Over-the-counter (OTC) medicines are drugs you can buy without a prescription. Some OTC medicines relieve aches, pains and itches. Some prevent or cure diseases, like tooth decay and athlete's foot. Others help manage recurring problems, like migraines.

In the United States, the Food and Drug Administration decides whether a medicine is safe enough to sell over-the-counter. Taking OTC medicines still has risks. Some interact with other medicines, supplements, foods or drinks. Others cause problems for people with certain medical conditions. If you're pregnant, talk to your health care provider before taking any medicines.

It is important to take medicines correctly, and be careful when giving them to children. More medicine does not necessarily mean better. You should never take OTC medicines longer or in higher doses than the label recommends. If your symptoms don't go away, it's a clear signal that it's time to see your health care provider.

American medicine cabinets contain a growing choice of nonprescription, over-the-counter (OTC) medicines to treat an expanding range of ailments. OTC medicines often do more than relieve aches, pains and itches. Some can prevent diseases like tooth decay, cure diseases like athlete's foot and, with a doctor's guidance, help manage recurring conditions like vaginal yeast infection, migraine and minor pain in arthritis.

The U.S. Food and Drug Administration (FDA) determines whether medicines are prescription or nonprescription. The term prescription (Rx) refers to medicines that are safe and effective when used under a doctor's care. Nonprescription or OTC drugs are medicines FDA decides are safe and effective for use without a doctor's prescription.

FDA also has the authority to decide when a prescription drug is safe enough to be sold directly to consumers over the counter. This regulatory process allowing Americans to take a more active role in their health care is known as Rx-to-OTC switch. As a result of this process, more than 700 products sold over the counter today use ingredients or dosage strengths available only by prescription 30 years ago.

Increased access to OTC medicines is especially important for our maturing population. Two out of three older Americans rate their health as excellent to good, but four out of five report at least one chronic condition.

Fact is, today's OTC medicines offer greater opportunity to treat more of the aches and illnesses most likely to appear in our later years. As we live longer, work longer, and take a more active role in our own health care, the need grows to become better informed about self-care.

The best way to become better informed—for young and old alike—is to read and understand the information on OTC labels. Next to the medicine itself, label comprehension is the most important part of self-care with OTC medicines.

With new opportunities in self-medication come new responsibilities and an increased need for knowledge. FDA and the Consumer Healthcare Products Association (CHPA) have prepared the following information to help Americans take advantage of self-care opportunities.

You wouldn't ignore your doctor's instructions for using a prescription drug; so don't ignore the label when taking an OTC medicine. Here's what to look for:

• PRODUCT NAME
• "ACTIVE INGREDIENTS":  therapeutic substances in medicine
• "PURPOSE":  product category (such as antihistamine, antacid, or cough suppressant)
• "USES":  symptoms or diseases the product will treat or prevent
• "WARNINGS":  when not to use the product, when to stop taking it, when to see a doctor, and possible side effects
• "DIRECTIONS":  how much to take, how to take it, and how long to take it
• "OTHER INFORMATION":   such as storage information
• "INACTIVE INGREDIENTS":   substances such as binders, colors, or flavoring

You can help yourself read the label too. Always use enough light. It usually takes three times more light to read the same line at age 60 than at age 30. If necessary, use your glasses or contact lenses when reading labels.

Always remember to look for the statement describing the tamper-evident feature(s) before you buy the product and when you use it.

When it comes to medicines, more does not necessarily mean better. You should never misuse OTC medicines by taking them longer or in higher doses than the label recommends. Symptoms that persist are a clear signal it's time to see a doctor.

Be sure to read the label each time you purchase a product. Just because two or more products are from the same brand family doesn't mean they are meant to treat the same conditions or contain the same ingredients.

Remember, if you read the label and still have questions, talk to a doctor, nurse, or pharmacist.     

• Be sure to look through your medicine supply at least once a year.
• Always store medicines in a cool, dry place or as stated on the label.
• Throw away any medicines that are past the expiration date.
• To make sure no one takes the wrong medicine, keep all medicines in their original containers.

