white and blue medication pill blister pack
white pills over a blue background

Over-the-counter (OTC) medications don’t require a prescription for purchase. You can buy them at most pharmacies, big box stores, grocery stores and convenience stores. There are rarely restrictions on these medications, making them a quick, easy treatment option for various conditions.

In fact, OTC medications actually help Americans save money on healthcare costs overal1 For every $1 we spend on over-the-counter medications, we save $7 in healthcare costs. However, that doesn’t mean OTC drugs are always safe. There are some over-the-counter medications that have the potential for abuse or even addiction. Some OTC drugs have negative side effects, too.

Mind-Altering OTC Drugs Can Lead to Abuse

Many consumers mistakenly believe that OTC drugs contain non-addictive ingredients. While that’s sometimes true, the truth is that a medication isn’t necessarily safe in large doses just because it’s easy to buy.

Some common OTC drugs contain mind-altering substances. Though you may not notice the effect with a standard dose, people who struggle with mind-altering substance addiction may be tempted to take much larger doses. This can lead to hallucinations, euphoria and other mental effects. Over time, it may lead to substance abuse or addiction.

The National Institute on Drug Abuse (NIDA)2 states that one popular OTC medication is frequently abused: dextromethorphan (or DXM), a common ingredient in cold and cough medicine.

Usually used as a cough suppressant, dextromethorphan has potential side effects. This medication may cause mental effects such as euphoria when taken in large doses.

In fact, DXM works much like more popular hallucinogenic drugs such as PCP or ketamine.

People who regularly take DXM may become dependent. If they continue taking the drug, they may form an addiction.

Common OTC Medications That May Be Harmful

When the FDA3 approves medications, they consider whether the benefits of a substance outweigh the risks. They may approve a certain dosage of a drug because the risks are low at that point. If you take more than the intended dosage, though, the risk grows. Once you start misusing the medication, the benefits may no longer be worth the risk.

In other words: A medication isn’t necessarily safe just because it’s FDA approved. If you take too much of any drug—even commonly used OTC drugs—there’s a risk of side effects, dependence or addiction.

Side Effects

A side effect may be any undesirable symptom you experience when you use a medication. For example, if you take a pain reliever, relieving pain is the medication’s intended effect. Some pain relievers may also cause nausea, however, which is a side effect.

Every drug has potential side effects. That includes over-the-counter medicine. Some side effects are mild; you may not even notice them. Other side effects are more severe. The most concerning side effects are life-threatening and possibly fatal.

Side effects may be short-term or long-term. Most drugs have both.

Dependence and Abuse

Drug dependence and abuse are common terms used to describe the misuse of medications. In the past, drug abuse referred to a lower level of misuse, such as taking more medication than prescribed or taking additional doses.

Drug dependence once referred to the inability to lead a normal life without taking medication. Dependence was considered more severe than abuse.

However, you may become dependent on a substance without abusing it. Dependence really just means that your body has adjusted to the drug and needs it to function normally. Drug dependence causes issues like high blood pressure or heart palpitations if you stop taking the drug. If you’re dependent on a drug, you may experience withdrawals. You may also need larger doses of the drugs to experience the intended effects.


Drug addiction is not the same as drug dependence or abuse, though some people use the terms interchangeably. You may be addicted to a drug without being physically dependent—and vice versa.

Addiction refers to behavioral changes as a result of drug use. For example, you may know the consequences of taking a drug are real but choose to take it, anyway. You may feel like you’re unable to stop taking a medication, even if you want to. You might notice your social life, work or school are affected by your drug use. These are all signs of addiction.

Today, drug abuse, dependence and addiction are called “substance use disorder.” Because most people are more familiar with the terms “dependence,” “addiction” and “abuse,” we will use all four terms throughout this guide.


Acetaminophen (aka Tylenol) is a popular OTC painkiller. You can buy acetaminophen nearly anywhere and dosages vary.

While acetaminophen typically works well for pain relief and fever reduction, it also has some short-term side effects.

These include:

  • Nausea
  • Headache
  • Itchiness
  • Stomach cramps
  • Rash or peeling skin

Of course, not everyone will experience these side effects when they take acetaminophen, but some people will. In fact, some people experience more severe side effects from acetaminophen. It can even be fatal. Recurrent, excessive or long-term use is more likely to cause these problems, which include liver failure and difficulty breathing4


Laxatives are another common type of OTC medication that have potentially serious side effects. Some people use laxatives long-term or take more than intended as a weight loss pill. This is extremely dangerous and may cause irreversible damage to the bowels, liver and colon.

The most common long-term side effects of laxative abuse5 include:

  • Severe dehydration
  • Physical dependency
  • Organ damage
  • IBS (Irritable Bowel Syndrome)
  • Liver damage or failure
  • A higher risk of colon cancer

Are you misusing OTC medications? We can help.

If you’re concerned that you may be misusing or abusing OTC medications, we can help. OTC substance use disorder is a common problem that affects more people than you may realize. Give us a call at (855) 430-9426 to discuss your options for recovery.

Mixing Over-the-Counter Medications With Other Substances

OTC risks aren’t always tied to substance abuse. If you take more than one medication at a time, you may create more serious issues, including potentially fatal effects.

