6 OTC Drugs That Can Be Dangerous for Older Adults

A recent review of over two dozen studies found that people aged 60 and older rely more heavily on over-the-counter (OTC) drugs than younger adults, often without realizing that they come with health risks and side effects.

The review, published in the journal Cureus, found that older adults rely on OTC drugs for a number of reasons: 

• They’ve used them before and trust the products they’re familiar with
• There’s no need for a doctor’s visit for a prescription
• OTC drugs are often more affordable than prescription drugs
• The drugs are often recommended by doctors, friends, and family

The most common health reasons for taking the drugs, according to the review, were headache, abdominal pain, cough, joint pain, and fever. The number one malady cited by participants was a headache, and the most commonly used nonprescription drugs were pain relievers.

Researchers also found that “seniors are more likely to experience negative medication responses than younger people.” This may pose an issue if and when they need care for those reactions: A 2013 FDA seminar on OTC drugs and older adults found that while 86% of people said they routinely used OTC drugs, only about half told their doctors. 

Why Are Older Adults More Sensitive to Medication?

Bodies handle medicines differently as they age, Hedva Barenholtz Levy PharmD, a geriatric pharmacist, told Verywell. For some, that means a decrease in kidney and liver function, which can slow down the speed at which drugs leave the body. The result is increased side effects.

“In general, older adults are more sensitive to the effects of medications, both good and bad. This means that often lower doses will be effective for older adults, and they have a greater likelihood of experiencing adverse effects,” Barenholtz Levy said.
 

While patients may view OTC drugs as less risky than prescription drugs, “OTC drugs are distinguished from prescription drugs only in that they are defined as safe and effective for use by the public without a physician’s prescription; they are not less potent or inherently safer than prescription medications,” Steven Albert, PhD, chair of the Department of Behavioral and Community Health Sciences at the University of Pittsburgh School of Public Health, told Verywell.

As a result, Albert suspects unintentional misuse of nonprescription drugs may be at play among many older adults. Because products are marketed toward symptom relief rather than active ingredients, people may not realize that two OTC medications—say, one for cough and one for congestion—contain the same active ingredient.

“If they use two products, they risk an unintentional overdose,” Albert said.

The risk of drug interactions and side effects is even greater among the many older adults who take prescription drugs.

“OTC may be the only branch of medicine where we expect people to choose therapies, decide when to start and stop, and interpret [effectiveness] on their own,” Albert said. “We need better consumer education, more involvement of physicians and pharmacists in OTC consults, and better packaging of the products themselves. It may be valuable to consider age-friendly aisles in pharmacies in which OTC products are vetted and pharmacy consults are more easily available.”

Top OTC Medications to Take With Caution

Pain Relievers

Drugs called non-steroidal anti-inflammatory medicines (NSAIDs) include Advil and Motrin (ibuprofen), Aleve (naproxen), and aspirin. All of them can cause ulcers and stomach bleeding. That’s especially concerning if you take blood thinners, or if you have uncontrolled diabetes or high blood pressure, Barenholtz Levy said. Long-term use can cause heart and kidney problems. Ask your doctor if Tylenol (acetaminophen) is a safer choice, but read the label about how much to take and how often. Long-term use of acetaminophen can cause liver problems. You should also check the label for guidance on limiting alcohol while on acetaminophen. The combination can cause organ failure. 

Frequent and long-term use of any pain relievers pose risks, says Kathryn Boling, MD, a family physician at Mercy Medical Center in Baltimore. Instead, your doctor can refer you to a pain specialist for non-medicine options, such as a physical therapist.

Benadryl (diphenhydramine) 

While it’s fine to keep Benadryl on hand to treat occasional mild allergic reactions, it should not be taken as a sleep aid, Boling told Verywell.

According to Albert, many other sleep aids on the market contain diphenhydramine. Use them under doctor’s orders and only for the length of time the doctor advises. Long-term use can lead to cognition issues, confusion, and memory loss.

Pseudoephedrine

Pseudoephedrine is the active ingredient in the decongestant Sudafed Sinus Congestion 24 Hour and in many generic decongestants. It can increase blood pressure.

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A better alternative is a decongestant specifically made for people with high blood pressure, such as Coricidin HBP Chest Congestion and Cough (dextromethorphan and guaifenesin), Barenholtz Levy said.

Boling said that even if you take blood pressure medication and your blood pressure is under control, decongestants can increase your BP levels, which is why it’s important to ask the pharmacist for help choosing a safer option. If you’re buying online, choose an online pharmacy with pharmacists on staff so you can ask questions about all the medications, including prescription and nonprescription drugs you take. Men with an enlarged prostate should steer clear of pseudoephedrine to avoid worsening urinary issues.

A drug that is similar to pseudoephedrine, called phenylephrine, has been determined to be ineffective, so toss it out if you still have it at home. An alternative that Barenholtz Levy recommends is a decongestant nasal spray such as Afrin (oxymetazoline), which stays in the nose instead of traveling to the bloodstream. Stop using it after three days to avoid a return of stuffiness. Flonase (fluticasone) and Rhinocort (budesonide) also treat congestion but can increase eye pressure in people with glaucoma.

Heartburn Medications

OTC drugs like Prilosec (omeprazole), Nexium (esomeprazole), and Prevacid (lansoprazole) are used to reduce stomach acid and treat heartburn. They’re meant for short-term use, but people often stay on them for months or years, Boling said. The concern with the drugs is that they can interfere with calcium absorption and lead to bone fractures. They can also cause diarrhea and pneumonia.
 

Milk of Magnesia and Magnesium Citrate

These are well-known nonprescription drugs often recommended to treat constipation. They pose a risk of side effects in people with kidney problems, especially if they’re used long-term, Barenholtz Levy said. If constipation is a problem, drink more water, eat more fiber, and get daily exercise. Reach out to your doctor about prescription or nonprescription options you can try if lifestyle remedies aren’t working for you. A stool softener may help.

Oxytrol

Over-the-counter Oxytrol (oxybutynin) can be effective for women with overactive bladders. (For men, the medicine still requires a prescription.) However, it can cause side effects like dizziness, dry mouth, and constipation. Barenholtz Levy notes more drugs are sometimes needed to treat the side effects. Before trying medication, ask your doctor for information on Kegel exercises that can strengthen your pelvic floor.