Just because you can buy a medication over the counter doesn’t mean it’s always safe. Here’s how you should really be using these common drugstore buys.
OTC Medication Mistakes: Doctors Advise You To Avoid Doing These
Updated on Dec. 05, 2024
Misuse of over-the-counter (OTC) medications causes 178,000 hospitalizations per year, according to 2022 research published in Research in Social and Administrative Pharmacy. “Every medication, whether OTC or by prescription, needs to be taken seriously,” says Stacy Jean Willner, DO, a cardiologist at University of Michigan Health and clinical assistant professor of internal medicine-cardiology at U-M Medical School. “Just because a medication was deemed safe enough to be given over the counter, it still can have potential side effects and interactions that need to be monitored.”
For instance, if you’re someone with no health problems taking just one OTC medicine, that one medicine will almost always be safe, says Matthew Badgett, MD, an internal medicine and pediatric specialist with the Cleveland Clinic. “But what happens if you’re on a blood thinner or have high blood pressure, which ones are safe?”
And the sheer variety of OTC products causes a lot of confusion, he adds. “There are so many different OTC medicines, so many different brands—and then you get into the cold and flu medicine, there’s all these combinations. It’s hard to tell what you are actually using and if you’re using it right.”
To help clear up confusion, our experts explain the most common OTC medication mistakes, as well as how people misuse other OTC products.
1. Mistake: Not telling your doctor what you are taking OTC medication
“The biggest mistake is not telling your doctor what you are taking over the counter,” Dr. Willner says. “Every medication or supplement should be disclosed so that potential drug interactions can be monitored.”
Some medication’s efficacy can be vastly different depending on what supplements are being taken, she explains. “In turn, you could not be adequately treated for a medical condition you have if your doctor is not aware of what other medications and supplements you are taking.”
2. Mistake: Double-dosing ingredients
“It is also easy to overdo it with pain medicines such as Tylenol or NSAIDs [ibuprofen (Advil, Motrin) or naproxen (Aleve)] because many ‘cold and flu’ medications contain various amounts of both,” Dr. Willner says.
Many cold and flu medicines contain an antihistamine (such as doxylamine) in their formulation as well. “People will take it without realizing that doxylamine is very similar to Benadryl—and then they’ll take Benadryl at the same time for their allergies,” explains Dr. Badgett. This double dose of antihistamine can lead to excessive sleepiness, confusion, and a fast heartbeat. It can also make you unsteady on your feet and impair your driving ability.
“It is always important to look at every ingredient in what you are taking to make sure you don’t go over the max daily dose,” Dr. Willner advises.
3. Mistake: Using decongestants if you have certain health issues
“Especially with cold and flu season upon us, many people can easily misuse or overuse decongestants,” Dr. Willner says. But “Patients with high blood pressure, heart arrhythmias, or other heart conditions should use these with caution or not at all.”
According to the Cleveland Clinic, OTC nasal decongestants can also interfere with certain prescriptions, such as asthma medication, blood pressure medication, and antidepressants. People with diabetes, prostate issues, glaucoma, or thyroid conditions should also avoid decongestants—and researchers aren’t sure if they’re safe to use when pregnant or breastfeeding.
4. Mistake: Using the wrong decongestant
Phenylephrine is an OTC drug that’s been around for decades. “People use it all the time as a decongestant—and it just doesn’t work,” Dr. Badgett says.
In 2005, the drug pseudoephedrine was taken off shelves and moved behind the counter due to its potential for abuse in making methamphetamine. (Today, you don’t need a prescription for pseudoephedrine, but you need to get it from a pharmacist directly.) This regulation by the US Food and Drug Administration (FDA) left phenylephrine as the only remaining oral decongestant sold OTC, and the drug made its way into many different products.
However, further studies conducted by the FDA showed that phenylephrine is no more effective than a placebo—even when administered at four times the recommended dose. “It is directly going to be removed from the market, but I’m sure it’s going to be in people’s cupboards for years to come,” Dr. Badgett says.
5. Mistake: Over-using NSAIDs
Another medication to be careful with in general is NSAIDs (nonsteroidal anti-inflammatory drugs), Dr. Willner says. This class of pain reliever includes ibuprofen and naproxen. “If used more frequently or in larger amounts than directed, you can suffer kidney damage as well as fluid retention, which can be detrimental for some patients, especially those with heart failure.”
