
- Acetaminophen/ibuprofen/naproxen: These medications are common in many different cough//cold meds. Be aware of what you are taking so you don’t accidentally exceed the recommended dosage of any one of these medications.
- Decongestants: the goal of a decongestant is to shrink the swollen lining of your nose and sinuses to help make you feel less stuffy. One of the most common decongestants up until recently was phenylephrine, found in a number of different cold medicines. However, an FDA Advisory Committee recently reported that phenylephrine, while not unsafe, is not actually effective for congestion when taken orally. Pseudoephedrine is a similar ingredient for congestion that is still felt to be effective, though it is kept behind the pharmacy counter and an ID must be shown when purchasing it (this is due to its use as an ingredient in making methamphetamine). Pseudoephedrine can also raise blood pressure in some people so should be taken with caution.
- Cough suppressants: Dextromethorphan is one of the most commonly known medications used for cough suppression. It acts directly on the part of the brain that helps to suppress cough. It is best used for dry coughs that aren’t producing mucus, as it can keep you from clearing mucus from your lungs if you are not coughing as much as your body needs. It also must be used as directed, as using too much can cause confusion or dizziness. In addition, it is not to be used in children under 4 years of age.
- Expectorants: Guaifenesin (Mucinex) is used to help thin mucus, which can make it easier to cough up. If you feel like you have mucus moving in your chest when you cough but can’t get it out, this may be a helpful ingredient in your cold medication.
- Antihistamines: Many cold and flu medicines contain antihistamines such as chlorpheniramine or diphenhydramine, which are more commonly used for allergy symptoms. They may be included in cold medicines because they can help a little bit with congestion… but their biggest effect is making you sleepy. This isn’t always bad when you can’t sleep due to your cold symptoms, but be aware of this side effect if you take this type of cold medicine during the day.
- Nasal decongestants: Nasal sprays that you squirt directly into your nose are marketed to shrink your nasal passages and make breathing easier. Oxymetazoline (Afrin) and phenylephrine (Neosynephrine) are two commonly used nasal sprays for colds and congestion. They can help, but should never be used longer than three days, or else they can cause “rebound congestion”- meaning that your nose will come to rely on these nasal sprays, and you will always be congested unless you use them, even when your cold is gone! Saline nasal sprays are saltwater sprays that help moisten your nose and make congestion easier to clear. These are safe and easy to use.
Over-the-Counter Medications: Allergy Medicine
Whether experiencing seasonal allergies or hives from an allergic reaction, many people reach for the following common over-the-counter medications:
- Non-drowsy antihistamines such as loratadine (Claritin, Alavert), cetirizine (Zyrtec), and fexofenadine (Allegra): These are less-sedating antihistamines that can typically be taken once per day to help with allergy symptoms. Just be aware that some formulations combine them with other medications to treat multiple symptoms, such as “Claritin-D” which also contains a decongestant.
- Antihistamines such as diphenhydramine (Benadryl) and chlorpromazine (Chlor-Trimeton): These “first generation” antihistamines are very sedating but also work well for allergies- they can also be found in some over-the-counter medications for sleep because of their sedating effects.
- Nasal steroid sprays- fluticasone (Flonase), triamcinolone (Nasacort): these sprays can be squirted into the nose to help with some of the most common symptoms of seasonal allergies such as sneezing, runny nose and congestion. There is little downside to these medications.
Over-the-Counter Medications: Sleep Aids
Over-the-counter medications that help with sleep are typically work in one of two ways:
- Antihistamines (Benadryl, Unisom): The side effect of “drowsiness” is so strong in these allergy medications that they are marketed to help you sleep as well. Be careful not to mix them with cold or allergy medications which might also contain antihistamines. They should only be used on an occasional basis.
- Melatonin: Melatonin is a hormone your body produces to help with sleep. Sometimes taking a melatonin supplement can be helpful if you have jet lag or insomnia. It is generally safe when taken as directed; some side effects can be headache, dizziness, or nausea.
Over-the-Counter Medications: Stomach Issues
Acid reflux, heartburn, diarrhea, and constipation are all common ailments that affect the digestive tract. Some over-the-counter medications that can be used to treat these issues include:
- Antacids like calcium carbonate (Tums, Rolaids, Alka Seltzer) and aluminum/magnesium hydroxide (Maalox): These medications help neutralize stomach acid and can provide quick relief from heartburn, indigestion, and sour stomach. The danger is that some of these taste like candy and therefore may be taken in excess. Take as directed on the packaging, as taking too many of these can be bad for your kidneys.
- H2-Blockers like famotidine (Pepcid) and cimetidine (Tagamet) help reduce the amount of acid in your stomach to help with occasional heartburn and reflux. They work quickly and are effective for the relief of occasional heartburn symptoms. A similar medication called ranitidine was taken off the market in 2020 due to a potentially increased cancer risk from a contaminant called NDMA, so if you have any old ranitidine on your medicine cabinet shelves, throw it away. Famotidine and cimetidine are considered safe when taken as prescribed, however.
