How Safe Are Over the Counter Drugs?

Reviewed By: Barbara Rexer, DSW, LCSW, LCADC, CCS, ICCS, DRCC

Written By: Sprout Editorial Team

Over-the-counter drugs can feel safe to use because they're legal and readily available, but not all are created equal. Use this guide to assess the risks of popular cold and allergy medications.

Pseudoephedrine
Codeine
Dextromethorphan
Ibuprofen
Loratadine
The Dangers of Mixing Drugs
Getting Help for Addiction
Helpful References

Have questions about addiction to OTC medications?
Call us at 855-430-9426 to speak with a recovery specialist.
As allergy season lingers and COVID-19 leads to more summer illnesses than usual, many people have turned to over the counter drugs to treat their symptoms. If you have a history of addiction, you might be concerned about which medications are safe to take, and which ones are best to avoid.

Although you should always speak to your doctor with any concerns about drugs found over the counter (OTC), here is a look at some of the most popular cold medications and their potential risks.

Pseudoephedrine

Brand names: Afrinol, Sudafed, Sinutab, Allegra-D

Pseudoephedrine is a decongestant that works by dilating the blood vessels in a person’s nasal passages and sinuses. Although it’s safe when used as directed, you will likely find drugs containing it behind the pharmacist’s counter, rather than in the aisle. Most states require you to show your ID to purchase. This is because pseudoephedrine can be altered to make methamphetamine. You cannot, however, use pseudoephedrine to get high.

When used as directed, potential side effects include:

Anxiety, restlessness, excitability
Blood pressure increase
Changes in appetite
Changes in heart rhythm
Dizziness
Easy bruising or bleeding
Skin rash, itching, or add sensations
Sleep issues
Weakness

Drugs with pseudoephedrine are not recommended for anyone taking stimulants, including ADHD medication. Additionally, pseudoephedrine should not be combined with other cold medicines or monoamine oxidase inhibitors (MAOIs).

Codeine

Brand names: Robitussin, Dimetapp DM, Nyquil, Theraflu, Virtussin

Codeine is an opioid used in cough medications. Because it can become habit-forming and is subject to abuse, not all states allow you to buy drugs with codeine over-the-counter.

On the street, codeine is known as “cough syrup,” schoolboy, coties, and t-three. If you are recovering from opioid addiction, it is important to speak with your doctor before taking medicines containing codeine. Your doctor will likely recommend an alternative.

Common side effects of codeine include:

Abdominal pain
Headache
Trouble urinating
Hallucinations
Seizures

In large amounts, it is also possible to overdose on codeine. Signs of overdose include breathing problems, loss of consciousness and coma. Consuming alcohol or taking other drugs, legal or otherwise, can increase the risk of side effects.

Dextromethorphan

Brand names: Delsym 12 hour, Robafen Cough, Robitussin Pediatric, Wal-Tussin Cough, Creomulsion Adult Formula

An opioid derivative, dextromethorphan (DXM) can behave like ketamine or PCP, which has driven recreational use of the drug. This makes it one of the more dangerous over the counter drugs. Moreover, some people use it improperly by snorting or injecting it to achieve a faster high. In large doses or when used improperly, the drug can become addictive.

Because of these risks, DXM may not be safe to use if you’re recovering from a substance use disorder. If you are struggling with cold or allergy symptoms, ask your doctor about alternative medicines.

Even when taken as directed, DMX can also lead to a number of side effects. These include:

Nausea
Vomiting
Dizziness
Drowsiness
Headache
Rash

Ibuprofen

Brand names: Advil, Motrin

Ibuprofen is a low-risk nonsteroidal anti-inflammatory drug (NSAID). Doctors generally consider the drug safe, which is why so many people turn to it for colds, inflammation and pain management. However, some groups should be careful. Doctors do not recommend ibuprofen for pregnant women or people with heart issues, since the drug can increase the risk of heart attack or stroke.

Stomach or intestinal bleeding may also occur, so it is important to follow the directions and take only as needed. Individuals with kidney or liver disease should avoid ibuprofen, as well as people with connective tissue diseases like Marfan syndrome or Sjogren’s syndrome.

Loratadine

Brand names: Claratin, Loradamed, Alavert

Like other antihistamines, loratadine treats allergy symptoms such as runny nose, itchy eyes and sneezing. Loratadine has a low risk of abuse, which may make it a good option for those with a history of addiction. However, the drug still has some side effects. These may include:

Headache
Drowsiness
Fatigue
Stomach pain
Diarrhea

Some loratadine medications, such as Claritin-D, also contain pseudoephedrine. As with other medications with pseudoephedrine, these versions are found behind-the-counter.

Have questions about addiction to OTC medications?
Call us at 855-430-9426 to speak with a recovery specialist.

The Dangers of Mixing Drugs

No matter how safe a medication may be on its own, it is never safe to mix over the counter drugs with recreational drugs or alcohol. The National Institute on Alcohol Abuse & Alcoholism warns that mixing alcohol with common cold medications can lead to nausea, vomiting, drowsiness or even fainting. You are also at risk of heart problems, breathing problems and internal bleeding. Meanwhile, the National Institute on Drug Abuse reports that mixing stimulants with cold medications can lead to a dangerous rise in blood pressure or irregular heart rhythms. When in doubt about the safety of mixing drugs, call your doctor or your local poison control center.

Getting Help for Addiction

If you struggle with addiction or feel tempted to misuse OTC medications, you are not alone. Flexible treatment programs can help you achieve a healthy life in recovery. They also give you tools and coping mechanisms to manage potentially triggering situations. It is also important to remember that recovery is an ongoing process. It’s always OK to ask for help when facing difficult situations, including stress or illness. If you have questions about where you can find support, start a conversation in the chat box below.