Best Practices for Choosing Safe OTC Medications at the Pharmacy

Every year, millions of people walk into a pharmacy looking for relief from a headache, a cold, or an upset stomach. They grab a bottle off the shelf, read the front label, and assume it’s safe. But here’s the truth: OTC medications aren’t harmless just because you don’t need a prescription. In fact, they’re responsible for nearly 200,000 emergency room visits in the U.S. each year - mostly because people didn’t read the label or didn’t know what they were taking.

Read the Drug Facts Label - Every Time

The most important thing you can do before buying any OTC medicine is to read the Drug Facts label. This isn’t just a formality. It’s your safety checklist. Since 1999, the FDA has required every OTC product to use this standardized format so you can compare products easily. The label breaks down five key things: active ingredients, purpose, uses, warnings, and directions.

Active ingredients are the only part that matters. That’s what actually treats your symptom. If you’re buying a cold medicine, you might see acetaminophen, dextromethorphan, and phenylephrine listed. If you’re already taking a prescription painkiller that contains acetaminophen, adding another product with it could lead to liver damage. The FDA says acetaminophen overdoses cause about 56,000 ER visits annually. That’s not a small risk.

Don’t skip the warnings section. It tells you who shouldn’t take it - like people with high blood pressure, liver disease, or pregnancy. It also lists what to avoid, like alcohol or other medicines. If you’re unsure, don’t guess. Talk to the pharmacist.

Know What’s in Your Medicine

Many people don’t realize that the same active ingredient can appear in multiple products under different brand names. Tylenol, Excedrin, and even some prescription pain relievers all contain acetaminophen. If you take two of them together, you’re doubling your dose - and that’s dangerous.

Same goes for ibuprofen and naproxen. Both are NSAIDs, and both can cause stomach bleeding or kidney damage if taken too often or in combination. If you’re treating a sore throat, you don’t need a cold medicine with decongestants and cough suppressants. Just pick something that targets your actual symptom.

Here’s a simple rule: pick the medicine with the fewest active ingredients you need. If you have a runny nose and a headache, don’t buy a four-in-one cold formula. Buy a single-ingredient pain reliever and a separate antihistamine if needed. That way, you control what you’re taking and avoid accidental overdoses.

Use the Right Dose - No Guessing

Children aren’t small adults. That’s not just a saying - it’s a medical fact. The FDA warns that estimating a child’s dose based on weight or age can be deadly. A teaspoon (TSP) is 5 milliliters. A tablespoon (TBSP) is 15 milliliters. That’s three times more. Kitchen spoons vary wildly in size - some hold twice as much as others. That’s why you should always use the measuring tool that comes with the medicine.

Even adults make this mistake. I’ve seen people take two tablets because they didn’t feel better after one. But OTC meds have maximum daily limits for a reason. Taking more won’t make you feel better faster - it just increases your risk of harm. For example, the daily limit for acetaminophen is 3,000 to 4,000 mg depending on your health. That’s about six extra-strength tablets. Go over that, and you’re putting your liver at risk.

For older adults, this is even more critical. People over 65 make up half of all adverse drug reactions, even though they’re only 13% of the population. Their bodies process drugs slower. They’re often on multiple medications. Mixing OTCs with prescriptions can be a silent danger.

Talk to the Pharmacist - It’s Free

Pharmacists aren’t just the people who hand you your pills. They’re trained to spot dangerous combinations, flag risks, and recommend safer alternatives. And yes, asking them for advice is free.

Let’s say you have diabetes and you’re thinking about buying a cold medicine. Some decongestants can raise your blood sugar. Some antihistamines can make it harder to urinate if you have an enlarged prostate. A pharmacist will know which products are safe for your condition - and which ones to avoid.

Studies show that when people talk to a pharmacist before buying OTC meds, medication errors drop by 67%. That’s not a small number. That’s life-changing. Don’t feel like you’re bothering them. They’re there for this exact reason. Bring your list of all your prescription meds, supplements, and even herbal products. Even something like St. John’s Wort can interact with antidepressants or birth control.

Check for Interactions - Especially With What You’re Already Taking

OTC meds don’t exist in a vacuum. They interact with everything else in your body. Here are a few common, dangerous combinations:

• Alcohol + antihistamines (like Benadryl) → extreme drowsiness, slowed breathing
• Alcohol + dextromethorphan (cough syrup) → increased risk of overdose
• Aspirin + blood thinners (like warfarin) → higher chance of bleeding
• Sleep aids + prescription sedatives → respiratory depression

And don’t forget about supplements. Fish oil, garlic pills, ginkgo biloba - they all thin your blood. If you’re on a blood thinner or about to have surgery, these can be risky. Always tell your pharmacist what you’re taking, even if you think it’s “just a natural remedy.”

Stick With One Pharmacy

If you use multiple pharmacies, no one has your full medication history. That’s a problem. Your pharmacist needs to know everything you’re taking - prescriptions, OTCs, vitamins - to catch dangerous overlaps. If you fill all your meds at one place, they can flag issues before you even walk out the door.

Many pharmacies now offer free medication reviews. Ask for one. It takes 15 minutes. It could save you from a hospital visit.

Know When to Stop - And When to See a Doctor

OTC meds are for short-term relief. If your headache lasts more than a few days, your cough drags on past two weeks, or your fever won’t go down after three days - it’s not an OTC problem anymore. It’s a sign you need professional care.

Don’t use OTC painkillers to mask symptoms so you can keep going. That’s how minor issues turn into serious ones. If you’re pregnant, breastfeeding, or caring for a young child, always check with a doctor before taking anything. Even something as simple as Pepto-Bismol can be risky during pregnancy because it contains bismuth subsalicylate, which is related to aspirin.

What’s New in 2025?

The FDA is updating its OTC drug review system under the CARES Act of 2020. By 2025, you’ll see faster updates to labeling and ingredient safety rules. For example, in 2023, fluticasone furoate became the first OTC nasal steroid for allergies - something that used to require a prescription. That’s progress. But it also means the rules are changing. What was safe last year might need a new warning today.

That’s why reading the label every time matters. Even if you’ve used the same product for years, the formula might have changed. The warnings might be updated. The dose might be adjusted.

Bottom line: OTC medications are powerful tools. But they’re not toys. Treat them with the same respect you’d give a prescription. Read the label. Know what’s in it. Talk to the pharmacist. And never assume because it’s over-the-counter, it’s safe to take without thinking.