Nonprescription Medicines and Products

Topic Overview

A nonprescription medicine-sometimes called an over-the-counter, or OTC, medicine-is any drug that you can buy without a doctor's prescription. But don't assume that all nonprescription drugs are safe for you. These drugs can interact with other medicines and can sometimes cause serious health problems. And if you take more than the normal or recommended amount, overdose may occur.

Some medicines 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 medicine, 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 medicines for other health problems. Ask your pharmacist for help in finding a nonprescription drug best suited to your needs. Use these tips on how to avoid common medicine problems.

And find out the safest way to throw away medicines that are expired or no longer used. Use these drug disposal tips to help prevent people and animals from taking medicines that aren't intended for them:

• Find out if your local trash and recycle center, pharmacy, or hospital offers a medicine take-back program or a place to drop off medicine. Ask your pharmacist if he or she knows of one. These are two of the best ways to safely throw away medicines.
• If there is not a take-back program or drop-off box near you, follow these steps to throw away medicine with the rest of your garbage:
  1. Mix medicine with a substance that doesn't taste good, such as cat litter, sawdust, or coffee grounds. Do not crush tablets or capsules.
  2. Place the mixture in a container, such as a sealed plastic bag.
  3. Put the container in your household trash.

Some common nonprescription medicines include:

• Antacids and acid reducers.
• Bulking agents, laxatives, and stool softeners.
• 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. 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 syndrome, a rare but serious illness in children.
• Calcium carbonate antacids (such as Tums) 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 women who are past menopause. If you have kidney problems, check with your doctor before you use aluminum-based antacids.
• Magnesium compounds (such as Phillips' Milk of Magnesia) may cause diarrhea.
• Combination aluminum-magnesium antacids are less likely to cause constipation or diarrhea than are aluminum-only or magnesium-only antacids. Examples include Maalox, Mylanta, and Riopan. Many of these types of antacids contain simethicone to help break down gas bubbles in your stomach.
• Antacids with alginic acid (such as Gaviscon) contain a foaming agent that floats on top of the stomach contents. This may help keep stomach juices from coming in contact with your esophagus.

Acid reducers decrease the amount of acid produced by the stomach. They help relieve heartburn. There are several types of nonprescription acid reducers on the market. Examples include H2 blockers (such as famotidine and ranitidine) and proton pump inhibitors (such as lansoprazole and omeprazole). 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 medicines. Antacids may interfere with the absorption and action of some prescription medicines. Also consult your doctor if you have ulcers or kidney problems.
• Do not use antacids for more than 2 weeks unless you have talked with your doctor about taking them on a long-term basis.
• If you have a problem with the function of your kidneys or liver, you should be careful using antacids. All drugs are broken down and removed from the body by the combined action of the liver and kidneys. If your kidneys are not working correctly, it is possible that too much of the drug will build up in your body.
• If you are on a low-salt diet, talk with your doctor or pharmacist before choosing an antacid. Some antacids have a lot of salt (sodium).
• Be careful when you take over-the-counter antacid medicines. Many of these medicines have aspirin in them. Read the label to make sure that you are not taking more than the recommended dose. Too much aspirin can be harmful. If you are pregnant, do not take aspirin or medicines that contain aspirin unless your doctor says it is okay.
• If you are pregnant, don't use antacids that have sodium bicarbonate (such as Alka-Seltzer) or magnesium trisilicate (such as Gaviscon).

Bulking Agents, Stool Softeners, and Laxatives

There are four types of products used to prevent or treat constipation: bulking agents, stool softeners, osmotic laxatives, and stimulant 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.

Stool softeners (such as Colace and Docusate Calcium) soften the stool, making it easier to pass. Stool softeners can be most effective if you drink plenty of water throughout the day.

Osmotic laxatives, such as Fleet Phospho-Soda, Milk of Magnesia, or Miralax, and nonabsorbable sugars (such as lactulose or sorbitol), hold fluids in the intestine. They also draw fluids into the intestine from other tissue and blood vessels. This extra fluid in the intestines makes the stool softer and easier to pass. Drink plenty of water when you use this type of laxative.

Stimulant laxatives (such as Correctol, Ex-Lax, and Senokot) make stool move faster through the intestines by irritating the lining of the intestines. Regular use of stimulant laxatives is not recommended. Stimulant laxatives change the tone and feeling in the large intestine, and you can become dependent on using laxatives all the time to have a bowel movement.

