Nonprescription Medications and Products

Overview

A nonprescription medication—sometimes called an over-the-counter, or OTC, medication—is any drug that you can buy without a doctor's prescription. However, don't assume that all nonprescription drugs are safe for you. These drugs can interact with other medications and can sometimes cause serious health problems.

Some medications should only be used by adults or older children. Be sure to read the package instructions carefully, or ask a pharmacist before giving any product to an infant or young child. If you are pregnant, always check with your pharmacist or doctor before using any nonprescription medication to make sure it is safe to use during pregnancy.

Carefully read the label of any nonprescription drug you use, especially if you also take prescription medications for other health problems. Ask your pharmacist for help in finding a nonprescription drug best suited to your needs. See the medication guidelines for tips on how to avoid common medication problems.

Some common nonprescription medications include:

• Antacids and acid reducers.
• Bulking agents and laxatives.
• Antidiarrheals.
• Cold and allergy remedies.
• Pain relievers.

These drugs can be very helpful when used properly but can cause serious problems if used incorrectly. The following tips will help you use common nonprescription drugs wisely and safely. In some cases, you may find that you don't need to take them at all.

Antacids and Acid Reducers

Antacids are taken to relieve heartburn or indigestion caused by excess stomach acid. While they are safe if used occasionally, antacids may cause problems if taken regularly. There are several kinds of antacids. Learn what ingredients are in each type so that you can avoid any adverse effects.

• Sodium bicarbonate antacids (such as Alka-Seltzer and Bromo Seltzer) contain baking soda. Avoid these antacids if you have high blood pressure or are on a salt-restricted diet. Alka-Seltzer contains aspirin, which is linked to Reye’s syndrome, a rare but serious illness in children.
• Calcium carbonate antacids (such as Tums and Alka-Mints) are sometimes used as calcium supplements. These products may cause constipation.
• Aluminum-based antacids (such as Amphojel) are less potent and work more slowly than other products do. They may also cause constipation. Some may cause calcium loss and should not be taken by postmenopausal women. If you have kidney problems, check with your doctor before using aluminum-based antacids.
• Magnesium compounds (such as Phillips' Milk of Magnesia) may cause diarrhea.
• Aluminum-magnesium antacids (such as Maalox, Di-Gel, Mylanta, and Riopan) are less likely to cause constipation or diarrhea than are aluminum-only or magnesium-only antacids.

Acid reducers decrease the amount of acid produced by the stomach. There are several types of nonprescription acid reducers on the market. Each has slightly different cautions for use. Read and carefully follow the instructions included with the package.

Antacid and acid reducer precautions

• Try to eliminate the cause of frequent heartburn instead of taking antacids regularly. For more information, see the topic Heartburn.
• Consult your doctor or pharmacist before taking an antacid if you take other medications. Antacids may interfere with the absorption and action of some prescription medications. Also consult your doctor if you have ulcers or kidney problems.
• If you have a problem with the function of your kidneys or liver, you should be careful in using acid reducers. All drugs are broken down and removed from the body by the combined action of the liver and kidneys. If your liver or kidneys are not working correctly, it is possible that too much of the acid-reducing drug will build up in your body.

Bulking Agents and Laxatives

There are two types of products used to prevent or treat constipation: bulking agents and laxatives.

Bulking agents, such as bran or psyllium (found in Metamucil, for example) ease constipation by increasing the volume of stool and making it easier to pass. Regular use of bulking agents is safe and helps make them more effective.

Laxatives (such as Correctol, Ex-Lax, Senokot, and Dulcolax) speed up the passage of stool by irritating the lining of the intestines. Regular laxative use is not recommended.

There are many other ways to treat constipation, such as drinking more water. For more information, see the topic Constipation, Age 12 and Older.

Precautions

• Take any laxative or bulking agent with plenty of water or other liquids.
• Do not take laxatives regularly. Overuse of laxatives decreases tone and sensation in the large intestine, causing laxative dependence. If you need help keeping your bowels regular, use a bulking agent.
• Regular use of some laxatives (such as Correctol, Ex-Lax, and Feen-a-Mint) may interfere with your body's ability to absorb vitamin D and calcium; this can lead to weakened bones.

Antidiarrheals

There are two types of antidiarrheal drugs: those that thicken the stool and those that slow intestinal spasms.

The thickening mixtures (such as psyllium) contain clay or fruit pectin and absorb the bacteria and toxins in the intestine. They are safe because they do not go into the blood, but these products also absorb the bacteria needed for digestion. Long-term use is not advised.

Antispasmodic antidiarrheal products slow the spasms of the intestine. Loperamide (the active ingredient in products such as Imodium A-D, Kaopectate, and Pepto Diarrhea Control) is an example of this type of preparation. Some products contain both thickening and antispasmodic ingredients.