Is your medicine cabinet full of expired drugs or medications you no longer use? Your medicine is for you. What’s safe for you might be harmful for someone else. The best way to dispose of your expired, unwanted, or unused medicines is through a drug take back program — or you can do it at home.

Drug Take Back Programs

The U.S. Drug Enforcement Administration (DEA) sponsors National Prescription Drug Take Back Day in communities nationwide. Many communities also have their own drug take back programs. Check with your local law enforcement officials to find a location near you or with the DEA to find a DEA-authorized collector in your community.

You can also check with your pharmacist. Some pharmacies offer on-site medicine drop-off boxes, mail-back programs, and other ways to help you safely dispose your unused medicines.

How to Dispose of Medicines at Home

When a take back option is not easily available, there are two ways to dispose of medicines at home, depending on the drug.

Flushing medicines: Because some medicines could be especially harmful to others, they have specific directions to immediately flush them down the sink or toilet when they are no longer needed, and a take-back option is not readily available.

How will you know? Check the label or the patient information leaflet with your medicine. Or consult the U.S. Food and Drug Administration’s list of medicines recommended for disposal by flushing when a take back option is not readily available. Remember, don’t flush your medicine unless it is on the flush list.

Disposing medicines in household trash: If a take back program is not available, almost all medicines, except those on the FDA flush list (see below), can be thrown into your household trash. These include prescription and over-the-counter (OTC) drugs in pills, liquids, drops, patches, and creams.

Follow these steps:

1. Remove the drugs from their original containers and mix them with something undesirable, such as used coffee grounds, dirt, or cat litter. This makes the medicine less appealing to children and pets and unrecognizable to someone who might intentionally go through the trash looking for drugs.
2. Put the mixture in something you can close (a re-sealable zipper storage bag, empty can, or other container) to prevent the drug from leaking or spilling out.
3. Throw the container in the garbage.
4. Scratch out all your personal information on the empty medicine packaging to protect your identity and privacy. Throw the packaging away.

If you have a question about your medicine, ask your health care provider or pharmacist.

Disposing Fentanyl Patches

The fentanyl patch is an example of a product that contains a powerful opioid medicine that can be dangerous to people it’s not prescribed for. This adhesive patch delivers a strong pain medicine through the skin.

Even after a patch is used, a lot of the medicine remains. That’s why the drug comes with instructions to flush used or leftover patches.

Disposing Inhaler Products

One environmental concern involves inhalers used by people who have asthma or other breathing problems, such as chronic obstructive pulmonary disease. Read handling instructions on the labeling of inhalers and aerosol products.

These products could be dangerous if punctured or thrown into a fire or incinerator. To properly dispose of these products and follow local regulations and laws, contact your trash and recycling facility.

Flushing Drugs and the Water Supply

Some people wonder if it’s okay to flush certain medicines when a take back option is not easily available. There are concerns about the small levels of drugs that may be found in surface water, such as rivers and lakes, and in drinking water supplies.

“The main way drug residues enter water systems is by people taking medicines and then naturally passing them through their bodies,” says Raanan Bloom, Ph.D., an environmental assessment expert at the FDA. “Many drugs are not completely absorbed or metabolized by the body and can enter the environment after passing through wastewater treatment plants.”

The FDA and the U.S. Environmental Protection Agency take the concerns of flushing certain medicines in the environment seriously. Still, there has been no sign of environmental effects caused by flushing recommended drugs.

Although mild and relatively uncommon, interactions involving OTC drugs can produce unwanted results or make medicines less effective. It's especially important to know about drug interactions if you're taking Rx and OTC drugs at the same time.

Some drugs can also interact with foods and beverages, as well as with health conditions such as diabetes, kidney disease, and high blood pressure.

