drugstore shelves

Americans love to play doctor. And the FDA has made it easy. That’s because the agency has allowed Pharma companies to switch many Rx drugs to OTC in a big way. We spend $33 billion on over-the-counter medicines. That’s 11 times more than the $3 billion spent in 1975. Some of those decisions were wise. Others were reckless.

If you play doctor, you’d better know the rules

The FDA has given you lots of tools to play doctor but not necessarily the rules to use them safely. Labels of nonprescription drugs have a fraction of the information found on the official prescribing package insert. That means you now have access to some pretty powerful meds, but little guidance on how to use them safely. And please be honest. How carefully do you read the tiny print on the label of over-the-counter medicines? Many people barely bother to check the dosing information.

The Big Switch:

Pain Relievers:

Many of the drugs that are now available in pharmacies, supermarkets, convenience stores and gas stations were once available only by prescription. Pain relievers are a great example. We now spend over $4 billion on OTC pills such as acetaminophen (Tylenol), ibuprofen (Advil, Motrin IB, etc) and naproxen (Aleve). All of these required a doctor’s prescription when they were first introduced.

Sleep Aids:

Sleep aids are another big category. The antihistamine diphenhydramine (DPH) is the “PM” in OTC nighttime pain relievers like Tylenol PM, Advil PM and Aleve PM. The FDA approved DPH in 1946 as the prescription drug Benadryl. Doctors prescribed it to their patients with allergies. The agency allowed it to move over the counter in the 1980s.

Since then, it has become more popular as a sleep aid than as an allergy medicine. That’s because it is highly sedating. When people with allergies took DPH, they often complained about feeling sluggish or spacey during the day. Drug companies took advantage of this side effect to offer people PM pain relief that would help them sleep.

Diphenhydramine and the Brain:

Such drugs don’t lose their side effects when they go over the counter. DPH is now recognized to have strong anticholinergic activity. That means it affects the action of a crucial neurochemical called acetylcholine. Older people may be vulnerable to cognitive impairment if they rely on such anticholinergic drugs too long (Clinical Therapeutics, Nov., 2016).

Learn more about drugs with anticholinergic activity at this link:

Will My PM Sleeping Pills Lead to Dementia?

Trusting Tylenol:

Although people were told for decades to “Trust Tylenol,” the drug has the potential to cause some serious adverse reactions. If the OTC dose is exceeded for several days, liver damage is a possibility. Even normal doses can be problematic if acetaminophen is combined with alcohol.

Regular use of acetaminophen has also been associated with asthma (Chest, Nov., 2009) and hearing loss (Otolaryngology–Head and Neck Surgery, March, 2015).  When pregnant women rely on acetaminophen for pain relief, there is concern that they may increase the risk of ADHD and other developmental challenges in their babies (Pediatrics, Nov., 2017; Hormones and Behavior, online Jan. 13, 2018).

You can learn more about acetaminophen toxicity at this link:

If Acetaminophen Is Killing People, Why Should You Trust Tylenol?

NSAIDs and Life-Threatening Side Effects:

Nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen are hugely popular to ease pain. Regular use of NSAIDs has been linked to heartburn, bleeding ulcers, heart failure, high blood pressure, ringing in the ears and liver and kidney damage.

Many people assume that if a drug doesn’t need a prescription, it can’t be very dangerous. They don’t always read labels that caution about dose and limit duration of use.

We stirred up a hornets nest when we asked a challenging question. Check out this link for more details about NSAIDs:

Should the FDA ban ibuprofen from OTC sale?

Heartburn Drugs:

Another hugely popular group of over-the-counter medicines includes heartburn products. It is estimated that $2.6 billion is spent on antacids or acid suppressing drugs. Medications such as esomeprazole (Nexium 24HR), lansoprazole (Prevacid24HR) and omeprazole (Prilosec OTC) are now available without a prescription.

When the FDA approved proton pump inhibitors (PPIs) for OTC sale, the agency may not have realized that such drugs might eventually be linked to complications such as liver and kidney disease, infections, heart attacks and weakened bones.

Some people became very upset when we shared the latest news about PPI side effects. Here is a link:

PPI Side Effects Continue to Scare Us To Death

What Over-the-counter Medicines Does People’s Pharmacy Recommend?


We recognize that aspirin has serious side effects. Like all NSAIDs it can cause stomach upset, bleeding ulcers or even perforations in the intestinal tract. It can also interact dangerously with certain prescription drugs. That said, it has benefits that most NSAIDs lack. It is just as effective as all other over-the-counter medicines for pain. In addition, it reduces the risk of blood clots that can form heart attacks or strokes. Aspirin also has anti-cancer activity. To learn more about this under-appreciated benefit, here is a link:

How Good Is Aspirin Against Cancer in New Study?

Cromolyn for Allergies:

When most people think about buying over-the-counter medicines for allergies they probably consider oral antihistamines or corticosteroid nasal sprays. The drug manufacturers spend millions advertising such products, many of which used to be available only by prescription. We have written extensively about the pros and cons of such drugs so we won’t bore you here.

One drug you probably have not seen advertised is NasalCrom (cromolyn sodium). It works by stabilizing mast cells in the nose, eyes and lungs. That way people avoid many of their allergic symptoms in response to allergens like pollen or cat dander. Here is a link to learn why this is one of our favorite over-the-counter medicines for allergies.

NasalCrom (Cromolyn Sodium) Is Surprisingly Helpful for Allergies

Readers weigh in:

Luke has had good results with NasalCrom:

Nasalcrom is the ONLY thing that helps me. I have allergies year round. So I use it year round.