Antidiarrheal precautions

• Diarrhea helps rid your body of an infection, so try to avoid using antidiarrheal medications for the first 24 hours. After that, use them only if cramping and pain continue and there are no other signs of illness, such as fever.
• Be sure to take a large enough dose. Take antidiarrheal preparations until your stools thicken, then stop immediately to avoid constipation.
• Replace lost body fluids. Dehydration can develop when someone, especially an infant, child, or older adult, has diarrhea. To help avoid dehydration, you can make a rehydration drink at home.
• If your child or teen gets chickenpox or flu, do not treat the symptoms with over-the-counter medicines that contain bismuth subsalicylate (such as Pepto-Bismol and Kaopectate). If your child has taken this kind of medicine and he or she has changes in behavior with nausea and vomiting, call your doctor. These symptoms could be an early sign of Reye's syndrome, a rare but serious illness. Ask your doctor if your child younger than 12 should take these medicines.

Cold and Allergy Remedies

In general, whether you take medications for your cold or not, you'll get better in about a week. Rest and liquids are the best treatment for a cold. Antibiotics will not help. However, nonprescription medications help relieve some cold symptoms, such as nasal congestion and cough.

Allergy symptoms, especially runny nose, often respond to antihistamines. Antihistamines are also found in many cold medications, often together with a decongestant. However, the value of antihistamines in treating cold symptoms is under debate.

Decongestants

Decongestants make breathing easier by shrinking swollen mucous membranes in the nose, allowing air to pass through. They also help relieve runny nose and postnasal drip, which can cause a sore throat.

Decongestants can be taken orally or used as nose drops or sprays. Oral decongestants (pills) are probably more effective and provide longer relief, but they cause more side effects. Pseudoephedrine (the active ingredient in products such as Sudafed) is an oral decongestant. In some states, medicines containing pseudoephedrine (such as Sudafed) are kept behind the pharmacist's counter or require a prescription. You may need to ask the pharmacist for it or have a prescription from your doctor to buy the medicine.

Sprays and drops provide rapid but temporary relief. Nasal sprays containing phenylephrine (such as Neo-Synephrine) are effective. Sprays and drops are less likely to interact with other drugs than oral decongestants are. Saline nose drops are not decongestants but may help keep nasal tissues moist so the tissues can filter air.

Decongestant precautions

• Do not give cold medicines or oral decongestants to a child younger than 2 unless your child’s doctor has told you to. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do. Nonprescription cold medicines have not been proven effective for preschool children.
• Do not use medicated nasal sprays or drops more than 3 times a day or for more than 3 days in a row. Continued use will cause a "rebound effect," in which your mucous membranes swell up more than before you used the spray.
• Drink extra fluids when taking cold medications.
• Decongestants can cause problems for people who have certain health problems, such as heart disease, high blood pressure, glaucoma, diabetes, or an overactive thyroid. Decongestants may also interact with some drugs, such as certain antidepressants and high blood pressure medications. Read the package carefully or ask your pharmacist or doctor to help you choose the best decongestant for you.
• If you are pregnant, check with your doctor or pharmacist before using a decongestant.

Cough preparations

Coughing is your body's way of getting foreign substances and mucus out of your respiratory tract. Coughs are often useful, and you shouldn't try to eliminate them. Sometimes, though, coughs are severe enough to impair breathing or prevent rest.

Water and other liquids, such as fruit juices, are probably the best cough syrups. They help soothe the throat and also moisten and thin mucus so it can be coughed up more easily.

You can make a simple and soothing cough syrup at home by mixing 1 part lemon juice with 2 parts honey. Use as often as needed. This can be given to children older than 1 year of age.

There are two kinds of cough medicines: expectorants and suppressants.

Expectorants help thin the mucus and make it easier to cough mucus up when you have a productive cough. Look for expectorants containing guaifenesin, such as Robitussin, Mucinex, and Vicks 44E.

Suppressants control or suppress the cough reflex and work best for a dry, hacking cough that keeps you awake. Look for suppressant medications containing dextromethorphan, such as Robitussin-DM or Vicks Dry Hacking Cough. Don't suppress a productive cough too much (unless it is keeping you from getting enough rest).

Cough preparation precautions

• Cough preparations can cause problems for people with certain health problems, such as asthma, heart disease, high blood pressure, or an enlarged prostate (BPH). Cough preparations may also interact with sedatives, certain antidepressants, and other medications. Read the package carefully or ask your pharmacist or doctor to help you choose one.
• Cough suppressants can stifle breathing. Use them with caution if you give them to someone who is very old or frail or if you have chronic respiratory problems.
• Read the label so you know what the ingredients are. Some cough preparations contain a large percentage of alcohol; others contain codeine. There are many choices. Ask your pharmacist to advise you.
• Do not give cough and cold medicines to a child younger than 2 unless your child’s doctor has told you to. If your child’s doctor tells you to give a medicine, be sure to follow what he or she tells you to do.
• If you are pregnant, check with your doctor or pharmacist before using a cough preparation.

Antihistamines

Antihistamines dry up nasal secretions and are commonly used to treat allergy symptoms and itching.

If your runny nose is caused by allergies, an antihistamine will help. For cold symptoms, home treatment and perhaps a decongestant will probably be more helpful. It is usually best to take only single-ingredient allergy or cold preparations, instead of those containing many active ingredients.

