Over the Counter Drugs

Over the Counter Drugs

What is an Over the Counter (OTC) Drug?

An over the counter (OTC) drug is a medication (nonprescription medicine) that can be obtained without a prescription from a health care practitioner. OTC medications treat various health conditions

Some examples of OTC drugs include cough medicine and pain relievers such as OTC ibuprofen (Advil). Some are used to relieve itches, aches, and pains. Over-the-counter drugs may prevent or cure conditions such as athlete’s foot or tooth decay.

The U.S. Food and Drug Administration (FDA) decides whether a medicine is safe and effective enough to sell over the counter. Since 1999 the FDA has set a uniform design and content requirements for labels on OTC drug products. Despite these medicines being available over the counter, they still have high abuse potential.

Types of Abused OTC Medicines

Person Checking Out with OTC Drug | La Hacienda

The most common types of abused OTC drugs (nonprescription medications) are dextromethorphan (DXM) in cough medicines, pseudoephedrine in cold medicines, dimenhydrinate in motion sickness medications, and ibuprofen (Advil) or acetaminophen (Tylenol) in pain relievers.

Here is more information about these available OTC medications.

Cough Medicines

Cough medicines are popular among young people. They can cause hallucinations and a “high” feeling if used in larger doses than recommended and are easy to find in home medicine cabinets. These OTC medicines containing DXM can also cause an overdose.

Cold Medicines

Pseudoephedrine, a stimulant, and the active ingredient in many cold medicines, is used to relieve nasal and sinus congestion from colds or allergies. In certain situations, when abused, pseudoephedrine can cause hallucinations or an intense “body high.”

Benadryl (Diphenhydramine)

One of the most abused over-the-counter drugs is Benadryl. The active ingredient in Benadryl is diphenhydramine, an antihistamine that works by blocking the effects of a chemical in the body that causes symptoms such as watery eyes, sneezing, itching, and runny nose.

It has been used for more than 50 years and is available without a prescription.

Benadryl is abused by persons seeking mood improvement, increased energy levels and the mild euphoria it can provide. Overdose symptoms mimic acute psychosis.

Pain Relievers

Pain relievers are medicines that reduce or relieve headaches, sore muscles, arthritis, or other aches and pains. There are many different pain medicines, and each one has advantages and risks. Often, OTC medicines treat a sore throat, headache, or stomachache. They can help with the called adverse effects of a viral infection, but do not act as a prescription drug.

Each pain reliever taken will affect each person differently. For example, ibuprofen may work to relieve a headache for one person, while acetaminophen works better for another.

Imodium (Loperamide)

Imodium (Loperamide) is an over-the-counter medication that helps prevent and treat diarrhea caused by infection, such as from bacteria or parasites. It may also be used to stop diarrhea caused by certain medications, including cancer medicines and water pills (diuretics).

Side effects may include constipation, abdominal pain, nausea, vomiting, headache, dizziness, and rash.

Imodium is highly abused because, in high doses, it has the same effects as opiates.

A Warning from the Drug Enforcement Administration

Just because a drug can be sold over the counter, does not mean it is harmless. The Drug Enforcement Administration warns of several instances in which their use can be dangerous.

For example, the cough suppressant dextromethorphan (DXM) is found in more than 120 OTC cold medications by itself or in combination with other drugs. Abusing these drugs means the user is abusing DXM.

Over the counter medications are also among the most common substances–along with alcohol and marijuana– found in drivers operating under the influence of drugs.

 Adverse Effects from OTC Drugs

If you use over the counter medications, you may experience negative side effects and symptoms. Some of the most common side effects include:

  • Confusion
  • Irritability
  • High blood pressure
  • Irregular heartbeat
  • Constipation
  • Breathing problems
  • Agitation
  • Anxiety
  • Mood changes

Allergic reactions to over-the-counter medicines are rare but happen. Signs of an allergic reaction include rash, hives, itching, and breathing problems. 

Pharmacists can help with understanding drug facts and the health risks of mixing medicines. They are prepared to discuss interactions between a prescribed medicine or OTC drug.

It is a good idea to keep a list of all medications you are taking so you can check for combinations that may adversely affect your health. Also, read drug facts labels and avoid taking different medicines that contain the same active ingredients. 

Who are Most at Risk for Experiencing Adverse Effects to OTC drugs?

