No Prescription Needed: How to Navigate Over-the-Counter Medications Safely
Taking a closer look at your medicine cabinet
Most people think of pharmacists as the people who hand them a bag and tell them not to drink while taking their antibiotics. That’s a real shame — because they’re among the most accessible, underutilized healthcare professionals we have. And right now, as physician shortages worsen and wait times stretch longer, that matters more than ever.
We’ve been thinking a lot about this lately — including in our TrumpRx breakdown, which looks at the gap between healthcare headlines and real solutions.
Tomorrow, we’re also dropping a new podcast episode with Dr. Christina Madison on exactly this topic: what pharmacists are actually trained to do, why the system holds them back, and what needs to change. (BTW — we were shocked to learn many of our Substack readers didn’t know we have a podcast. If that’s you: YES, we have a podcast! You can tune in wherever you listen to podcasts, including Apple, Spotify, etc., and even WATCH on YouTube!)
Today, we’re starting closer to home. Unbiased Scientist Dr. Jennifer Gershman is a pharmacist, and she’s written a practical guide to navigating OTC medications safely — the kind of thing your pharmacist wishes everyone knew before reaching for the medicine cabinet. Over to Jennifer…
As I pack for my family’s vacation to Disney, I’m reminded of just how much we need for a trip away from home. Yes, there’s the clothes and snacks…but there’s also the “in case of an emergency” stuff, including over-the-counter (OTC) medications. As a pharmacist, I’m usually the one deciding what to pull out from the medication cabinet for my family, but this kind of decision-making comes up in many households, often without clear guidance.
While OTC medications are commonly used year-round, you may use them even more now with sick season in full swing. Whether it’s the flu, common cold, COVID, or even a simple headache, knowing some basic OTC medication safety tips is a good idea. Here’s what I tell my patients, family, and friends.
1. The Drug Facts Label is Your Friend
The ‘Drug Facts’ label, often found on the back or side of an OTC medication bottle or label, serves as a central source of information about how to use a product safely. Below is a breakdown of what each section includes:
Active ingredients: Tells you about what medication(s) the product contains. For instance, acetaminophen is the active ingredient in the brand-name product Tylenol.
Purpose: Describes what the medication is intended to do. For instance, the purpose section on acetaminophen’s drug facts label says “pain reliever/fever reducer.” If the term in this section is unfamiliar to you, the Uses section spells out the specific symptoms the medication treats.
Uses: Details the symptoms this medication treats
Warnings: Discusses situations where the medication should be avoided, or situations where you should speak with a physician or pharmacist before taking the medication
Directions: Reviews how to take the medication, which may include the dose, how often to take it, how long it can be used, and how much you can take in a day
Inactive ingredients: Lists the ingredients in the product that aren’t active in your body, meaning these ingredients don’t give the medication its effect. These ingredients may include dyes, flavors, preservatives, and stabilizers.
Other information: Highlights proper storage and handling information, and sometimes additional statements about the medication
2. Consider Drug Interactions
“Hi Jen, I took acetaminophen for my headache. Is it okay to have a cup of coffee after?”
I get texts like these from family and friends all the time. And even though the combination of acetaminophen and a cup of coffee is usually nothing to worry about, OTC drugs can interact with certain medications and foods, and can even make certain health conditions worse.
Luckily, almost 90% of people in the U.S. live within five miles of a pharmacy (though pharmacy deserts are a growing problem). As drug experts, pharmacists are great resources to ask about drug interactions before starting a new medication.
Below, we’ll cover a few of the most common OTC drug interactions.
Blood Thinners and Nonsteroidal Anti-Inflammatory Drugs (NSAIDs)
If you’re taking a blood thinner like warfarin or rivaroxaban (Xarelto), it’s usually best to avoid nonsteroidal anti-inflammatory drugs (NSAIDs). NSAIDs are some of the most commonly used OTC drugs, and include aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve, Naprosyn).
