OTC Medications: Understanding the Risks

Over-the-counter (OTC) medications may seem risk-free – after all, you don't need a doctor's prescription to buy them. But just because they are readily available doesn't mean you don't need to follow an OTC drug's directions carefully.

Some OTC medicines pose risks for people with certain medical conditions, as well as for pregnant women. Some drugs can interact adversely with other medications, food, or drinks. And if you take too much medication, use it for too long a period of time, or otherwise misuse the medication, you face other risks.

Here's what you need to know about the most common types of OTC medicines.

Pain relievers

OTC pain relievers are typically used for mild pain or fever. The active ingredients in these medications are either acetaminophen or 1 of the nonsteroidal anti-inflammatory drugs (NSAIDs) – aspirin, ibuprofen, or naproxen sodium.

These drugs are generally safe and free of side effects when taken as directed, but you need to be aware of several risks. First is the risk for liver damage from taking too much acetaminophen. Ibuprofen and naproxen can cause kidney damage or stomach bleeding in certain situations. And children and teens should not take aspirin for fever or flu because it increases the risk for an illness called Reye syndrome.


Laxatives pose some risks if used improperly, but the most common problems that stem from laxatives are because of overuse. Typically, OTC laxatives are not recommended for people with mild constipation. For chronic constipation, your doctor may recommend 1 for a short period of time.

If you use a laxative frequently, you may become reliant on laxatives to have a bowel movement. You may also need to take an increasing dose of a laxative to achieve the same effect.

Heartburn remedies

Traditional OTC drugs for heartburn are antacids with familiar household names, such as Rolaids, Tums, and Maalox; they work by neutralizing acid in the stomach. Newer remedies, such as H2 blockers and proton pump inhibitors, literally halt the production of acid in the first place.

Traditional antacids are typically made up of some combination of salts, which may cause diarrhea or constipation in some people. They may also interfere with absorption of some prescription medications. The H2 blockers and proton pump inhibitor drugs are generally free of these side effects, but they don't work for everyone, and they can interact with some prescription medications.

Sleep aids

OTC sleep aids don't cause "sleepwalking," as some prescription sleep medicines do, but they still have some risks. Some OTC sleep aids last longer than 8 hours, which means you may still be drowsy after using the drug to sleep through the night.

Another warning about OTC sleep aids: You shouldn't use them for longer than 2 weeks – a guideline that many people ignore. Most experts agree that if you still have sleeping problems after 2 weeks, you should see your doctor.

Cough, cold, and allergy remedies

Common OTC options include decongestants, antihistamines, cough suppressants, and expectorants. Make sure to choose a drug that closely matches your symptoms and use it as directed.

Some of these drugs do pose risks for certain people. For example, if you have high blood pressure or heart disease, talk with your doctor before using OTC decongestants. Some older antihistamine medications, commonly called "first generation" antihistamines, cause drowsiness, as well as eye and mouth dryness, abdominal pain, and headaches. These side effects are much less common with some of the newer, "second generation" antihistamines, which often are labeled "nondrowsy" on their package. 

The FDA and the American Academy of Pediatrics advise parents not to give OTC cold and cough medication to infants or small children younger than 4 years old because of life-threatening side effects.