Over-the-counter medications come in handy for many short-term health woes, from allergies and headaches to minor injuries. And if you’ve been turning to OTC options since the pandemic started instead of going to the doctor, you’re not alone.
“Many of my patients haven’t seen their primary care physician or even certain specialists in almost two years,” said Ken Perry, an emergency physician based in Charleston, South Carolina. “It’s not uncommon for patients to make their way to the pharmacy to try to fix their ailments on their own, and COVID has further exacerbated this issue.”
For many people, it’s appropriate and safe to find an OTC medication to help alleviate their symptoms at home without much concern for harm, Perry said. But if you take certain OTCs long-term and don’t update your doctor or pharmacist about what you’re doing, things can get dicey.
Say you’re taking an over-the-counter NSAID ― a nonsteroidal anti-inflammatory drug ― for pain relief, and you don’t disclose this to your doctor. If you go to your doctor’s office with pain that they diagnose as arthritis or some other inflammation, they may give you an NSAID or equivalent prescription to take.
“If that patient takes both medications, they can possibly cause GI bleeding or even kidney damage,” Perry said.
If you’re on prescription medications, taking certain OTCs in tandem can reduce their efficacy and may cause adverse effects.
“Your age can also impact how your body will react to an OTC medicine,” said Janice Johnston, co-founder and chief medical officer of the U.S. health care plan Redirect Health. “By keeping your doctor up-to-date about your OTC usage, they’ll be able to give their expert opinion on the best — and safest — course of action for your overall well-being.”
Plus, the persistent symptoms you’re masking with OTC medications could be a sign of an underlying condition that your doctor can help you nail down and treat.
Each OTC medicine has recommended dosages, and information about when to inform your doctor, printed right on the label — but here are some general guidelines on common OTCs to get you started:
Acetaminophen is a common OTC medication best known for relieving pain and reducing fever.
“It’s generally safe when taken as directed for up to 10 days,” Johnston said. “However, you should check with your health care provider if you have any medical conditions or are on any medications where acetaminophen should be avoided.” (Think: if you have liver disease or are taking warfarin, a blood thinner.)
According to the U.S. Food and Drug Administration, there are over 600 OTC and prescription medicines that contain acetaminophen. It’s crucial to read medication labels carefully to make sure you don’t exceed the maximum daily dose, as this can cause liver damage — especially if combined with alcohol. (When a prescription medicine contains acetaminophen, the drug label might not spell out the entire word. It might also use the abbreviation “APAP.”)
Most healthy people can take acetaminophen safely by not using more than one medicine containing acetaminophen in a day and following the directions on the medicine label.
“Contact your primary care provider if your symptoms get worse or new symptoms appear for more than three days,” said Jessica Nouhavandi, co-founder and lead pharmacist of the online pharmacy Honeybee Health.
Aspirin is used for short-term relief of headaches, pain, swelling or fever, and in daily low doses for prevention of heart attack and clot-related strokes.
It’s generally safe to take as directed for up to three days for fever, or up to 10 days for pain. “If you wish to use aspirin daily for chronic pain, make sure to connect with your physician first,” said Siddharth Tambar, a board-certified rheumatologist with Chicago Arthritis and Regenerative Medicine.
The same applies if you want to take aspirin for heart attack prevention, since there are many health factors that need to be considered. For people who are at low risk for heart attack, for example, the benefits of daily aspirin therapy don’t outweigh the long-term toxicity risks that aspirin can have on the gastrointestinal tract (like stomach ulcers or internal bleeding).
“The daily consumption of aspirin can also cause easy bruising and dangerous acid-base imbalances in your blood,” said Spencer Kroll, a board-certified internal medicine specialist and pharmacologist based in New Jersey. This can severely affect vital organs, such as your lungs and kidneys.
Aspirin is now recommended as a chronic therapy only for people with established heart disease or who are very high-risk, and it should only be taken under the supervision of your doctor, according to the Mayo Clinic.
NSAIDs, such as ibuprofen and naproxen, are also taken for temporary pain relief and can decrease inflammation, such as fever, swelling and redness.
When taken as directed and for a short period of time (up to three days for fever and 10 days for pain), NSAIDs are safe for most people. If you take them for longer than that, it’s important to consult with your doctor for further instruction, Tambar said.
Long-term use can increase your risk of heart attack, stroke and high blood pressure, whether you have heart disease or not, according to the Mayo Clinic ― which is why it’s so important your doctor has your NSAID use on their radar.
“You should also check with your doctor before taking NSAIDs if you have preexisting conditions or are taking other prescription medications,” Johnston said. They have the potential to cause gastrointestinal bleeding, especially in people who’ve had stomach ulcers or bleeding problems before.
NSAIDs aren’t recommended for people who are planning to get pregnant or have currently been pregnant for 20 weeks or longer, because these medications can cause harm to the unborn baby, Nouhavandi said.
Antihistamines are generally used for short-term relief of allergy symptoms (say, seasonal allergies). They’re broken down into two categories — first- and second-generation.
First-gens cross the blood-brain barrier and cause drowsiness, while second-gens interact with fewer drugs and are much less likely to cause drowsiness, according to the Cleveland Clinic.
“Many allergy medications are safe for everyday use and often treat symptoms better when used daily,” Johnston said. For otherwise healthy people with year-round allergies, second-generation antihistamines (like Allegra, Claritin and Zyrtec) maintain their effectiveness even if taken daily, and they don’t cause drowsiness.
If you have a chronic medical condition, such as diabetes, glaucoma or high blood pressure, you should talk to your provider before taking antihistamines to make sure there aren’t any contraindications. (The same goes if you’re pregnant or breastfeeding.)
