Commonly Used Over the Counter (OTC) Medications and Potential Problems
OTC Medication/Classification
Problems/Concerns
NSAIDS
 Can impair renal function
Ibuprofen,(e.g. Motrin, Advil)
 Can cause gastric bleeding
Naproxen (e.g. Aleve)
 Can cause increase in blood pressure
 Counteracts the antihypertensive effects of
thiazide diuretics, beta-blockers, alphablockers, and ACE inhibitors (Neafsey &
Shellman, 2001)
Aspirin
Acetaminophen (e.g. Tylenol)
Antacids and Calcium Supplements
Antihistamines (e.g. diphenhydramine,
Benadryl, Nytol, Sominex)
 Can reduce the effectiveness of ACE
inhibitors
 Can increase bleeding risk for those taking
anticoagulants and should be avoided by
those persons
 Can cause gastric bleeding (Merck, 2006)
 Can be toxic to the liver when taken in
excessive doses or if combined with heavy
alcohol use
 Rarely, can cause nephrotoxicity
 Persons with renal or hepatic impairment
should limit use
 Persons taking warfarin should limit use to
no more than 6 regular strength tablets per
week. Higher doses inhibit liver metabolism
of warfarin resulting in increased INR
 Educate patients on combination products
that contain acetaminophen to avoid
overdosing (Neafsey & Shellman, 2001)
 Can reduce the absorption of medications
such as levothyroxine, digoxin, phenytoin
and ciprofloxacin, and nutrients such as iron,
zinc, vitamin B12 and thiamin.
 Counsel patients to take at least 2 hours
apart from any medication (Neafsey &
Shellman, 2001)
 Antacids that contain aluminum are more
likely to cause constipation, and those that
contain magnesium are more likely to cause
diarrhea and dehydration.
 Antacids containing magnesium or
aluminum can reduce the absorption of
digoxin (Merck, 2006)
 May worsen effects of glaucoma and
enlarged prostate
Decongestants
Cold Remedies
 May cause dizziness, drowsiness, and
unsteadiness, leading to falls
 In higher doses or in combination with other
drugs may cause blurred vision, lightheadedness, dry mouth, difficulty with
urination or constipation (Neafsey &
Shellman, 2001)
 Patients with chronic conditions such as
hypertension, heart disease, asthma,
diabetes, glaucoma or hyperthyroidism
should consult a physician before taking
antihistamines or decongestants (Merck,
2006)
Can increase blood pressure (Neafsey &
Shellman, 2001)