Here are a few drug interaction cautions for some common OTC ingredients:

• Avoid alcohol if you are taking antihistamines, cough-cold products with the ingredient dextromethorphan, or drugs that treat sleeplessness.
• Do not use drugs that treat sleeplessness if you are taking prescription sedatives or tranquilizers.
• Check with your doctor before taking products containing aspirin if you're taking a prescription blood thinner or if you have diabetes or gout.
• Do not use laxatives when you have stomach pain, nausea, or vomiting.
• Unless directed by a doctor, do not use a nasal decongestant if you are taking a prescription drug for high blood pressure or depression, or if you have heart or thyroid disease, diabetes, or prostate problems.

This is not a complete list. Read the label! Drug labels change as new information becomes available. That's why it's important to read the label each time you take medicine.   

Drugs can pass from a pregnant woman to her unborn baby. A safe amount of medicine for the mother may be too much for the unborn baby. If you're pregnant, always talk with your doctor before taking any drugs, Rx or OTC.

Although most drugs pass into breast milk in concentrations too low to have any unwanted effects on the baby, breast-feeding mothers still need to be careful. Always ask your doctor or pharmacist before taking any medicine while breast-feeding. A doctor or pharmacist can tell you how to adjust the timing and dosing of most medicines so the baby is exposed to the lowest amount possible, or whether the drugs should be avoided altogether.    

OTC drugs rarely come in one-size-fits-all. Here are some tips about giving OTC medicines to children:

• Children aren't just small adults, so don't estimate the dose based on their size.
• Read the label. Follow all directions.
• Follow any age limits on the label.
• Some OTC products come in different strengths. Be aware!
• Know the difference between TBSP. (tablespoon) and TSP. (teaspoon). They are very different doses.
• Be careful about converting dose instructions. If the label says two teaspoons, it's best to use a measuring spoon or a dosing cup marked in teaspoons, not a common kitchen spoon.
• Don't play doctor. Don't double the dose just because your child seems sicker than last time.
• Before you give your child two medicines at the same time, talk to your doctor or pharmacist.
• Never let children take medicine by themselves.
• Never call medicine candy to get your kids to take it. If they come across the medicine on their own, they're likely to remember that you called it candy.     

Child-resistant closures are designed for repeated use to make it difficult for children to open. Remember, if you don't re-lock the closure after each use, the child-resistant device can't do its job—keeping children out!

It's best to store all medicines and dietary supplements where children can neither see nor reach them. Containers of pills should not be left on the kitchen counter as a reminder. Purses and briefcases are among the worst places to hide medicines from curious kids. And since children are natural mimics, it's a good idea not to take medicine in front of them. They may be tempted to "play house" with your medicine later on.

If you find some packages too difficult to open—and don't have young children living with you or visiting—you should know the law allows one package size for each OTC medicine to be sold without child-resistant features. If you don't see it on the store shelf, ask.

Makers of OTC medicines seal most products in tamper-evident packaging (TEP) to help protect against criminal tampering. TEP works by providing visible evidence if the package has been disturbed. But OTC packaging cannot be 100 percent tamper-proof. Here's how to help protect yourself:

• Be alert to the tamper-evident features on the package before you open it. These features are described on the label.
• Inspect the outer packaging before you buy it. When you get home, inspect the medicine inside.
• Don't buy an OTC product if the packaging is damaged.
• Don't use any medicine that looks discolored or different in any way.
• If anything looks suspicious, be suspicious. Contact the store where you bought the product. Take it back!
• Never take medicines in the dark.

Over-the-counter (OTC) medicines are those that can be sold directly to people without a prescription. OTC medicines treat a variety of illnesses and their symptoms including pain, coughs and colds, diarrhea, constipation, acne, and others. Some OTC medicines have active ingredients with the potential for misuse at higher-than-recommended dosages.

How do people use and misuse OTC medicines?

Misuse of an OTC medicine means:

• taking medicine in a way or dose other than directed on the package
• taking medicine for the effect it causes- for example, to get high
• mixing OTC medicines together to create new products

"Behind-the-Counter"

Pseudoephedrine, a nasal decongestant found in many OTC cold medicines, can be used to make methamphetamine. For this reason, products containing pseudoephedrine are sold "behind the counter" nationwide. A prescription is not needed in most states, but in states that do require a prescription, there are limits on how much a person can buy each month. In some states, only people 18 years of age or older can buy pseudoephedrine.