There are many other ways to treat constipation, such as drinking more water. For more information, see the topics Constipation, Age 12 and Older and Constipation, Age 11 and Younger.

Precautions

• Take any laxative or bulking agent with plenty of water or other liquids.
• Do not take laxatives regularly. They change the tone and feeling in the large intestine. And you can become dependent on using them all the time to have a bowel movement. If you need help having regular bowel movements, use a bulking agent.
• Regular use of laxatives may change your body's ability to absorb vitamin D and calcium. This can lead to weakened bones.

Antidiarrheals

There are two types of medicines that help stop diarrhea, those that thicken the stool and those that slow intestinal spasms.

Thickening mixtures (such as psyllium) absorb water. This helps bulk up the stool and make it more firm.

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

Antidiarrheal precautions

• Use antidiarrheals if you have diarrhea for longer than 6 hours. Do not use these medicines if you have bloody diarrhea, a high fever, or other signs of serious illness.
• Read and follow all label directions. Be sure to take the recommended dose.
• Long-term use is not recommended. To avoid constipation, stop taking antidiarrheal medicines as soon as stools thicken.
• 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 Kaopectate and Pepto-Bismol). 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 syndrome, a rare but serious illness.
• Ask your doctor if your child younger than 12 should take these medicines.

For more information on diarrhea symptoms and treatment, see the topics Diarrhea, Age 12 and Older and Diarrhea, Age 11 and Younger.

Cold and Allergy Remedies

In general, whether you take medicines 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. But nonprescription medicines help relieve some cold symptoms, such as nasal congestion and cough. Be safe with medicines. Read and follow all instructions on the label.

Allergy symptoms, especially runny nose, often respond to antihistamines. Antihistamines are also found in many cold medicines, often together with a decongestant.

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) provide longer relief, but they cause more side effects.

Sprays and drops provide rapid but temporary relief. 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.

Your pharmacist can suggest a medicine for your cold and allergy symptoms.

Decongestant precautions

• Be careful with cough and cold medicines. Don't give them to children younger than 6, because they don't work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included.
• 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 medicines. Read the package carefully or ask your pharmacist or doctor to help you choose the best decongestant for you.
• Don't use the ones for the nose longer than the label says. 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 you are taking cold medicines.
• If you are pregnant, check with your doctor or pharmacist before using a decongestant.

Steroid nasal sprays help relieve a stuffy nose also. They work in a different way than decongestant medicines work. And they don't cause a rebound effect. They start working quickly, but it may be several weeks before you get the full effect.

Cough preparations

Coughing is your body's way of getting foreign substances and mucus out of your respiratory tract. Sometimes, though, coughs are severe enough to impair breathing or prevent rest.

There are two types of coughs: productive and nonproductive. A productive cough produces phlegm or mucus (sputum). It's generally best if you don't try to stop (suppress) a productive cough. A nonproductive cough does not produce sputum. It is a dry cough.

Water and other liquids, such as fruit juices, are good 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 1 year and older.

There are two kinds of cough medicines:

• Expectorants help thin the mucus and make it easier to cough mucus up when you have a productive cough. Look for expectorants containing guaifenesin.
• Suppressants control or suppress the cough reflex and work best for a dry, hacking cough that keeps you awake. 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 who have 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 medicines. Read the package carefully, or ask your pharmacist or doctor to help you choose.
• Cough suppressants can stifle breathing. Use them with caution if you are older than 60 or if you have chronic respiratory problems.
• Be careful with cough and cold medicines. Don't give them to children younger than 6, because they don't work for children that age and can even be harmful. For children 6 and older, always follow all the instructions carefully. Make sure you know how much medicine to give and how long to use it. And use the dosing device if one is included.
• Read the label so you know what the ingredients are. Some cough preparations contain a large percentage of alcohol, and others contain codeine. There are many choices. Ask your pharmacist to advise you.
• Avoid cold remedies that combine medicines to treat many symptoms.
• Avoid alcohol if you are taking medicine with dextromethorphan in it.
• 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.

There are two types:

• Older, first-generation antihistamines (such as chlorpheniramine and diphenhydramine). These may make you sleepy or make it harder for you to concentrate. They can also affect your coordination, even when they do not make you drowsy.
• Newer, second-generation antihistamines (such as cetirizine and loratadine). These have fewer side effects. Many of the newer antihistamines cause less drowsiness than older antihistamines or cause no drowsiness at all.

