Over the counter pills; Can't live with them and can't live without them

Over-the-counter (OTC) medications, also known as P-category drugs, are those trusty little pills you reach for when a headache strikes or a cough won’t stop.

They’re convenient, effective, and, most importantly, they don’t require a long wait or appointment with a doctor to know how to use them. But, as with all things that seem too good to be true, there’s more to the story.

Today, we’ll be discussing this with Mohammed A. Rashad (MPharm, MAPCPharm, IPresc, ACP, MSc), a Director and an Advanced Clinical Practitioner on

With his definite and wholesome insight, we get to learn about how the increasing availability of OTC drugs, alongside initiatives like Pharmacy First in England, has made self-medication easier than ever—sometimes too easy.

Interviewer: Let’s break down the latest trends, common misconceptions, and the hidden dangers of those “harmless” drugs everyone probably has stashed in their bathroom cabinet or their mom’s basket of meds.

MAR: With the Pharmacy First initiative, anyone can pop into their local pharmacy and leave with treatment for minor ailments after a quick chat with the pharmacist.

This sounds great for avoiding long waits at the doctor’s office, right? Well, not so fast. While this system is a lifesaver for minor issues like a runny nose, it also opens the door for potential trouble.

Interviewer: Trouble sounds bad. Why would that be?

MAR: Pharmacists don’t have your full medical history, and they’re working against the clock. A rash that looks like a mild irritation might actually be the early sign of Lyme disease. If it’s brushed off, you could be in for some serious health complications down the line. Red flags might be waving, even when the symptoms seem minor.

Interviewer: Yikes.

MAR: Yup, and that isn't all. With pharmacists taking on more responsibility for treating minor infections, there’s a real risk of issues like antibiotic over-prescription. This isn’t just a personal problem—it’s a global one. Antibiotic resistance is on the rise, and that’s a battle none of us wants to lose.

Interviewer: For our readers, that means that the increased use of antibiotics gets the system too accommodated, and the minute you need it to work the most, it fails. Imagine a world where drugs don’t work—not a fun one.

Besides that, my major issue with OTC drugs is the misconceptions. For example, the myth about paracetamol containing cocaine. So, a straightforward question: These drugs are safe, right?

MAR: That’s dicey. I actually find the opposite to be true. One of the biggest myths surrounding OTC drugs is that they’re completely safe just because they don’t require a prescription. News flash: OTC drugs can still pack a punch if misused. Take ibuprofen, for instance. Yes, it’s a hero for pain relief, but did you know it can mess with your stomach and kidneys if overused? Chronic use can potentially lead to ulcers, gastrointestinal issues, or even kidney damage. Not so friendly now, huh? Paracetamol seems innocent enough, but take too much, and you’ll find yourself dealing with liver toxicity—a leading cause of hospital admissions in the UK.

Interviewer: Over here as well!

MAR: Exactly. Another common belief is that doubling up on OTC drugs will speed up recovery. Not only is that false, but it’s also potentially dangerous.

Regular use can lead to medication overuse headaches (MOH), where the very thing you’re taking to relieve headaches ends up causing them. Decongestants and laxatives, for example, are meant for short-term use. That diphenhydramine you’re using as a sleep aid? It might knock you out for the night, but long-term use can cause sedation and cognitive impairment. Overdo it, and your body might start relying on them, making things worse.

Interviewer: Horrific, really. I guess as humans, we want the fastest solutions. OTCs exist for a reason, so they can’t be all that bad. Are there any OTC drugs that should never be taken together? If so, which ones?

MAR: Of course! Drug misuse is a vital issue. Everyone should check the warnings on drugs before use, but a general rule of thumb is that NSAIDs (e.g., ibuprofen, aspirin, or naproxen) should not be taken together. Paracetamol and cold/flu remedies shouldn’t be taken together either because many cold and flu medications already contain paracetamol. Also, avoid taking multiple antihistamines, like loratadine and diphenhydramine, as this can lead to excessive sedation, confusion, and dry mouth, particularly in older adults. Lastly, antacids containing magnesium or calcium can interfere with the absorption of antibiotics like ciprofloxacin, reducing their effectiveness.

Interviewer: This is all remarkable information, so how can we safely navigate the OTC drug aisle?

MAR: First, don’t grab just anything. If you’ve got a headache, go for painkillers like paracetamol, not decongestants. Also, don’t take multiple medications with the same active ingredient. Mixing cold meds and painkillers, both containing paracetamol, is a recipe for liver trouble. If you’re already on prescription drugs, make sure your OTC choices won’t clash. Pharmacists are there for a reason—ask them!

Not all OTC drugs are created equal, and what’s safe for one person might be risky for another. So here's a cheat sheet:

- Older Adults: Paracetamol is generally safer for pain relief, but NSAIDs like ibuprofen can increase the risk of gastrointestinal bleeding and heart problems. Beware of first-generation antihistamines like diphenhydramine—they can cause confusion and increase the risk of falls.

- Children: Stick to paracetamol and ibuprofen for pain and fever relief. Don’t give aspirin to children under 16 due to the risk of Reye’s syndrome—a condition that can seriously damage the brain and liver.

- Pregnant Women: Paracetamol is usually safe, but steer clear of NSAIDs like ibuprofen, which can pose risks to both mother and baby.

- Chronic Conditions: If you’ve got high blood pressure or kidney disease, paracetamol is your friend. NSAIDs? Not so much—they can worsen both conditions.

OTC drugs are a lifesaver for minor ailments, but they’re not without risks. Next time you reach for that ibuprofen or decongestant, take a moment to make sure you’re using it safely. Pharmacists, like our guest in this post, are there to help—so don’t hesitate to ask questions, even if the answer seems obvious.

Better safe than sorry!