Dr. Badgett says that it’s also not uncommon for people to “self-prescribe” high NSAID doses. “Some people know that doctors can prescribe up to 800 milligram (mg) tablets (ibuprofen is available OTC at 200mg)—and they just blow way past the recommended amount.”
If you find yourself needing these OTC medications often, make sure it’s under a doctor’s supervision, says Kristine Arthur, MD, an internist at MemorialCare Group in Laguna Woods, California. It’s important to make sure your kidney function is up to par. She notes, “You may need to add a medication to protect your stomach lining from developing an ulcer.”
6. Mistake: Mixing NSAIDs
“A lot of people don’t realize that NSAIDs—ibuprofen, naproxen, and aspirin—should all be taken separately and not with any other NSAIDs,” Dr. Badgett says. “I’ll have patients that are on Meloxicam, a prescription NSAID, and they’ll take ibuprofen on top of that because it’s OTC, so they think it must be safe.” But it’s dangerous mixing this class of drugs. “By taking another [NSAID], they’re not really going to get a lot more pain control, but they are going to get a significantly higher risk of kidney problems and stomach bleeding.”
However, any individual NSAID can be used with Tylenol, he explains. “You’re better off taking Tylenol and adding a little bit of ibuprofen rather than taking a really high dose of ibuprofen [or multiple NSAIDs] simply because Tylenol is better tolerated and has fewer side effects,” he says. “I’ve never seen a hospitalization or a severe problem with Tylenol, but I see them all the time with aspirin, ibuprofen, naproxen—kidney disease, hypertension, stomach ulcers, bleeds, duodenal ulcers, and perforations in the bowel.”
7. Mistake: Habitual Tylenol use
While Tylenol is considered safe, it can still cause problems in some cases. “You should not be taking Tylenol regularly if you have liver disease, and you need to be sure you pay careful attention to the total amount you take in a day,” says Dr. Arthur. “This includes the amounts that may result in the use of combination medications such as cold and flu meds.”
The same goes for the PM formulas for both Tylenol and Advil. Many people rely on them to sleep better—even when they have no pain or cause for concern. In fact, data from the Substance Abuse and Mental Health Services Administration (SAMHSA) suggests that over 50% of people who use OTC pain relievers report misusing them at one point or another.
“This can lead to kidney or liver problems when taken long-term,” Dr. Arthur says.
8. Mistake: Taking aspirin for pain relief
“Aspirin should not be used for significant pain control compared to ibuprofen or Tylenol,” Dr. Badgett says. “Aspirin increases [gastrointestinal] bleeding risk more than ibuprofen does because it lasts longer—it permanently binds to [blood] platelets. Fortunately, platelets only last seven days, so it wears off in that sense, but there is a greater bleeding risk.”
9. Mistake: Taking Aspirin for heart attack prevention
“A lot of older adults will just start taking aspirin like a vitamin because it’s over the counter, and the assumption is they’re supposed to take it to prevent heart attack and stroke,” Dr. Badgett says. While this was the recommendation a few decades ago, experts have since realized the GI bleeding risk is much higher than appreciated. “And so you’re lowering the heart attack risk slightly but elevating your bleeding risk more.”
Doctors will still prescribe low-dose “baby” aspirin for blood-thinning effects for patients at a very high risk for heart attacks, Dr. Badgett says, but most people shouldn’t be taking it regularly.
10. Mistake: Using NSAIDs during athletic events
“A lot of people take NSAIDs when they do athletics—and there’s pretty good evidence that [endurance exercise] with ibuprofen ends very badly for people,” Dr. Badgett says. “The stress of the event plus the NSAID makes the NSAID more dangerous,” such as contributing to kidney failure and stomach ulcers.
A study published in the Emergency Medicine Journal showed that kidney injury was common among runners taking ibuprofen during a race. Additionally, a 2024 report in The American Journal of Medicine says that even short courses of NSAIDs during prolonged repetitive exercise can cause serious GI complications.
What’s more, NSAIDs might not even work to manage muscle soreness, expedite recovery, or improve athletic performance, according to 2024 research published in the Journal of Science and Medicine in Sport.
