Familiar but Risky: 5 Over-the-Counter Medications Most Americans Are Using the Wrong Way
Walking down the pain relief or cold-and-flu aisle of any American drugstore presents an abundance of choices—colorful boxes, confident marketing claims, and the quiet reassurance that a pharmacist approved their sale without a prescription. This accessibility is genuinely valuable; OTC medications empower millions of Americans to manage minor ailments efficiently and affordably. But accessibility can breed familiarity, and familiarity has a tendency to breed complacency.
Each year, the American Association of Poison Control Centers fields hundreds of thousands of calls related to OTC medication exposures. Emergency departments across the country treat patients for liver damage, gastrointestinal bleeding, and other preventable complications traceable directly to products purchased without a prescription. The medications involved are not obscure. They are the ones already in your cabinet.
The following five OTC medications are among those most frequently misused by American consumers—not because people intend to cause themselves harm, but because widely held misconceptions about their safety and proper use create dangerous gaps between intention and outcome.
1. Acetaminophen (Tylenol and Hundreds of Combination Products)
The misconception: Acetaminophen is gentle on the stomach and therefore safe to take liberally.
The reality: Acetaminophen-induced liver injury is the leading cause of acute liver failure in the United States. The maximum recommended daily dose for a healthy adult is 4,000 milligrams (mg), though many clinicians advocate keeping routine use below 3,000 mg per day to maintain a meaningful safety margin.
The most dangerous pattern of misuse is not a single large dose—it is the cumulative, unrecognized consumption that occurs when patients take multiple products simultaneously without realizing they share an active ingredient. Acetaminophen appears in more than 600 OTC and prescription products, including NyQuil, Theraflu, Excedrin, Percocet, Vicodin, and numerous store-brand cold remedies. A patient who takes two Tylenol tablets, a dose of NyQuil before bed, and a Theraflu packet the following morning may unknowingly approach or exceed the daily maximum without taking a single dose that appears excessive on its own.
Alcohol use compounds the risk substantially. Individuals who consume three or more alcoholic beverages daily should consult a pharmacist or physician before using any acetaminophen-containing product.
Safe use guidance: Read every label for active ingredients before combining products. Keep a running total of your daily acetaminophen intake across all sources. If you are unsure whether a product contains acetaminophen, ask your pharmacist—that is precisely what they are there for.
2. Ibuprofen and Other NSAIDs (Advil, Motrin, Aleve)
The misconception: Anti-inflammatory pain relievers are interchangeable with acetaminophen and are safe for long-term, frequent use.
The reality: Nonsteroidal anti-inflammatory drugs (NSAIDs), including ibuprofen and naproxen sodium, carry a distinct and serious risk profile that differs meaningfully from acetaminophen. Their primary dangers involve the gastrointestinal tract and the cardiovascular and renal systems.
NSAIDs inhibit prostaglandins that protect the stomach lining, creating conditions favorable to ulcers and gastrointestinal bleeding—a risk that escalates with dose, duration of use, and patient age. Cardiovascular risk, including increased likelihood of heart attack and stroke, is documented across the NSAID class and is reflected in FDA black box warnings. Renal function can deteriorate with chronic NSAID use, particularly in patients who are dehydrated, elderly, or have pre-existing kidney disease.
A common real-world scenario: an older adult takes naproxen twice daily for chronic knee pain over several weeks, assuming that because it is available over the counter it poses minimal risk. Meanwhile, their kidney function quietly declines and their blood pressure—already managed with medication—becomes harder to control, as NSAIDs can blunt the effectiveness of certain antihypertensives.
Safe use guidance: OTC NSAIDs are intended for short-term use, typically no more than ten days for pain or three days for fever, unless directed otherwise by a physician. Adults over 60, those with cardiovascular disease, kidney disease, or peptic ulcer history, and patients on blood thinners or corticosteroids should consult a healthcare provider before using these medications.
3. Diphenhydramine (Benadryl, ZzzQuil, Many Sleep Aids)
The misconception: First-generation antihistamines are harmless sleep aids, and tolerance is not a concern.
The reality: Diphenhydramine, the active ingredient in Benadryl and numerous OTC sleep formulations, is a first-generation antihistamine with significant anticholinergic activity. This means it blocks acetylcholine, a neurotransmitter involved in numerous bodily functions. The consequences of this mechanism are particularly problematic in older adults, who are more vulnerable to anticholinergic effects including confusion, urinary retention, constipation, blurred vision, and increased fall risk.
