When it comes to substance abuse, most people focus on the dangers of illegal drugs or even prescription drugs like opioid painkillers, but we do not often talk about the dangers of over-the-counter medications. These common medications, drugs that don’t even require a doctor’s prescription to slip into our grocery carts, may contain hidden dangers. Over-the-counter (OTC) drugs can treat anything from the common cold to fungal infections, but there are limits to how benign they can be.

Prescription Drugs and Over-the-Counter Drugs

In the United States, there are two types of commercially available pharmaceutical medications: prescription drugs and over-the-counter drugs. As explained by the U.S. Food and Drug Administration, prescription drugs have to be prescribed by a doctor or nurse practitioner, they have to be purchased at a pharmacy, they have to be used exclusively by the patient, and exclusively for the reason they were initially prescribed.1

Some prescription drugs are heavily regulated and monitored if they carry a significant risk to cause physical and/or psychological dependence. This is a good precaution, because the National Institute on Drug Abuse has estimated that over 52 million American adults used prescription drugs for nonmedical purposes in a given year.2

By comparison, over-the-counter drugs are slightly easier to procure. They often contain milder doses and potency than prescription medication, so they do not require a doctor’s approval to be purchased; they’re often much cheaper than prescription medication; they are stocked and found in larger quantities; and the causes for which they are taken are rarely (if ever) as serious as those that require a doctor’s input. Over-the-counter drugs are made available to the general public with the understanding that they will be used responsibly, without the need for supervision by a health care professional.

OTC drugs in medicine cabinet

OTC Medicine and Pregnancy

Any substance can be abused; patients may consume dangerous amounts of any drug. Also, over-the-counter meds may react negatively with other drugs (either prescription or recreational) that are taken at the same time. In some cases, over-the-counter medications may exacerbate pre-existing mental health or medical conditions.

Pregnant women should not take an over-the-counter medication without first consulting with their doctor. Some studies show that there is insufficient data to say if even up to 98 percent of commercially available medicines (whether prescription or otherwise) are safe to take during pregnancy. For obvious reasons, the Food and Drug Administration does not often test medicines on pregnant women and their unborn children.4,5

Unfortunately, many people, not just pregnant woman, assume that if drugs are available over the counter, and if they are approved by the FDA, the drugs are safe to take at anytime. However, human fetuses are incredibly sensitive to any chemical or hormonal changes in their mother’s body, and that is why even the most basic of over-the-counter medications have to be approached with caution. Hormonal changes readjust the entire system of the mother’s body.6

Misusing Over-the-Counter Medicines

Pregnant women are not the only people who should be careful about taking over-the-counter medications. Over-the-counter drugs are purely for treating short-term illnesses and symptoms, yet they often get used for much longer periods of time. Taking these medications over a long period of time increases chances of adverse effects on health and worsening of pre-existing medical conditions that then require medical intervention.

A large part of the problem is that many people do not fully understand what they are putting into their bodies. Even medications that are meant to treat the most basic conditions are formulations of several drugs. For example, cold and cough medicines contain pseudoephedrine, and if a patient is taking antidepressants or stimulants to treat ADHD, the cocktail can cause high blood pressure to the point of becoming life-threatening.7

Another good example surrounds the warning from the FDA that targets drugs that exceed 325 mg of acetaminophen per dose. While acetaminophen is commonly found in many over-the-counter drugs for the treatment of pain and fever, patients are unaware of (or willfully ignore) the maximum recommended dosages. In the case of acetaminophen, taking more than a recommended dose can cause irreversible, fatal liver damage.8,9

The seemingly innocuous nature of over-the-counter drugs, and the fact that they are sold in such large quantities, is what disarms a lot of people and lures them into excessive consumption. Even simple, everyday drugs, like aspirin, can interact with blood thinners and antibiotics, which may cause severe internal bleeding, while some anti-inflammatory painkillers, like ibuprofen, can lead to ulcers.10,11

Other over-the-counter drugs that may be misused include diet pills or laxatives, partly because they are believed to cause a mild buzz when taken in large doses, but also because individuals who deeply struggle with body image may overdose or damage their digestive tracts in an attempt to lose weight quickly.12

Dangers of OTC Cough Syrup: Dextromethorphan Abuse

Cough syrup in spoonUnfortunately, some OTC medications are recreationally abused, and many of the people who misuse those drugs are under the age of 18. While prescription medication abuse remains a massive problem, the ease with which OTC drugs can be obtained, and the erroneous belief that they cannot be too harmful, leads some young people to experiment with them.

