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The Best and Worst OTC Medications


Dan Roe


May 27, 2022


Not all drug store meds are the same. Here’s what you need to know.

There are so many over-the-counter (OTC) medications in the average drug store that you might think they’re mostly low-risk and interchangeable. 

Not the case, says Rhondee Baldi, M.D., Physician Leader at Emcara Health.

In reality, all OTC drugs have side effects and the potential to harm certain people, just like their prescription counterparts. In some ways, they can be riskier: Without a doctor to oversee your drug choices and monitor your intake, you could end up causing bigger health issues than the ones you sought to treat.

While drugs that get approved for OTC use have enough potential benefits to outweigh their risks, the risk-benefit ratio of a medication is unique to each person. Be sure to consult your Emcara Health clinical services manager or advanced care physician if you’re unclear about any drug you’re currently taking or considering.

In her 19 years of practicing medicine, Dr. Baldi has seen patients defaulting to OTC medications that they shouldn’t use long-term without supervision. Conversely, people often overlook simpler, less risky alternatives to the leading OTC drugs. 

Dr. Baldi encourages everyone to take a few minutes to review their OTC meds, consider risk factors they may not be aware of, and find other options if needed. To get you started, here is a look at five common OTCs and their mix of potential benefits and risks. 

Low Risk of Overuse, High Benefit

Pain Relief: Diclofenac 

Similar to Aleve and Motrin, diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that reduces pain and inflammation by blocking the enzymes that cause pain sensitivity and elevated body temperature. It also comes in more forms than most NSAIDs: for example, gels and solutions that can be applied topically to target specific areas of pain and inflammation, or tablets that cover all over the body. 

People taking diclofenac may be able to use it more regularly than other NSAIDs because of reduced side effects, such as upset stomach and increased risk of heart disease. “You can use it two to three times daily to relieve pain, swelling, and joint stiffness caused by arthritis,” Dr. Baldi says. 

Allergies: Nasal Saline

OTC nasal saline spray and nasal steroids can reduce allergy-related congestion. Salines are more commonly used in children but can provide the same benefits for adults, moisturizing your sinuses to reduce irritation and lowering inflammation of mucous membranes. And they’re particularly beneficial for people with high blood pressure or heart disease risk factors. 

“You’re probably a little bit safer with nasal saline than you are with pseudoephedrine,” Dr. Baldi says. “People with high blood pressure should stay away from pseudoephedrine because it raises their blood pressure by tightening their blood vessels.” 

Higher Potential for Side Effects with Overuse

Heartburn: Prilosec

Prilosec, also known by its generic name omeprazole, is an effective short-term treatment for severe heartburn. It works by slowing down the production of stomach acid, reducing the acidity of your stomach, and quelling heartburn symptoms as it allows damaged tissue to heal itself. 

However, in the long run, taking Prilosec every day can lower your body’s magnesium levels, causing your brain and muscles to feel tired and shaky. It’s also been linked to stomach infections and bone fractures. 

“If you use Prilosec for more than three months, it’s a good idea to talk to your doctor and make sure the medicine is right for you,” Dr. Baldi says. “Because these drugs are OTC, we put people on these medicines for years, but we now know they can cause secondary problems. Just because you can buy something OTC doesn’t mean we recommend using it for an extended period of time.” 

Insomnia: Benadryl

Benadryl is an antihistamine, meaning it blocks the effects of histamines (something your body releases when it detects a harmful intruder, such as allergens). It’s an effective remedy for seasonal allergies and acute allergies like poison ivy, and it may be taken frequently as directed by your doctor. 

However, Benadryl tends to make you drowsy, and some people turn to Benadryl to help themselves fall and stay asleep. Don’t do this. As a sleep aid, antihistamines may reduce your quality of sleep and cause sleep walking, and you’re likely to build up a tolerance quickly. They may also compound the effects of other drowsy medications you’re on. 

For healthy people and young people, Benadryl can cause mild side effects like dry mouth and brain fog. But the side effects for elderly people and people with high blood pressure, heart disease, and liver disease can be more severe, especially if you’re increasing your dosage to fall asleep. 

“If you’re having trouble sleeping, talk to your doctor. Don’t choose Benadryl, especially if you’re 65 or older,” Dr. Baldi says. 

Pain and Swelling: Acetaminophen, Ibuprofen, and NSAIDs 

Ibuprofen and acetaminophen are the most popular drugs for treating pain and inflammation. Acetaminophen, or Tylenol, doesn’t relieve inflammation and therefore doesn’t count as an NSAID. Ibuprofen, also known as Advil, Motrin, and Aleve, relieves inflammation and reduces pain, making it an NSAID. Other prescription drugs like Celebrex are NSAIDs but don’t use ibuprofen. 

Because these drugs are effective, cheap, and widely available, people may use them for a prolonged period of time to treat ongoing symptoms. But they can also raise your blood pressure (increasing your risk of a heart attack) and induce swelling in your legs. Like any OTC drug, consult your doctor before relying on a new medication for daily relief. 

“You’ll want to use them for a limited amount of time if you’re not taking them under the direction of your primary care provider,” Dr Baldi says, “because they raise your blood pressure and have been associated with heart disease, mostly heart attacks. Ibuprofen can also affect your kidneys if you use it a lot.” 

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