Commonly Used Over the Counter (OTC) Medications and Potential Problems

OTC Medication/Classification / Problems/Concerns
NSAIDS
Ibuprofen,(e.g. Motrin, Advil)
Naproxen (e.g. Aleve)
Aspirin /
  • Can impair renal function
  • Can cause gastric bleeding
  • Can cause increase in blood pressure
  • Counteracts the antihypertensive effects of thiazide diuretics, beta-blockers, alpha-blockers, and ACE inhibitors(Neafsey & Shellman, 2001)
  • Can reduce the effectiveness of ACE inhibitors
  • Can increase bleeding risk for those taking anticoagulants and should be avoided by those persons
  • Can cause gastric bleeding(Merck, 2006)

Acetaminophen (e.g. Tylenol) /
  • Can be toxic to the liver when taken in excessive doses or if combined with heavy alcohol use
  • Rarely, can cause nephrotoxicity
  • Persons with renal or hepatic impairment should limit use
  • Persons taking warfarin should limit use to no more than 6 regular strength tablets per week. Higher doses inhibit liver metabolism of warfarin resulting in increased INR
  • Educate patients on combination products that contain acetaminophen to avoid overdosing(Neafsey & Shellman, 2001)

Antacids and Calcium Supplements /
  • Can reduce the absorption of medications such as levothyroxine, digoxin, phenytoin and ciprofloxacin, and nutrients such as iron, zinc, vitamin B12 and thiamin.
  • Counsel patients to take at least 2 hours apart from any medication (Neafsey & Shellman, 2001)
  • Antacids that contain aluminum are more likely to cause constipation, and those that contain magnesium are more likely to cause diarrhea and dehydration.
  • Antacids containing magnesium or aluminum can reduce the absorption of digoxin(Merck, 2006)

Antihistamines (e.g. diphenhydramine, Benadryl, Nytol, Sominex)
Decongestants
Cold Remedies /
  • May worsen effects of glaucoma and enlarged prostate
  • May cause dizziness, drowsiness, and unsteadiness, leading to falls
  • In higher doses or in combination with other drugs may cause blurred vision, light-headedness, dry mouth, difficulty with urination or constipation(Neafsey & Shellman, 2001)
  • Patients with chronic conditions such as hypertension, heart disease, asthma, diabetes, glaucoma or hyperthyroidism should consult a physician before taking antihistamines or decongestants(Merck, 2006)
Can increase blood pressure(Neafsey & Shellman, 2001)