One very commonly abused household medicine can be found in cough syrup. Dextromethorphan, the active ingredient in most cough syrups, can also cause a number of dangerous side effects, including:

  • Vomiting
  • Difficulty breathing
  • Inability to concentrate
  • Difficulty coordinating muscle movement
  • Blurred vision
  • Extended periods of drowsiness13

When combined with alcohol or other drugs, an excessive dose of otherwise everyday cough and cold syrup can be deadly. Further, many cough syrups contain alcohol. The common cough syrup brand name NyQuil has an alcohol content ranging from 10 percent to 25 percent (more than most domestic beers), so it is perhaps not too surprising that this substance can tie in with alcohol dependence.14

Combining OTC Medications with Alcohol

Why does alcohol react so adversely with medication? The National Institute of Alcohol Abuse and Alcoholism explains that since medicines are drugs (and have drugs in them), and alcohol itself is a drug, the combination often leads to undesirable reactions in the human body, especially when other factors are taken into consideration:

  • Age
  • Gender
  • Body weight
  • Previous substance use
  • Physical health
  • Family history of medical and mental health issues15

Using Over-the-Counter Medication Properly

All-in-all, it is important to learn as much as you can and use all medicines — OTC or prescription — wisely. Any substance can be misused, and most substances can be dangerous if taken in dangerous ways. If addiction has impacted you or your family, it is especially important to watch these medications carefully and exercise care when using any substance.

Read labels carefully to ensure that the ingredients of the medication do not clash with other medications currently being taken. Questions should be asked directly to a pharmacist and if you choose to research your medications on the internet, find multiple reliable sources before proceeding.

Over-the-counter tablets should not be crushed or mixed with other liquids for faster consumption and effect. This is a common way that people who misuse medication try to get higher faster or to get rapid relief from their conditions. However, even OTC medications are only meant to be taken as directed. Altering medication in any way (by crushing the tablets and dissolving them in liquid, for example) might overwhelm the body with the drug.

While they are not manufactured with the intent of causing addictions and lining the pockets of drug dealers and manufacturers, OTC drugs are still drugs. Those going to their neighborhood grocery store to get something for a cold or an upset stomach should know what they are putting into their bodies.

If you or someone you care about has been misusing substances of any kind, we are here to help. Our experienced treatment team has resources to help individuals and families overcome addiction and its effects. Call us today to find support and information that can improve your life.


1 Prescription Drugs and Over-the-Counter Drugs: Questions and Answers. U.S. Food and Drug Administration. Jan 2018.

2 What is the scope of prescription drug misuse? National Institute on Drug Abuse. Jan 2018.

3 Winstock, A. Why America Has a Prescription Drug Epidemic: To Regulate or to Educate? No Question — You Do Both. The Huffington Post. Dec 2013.

4 “Taking Medicine During Pregnancy.” WebMD. Aug 2016.

5 Briggs GG, Freeman RK, Yaffe S.10 Over-the-Counter Drugs to Avoid During Pregnancy. Consumer Reports. Jun 2014.

6 Healthline.How Baby Changes the Body: See the Power of Pregnancy.21 Jun 2016.

7 Bahndari, S. “Coping With Side-Effects of Antidepressants.” WebMD. 23 Jun 2013.

8 FDA. All manufacturers of prescription combination drug products with more than 325 mg of acetaminophen have discontinued marketing. Mar 2014.

9 Tylenol (Acetaminophen) Liver Damage. Medicinenet. Jan 2014.

10 Palmer, B. What’s the Most Dangerous Over-the-Counter Drug? Slate. Dec 2011.

11 Portenoy, R. Can Over-the-Counter Pain Relievers Be Harmful, Are They Safer Than Other Drugs? ABC News. Nov 2008.

12 Use Certain Laxatives With Caution. U.S. Food and Drug Administration. Feb 2013.

13 Griffin, M. “Teens and DXM Drug Abuse.” WebMD. 2012.

14 Fortier, A. Amount of Alcohol in Nyquil. Livestrong. Aug 2013.

15Harmful Interactions: Mixing Alcohol with Other Drugs. National Institute of Alcohol Abuse and Alcoholism. 2014.