The American Geriatrics Society includes diphenhydramine on its Beers Criteria list of medications potentially inappropriate for older adults. Despite this, it remains one of the most widely used OTC sleep aids among Americans over 65.
Tolerance to diphenhydramine's sedative effects also develops rapidly—often within just a few days of regular use—leading some individuals to take higher doses in search of the same effect, escalating anticholinergic exposure in the process.
Safe use guidance: Diphenhydramine is appropriate for occasional, short-term use in healthy adults under 65. It should not be used nightly as a sleep maintenance strategy. Patients over 65, those with enlarged prostate, glaucoma, or bladder disorders, and individuals taking other anticholinergic medications should consult a pharmacist or physician before use. For chronic sleep difficulties, evidence-based behavioral interventions (such as cognitive behavioral therapy for insomnia, or CBT-I) remain the recommended first-line approach.
4. Laxatives (MiraLAX, Dulcolax, Senokot, and Others)
The misconception: Stimulant laxatives are appropriate for regular, ongoing use to maintain bowel regularity.
The reality: Laxatives encompass several distinct mechanisms—osmotic agents, stimulants, bulk-forming fibers, and stool softeners—and they are not interchangeable. Stimulant laxatives such as bisacodyl (Dulcolax) and senna (Senokot) work by stimulating intestinal muscle contractions. While effective for short-term relief, chronic reliance on stimulant laxatives can contribute to a pattern sometimes described as laxative dependence, wherein the bowel becomes less responsive to natural stimuli over time.
Electrolyte imbalances—particularly low potassium (hypokalemia)—represent another serious risk of laxative overuse, with implications for heart rhythm and muscle function. This concern is especially relevant for patients with eating disorders who misuse laxatives for weight control, a practice that is both medically dangerous and clinically ineffective for fat loss (laxatives act on the large intestine, after caloric absorption has already occurred in the small intestine).
A practical scenario: a patient begins using a stimulant laxative after a brief bout of travel-related constipation. Finding it effective, they continue daily use for several months without consulting a provider. Over time, spontaneous bowel movements become less frequent, reinforcing continued reliance on the product.
Safe use guidance: Stimulant laxatives are appropriate for occasional, short-term use. For ongoing constipation management, bulk-forming agents such as psyllium (Metamucil) or osmotic agents such as polyethylene glycol (MiraLAX) are generally considered safer for longer-term use. Adequate hydration and dietary fiber intake remain the foundation of healthy bowel function. Persistent constipation warrants evaluation by a healthcare provider to rule out underlying conditions.
5. Decongestants Containing Pseudoephedrine or Phenylephrine (Sudafed, DayQuil)
The misconception: Nasal decongestants are benign symptom relievers suitable for anyone with a stuffy nose.
The reality: Oral decongestants, particularly pseudoephedrine, are sympathomimetic agents that constrict blood vessels throughout the body—not merely in nasal passages. This mechanism raises blood pressure and heart rate, making these medications genuinely risky for individuals with hypertension, coronary artery disease, hyperthyroidism, or benign prostatic hyperplasia. They can also interact with monoamine oxidase inhibitors (MAOIs) in a potentially life-threatening manner.
Additionally, oxymetazoline-based nasal sprays (Afrin) carry their own misuse risk: rhinitis medicamentosa, or rebound congestion. Using these topical decongestants for more than three consecutive days can trigger a cycle in which nasal congestion returns more severely upon each application, driving continued—and increasingly frequent—use.
Safe use guidance: Adults with cardiovascular conditions, uncontrolled hypertension, thyroid disorders, or prostate issues should consult a pharmacist before using any oral decongestant. Oxymetazoline nasal sprays should be limited strictly to three days of use. Saline nasal irrigation offers a non-pharmacological alternative for congestion relief without systemic or rebound risks.
The Pharmacist Is Your Most Underutilized Healthcare Resource
A consistent thread runs through each of the scenarios described above: many of these adverse outcomes are preventable with a brief conversation. American pharmacists are among the most accessible healthcare professionals in the country—no appointment required. They are trained to identify drug interactions, flag contraindications based on your health history, and recommend the most appropriate OTC option for your situation.
At PharmaciTical, we believe that medication literacy is not a luxury—it is a fundamental component of personal health. Understanding what you are taking, why you are taking it, and how to use it correctly transforms an OTC purchase from a routine transaction into an informed healthcare decision. The label on the box is a starting point, not the complete picture.
This article is provided for educational purposes only and does not constitute medical or pharmaceutical advice. Consult a licensed pharmacist or physician with questions about your specific medications or health conditions.