Antacids offer quick relief from heartburn, acid indigestion and upset stomach.
They’re generally safe for long-term use when used as directed, but it’s recommended to check in with your doctor if you have to pop antacids more than twice a week or your symptoms aren’t relieved after two weeks of use.
“Antacids are extremely effective at reducing stomach acid — so much so, the reduction of pain that comes from the reduction of acid could mask underlying health conditions, such as peptic ulcer disease or even stomach cancer,” Kroll said.
Another reason it’s important to consult with your doctor about your antacid use is the possibility of drug-to-drug interactions, Nouhavandi said. Because antacids can change the way your body absorbs other medicines you’re taking, it’s best to take your other meds either one hour before or four hours after you take antacids.
People who are pregnant should consult with their doctor before using antacids to make sure they’re making the safest choice, Nouhavandi said. Antacids that contain aspirin can increase the risk of various complications, while antacids containing sodium can cause fluid buildup.
Ongoing use of antacids that contain sodium can also result in kidney problems if a low-sodium diet isn’t implemented, Nouhavandi added.
OTC anti-nausea medications can be very effective in managing an upset stomach, especially if you experience motion sickness or vertigo.
“Common OTC anti-nausea medications include Pepto Bismol and Dramamine,” Johnston said. “Each one manages symptoms in its own unique way, whether through reducing the amount of acid in the stomach or through blocking the receptors in the brain that cause nausea.”
The type of medication will determine how long you can safely take it (no more than two days for Pepto Bismol, for instance, whereas Dramamine Non-Drowsy is safe to take every day you travel), but if your symptoms persist, you should check in with your doctor.
“By continuing to take OTC anti-nausea medications, you put yourself at risk of experiencing side effects, including drowsiness, headaches, insomnia and more,” Johnston said. Plus, you could be masking a health condition that needs to be treated.
“OTC anti-gas medications are often made with simethicone, which works by enabling the gas bubbles within the intestines to come together, therefore making it easier for your body to expel the gas,” Johnston said.
Generally, they’re safe even when taken daily, so long as the correct dosage is being followed.
“But if you’re experiencing ongoing discomfort due to gas buildup, it’s important to reach out to your medical provider for help,” Johnston said ― especially if the gas you’re experiencing is persistent or severe and accompanied by other symptoms, such as vomiting, diarrhea or unintentional weight loss. It could be a sign of a more serious issue, such as diabetes or gastroparesis.
OTC diarrhea medications can offer quick relief by stopping or slowing down loose stool in the intestines. “It’s important to note that diarrhea medications often won’t treat the underlying cause of diarrhea, and are simply meant to provide short-term relief,” Johnston said.
Read the label carefully and follow the recommended dosage. If the diarrhea is caused by bacteria or a virus, it should resolve itself within a couple of days. “If it persists longer than that, it’s important to seek help from a medical professional,” Johnston said.
If you’re on prescription meds (such as blood thinners, or medication for arthritis, diabetes or gout), check in with your doctor before taking an anti-diarrheal, as it may impact the efficacy of your medications, according to the American Academy of Family Physicians.
Laxatives can be a great way to overcome constipation. “There are various ways different laxatives work within the body,” Johnston said.
Some add bulk to soften the stool and stimulate the intestinal muscles to naturally contract. Others aim to increase contractions within the intestines to move things along.
Bulk-forming laxatives are generally safe for ongoing use to promote digestive regularity, and can be especially helpful to people with conditions like irritable bowel syndrome or hemorrhoids. However, they can cause side effects like bloating, gas or cramps, especially if you don’t drink enough water, so make sure to follow the directions on the label closely.
Stimulants, on the other hand, should only be used if absolutely necessary — for no longer than one week — and only under the supervision of a physician.
Laxatives may interfere with your body’s absorption of certain medications and nutrients and can lead to an electrolyte imbalance, especially after prolonged use, according to the Mayo Clinic. Your body can also become too dependent on laxatives, which can cause your colon to stop functioning properly.
“Your doctor should be alerted of any sudden change in your bowel habits that are present for more than a few weeks,” Kroll said. “This could indicate many different disease processes.”
“OTC sleep medications can help individuals struggling with acute insomnia or jet lag fall asleep faster, often through binding to specific receptors in the brain that cause drowsiness,” Johnston said.
However, these sleep aids aren’t intended for long-term use. Tolerance to the sedative effects can develop quickly, so the longer you take them, the less likely they are to make you sleepy.
“When used long-term, people can become reliant on — and even addicted to — sleep aids,” Johnston said. To top it off, they can cause daytime drowsiness, as well as issues with concentration and memory.
It’s generally recommended that OTC sleep aids not be used any longer than two weeks, according to the Mayo Clinic. You should also check in with your doctor or pharmacist to make sure the sleep aid you choose doesn’t mess with any medications you’re on.
For most people, a healthy diet should provide sufficient vitamins for good health. “There may be reasons to use a quality daily multivitamin that has the recommended daily allowance (such as being vegetarian or vegan), which are generally safe to use for most people,” Johnston said.
But it’s important to consult with your health care provider on the use and proper dosage of individual vitamin supplements, like vitamin D or vitamin A. At too high a dose, they may cause side effects or interfere with medications. (“Vitamins E and K can also increase risk of bleeding if you’re taking blood thinners,” Johnston said.)
“Timing is critical for some vitamins, in that they can interfere with the absorption of some medications if taken at the same time,” Kroll said. Your doctor can help make sure the efficacy of both your medications and your vitamins are maximized.
The best way to know if you need a vitamin supplement, Nouhavandi said, is to get your bloodwork done to find out if supplementation is appropriate for you. Your doctor can then recommend accurate dosages and keep tabs on any deficiencies you might have.