Products such as Chlor-Trimeton (chlorpheniramine) and Benadryl (diphenhydramine) are single-ingredient antihistamine products.

Products such as Dristan, Coricidin, and Triaminic contain both a decongestant and an antihistamine.

Antihistamine precautions

• Do not give antihistamines to infants younger than 4 months of age. For children between 4 months and 1 year, ask your doctor first.
• Use of antihistamines to treat the stuffiness of a cold will often thicken the mucus, making it harder to get rid of.
• Drink extra fluids when taking antihistamines.
• Antihistamines can cause problems for some people with health problems, such as asthma, glaucoma, epilepsy, or an enlarged prostate. Antihistamines may also interact with certain antidepressants, sedatives, and tranquilizers. Read the package carefully or ask your pharmacist or doctor to help you choose one that will not cause problems.
• If you are pregnant, check with your doctor or pharmacist before using an antihistamine.
• The drowsiness that antihistamines often cause usually lessens with continued use. If it continues, or if the medication isn't helping your allergies after 1 week, call your doctor for advice.
• Antihistamines that don't cause drowsiness are available by prescription. Ask your health professional if these are appropriate for you.

Pain Relievers

There are dozens of pain-relief products. Most contain either aspirin, ibuprofen, or acetaminophen. These three drugs, as well as naproxen sodium, relieve pain and reduce fever. Aspirin, ibuprofen, and naproxen sodium also relieve inflammation. They belong to a class of drugs called nonsteroidal anti-inflammatory drugs (NSAIDs).

When purchasing pain relievers, keep in mind that generic products are chemically equivalent to more expensive brand-name products, and they usually work equally well.

Aspirin

Aspirin is widely used for relieving pain and reducing fever in adults. It also relieves minor itching and reduces swelling and inflammation. Most tablets contain 325 mg of aspirin. Although it seems familiar and safe, aspirin is a very powerful drug.

Aspirin precautions

• Keep all aspirin, especially baby aspirin, out of children's reach.
• Aspirin increases the risk of Reye's syndrome in children. Do not give aspirin to anyone younger than 20 unless your doctor tells you to do so.
• Aspirin can irritate the stomach lining, causing bleeding or ulcers. If aspirin upsets your stomach, try a coated brand, such as Ecotrin. Talk with your doctor or pharmacist to determine what will work best for you.
• Some people are allergic to aspirin. They may also be allergic to ibuprofen.
• Throw aspirin away if it starts to smell like vinegar.
• Do not take aspirin if you have gout or if you take blood thinners (anticoagulants).
• If you are pregnant, check with your doctor or pharmacist before taking aspirin.
• Do not take aspirin for a hangover. Aspirin used with alcohol increases your risk for stomach irritation.
• High doses may result in aspirin poisoning (salicylism). Stop taking aspirin and call a health professional if any of these symptoms occur:
  • Ringing in the ears
  • Visual disturbances
  • Nausea
  • Dizziness
  • Rapid, deep breathing

Other aspirin uses

In addition to relieving pain and inflammation, aspirin is effective against many other ailments. Because of the danger of side effects and the interactions aspirin may have with other medications, do not try these uses of aspirin without a doctor's supervision.

Heart attack and stroke: Aspirin in low but regular doses helps prevent heart attacks and strokes in certain people, including people with diabetes. Doses as low as 30 mg per day have helped. Aspirin may also help as a first aid measure for heart attacks. Chewing half of a tablet may be enough to help. For more information, see the topics Chest Pain and Heart Attack and Unstable Angina.

Stomach and colon cancer: Some studies have shown that taking one aspirin tablet per day can reduce the risk of cancers in the digestive system.

Migraines: Regular, low-dose aspirin use may reduce the frequency of migraine headaches.

Other pain relievers

Ibuprofen (the active ingredient in products such as Advil and Nuprin) and naproxen sodium (in products such as Aleve) are other nonsteroidal anti-inflammatory drugs (NSAIDs). Like aspirin, these drugs relieve pain and reduce fever and inflammation. Also like aspirin, they can cause nausea, stomach irritation, and heartburn. People who take blood thinners (anticoagulants) should use these drugs with caution.

Acetaminophen (the active ingredient in products such as Tylenol) reduces fever and relieves pain. It does not have the anti-inflammatory effect of NSAIDS, such as aspirin and ibuprofen, but it also does not cause stomach upset and other side effects.

The product's package label will tell you how many milligrams (mg) of medicine are in each pill; how much you should take; and how often you should take it. Do not exceed the dosage limits, and follow the instructions on the package if you have health problems that may make it unsafe for you to take the usual dosage of a product.

If you are pregnant, check with your doctor or pharmacist before taking any kind of pain reliever.

Related Information

• Allergic Rhinitis
• Constipation, Age 11 and Younger
• Constipation, Age 12 and Older
• Coughs
• Dehydration
• Diarrhea, Age 11 and Younger
• Diarrhea, Age 12 and Older
• Headaches
• Heartburn
• Poisoning
• Respiratory Problems, Age 11 and Younger
• Respiratory Problems, Age 12 and Older
• Your Home Health Center