If your runny nose is caused by allergies, an antihistamine may 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 chlorpheniramine (Chlor-Trimeton) and diphenhydramine (Benadryl) are single-ingredient antihistamine products.

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

Antihistamine precautions

• Don't give antihistamines to your child unless you've checked with the 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.
• Avoid alcohol 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.
• When you take an antihistamine that makes you drowsy, the drowsiness usually decreases with continued use. Talk to your doctor or pharmacist if the medicine still makes you drowsy or if the medicine isn't helping your symptoms after 1 week. You may want to try an antihistamine that doesn't cause drowsiness.
• If you are pregnant, check with your doctor or pharmacist before using an antihistamine.

Pain Relievers

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

When you buy 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. Aspirin comes as adult-strength (325 mg) or low-dose (81 mg). Although it seems familiar and safe, aspirin is a very powerful drug.

Aspirin precautions

• Keep all aspirin out of children's reach.
• Aspirin increases the risk of Reye 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 find out what may work best for you.
• Do not take NSAIDs if you have had an allergic reaction to this type of medicine in the past.
• Throw aspirin away if it starts to smell like vinegar.
• Because aspirin can increase the risk of bleeding, it is not recommended for new injuries. Take other medicines such as ibuprofen or naproxen for the first 2 or 3 days after an injury.
• If you take a blood thinner or if you have gout, talk to your doctor before you take aspirin.
• High doses may result in aspirin poisoning (salicylism). To help prevent taking a high dose, follow what the label says or what your doctor told you. Stop taking aspirin and call a doctor if any of these symptoms occur:
  • Ringing in the ears
  • Visual disturbances
  • Nausea
  • Dizziness
  • Rapid, deep breathing
• If you are pregnant, check with your doctor or pharmacist before taking a pain reliever.

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 medicines, do not try these uses of aspirin without a doctor's supervision.

Heart attack and stroke: Aspirin in low but regular doses may help prevent heart attacks and strokes in certain people. For more information, see:

• Coronary Artery Disease.
• Aspirin: Should I Take Daily Aspirin to Prevent a Heart Attack or Stroke?

Migraines: Regular, low-dose aspirin use may reduce the frequency of migraine headaches. For more information, see the topic Migraine Headaches.

Other pain relievers

Ibuprofen (the active ingredient in products such as Advil and Motrin) and naproxen (in products such as Aleve) are other NSAIDs. Like aspirin, these drugs relieve pain and reduce fever and inflammation. Also like aspirin, they can cause nausea, stomach irritation, and heartburn.

NSAID precautions (also see aspirin precautions)

• Do not use an NSAID for longer than 10 days without talking to your doctor.
• Talk to your doctor before taking NSAIDs if you have:
  • Ulcers or a history of bleeding in your stomach or intestines.
  • Stomach pain, upset stomach, or heartburn that lasts or comes back.
  • Anemia.
  • Bleeding or easy bruising.
  • A habit of drinking more than 3 alcoholic drinks a day. This increases your risk of stomach bleeding.
  • High blood pressure.
  • Kidney, liver, or heart disease.
• Talk to your doctor before using NSAIDs if you take:
  • Medicine (called a blood thinner) to prevent blood clots.
  • Medicine to treat mental health problems.
  • Medicine to decrease swelling (water pills).
  • Medicine for arthritis or diabetes.
• Read and follow all the instructions on the medicine bottle and box carefully before giving your child ibuprofen. For more information, see Use of Ibuprofen in Young Children.
• Talk to your doctor before you give fever medicine to a baby who is 3 months of age or younger. This is to make sure a young baby's fever is not a sign of a serious illness.

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.

Acetaminophen precautions

• The product's package label will tell you how many milligrams (mg) of medicine are in each pill or liquid dose, 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.
• Read and carefully follow all the instructions on the medicine bottle and box before giving your child acetaminophen. For more information, see Use of Acetaminophen in Young Children.
• Talk to your doctor before you give fever medicine to a baby who is 3 months of age or younger. This is to make sure a young baby's fever is not a sign of a serious illness.
• If you are or could be pregnant, do not take any kind of pain reliever unless your doctor has told you to. For more information, see Acetaminophen Use During Pregnancy.