Over-the-counter (OTC) pain meds can be safe and effective — when they’re taken the right way.

When a migraine strikes, the pain can seem unbearable. Stephanie Hutchinson’s 11-year-old daughter has a prescription for her reoccurring migraines — but one hit when she was out of medicine. A specialist recommended she try an OTC drug for migraine pain.

The drug had a warning that it was only meant for those ages 12 and up. Hoping to give her child some relief, Stephanie gave her the medicine anyway.

Her daughter soon had a reaction to the caffeine and aspirin in the OTC drug. Her elevated heart rate returned to normal two days later, but the experience caused them both a scare.

Her primary care doctor later told Stephanie not to give her daughter any aspirin products until she is at least 16.

Read Between the Lines: Labels Have Important Information

Some people may not even think to look at the warning labels on OTC drugs. They may think they are safe to take because they are not prescription drugs.

But Buki Fabusiwa, a Blue Cross and Blue Shield Plan clinical pharmacist, says people need to take label warnings for OTC drugs seriously.

“Understand that a drug, whether prescription or OTC, is a chemical that causes changes to the body and should always be taken with reasonable caution,” Fabusiwa says.

Before you take an OTC drug, Fabusiwa recommends that you:

  • Read the label to check for drug warnings.
  • Stay within recommended doses according to the directions. And don’t take it for longer than the directions say to.
  • Check with a pharmacist or doctor if you take other OTC drugs or prescription medicines or have health problems. 

Warning: Danger Ahead

Some OTC drugs can cause problems when you take too much of them or when they’re mixed with other medicines. And sometimes it’s mixing them with other medicines that can cause you to wind up taking too much.

For example, taking too much of an acetaminophen can cause liver damage. Tylenol is acetaminophen. Many other OTC products also contain acetaminophen, including medicines for cough, cold and flu. Even some sleep medicines have acetaminophen. You can accidentally take too much acetaminophen if you take these drugs in combination with each other or with Tylenol. For example, Dayquil cough syrup contains acetaminophen, so a person who takes cough syrup a few times a day and also takes Tylenol may be at risk.

Here are a few other common OTC drugs that can cause problems:

  • Prolonged use of ibuprofen can cause stomach bleeding, and in higher doses, it can harm your kidneys.
  • People with underlying health issues such as pregnancy or high blood pressure may not be able to take certain OTC drugs, like decongestants.
  • Aspirin, naproxen and other non-steroidal anti-inflammatory drugs can have a blood-thinning effect, especially when taken with thinners such as Warfarin, Xarelto, Plavix, Eliquis and others.
  • Drinking alcohol with OTC products may also add to their potential adverse effects. For example, taking Tylenol and drinking alcohol can damage your liver.

Times Change, Labels Change

A few years ago, the U.S. Food and Drug Administration (FDA) issued a regulation to standardize OTC drug labels by adding the Drug Facts label. The regulation set rules about the content and formatting of the labels to make them easier for consumers to understand. For example, listing information like active ingredients, uses and warnings in the same order on all labels makes it easier to compare drugs.

Sometimes, drugs that were only available by prescription become available to buy over the counter. Here are a few OTC drugs and their warnings that may be new to some consumers since they were once only available by prescription.

  • Xyzal, an antihistamine drug for allergies, should not be taken with other OTC allergy medicines such as Benadryl (diphenhydramine) or prescription allergy medicines without talking to your doctor first. Xyzal can also cause drowsiness, so you should avoid taking it before you drive, use tools or do any tasks that need your full attention.
  • Flonase allergy relief may cause nasal irritation or bleeding. Be sure to let your doctor or pharmacist know if you are currently taking steroids or have a disease of the immune system.
  • Differin gel, used to treat acne, can cause sensitive skin, so always use sunscreen and avoid tanning beds. Be careful using it with other skin products that can dry or irritate your skin.
  • Taking proton pump inhibitors (like Nexium, Prevacid or Prilosec) to treat ulcers and heartburn for an extended period can increase the risk of body fluid imbalances, stomach infections and fractures. Don’t use OTC proton pump inhibitors for more than 14 days without talking to your doctor.

Safety Tips

Have a question about an OTC drug or its interactions? Are you taking prescription drugs or more than one type of OTC medicine, including herbal supplements? When in doubt, check with your doctor or pharmacy.

Here are some additional things to keep in mind:

  • Always tell your doctor and pharmacist about all the drugs and supplements you’re taking.
  • Always read the label.
  • Keep medicine out of reach of children and pets.
  • When measuring out liquid medicine, only use the measuring syringe or cup that you received with it. Getting the dose exactly right is especially important for kids and the elderly, who may be more sensitive to the medicine.