How to Use Over-the-Counter Meds the Right Way

These drugs can have powerful effects, especially on older adults, so pick wisely and stick with recommended doses

A person looking at over the counter medications in pharmacy aisle Photo: Alexander Ford/Getty Images

You might not think twice about reaching for an over-the-counter pain reliever for a headache, or an OTC antihistamine when seasonal allergies flare up. But experts say you should. “Many seniors consider these over-the-counter medications harmless, but they’re drugs, and the older you get, the more susceptible you are to their side effects,” says Jeffrey Kullgren, MD, an associate professor of internal medicine at the University of Michigan Institute for Healthcare Policy and Innovation in Ann Arbor.

So while it’s important for everyone to follow instructions for OTCs, it’s essential for older adults, he adds. And go over all your meds—prescription, supplements, and OTC—with your primary care doctor or pharmacist at least once a year. This can help you ensure that you’re taking the right meds at the proper doses, says David Hochman, MD, an internal medicine physician at Keck Medicine of USC in Los Angeles. This is key for older adults, who are more likely to use multiple meds. About half of those between ages 50 and 80 report regular use of at least two OTC drugs, a University of Michigan National Poll on Healthy Aging published in 2020 found. Among those who used five or more prescription drugs, 32 percent took an addi­tional five or more OTC meds.

It’s also important to know that some OTCs are more appropriate for older adults than others, says Nina Blachman, MD, assis­tant professor of medicine and geriatrics at NYU Grossman School of Medicine in New York City. OTC drugs you tolerated well in the past, such as nonsteroidal anti-inflammatories (NSAIDs) like ibuprofen (Advil, Motrin IB) and naproxen (Aleve and others), could become problematic. You might not need medication for a problem such as a cough or mild heartburn, but if you choose to take meds, this guide can help you pick the safest options.

Ease Pain or Fever

Consider using: For most people, acetaminophen (Tylenol and generic) is best for pain and fever. “I tell my patients that if they were stranded on a desert island, the one medication they’d want to have with them is acetaminophen,” Hochman says. For arthritis pain, another option is the over-the-counter NSAID gel diclofenac (Voltaren).

Be cautious with: Ibuprofen, naproxen, and other oral NSAIDs, which can cause side effects such as gastro­intestinal bleeding with chronic use, Hochman says. Aspirin is generally not recommended as a pain or fever reducer for older adults. (It’s wise to keep a small bottle on hand, in the event of symptoms that may signal a heart attack, or to take a daily baby aspirin if your doctor advises it to protect your heart.)

And skip oral pain relievers before the COVID-19 vaccine if your intention is to prevent side ­effects: “There’s some concern that it may decrease the immune response your body will have after it gets the vaccine,” says Chad Worz, PharmD, chief executive of the American Society of Consultant Pharmacists. Taking antihistamines before getting the vaccine to prevent allergic reactions afterward is also not recommended.

Quiet a Nagging Cough

Consider using: Guaifenesin—found in OTC products such as Mucinex—thins ­mucus in your lungs so that you can bring it up more easily, says Sunny Linnebur, PharmD, a clinical pharmacy specialist at the University of Colorado Hospital ­Seniors Clinic in Aurora and past president of the American Geriatrics ­Society. Drinking a lot of fluids also helps.

More on Meds

Be cautious with: Products that contain the decongestants phenylephrine or pseudoephedrine, such as certain OTC multi­symptom cold and cough remedies. These ingredients are sometimes not advised for older adults because they can drive up blood pressure, affect sleep, and cause urination problems, Linnebur says.

An ingredient to avoid is the antihistamine diphenhydramine, which is often found in OTC nighttime cold and cough medicines and has been linked to dizziness, sleepiness, and cognitive impairment in seniors, Blachman says. Certain OTC cough and cold products also contain acetaminophen, so if you’re already taking acetaminophen on its own, “you run the risk of an accidental overdose,” Blachman says.

Reduce Allergy Symptoms

Consider using: An OTC steroid nasal spray such as fluticasone (Flonase and generic), triamcinolone (Nasacort AQ and generic), or budesonide (Rhinocort Aqua). These are the first-line treatments for allergies and are considered safe for seniors, Worz says. A simple saline spray can also help flush allergens and mucus from your nose.

Be cautious with: The OTC antihistamines chlorpheniramine (Chlor-Trimeton and generic) and clemastine (Tavist and generic), unless your doctor advises it. These often cause sedation, especially in older adults, Worz says. Avoid diphenhydramine (Benadryl and generic). It’s an anticholinergic, a type of drug that has been linked to a higher risk of dementia in seniors.

Stop Constipation and Diarrhea

Consider using: You can help ward off constipation by consuming about 20 to 25 grams of fiber per day, Blachman says. Another option is an OTC fiber supplement such as psyllium (Metamucil), which gets your GI tract moving. But these can take several days to work. The OTC laxative polyethylene glycol (Mira­Lax and generic) may offer a faster fix for constipation. “Make sure you consult with a physician if daily or regular use of any laxative is required,” Blachman says.

To ease diarrhea and possibly prevent the dehydration it can cause, you can try loperamide (Imodium and generic) as long as your temperature is below 100.4° F and your stools aren’t bloody, Worz says. (And drink extra fluids that contain water, salt, and sugar, such as Pedialyte, to replace what your body has lost.) Note: Call your doctor if diarrhea is persistent, you have blood in your stool, your urine is dark yellow, you’re urinating only a few times a day, or you develop a fever.

Be cautious with: Stimulant laxatives such as bisacodyl (Correctol, Dulcolax, and generic) and senna (Ex-Lax, Senokot, and generic) can cause diarrhea and fluid loss if taken too often, Linnebur says. Stool softeners, such as docusate (Colace and generic), may work no better than placebos. For diarrhea, it’s best to avoid products with bismuth subsalicylate (Pepto-Bismol and generic). Salicylates are similar to aspirin, which can be problematic for seniors, Linnebur says.

Get Help for Heartburn

Consider using: An OTC antacid with calcium carbonate, such as Tums, or an H2 blocker such as famotidine (Pepcid AC and generic) is fine for occasional heartburn, Linnebur says.

Be cautious with: Proton pump inhibitors, such as omeprazole (Prilosec OTC and generic) and omeprazole and sodium bicarbonate (Zegerid OTC and generic), without checking with your doctor. They can lead to low magnesium and vitamin B12 and hike the risk of bone fractures, pneumonia, and serious Clostridioides difficile infection if used for long periods. “Many older adults start taking them and never go off them, when in reality they should only be on them for a few weeks,” Linnebur says.

Editor’s Note: A version of this article also appeared in the July 2021 issue of Consumer Reports on Health.  


Hallie Levine

Hallie Levine is an award-winning magazine and freelance writer who contributes to Consumer Reports on health and fitness topics. Her work has been published in Health, Prevention, Reader's Digest, and Parents, among others. She's a mom to three kids and a fat but feisty black Labrador retriever named Ivry. In her (nonexistent) spare time, she likes to read, swim, and run marathons.