“My sinuses are clear because of this. but after a while you only need this like twice a day.”

Marilyn in Florida concurs:

My husband had chronic rhinitis for over 20 yrs. Doctors prescribed antihistamines and steroid nasal inhalers with no relief. He started using NasalCrom and all allergies are gone. Only to start sneezing and dripping nose if he forgets to use it. This has been a blessing since it was driving me crazy because he was constantly sneezing and blowing his nose especially after getting out of bed in the morning.”

Vicks VapoRub for Just About Everything:

Vicks VapoRub has existed for well over 100 years. It was developed by a pharmacist in North Carolina. Lunsford Richardson wanted a vaporizing salve that could ease congestion for his own children. Now, Vicks is found around the world. It still delivers the original formula of menthol, camphor, eucalyptus oil, cedarleaf oil, nutmeg oil, thymol and turpentine oil.

The never-ending story of “off-label” uses for Vicks VapoRub got its start many years ago when foot-care nurse Jane Kelley, RN, contacted us to report that vinegar soaks could be helpful for nail fungus. She added, almost as an afterthought, that some people were coating infected nails with Vicks twice a day and getting good results.

We wrote about this unique use for Vicks in our syndicated newspaper column. Then the letters started pouring in. People shared amazing stories about using the ointment to clear up difficult-to-treat cases of nail fungus.

Michigan State University researchers finally verified what we had been talking about for almost a decade. They found that daily applications of Vicks cleared fungal infection in 32 of 85 patients. Patience is necessary, though, since it took anywhere from 5 to 16 months to achieve results (Consumer Reports, March, 2006). Another study published in the Journal of the American Board of Family Medicine (Jan-Feb, 2011) reported an 83% response to Vicks. The authors concluded:

Vicks VapoRub seems to have a positive clinical effect in the treatment onychomycosis [nail fungus].”

Other Uses for Vicks VapoRub:

  • Ant repellant
  • Calluses
  • Cracked fingertips
  • Chest congestion
  • Chigger bites
  • Dandruff
  • Fire ant bites
  • Headaches
  • Hemorrhoids (external)
  • Kitten scratches
  • Leg cramps
  • Mosquito bites
  • Paper cuts
  • Poison ivy
  • Scaly skin
  • Seborrheic dermatitis
  • Sore heels
  • Squirrel repellant
  • Tennis elbow

Learn more about Vicks Vaporub and other unusual uses for over-the-counter medicines in our book, The People’s Pharmacy Quick & Handy Home Remedies.

Some Reviews of Quick & Handy:

Ann says:

So far, I have tried 6 of the remedies in this book. You have not let me down. A win every time. Every family should own this book.”

Vince adds:

This is a must-have book for any household.”

Sally in Texas sums it up this way:

The book title tell it all! For me and my family members, the book has provided solutions for common ailments as well as information on other maladies not previously considered. The book is a source of wisdom and helpfulness that I will always reach for when questions need answers. Thank you for this publication.”

People’s Pharmacy Perspective on Over-the-Counter Medicines:

If you are given the tools to play doctor, it is imperative that you do your homework as if you were a doctor. Read labels, follow instructions and search out reliable drug information online. You can search www.PeoplesPharmacy.com for information on over-the-counter medicines as well as prescription drugs. We have lots of other favorite products. You can search our site by health concerns to find out more.

Use good common sense whether you try a home remedy in our book Quick & Handy or grab and go from a pharmacy. Equally important, be alert for side effects from seemingly safe OTC drugs.

Share your experience with over-the-counter medicines below in the comment section. Do you read the labels? Do you follow the instructions to limit use of OTC pain relievers for 10 days or less “unless directed by a doctor”? Can you even read the small print on the label of over-the-counter medicines? We’d love to hear from you.

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  1. Kaye

    Why play with fire? This discussion of OTC medicines with their many disastrous side effects and being abused really scares me. I am a healthy 75 year old and I don’t play around with these drugs. It is true that some people have to rely on drugs to make it, but I have been blessed to ingest as few drugs as possible in order to have a healthy body. And to add to that, all those pills have to be filtered through the liver thus possibly causing liver disease and death. I don’t know about others, but this is just too risky for me. I was brought up to believe that “Cleanliness is next to Godliness”. Instead of ingesting a costly amount of pills into your body, and taking the risk of such damage to your body, why not just use 2 quarts of God’s water twice a week with what I call my “Fountain (Syringe) of Youth”. To me, this is the only way to go for a less costly, healthy and a longer lasting life.

  2. Elizabeth
    Cary, NC

    This article, along with too many others in your daily newsletters, lures your readers in with catchy headlines, and then makes them spend way too much time trying to find what you are promising to review. You never really do give a concise answer as to how best to choose over-the-counter medications! You give a few examples, including Vicks (for just about everything!) – how is that helping me figure out how to best choose an over-the-counter product? What about something like upset stomach or arthritis? What are things I should be looking for in general when buying OTC products? What about store brands vs. name brands? You always give a bunch of links that are supposedly helpful, but then take an inordinant amount of time to get through and don’t usually answer the original question concisely. And then to top everything off, you encourage everyone to buy your home remedies publication. I really enjoy your show on NPR, but these newsletters are generally very frustrating to get through and end up being a waste of time.

  3. Linda

    I had to stop the Benadryl with my 96 yo hubby – it was causing hallucinations. I was using the generic form.

  4. Julie

    Aspirin might do some good for the things mentioned but it can also cause bleeding in the eyes. Want to be partially sighted or blind in order to maybe, or maybe not, prevent other things? Something to think about before taking aspirin.

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