- Proton Pump Inhibitors (PPIs) like omeprazole (Prilosec), esomeprazole (Nexium), pantoprazole (Protonix), and lansoprazole (Prevacid): These medications are used to treat more serious episodes of reflux and heartburn by shutting down the pumps in the stomach that produce acid. They can take a few days to fully kick in, and are best used when you have been having regular daily episodes of reflux. It is recommended that you take them before your first meal of the day. Plan to take them for approximately 2 weeks at a time, unless your doctor recommends a longer course.
- Antidiarrheals such as loperamide (Imodium) and bismuth subsalicylate (PeptoBismol, kaopectate) are used to decrease the frequency of loose watery stool:
- Loperamide: can help you have fewer bowel movements and shorten the number of days that you have diarrhea. But take it exactly as prescribed, as extra doses can cause serious heart rhythm problems, dizziness, or drowsiness.
- Bismuth subsalicylate (Pepto Bismol, Kaopectate):This medication can be helpful for diarrhea and upset stomach, but be aware that it can temporarily make your stool and tongue look black! In addition, it contains an ingredient similar to aspirin, so should not be mixed with any aspirin-containing products.
- Meds for constipation: While the best thing to do for occasional constipation is to make lifestyle changes like increasing water and fiber intake as well as upping your physical activity, there can be times when medication can be helpful. Some common medications for constipation include:
- Stool softeners such as docusate sodium (Colace): help to soften the stool and avoid strainingFiber supplements such as psyllium husk (Metamucil) and methylcellulose (Citrucel): these absorb water to help bulk up the stool and make it softer and easier to pass. However, they should be taken with a lot of water or else they can actually block things up more. Some people find that these meds can cause gas and bloating, especially in the first few days of use.
- Osmotic laxatives such as polyethylene glycol (miralax): this type of medication help pull water into the stool in your large intestine to make it easier to pass. This is a safe way to help stimulate a bowel movement.
- Stimulant laxatives such as bisacodyl (dulcolax) and senna (Ex-Lax): these medications work by making the muscles of your intestine squeeze to help produce a bowel movement. These should only be used very occasionally, as the body can become dependent on them to produce a bowel movement. In addition, they can cause severe cramping.
Over-the-Counter Medications: Eye Drops
Dry, red eyes can be uncomfortable and irritating. If you experience this, you should see an eye doctor for a formal diagnosis. If serious conditions have been ruled out, there are several different types of eye drops on the market that can be used to help with symptoms. Eye drops are usually dispensed in either single-use containers, or multi-use bottles. If purchasing a multi-use bottle, it is critical to never share it with others, and never let the tip of it touch your eye or any other surface. There was a 2022 research review that showed that 24% of multi-use bottles become contaminated when used for greater than a week.
For this reason alone, using single-use containers is preferable. Types of over-the-counter medications that might be in your medicine cabinet include:
- Artificial Tears/Rewetting drops/lubricants: there are a number of different brands of eye drops/lubricants designed to keep your eyes moist and comfortable. The key with these is to find the type that works best for you. In addition, be aware that many that come in multi-use bottles contain preservatives, which can cause irritation for some. Single-use packaging might be preferable for these types of drops.
- Allergy drops: Seasonal allergies can cause itchy, watery eyes. There are antihistamines designed for the eyes- olopatadine (Patanol) is one example. This type of drop cannot be used while wearing contact lenses- remove your lenses and wait at least 10 minutes before trying these drops. But you might be better off trying a non-sedating oral antihistamine instead.
- Anti-redness drops such as tetrahydrozoline (Visine, Clear Eyes): This type of medicine causes the blood vessels in your eyes to shrink down, making them appear less red. Unfortunately, they can cause “rebound redness” meaning that as they wear off your eyes become red again. Most ophthalmologists recommend against using them. If you do choose to use them, try to use them as little as possible- for example, before having your picture taken, or before an important meeting. And definitely never use them longer than 72 hours!
The Bottom Line
Finally, ensure that your medications are stored in their original containers, in a cool, dry place, and out of reach of children. Keep track of expiration dates and dispose of any expired medications properly. Avoid crushing or breaking tablets unless your healthcare provider advises it, as some medications have special coatings for slow release. If you're unsure about how to take a medicine, consult your doctor or pharmacist.
Over-the-counter medications are valuable tools when used responsibly. Understanding their types, safe usage practices, and potential risks will empower you to make informed decisions when choosing an OTC medication. Always consult healthcare professionals when in doubt, and make sure to read labels! By following these guidelines, you can confidently navigate the world of over-the-counter medications, understanding exactly what you are taking and why.
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