The very young, older adults, and those taking more than one type of medicine have a higher risk for adverse effects with OTC drugs

Healthy adults who use OTC medicines properly have a low risk of adverse effects.

Regardless of age, the following health conditions create a higher risk for side effects:

  • Asthma
  • Bleeding disorders
  • Thyroid problems
  • Blood clotting disorders
  • Parkinson’s disease
  • Kidney problems
  • Glaucoma
  • Breathing problems
  • Diabetes
  • High blood pressure
  • Psychiatric problems
  • Immune system problems
  • Enlarged prostate glands
  • Epilepsy
  • Gout
  • Heart disease
  • Liver problems

Before Taking an OTC Medicine

If you plan to take an OTC medication, ask yourself these questions:

  • What are the possible interactions with other medicines I take?
  • Is my symptom a side effect or a serious allergic reaction to the medicine I am taking?
  • Should I take my medicines on an empty stomach or with food?
  • What symptoms should I be aware of that could cause an adverse reaction to my OTC medicine?
  • Did my health care professional prescribe the medication?
  • Did I receive a drug evaluation before taking such drugs
  • know about the supplements or vitamins or OTC medicines that I take regularly?

If you have any concerns about taking over-the-counter medications, discuss them with your family physician or pharmacist.

Can OTC Medications be Abused?

Yes, over the counter medications can be abused. Using these drugs to achieve a euphoric feeling, and not for what the drug was intended for, is a sign of a drug problem.

The abuse of over the counter (OTC) medications is particularly problematic because many of them are easily obtained. 

OTC Drug Statistics

  • DXM is an active ingredient in more than 125 over-the-counter products.
  • Close to 750,000 retail outlets sell OTC medicine.
  • One in eight teenagers admit to abusing OTC cough medicine.
  • 5 percent of 8th graders abuse some form of cold/cough medicine, according to the National Institute on Drug Abuse
  • Around 80,000 people visit emergency rooms each year due to acetaminophen drug overdose.
  • In 2005, the FDA issued a warning about dextromethorphan abuse after a series of drug abuse incidents.
  • 3.1 million young people aged 12 to 25 have used a nonprescription cough and cold medication to get high.

OTC Drugs that were Prescription Medicines

Some over the counter medications were once prescription drugs. As time and use proved their worth and safety to The U S Food and Drug Administration, their classification was changed.

For example, the antihistamine diphenhydramine (Benadryl) started as a prescription medication in 1946, but in the 1980s was approved as an over-the-counter drug in the US.

That does not mean diphenhydramine does not have a higher risk for adverse effects if misused. There have been reports in recent years of teenagers overdosing on the drug as the result of a so-called Benadryl Challenge on the Internet.

Find Help at La Hacienda Treatment Center

La Hacienda Campus | OTC

At La Hacienda Treatment Center we believe addiction is a treatable disease which manifests itself in many complex physical, behavioral, psychological, and spiritual patterns. These symptoms affect not just the patient but also, in a very profound way, the entire family.

We further believe that once an individual develops the disease of chemical dependency, recovery can only occur if total abstinence is maintained from all mood/mind-altering chemicals unless competently prescribed. Continuing care follow-up and involvement in a 12-Step support program are essential to recovery.

La Hacienda Treatment Center has been helping people for 50 years. We believe in making treatment accessible and are in network with most major insurance companies. Our beautiful 40-acre campus in the Texas Hill Country is a restful and supportive environment for recovery.

Phone (800) 749-6160 today and talk with one of our caring and dedicated on-site admission specialists.

Bottle Pouring OTC Medicines into Spoon | La Hacienda


Dextromethorphan (DXM), a drug found in many over the-counter medications, is psychoactive when ingested in greater-than-recommended doses.

Box of OTC Medicines | La Hacienda

Cough Medicines

Abuse of cough medicines is popular among young people, according to the National Institute on Drug Abuse. These over-the-counter medications cause a “high” feeling and are easy to find at home.

Provide Medical Advice | La Hacienda

Cold Medicines

Many cold medications include pseudoephedrine, a stimulant which, when abused, can cause hallucinations or an intense feeling of euphoria.

Variety of Prescription Medications | La Hacienda

Motion Sickness Pills

In high doses, motion sickness pills containing dimenhydrinate, an antihistamine, can cause nausea, ringing in the ears, hallucinations, irregular heartbeat, coma, seizures, and even death.