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Over-the-Counter Medications: Use with Caution

Cold and flu medications treat individual symptoms, while the body’s immune system fights the disease

Everyone keeps over-the-counter medication on hand. Available without a doctor’s prescription, these meds are often our first choice when we don’t feel well. We take them because they’re generally effective, and they’re convenient to obtain.

Though many people think these meds—also known as OTC drugs—are safer or have fewer side effects than their prescription counterparts, sometimes they can make conditions worse. They may cause side effects or may interact with other medicines or supplements you might be taking. It’s important to follow the directions on the label or instructions given by your health-care provider when taking all medications, including OTC ones, and especially as we get older.

Most of the information we know about medication dosage, effectiveness and side effects are based on studies typically conducted in younger, healthy adults, not older adults. Many of these older adults may be afflicted with multiple medical conditions and be taking other medications for them. In addition, these medications may work differently in older adults as their bodies change with age. Therefore, as an older adult, before you take any new OTC medication, just as with prescription medications, check with a clinical professional, someone who is knowledgeable about your health conditions and other medications you might be taking, such as your doctor or pharmacist. Here is some helpful information about some categories of OTC medications that are often used by older adults.

Sleep aids

Sleep problems are common in older adults. Several factors can affect sleep, such as pain, urinary symptoms, sleep hygiene issues, side effects of medications, sleep apnea, and restless legs syndrome. Before starting any sleep aid, it’s important to look for an underlying cause and implement good sleep habits, such as avoiding late-day caffeine.

Many OTC sleep products, such as ZzzQuil, Unisom, or any products containing “PM” in the name (such as Advil PM or Tylenol PM), contain an antihistamine, such as diphenhydramine, chlorpheniramine, and doxylamine. Antihistamines are typically used for seasonal allergies, but their side effects can include confusion, constipation, dry eyes and urinary retention. In addition, they can increase the risk for falls. Long-term use has been associated with increased risk for Alzheimer’s disease. As an alternative, the food supplement, melatonin, is considered fairly safe with minimal side effects.

Cold medicine

The symptoms of the common cold can include runny nose, congestion, sneezing, coughing, muscle aches, and sore throat. There is no cure for the common cold at this time. Cold and flu medications treat individual symptoms, while the body’s immune system fights the disease. Many cold and flu OTC products (Tylenol Cold Multisymptom, DayQuil, or Theraflu) contain a combination of cough suppressants (dextromethorphan), expectorants (guaifenesin), decongestants (phenylephrine or pseudophedrine), and antihistamines (diphenhydramine or chlorphenaramine). Many of these products may not be appropriate for people who have other medical conditions, such as high blood pressure, irregular heartbeat, or seizure disorder, or who are taking other medications. Whenever possible, older adults should avoid these cold products and try using non-drug treatment options, such as a saline nasal rinse or running a humidifier. If you must use a product for extra relief, consider choosing a single-ingredient product that treats the most pressing problem, so there is less risk of side effects.

Pain relievers

Arthritic pain is common in older adults and is a common cause of limited physical activity. Other pain we often experience include headache, muscle ache or toothache. There are several OTC pain relievers, including acetaminophen (Tylenol), ibuprofen (Motrin), and naproxen (Aleve). Non-steroidal anti-inflammatory (NSAIDs) pain relievers, such as ibuprofen, aspirin, and naproxen can cause upset stomach or stomach bleeding, kidney issues, and worsening of high blood pressure, especially if used regularly over a long period of time. Acetaminophen is a safer alternative to treat pain though it should be used with caution in people who have liver conditions or drink alcohol regularly. Low-level heat wraps and topical treatments might also provide some pain relief and should be considered.

Final thoughts

Before you treat your symptoms with OTC medications, consult with your clinician to help you figure out the best way to treat your symptoms, without the risk of having unwanted or potentially unsafe side effects. Whenever you see your health-care provider, share your complete medication list, including OTC and supplements, the dosage, and the reason for taking them. Remember, medications are made to treat certain conditions, but they won’t work well if you don’t use them properly.

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