Best Practices for Choosing Safe OTC Medications at the Pharmacy

Every year, millions of people in the UK and across the world pick up OTC medications without a prescription-headache pills, cold syrups, antacids, or allergy tablets. It’s easy to assume they’re harmless because you can buy them off the shelf. But here’s the truth: OTC medications are still drugs. And like any drug, they can hurt you if you don’t use them right.

Read the Drug Facts Label-Every Time

You’ve probably glanced at the back of a medicine bottle a hundred times. But how often do you actually read it? The FDA made the Drug Facts label mandatory in 1999 so you wouldn’t have to guess what’s in your medicine. It’s not decoration. It’s your safety guide.

Look for these six sections:

• Active ingredients: These are the actual drugs in the product. Don’t just look for the brand name. If you’re taking two different cold medicines, you might accidentally double up on acetaminophen or diphenhydramine.
• Purpose: What is this medicine supposed to do? For example, is it a pain reliever, a decongestant, or an antihistamine?
• Uses: What symptoms is it meant to treat? If you have a sore throat and a runny nose, but the bottle only says “for fever and pain,” it won’t help your congestion.
• Warnings: This is where you find red flags. Does it say “do not use if you have high blood pressure”? “Avoid alcohol”? “Consult your doctor if you’re pregnant”? Skip this section at your risk.
• Directions: How much? How often? For how long? Never assume “more is better.” Exceeding the dose doesn’t make it work faster-it just makes it more dangerous.
• Inactive ingredients: These don’t treat your symptoms, but they can cause reactions. If you’re allergic to dyes, gluten, or certain preservatives, this is where you’ll find out.

Here’s a real example: You grab a “Nighttime Cold & Flu” tablet. It says it contains acetaminophen, dextromethorphan, and doxylamine. You already took Tylenol for your headache earlier today. Now you’ve doubled your acetaminophen dose. That’s how liver damage starts.

Know Your Active Ingredients

Brand names change. Packaging changes. But active ingredients? They stay the same. That’s why you need to memorize the most common ones.

• Acetaminophen (Tylenol, Panadol): Great for pain and fever. But it’s in over 600 OTC products-from cold medicines to sleep aids. Taking more than 4,000 mg in 24 hours can cause serious liver damage. The FDA says it causes about 56,000 ER visits every year in the US alone. Don’t take it with alcohol. Ever.
• Ibuprofen (Advil, Nurofen): Good for inflammation, muscle aches, or menstrual pain. But it can irritate your stomach, raise blood pressure, or harm your kidneys if you take it too long or too often.
• Diphenhydramine (Benadryl): An antihistamine that causes drowsiness. Used for allergies or sleep. But it can cause confusion, dry mouth, or urinary retention-especially in older adults.
• Pseudoephedrine (Sudafed): A decongestant that shrinks swollen nasal passages. But it can spike blood pressure and make heart conditions worse. In the UK, it’s kept behind the counter for a reason.
• Dextromethorphan (Robitussin): A cough suppressant. But when taken in high doses, it can cause hallucinations or even overdose. Some teens abuse it. Don’t take it with antidepressants-it can trigger serotonin syndrome.

Never assume a “multi-symptom” product is better. If you only have a headache, buy acetaminophen alone. If you have a cough and nothing else, get a simple cough syrup. More ingredients = more chances for mistakes.

Don’t Guess the Dose

Children aren’t just small adults. And adults aren’t just big kids. Dosing isn’t about weight alone. It’s about age, liver function, kidney health, and other medications you’re taking.

Here’s a common mistake: Using a kitchen spoon to measure liquid medicine. A tablespoon isn’t a tablespoon. A teaspoon isn’t a teaspoon. The FDA tested household spoons and found their volumes varied by up to 200%. That means you could be giving your child half the dose-or twice the overdose.

Always use the measuring cup, syringe, or dosing spoon that comes with the medicine. If it’s missing, ask the pharmacist for one. They’ll give it to you for free.

And don’t assume “one pill a day” means “one pill every 24 hours.” Some medicines say “every 4 to 6 hours.” That means you can take it up to 4 times a day-not just once. Read the directions again. Then read them once more.

Talk to the Pharmacist

You don’t need a prescription to buy OTC meds. But you absolutely need to talk to the pharmacist.

They’re not just the person who rings you up. They’re trained professionals who know what’s in every bottle, what interacts with what, and who’s at risk. They’ve seen people take five different cold remedies at once. They’ve seen seniors on eight prescriptions accidentally add a sleep aid that made them fall. They’ve seen pregnant women take ibuprofen because they thought it was “just a painkiller.”

Ask them:

• “Is this safe with my other medications?”
• “Does this have acetaminophen in it?”
• “Is this okay for someone with high blood pressure/diabetes/liver problems?”
• “Is there a simpler option?”

Pharmacist consultations are free. No appointment needed. And they can cut your risk of an adverse reaction by two-thirds, according to a 2022 study in Research in Social and Administrative Pharmacy.

Watch Out for Hidden Risks

Some conditions make OTC meds dangerous-even if they seem harmless.

• Diabetes: Decongestants can raise blood sugar. Some cough syrups are loaded with sugar. Look for sugar-free versions.
• High blood pressure: Avoid decongestants like pseudoephedrine and phenylephrine. They tighten blood vessels-which is the opposite of what you need.
• Enlarged prostate: Antihistamines and decongestants can make it harder to urinate. This can lead to urinary retention, which is a medical emergency.
• Heart disease: NSAIDs like ibuprofen can increase the risk of heart attack or stroke, especially with long-term use.
• Pregnancy or breastfeeding: Some OTC drugs cross the placenta or enter breast milk. Acetaminophen is usually okay in moderation. Ibuprofen and aspirin are not. Always check.
• Older adults: One in two adverse drug reactions in the UK happens to people over 65. Why? They often take multiple medications, and their bodies process drugs slower. A dose that’s fine for a 30-year-old could be toxic for a 70-year-old.

Keep a Medication List

Write down everything you take-prescription, OTC, vitamins, supplements. Include the name, dose, and how often you take it. Update it every time you start or stop something.

Bring this list to every doctor’s visit. Show it to the pharmacist when you buy OTC meds. If you’re rushed or confused, your list will keep you safe.

Use your phone. Use a notebook. Use a free app. Just don’t rely on memory.

Don’t Use Old Medicine

That bottle of ibuprofen from last winter? The cough syrup from when you had the flu in January? Toss it.

Medicines lose potency over time. Some can even break down into harmful substances. The expiration date isn’t a suggestion. It’s a safety cutoff.

And never take medicine prescribed for someone else-even if they had the same symptoms. Their body, their history, their risks-none of that applies to you.

What If You Make a Mistake?

If you took too much, took the wrong one, or feel strange after taking an OTC drug:

• Call NHS 111 immediately.
• Don’t wait for symptoms to get worse.
• Have the medicine bottle with you when you call.

The UK’s National Poisons Information Service handles over 198,000 OTC medication exposures every year. Most are preventable. But they’re not always obvious. A headache after taking too much acetaminophen might not show up for 12 hours. By then, the damage is done.

When in doubt-call someone who knows.