What are some of the commonly misused OTC medicines?

There are two OTC medicines that are most commonly misused.

Dextromethorphan (DXM) is a cough suppressant found in many OTC cold medicines. The most common sources of abused DXM are "extra-strength" cough syrup, tablets and gel capsules. OTC medications that contain DXM often also contain antihistamines and decongestants. DXM may be swallowed in its original form or may be mixed with soda for flavor, called "robo-tripping" or "skittling." Users sometimes inject it. These medicines are often misused in combination with other drugs, such as alcohol and marijuana.

Loperamide is an anti-diarrheal that is available in tablet, capsule, or liquid form. When misusing loperamide, people swallow large quantities of the medicine. It is unclear how often this drug is misused.

How do these OTC medicines affect the brain?

DXM is an opioid without effects on pain reduction and does not act on the opioid receptors. When taken in large doses, DXM causes a depressant effect and sometimes a hallucinogenic effect, similar to PCP and ketamine. Repeatedly seeking to experience that feeling can lead to addiction-a chronic relapsing brain condition characterized by inability to stop using a drug despite damaging consequences to a person's life and health.

Loperamide is an opioid designed not to enter the brain. However, when taken in large amounts and combined with other substances, it may cause the drug to act in a similar way to other opioids. Other opioids, such as certain prescription pain relievers and heroin, bind to and activate opioid receptors in many areas of the brain, especially those involved in feelings of pain and pleasure. Opioid receptors are also located in the brain stem, which controls important processes, such as blood pressure, arousal, and breathing.

Opioid Withdrawal Symptoms

These symptoms include:

• muscle and bone pain
• sleep problems
• diarrhea and vomiting
• cold flashes with goose bumps
• uncontrollable leg movements
• severe cravings

What are the health effects of these OTC medicines?

DXM
Short-term effects of DXM misuse can range from mild stimulation to alcohol- or marijuana-like intoxication. At high doses, a person may have hallucinations or feelings of physical distortion, extreme panic, paranoia, anxiety, and aggression.

Other health effects from DXM misuse can include the following:

• hyperexcitability
• poor motor control
• lack of energy
• stomach pain
• vision changes
• slurred speech
• increased blood pressure
• sweating

Misuse of DXM products containing acetaminophen can cause liver damage.

Loperamide
In the short-term, loperamide is sometimes misused to lessen cravings and withdrawal symptoms; however, it can cause euphoria, similar to other opioids.

Loperamide misuse can also lead to fainting, stomach pain, constipation, eye changes, and loss of consciousness. It can cause the heart to beat erratically or rapidly, or cause kidney problems. These effects may increase if taken with other medicines that interact with loperamide. Other effects have not been well studied and reports are mixed, but the physical consequences of loperamide misuse can be severe.

Can a person overdose on these OTC medicines?

Yes, a person can overdose on cold medicines containing DXM or loperamide. An overdose occurs when a person uses enough of the drug to produce a life-threatening reaction or death (Read more on our Intentional vs. Unintentional Overdose Deaths webpage).

As with other opioids, when people overdose on DXM or loperamide, their breathing often slows or stops. This can decrease the amount of oxygen that reaches the brain, a condition called hypoxia. Hypoxia can have short- and long-term mental effects and effects on the nervous system, including coma and permanent brain damage and death.

How can these OTC medicine overdoses be treated?

A person who has overdosed needs immediate medical attention. Call 911. If the person has stopped breathing or if breathing is weak, begin CPR. DXM overdoses can also be treated with naloxone. Read more about naloxone at our Naloxone webpage.

Certain medications can be used to treat heart rhythm problems caused by loperamide overdose. If the heart stops, health care providers will perform CPR and other cardiac support therapies.

Can misuse of these OTC medicines lead to addiction?

