Best Practices for Choosing Safe OTC Medications at the Pharmacy

Every year, millions of people walk into a pharmacy looking for relief from a headache, a cold, or an upset stomach. They grab a bottle off the shelf, read the front label, and head out. But here’s the truth: OTC medications aren’t harmless. They’re powerful chemicals, and using them wrong can land you in the ER. You don’t need a prescription to buy them, but that doesn’t mean you shouldn’t treat them with care.

Read the Drug Facts Label - Every Time

The most important thing you’ll find on any OTC medicine is the Drug Facts label. It’s not just a sticker - it’s your safety guide. Since 1999, the FDA has required all OTC products to use this standardized format. It’s organized the same way on every box: active ingredients, purpose, uses, warnings, directions, and other information.

Don’t skip this. People often glance at the brand name - Tylenol, Advil, DayQuil - and assume they know what’s inside. But two different cold medicines might both contain acetaminophen. Take both, and you’re doubling your dose without realizing it. That’s how liver damage happens. The FDA says about 56,000 emergency room visits each year are caused by too much acetaminophen. That’s not a rare mistake. It’s common.

Look at the active ingredient first. That’s what actually works. If you’re treating a stuffy nose, you might need pseudoephedrine. If it’s a cough, dextromethorphan. If you’re unsure, ask the pharmacist. They’ve seen this a hundred times. And if you’re buying something for the first time, read the whole label. Warnings aren’t there to scare you. They’re there to keep you alive.

Don’t Mix Medications - Even If They’re ‘Natural’

You might think, “I’m just taking this herbal tea and this painkiller - how bad could it be?” But herbs aren’t harmless. St. John’s wort can interfere with blood thinners. Garlic supplements can thin your blood too. Even vitamin E in high doses can be risky if you’re on anticoagulants.

And it’s not just supplements. Many OTC medicines have the same active ingredients under different names. Cold and flu combos often include acetaminophen, antihistamines, and decongestants. If you take one of those plus a separate pain reliever, you’re stacking ingredients. That’s how you overdose. The Mayo Clinic says the most dangerous mistake is taking two medicines with the same active ingredient. You don’t need to treat every symptom at once. Pick the one that matches your worst symptom - and nothing else.

For example: if you have a headache and a runny nose, don’t grab a full-symptom cold tablet. Just take acetaminophen for the headache and a saline nasal spray for the congestion. Fewer ingredients. Less risk.

Know Your Body - And Your Health Conditions

OTC meds aren’t one-size-fits-all. What’s safe for a 30-year-old athlete might be dangerous for a 70-year-old with high blood pressure. If you have diabetes, avoid decongestants - they can spike your blood sugar. If you have an enlarged prostate, antihistamines like diphenhydramine can make it harder to urinate. If you have heart disease, some antacids contain sodium that can worsen fluid retention.

The Merck Manual says older adults are the most at risk. They make up only 13% of the U.S. population but account for half of all adverse drug reactions. Why? Because they’re often on multiple prescriptions. Add an OTC painkiller, a sleep aid, and a cough syrup, and you’ve got a chemical cocktail no one tested.

And if you’re pregnant or breastfeeding? Don’t guess. Even something as simple as ibuprofen can affect fetal development in early pregnancy. Acetaminophen is usually safer, but you still need to check with a pharmacist. There’s no such thing as a “safe for everyone” OTC drug. Your health history matters.

Dosage Isn’t Guesswork - Use the Right Tool

Ever used a kitchen spoon to measure medicine? You’re not alone. But here’s the problem: a tablespoon from your kitchen might hold 10 milliliters - or 20. The FDA tested kitchen spoons and found volume differences of up to 200%. That’s not a typo. Two hundred percent.

Children are especially vulnerable. “Kids aren’t just small adults,” the FDA says. You can’t eyeball a dose based on size. Always use the measuring cup, dropper, or syringe that comes with the bottle. If it’s missing, ask the pharmacist for one. They’ll give it to you for free.

And never assume the label says “adult dose” means you can give it to a teen. Some products have separate dosing for teens and adults. Others have warnings like “not for children under 12.” Read it. Write it down if you need to. This isn’t just caution - it’s survival.

Use the Same Pharmacy - Always

You might think it doesn’t matter where you buy your meds. But it does. When you use the same pharmacy for all your prescriptions - and your OTC purchases - they build a complete record. That means if you pick up a new painkiller, the pharmacist can check it against your blood pressure med, your antidepressant, and your daily aspirin.

They’ll catch interactions you didn’t even know existed. One study found pharmacist consultations reduced OTC medication errors by 67%. That’s not a small number. That’s life-saving.

Even if you’re buying something basic - like antacids or allergy pills - let them know. Tell them what else you’re taking. Even if you think it’s “just a little something.” That’s their job. And it’s free.

When in Doubt, Ask the Pharmacist

This is the single most important habit you can build. Pharmacists aren’t just people who hand out bottles. They’re trained to spot risks, explain side effects, and recommend alternatives. You don’t need to be embarrassed. You don’t need to have a list. Just say: “I’m not sure which one to pick.”

They’ll ask you: What are your symptoms? How long have you had them? What else are you taking? Do you have any health conditions? Then they’ll point you to the right product - or tell you to see a doctor.

And if you’re still confused after reading the label? That’s exactly when you should ask. The FDA says: “If you read the label and still have questions, talk to a doctor, nurse, or pharmacist.” That’s not a suggestion. It’s the rule.

Watch for Red Flags - And When to Walk Away

Not every OTC product is created equal. Watch out for:

• Products with too many ingredients - especially if you only have one symptom
• Labels that don’t list active ingredients clearly
• Packages that look outdated or poorly printed
• Products marketed with vague claims like “miracle cure” or “all-natural relief”

The FDA doesn’t approve every OTC product individually - they rely on monographs, which are like rulebooks for safe ingredients. But if a product doesn’t follow the Drug Facts format, it’s a red flag. Don’t buy it.

And if your symptoms don’t improve in 3-5 days, or they get worse? Stop taking the medicine. Don’t double the dose. Don’t switch to another brand. See a doctor. OTC meds are for short-term relief - not long-term fixes.

What’s Changing in 2025?

The FDA is updating the OTC drug review system for the first time in decades. This is part of the CARES Act from 2020, and by 2025, you’ll start seeing clearer labels, updated warnings, and faster changes when new risks are found. For example, fluticasone furoate - a nasal spray once only available by prescription - is now OTC for allergies. That’s progress. But it also means you need to be even more careful. New OTC options mean more choices - and more chances for mistakes.

What’s not changing? The need to read the label. The need to ask questions. The need to know your own body.

OTC medications are meant to give you control over your health. But control only works when you’re informed. Don’t let convenience replace caution. A few extra minutes reading a label or asking a pharmacist can save you from a hospital visit - or worse.