11. Mistake: Using certain medications for too long
Some OTC medications can make things worse when you use them too often. “One of my favorites is oxymetazoline, a very good decongestant nasal spray,” Dr. Badgett says. But if you use it for more than three days, it can actually make your congestion worse. “Your body becomes tolerant of the drug,” he says. “So the congestion will start getting worse and worse, and the only way to treat that congestion is by using the nasal spray.”
Regular use of medicated nasal sprays can also lead to chronic problems with the nasal passages, such as bleeding, ulcers, or even glaucoma or cataracts with extended use, Dr. Arthur adds.
Even OTC pain relievers can backfire with overuse. “You can get rebound headaches,” Dr. Badgett says. “If you take ibuprofen or Tylenol too often for headaches, then you can start waking up every day with a headache unless you take the ibuprofen or Tylenol—and unfortunately, at that point, the cure is to get rid of the meds and just suffer through it for a couple of days.”
12. Mistake: Over-relying on sleep aids
The two main sleep aids you’ll find at your drugstore—diphenhydramine and doxylamine—can be helpful for short-term use, but only at their recommended doses. “If you can’t sleep after taking one and decide to take two, it may actually have the opposite effect,” says Dr. Arthur. “This can result in palpitations, dizziness, rapid heart rate, and sweating.”
The supplement melatonin is another sleep aid that needs to be used correctly, as too many brands recommend a dosage that’s too high. “If used for an extended period of time, melatonin can affect the natural production of the hormone, so it’s best to start at the lowest dose available and speak to your doctor before upping the amount,” she says.
13. Mistake: Using antacids every day
These drugs work wonders for relieving heartburn or gastrointestinal discomfort from eating certain foods or acidic beverages, but they should not be used daily—especially without your doctor’s permission.
“Using an occasional chewable antacid over-the-counter is fine, but if you’re needing them daily see your doctor, as you may need a stronger medication such as a proton pump inhibitor,” says Dr. Arthur. “The need for daily use can also signal a stomach ulcer or more severe problem.”
It’s also possible to overdose on these types of chewable tablets due to their high calcium content, which could lead to kidney stones, constipation, and kidney failure.
14. Mistake: Consistent use of diuretics
Whether you want to debloat before an important event or reduce pesky symptoms of PMS, relying on the use of diuretics on a regular basis can cause serious problems—such as kidney failure and severe electrolyte disturbances like low potassium. “This can even lead to health concerns as large as heart arrhythmias,” says Dr. Arthur. “If you have problems with chronic bloating or leg swelling, it’s important to notify your doctor to be sure there is not a serious problem going on.”
15. Mistake: Masking a problem by treating symptoms
There’s a common theme to many of these OTC mistakes: self-medicating. Research published in Hospital Pharmacy in 2023 explains the dangers of self-medication—most of us have poor knowledge about the therapeutic dose, frequency, and duration of OTC medications, which can result in either a delay in treating a severe illness or adverse events.
“OTC medications aren’t treating anything—they’re managing symptoms,” Dr. Badgett says. “And that could mean they’re hiding the symptoms of a disease.” In general, if you’re using OTC medications to manage pain, fever, or other novel symptoms for more than a week, make sure to see your doctor about what might be causing the issues.
16. Mistake: Assuming all supplements are safe
“An important note about dietary and herbal supplements is that they are not regulated like prescription and over the counter medications are,” Dr. Willner says. That means you can’t know for sure what ingredients are in the bottle and in what amounts—regardless of what the label says.
Many supplements have also not been very well studied. “Some of these might be inducing liver enzymes in ways that we don’t know about,” Dr. Badgett says. “And there are plenty of case reports of different [drug] interactions.”
Before taking a new supplement, always check with your doctor. “Your doctor can help guide you in what might be beneficial supplement-wise and what you should steer clear of based on your medical conditions,” Dr. Badgett advises.
17. Mistake: Using antiperspirants incorrectly
If you’re used to applying your deodorant directly after you shower, it’s time to switch up your routine.
“Antiperspirants are more effective when applied to dry skin,” says Fayne Frey, MD, board-certified dermatologist with more than 30 years of experience. “This is because they work by creating a protein plug within the sweat gland, thus preventing that gland from releasing sweat, and cannot effectively do this when the skin is wet.”