The risks of combining substances aren’t always intentional. It is all too easy to take one medication then forget and take another medication a few hours later. Sometimes, the combination is intentional.

For example, assume you have a headache. You take naproxen, which is a common non-steroidal anti-inflammatory drug (NSAID) used for pain relief and marketed under the brand name Aleve. However, your headache persists an hour or two later. You decide to take ibuprofen (aka Advil or Motrin), too. However, these two medications are very similar and in the same class of drugs. You’re not supposed to take a full dose of both medications together. You have (possibly inadvertently) abused your medication, and there are potential risks involved.

It’s also worth noting that, in this example, both medications may interact with other medicines, as well. These may include diuretics, aspirin, blood thinners, lithium and certain blood pressure medications. Naproxen may also interact with antacids, SSRIs and SNRIs.

Alcohol and Medicine Interactions

While potential drug interactions are too numerous to list for all OTC medications, there’s one substance that’s worth mentioning: alcohol.

The National Institute on Alcohol Abuse and Alcoholism6 advises that mixing medications (both OTC and prescription) with alcohol can intensify side effects or create new risks.

Older people are at a higher risk for these side effects, though anyone may be affected. That’s because your body can’t metabolize alcohol as well at 60 (for example) as it can at 25. As you age, alcohol stays in your body longer. Of course, older people are also more likely to take daily medication, which makes this issue a bigger concern. Though senior citizens are only 13 percent of the population, they use 30 percent7 of all OTC drugs.

Though we can’t list all the potential risks involved when combining alcohol and OTC drugs, here are some of the side effects when you mix alcohol with common medications:

  • Allergy medicine (e.g. Benadryl): drowsiness, dizziness, higher potential for overdose
  • Cough medicine (e.g. Robitussin, Mucinex): drowsiness, dizziness, higher potential for overdose
  • Motion sickness medication (e.g. Dramamine): drowsiness, dizziness, higher potential for overdose
  • Sleep remedies (e.g. Unisom): excessive drowsiness
  • Pain relievers (e.g. Tylenol): stomach bleeding, ulcers, liver damage and increased heart rate
  • Heartburn remedies (e.g. Pepcid): high or low blood pressure, increased heart rate, increased effects of alcohol

Of course, death is the biggest risk when you combine alcohol with any substance. That’s true with OTC medications and alcohol, as well.

There’s one more thing worth mentioning: Many common OTC medications were once available only via prescription. Nearly all substances (prescription, OTC and illegal) are more accessible now than they were in the past. As a result, the potential for overdose (including fatal overdose) is higher than ever8 because of the high risks involved with combining substances.

If you struggle with OTC drug dependence or find yourself combining substances to achieve more potent effects, please seek immediate assistance. Call Windward Way Recovery at (855) 430-9426 to discuss your options now.

Taking OTC Medications During Pregnancy or While Breastfeeding

Pregnant or breastfeeding women are particularly vulnerable to the risks of OTC drugs. Their unborn children are also susceptible to the side effects (including fatal side effects) of these medications.

Please remember that many over-the-counter drugs aren’t safe during pregnancy or while breastfeeding. Before you take a dose of any medicine, ask your doctor or medical provider whether it’s approved during pregnancy. Even if you’ve heard that the medicine is approved during pregnancy or while breastfeeding, your doctor may advise differently. In addition, some OTC medications are safe to take during one trimester of pregnancy (e.g. the first few months) but not safe during another trimester (e.g. closer to delivery).

If you take certain medications during pregnancy, you may cause unnecessary risks for yourself or the developing fetus. If you take certain medications while breastfeeding, you may unknowingly pass the medication to your infant, which can be harmful.

While you should always ask your doctor for medical advice, here is a shortlist of medications you should avoid throughout pregnancy, according to Consumer Reports9

  • Aspirin (e.g. Bayer)
  • Bismuth subsalicylate (e.g. Pepto Bismol)
  • Ibuprofen (e.g. Advil, Motrin)
  • Naproxen (e.g. Aleve)
  • Phenylephrine (a nasal decongestant used in many OTC cold remedies)
  • Pseudoephedrine (e.g. Sudafed)

Recovering From Over-the-Counter Drug Dependency

As you read through this guide, you may have realized that you take more over-the-counter medications than you should. You may already suspect you have a dependency on one or more OTC drugs.

If this sounds familiar, please seek help now.

While over-the-counter drugs are generally less concerning than prescription drugs for dependency, addiction or abuse, the potential risks are there. Perhaps more importantly, OTC drug abuse often leads to the abuse of stronger substances.

As your body adjusts to an over-the-counter medication, you may feel fewer or less potent effects from the drug. This creates a need for stronger substances to achieve the same effect.

Many people become addicted to prescription or street drugs because they first developed a dependence on OTC medications.

Whether you are simply taking too much medication or you are struggling with severe addiction, help is available. Windward Way Recovery has helped many patients recover from alcohol and substance abuse in California and throughout the country. We can help you, too.

Contact us online or give us a call at (855) 491-7694 to start your recovery today.

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