This is another topic requested by one of my patients and readers. Over-the-counter (OTC) medications are medicines that you can buy at a pharmacy without a prescription from a doctor. These are regulated by the FDA for quality and safety. One mistake made by many people is assuming that all over-the-counter medications are safe because you don’t need a prescription. Why would the FDA allow just anyone to buy a medication if it were dangerous? The logic of this assumption is sound, however, there are many over-the-counter medications that are quite dangerous if not used properly. Below are what I consider to be the 5 most dangerous.

1. NSAIDs

NSAIDS: non-steroidal anti-inflammatory drugs. This class of over-the-counter medication includes ibuprofen (Advil, Motrin) and naproxen (Aleve, Naprosyn) to name a few. These anti-inflammatory medications are commonly used to treat pain and inflammation. The main side effects associated with these medications include stomach ulcers, kidney dysfunction and heart disease. Patients with stomach, kidney, and heart disorders should discuss with their physician before taking this class. Occasional use of these medications for pain or inflammation is ok, but chronic daily use can cause the issues listed above.

The max dose of ibuprofen is 2400mg in 24 hours or 800mg three times per day. If you exceed the max doses or use for prolonged periods, you may develop stomach, kidney and heart problems as well. Also, if you take any blood thinners like warfarin, Pradaxa, Eliquis, or Xarelto, then NSAIDs are strictly off limits due to a major increase in bleeding risk.

2. Tylenol

Acetaminophen: Tylenol. Acetaminophen (APAP) is another great medication for fever and pain, when used appropriately. The major complication associated with APAP is liver dysfunction and in some cases even complete liver failure. The max dose of APAP is 4000mg in 24 hours. However, if you have a dysfunctional liver to begin with, then the max dose is 2000mg in a day.

A major problem arises when someone takes APAP and then takes another medication with APAP in it without being aware. Lots of opiate pain medications are combined with APAP, like Norco, Vicodin, Percocet, etc. If you are taking APAP, then check the labels of all of your medications to make sure you are not getting any extra acetaminophen from any other source.

3. Benadryl

Diphenhydramine: Benadryl. Diphenhydramine is in a class of medications called antihistamines. I consider it a strong antihistamine, and it works well to control things like seasonal allergies and allergic reactions. Diphenhydramine is also considered an anti-cholinergic medication, meaning it works on choline neurotransmitters in the brain. For young people, the only major side effect is drowsiness, but as we get older the anticholinergic side effects get much stronger. Anti-cholinergic side effects include confusion, dizziness, dry mouth, urinary retention and an increased risk of falls. I would not consider this a safe medication for anyone over the age of 65.

Like APAP, diphenhydramine is another medication that frequently comes in combination with other meds. For example, if an over-the-counter medication has “PM” at the end of the name, then it likely has an antihistamine diphenhydramine in it (Advil PM, Tylenol PM, Unisom PM).

4. Aspirin

Acetylsalicyclic acid (ASA): Aspirin. If you have not read my previous article on aspirin, then take a look at it now: So Wait, Should I Take An Aspirin or Not? Aspirin is a decent anti-inflammatory tablet, but its main use is as an anti-platelet medication to prevent heart attack and stroke. The major risk with aspirin is bleeding. This can include traumatic head bleeding from a minor accident, or internal gastrointestinal bleeding from a stomach ulcer. Aspirin should not be given to children due to an increased risk of a rare, but severe reaction call Reye’s syndrome, which causes liver damage and brain swelling.

5. Sudafed

Pseudoephedrine: Sudafed. This is a very strong, short acting decongestant. While not meant to be used every day, this medication works very well with intermittent use. Pseudoephedrine is an over-the-counter medication, however at most pharmacies you have to show your ID to the pharmacist in order to buy it. So pharmacies will keep track of how much and how often people buy pseudoephedrine in order to catch people buying it for illegal purposes, like making meth.

The main side effect to worry about is increased blood pressure. If you have normal blood pressure, then a small infrequent rise is not likely to cause any problem. However, you could have a problem if you have high blood pressure and take one or more medications to control this. Pseudoephedrine can actually elevate your blood pressure even further and rarely can send you into hypertensive emergency. This is a dangerous syndrome in which your blood pressure soars above 200/120. This elevated blood pressure can cause you to have symptoms like headache, blurry vision, confusion, chest pain, kidney dysfunction, etc.

If you have high blood pressure and are looking for a decongestant cold medication over-the-counter, then look for the heart in the corner of the package indicating it is safe for high blood pressure. Or look for “HBP” in the name (high blood pressure) like Corcidin HBP or Vicks HBP. These are all safe for people with high blood pressure.

As you can see, not all over-the-counter medications are perfectly safe for everyone. I recommend you talk with your doctor before using any over-the-counter medications especially if you are taking any of these routinely. Remember to read the generic names listed on these products to know exactly what you are taking. As a Wise Patient, I want you to be aware of what you are getting over-the-counter.

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