Yes, misuse of DXM or loperamide can lead to addiction. An addiction develops when continued use of the drug causes issues, such as health problems and failure to meet responsibilities at work, school, or home.

The symptoms of withdrawal from DXM and loperamide have not been well studied.

How can people get treatment for addiction to these OTC medicines?

There are no medications approved specifically to treat DXM or loperamide addiction. Behavioral therapies, such as cognitive-behavioral therapy and contingency management, may be helpful. Cognitive-behavioral therapy helps modify the patient's drug-use expectations and behaviors, and effectively manage triggers and stress. Contingency management provides vouchers or small cash rewards for positive behaviors such as staying drug-free. Read more about drug addiction treatment in our Treatment Approaches for Drug Addiction DrugFacts.

Points to Remember

• Over-the-counter (OTC) medicines are those that can be sold directly to people without a prescription. Those that have the potential for misuse include:
  • Dextromethorphan (DXM), a cough suppressant found in many OTC cold medicines
  • Loperamide, an anti-diarrheal
• When misusing DXM, people swallow large quantities of the medicine, sometimes mixing it with soda for flavor, called "robo-tripping" or "skittling." Loperamide may also be swallowed.
• Short-term effects of DXM misuse can range from mild stimulation to alcohol-or marijuana-like intoxication. Loperamide misuse can cause euphoria, similar to other opioids, or lessen cravings and withdrawal symptoms, but other effects have not been well studied and reports are mixed.
• A person can overdose on cold medicines containing DXM or loperamide.
• Overdose can be treated with CPR and certain medications depending on the person's symptoms, but the most important step to take is to call 911.
• Misuse of DXM or loperamide can lead to addiction.
• There are no medications to treat DXM or loperamide addiction. Behavioral therapies, such as cognitive-behavioral therapy and contingency management, may be helpful.

Medicines can treat health problems and help you live a healthier life. When used incorrectly, medicines can cause serious injuries or even death. Many of these problems can be prevented. Read this guide to learn four (4) ways to avoid common medicine mistakes.

1. Ask questions.
2. Keep a medicine list.
3. Follow directions.
4. Safely store and throw out medicines.

1. Ask Questions

Ask your doctor, nurse, or pharmacist to tell you the facts about each medicine you take.

• What is the name of the medicine?
• What is the active ingredient(s)?
• What is the medicine for?
• How much do I take and when should I take it?
• What does it look like?
• When does it expire?
• Are there any side effects or special warnings?
• What should I do if I start having side effects?
• Can I take it if I am pregnant or breastfeeding?
• What other medicines or foods should I avoid?

2. Keep a Medicine List

Write down the important facts about each medicine you take.

• List each prescription medicine.
• Include vitamins and over-the-counter medicines like aspirin and cold medicine.
• Keep the list with you all the time.
• Show it to your doctor, nurse, and pharmacist.

3. Follow Directions

Your medicine may not work if you don’t follow the directions. Taking too much or too little can make you very sick.

Use Medicines as Directed.

• Read the directions on the label and ask your healthcare provider how much you should take and when.
• Never skip taking your prescription medicine. Talk to your healthcare provider before you stop taking your medicines.
• Only take the suggested dose.

Avoid Common Problems.

• Don’t share medicines.
• Don’t use medicine in the dark where you can’t see what you are taking.
• Check the expiration date on your medicine. It may not be safe or work after it has expired.

4. Safely Throw Out Medicines

Ask your doctor, nurse or pharmacist how you should get rid of unused medicines. Find out if you should:

• flush it down the toilet or sink.
• put it in a sealed plastic bag with coffee grounds or kitty litter and throw it in the trash.
• drop it off at a drug take-back program in your community.

Be sure to scratch off your name and personal information before you put empty pill bottles in the trash.

Make sure that children can’t get to medicines including patches that you put in the trash.

Avoid common medicine mistakes.

• Get a record keeper to list your medicines.
• Download a booklet to help you talk to your doctor about your prescription medicines.
• Watch videos to learn other helpful tips.