Instead, lather on your deodorant once your underarm area is dry and your sweat glands are not worked up.
18. Mistake: Inconsistent sunscreen use
“Sunscreen is the most crucial anti-aging [and skin cancer prevention] product, yet many people forget to reapply it throughout the day or skip it on cloudy days,” says Anne Chapas, MD, FAAD, FASLMS, FACMS, FASDS, a Fellow with the American Academy of Dermatology and the medical director and founder of UnionDerm in Manhattan, New York. Apply sunscreen generously and reapply every two hours when outdoors, she advises.
Another mistake? “People often stop skincare at their jawline, leaving the neck and chest exposed to the same environmental factors that cause facial aging, such as UV radiation and pollution,” she says.
This rule holds steady even if you’re spending the day indoors. “Most individuals get more sun exposure incidentally, heading to and from their car when shopping, going to the post office, walking the dog, checking the mailbox, or doing yard work,” says Dr. Frey.
19. Mistake: Mixing irritating skincare ingredients
When it comes to skincare, many people assume that if a little is good, more is better—especially with products containing actives like retinoids, AHAs, or BHAs. But Dr. Chapas says, “Overusing these can lead to skin irritation, peeling, or even [skin] barrier damage. It’s essential to start slowly and gradually increase usage.”
20. Mistake: Using expired products
When you’re not feeling well, it’s tempting to reach into the medicine cabinet for whatever’s on hand. But make sure to check the product’s expiration date. The FDA says that expired OTC medications can be less effective or even risky due to a change in chemical composition or a decrease in strength.
This is true for skincare products, too. “Expired products often have diminished efficacy and can become breeding grounds for bacteria,” Dr. Chapas says. “Sunscreens, for instance, lose their protective power over time, leaving skin more susceptible to UV damage.”
21. Mistake: Deep ear cleaning with cotton swabs
“Many people stick [cotton swabs] all the way into the ear canal to scratch certain itches they think they’re feeling that deep,” says Michelle Yagoda, MD, PC, facial plastic surgeon, ENT (ear, nose, and throat) specialist, and voice care physician. “Not only is this ear wax back there good for you, but putting a cotton swab anywhere close to your eardrum can cause serious—and even permanent—damage.”
Plus, doing so may actually even push the earwax even deeper into your ear canal. Instead, stick to the lower half of the ear only and not deep inside. (Here’s how you should really be cleaning your ears—no Q-Tips required.)
About the Experts
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Sources
- Stacy Willner, DO, cardiologist at University of Michigan Health and clinical assistant professor of internal medicine-cardiology at U-M Medical School
- Matthew Badgett, MD, an internal medicine and pediatric specialist with the Cleveland Clinic
- Kristine Arthur, MD, internist at Orange Coast Memorial Medical Center in Fountain Valley, California
- Fayne L. Frey, MD, board-certified dermatologist and dermatological surgeon
- Ann Chapas, MD, FAAD, FASLMS, FACMS, FASDS, a Fellow with the American Academy of Dermatology, Instructor of Dermatology at Mount Sinai Medical Center, and the Medical Director at Unionderm in Manhattan
- Michelle Yagoda, MD, facial plastic surgeon, ENT specialist, and voice care physician
- Research in Social and Administrative Pharmacy: “Effectiveness and sustainment of a tailored over-the-counter medication safety intervention in community pharmacies: A randomized controlled trial”
- Cleveland Clinic: “Nasal Decongestant”
- The BMJ: “Phenylephrine: Commonly used decongestant in cold and flu remedies doesn’t work, says FDA”
- American Addictions Centers: “Abusing OTC Drugs: Dangers, Signs, and Getting Help”
- Emergency Medicine Journal: “Ibuprofen versus placebo effect on acute kidney injury in ultramarathons: a randomised controlled trial”
- The American Journal of Medicine: “The Gastrointestinal Risks of Combining NSAIDs and Endurance Exercise”
- Journal of Science and Medicine in Sport: “NSAIDs do not prevent exercise-induced performance deficits or alleviate muscle soreness: A placebo-controlled randomized, double-blinded, cross-over study”
- Hospital Pharmacy: “The Abuse and Misuse of Over-the-Counter Medicines During COVID-19”
- FDA: “Don’t Be Tempted to Use Expired Medicines”
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