The combination of blood thinners and NSAIDs can increase the risk of bleeding. So if you take a blood thinner, acetaminophen is typically a better option for pain relief or fever reduction. But one exception to this rule is warfarin. Taking acetaminophen with warfarin can raise the risk of bleeding more so than taking warfarin alone. So let your healthcare team know before you take acetaminophen. They may do more frequent lab monitoring (particularly, a lab test called the international normalized ratio) to check your bleeding risk if you take acetaminophen and warfarin together. In some cases, your healthcare provider may decide to adjust your warfarin dose, or recommend avoiding acetaminophen altogether.
Calcium and Certain Medications/Supplements
Before you reach for your calcium supplement (or a glass of milk), ask your pharmacist whether you need to separate calcium from any other medications or supplements you’re taking. Calcium can bind to certain medications, blocking their absorption and making them less effective.
Certain antibiotics, like doxycycline and ciprofloxacin (Cipro), are examples of medications that may become less effective if you take them at the same time as calcium. This includes cheese, milk, and other dairy products. I typically recommend separating these antibiotics from your calcium supplement or calcium-rich foods and beverages by at least 2 hours.
Calcium may also reduce the effectiveness of iron supplements. Although studies on this interaction are mixed, it’s a good idea to separate iron supplements and calcium (from supplements, foods, or drinks) by at least two hours.
Oral Decongestants in People With High Blood Pressure
If you have a stuffy nose and sinus congestion, OTC decongestants like pseudoephedrine (Sudafed) can help relieve symptoms. But they may not be the best option for everyone. Decongestants constrict (tighten) blood vessels, which can increase blood pressure.
For this reason, talk with your healthcare provider before taking a decongestant if you have high blood pressure. In some cases, you may need to avoid them entirely.
3. Avoid Doubling up on Medications
One of the biggest risks of taking OTC medications, and specifically cough and cold products, is accidentally doubling up on ingredients. For example, over 600 OTC and prescription medications contain acetaminophen. This is one reason it’s important to read the Drug Facts label I wrote about earlier.
Acetaminophen poisonings account for over 55,000 emergency department visits a year, according to some estimates, and can lead to acute liver failure or liver transplant. Accidental overdoses are especially risky in children, where giving the wrong dosage is easy to do. So.while it may be tempting to use a kitchen spoon to measure your child’s liquid medication, stick with the measuring device (dropper, oral syringe, medication cup) that comes with the OTC product. Kitchen spoons come in different sizes, which can result in your child getting too much or not enough medication.
Another risk of OTC medications is getting ingredients you don’t even need. Combination products, or those containing more than one active ingredient, can contain several different medications. For example, one product can contain a pain reliever, cough suppressant, and decongestant. But if you’re not coughing, for example, you don’t need a cough suppressant. And taking one exposes you to potential side effects without any upside.
Additionally, avoid taking more than one medication containing acetaminophen, which makes an accidental overdose more likely. DayQuil Cold & Flu, NyQuil Cold & Flu, and Theraflu Severe Cold Relief Nighttime are a few examples of combination products that contain acetaminophen.
Reach out to your pharmacist with any questions about OTC products, especially if you’re thinking about combination products. They can help guide you in the right direction about which cough and cold products are safest for you and your loved ones.
4. Store and Dispose of Medications Safely
You turn your head for a second and realize your child has gotten into your medication. It’s a scary feeling that can happen to any parent. In these situations, contacting Poison Control at 1-800-222-1222 right away is important. This free hotline is available 24/7 and staffed by healthcare professionals trained in toxicology. They’ll advise you on what next steps you should take, if any.
To prevent this situation, use strategies to keep medications away from your kids’ reach. Store your OTC medications in their original child-resistant packaging, and ask for your prescription medications in child-resistant bottles. And keep your medications out of reach, in a high cabinet or a locked shelf. And don’t just think about your own medications. When it’s Grandma Suzy’s birthday, and you have 20 guests at your house, store handbags on a high shelf since people tend to keep their medications in them.
When you think of OTC medication safety, I hope you think of safe disposal practices, too. Whether you have a medication you’re no longer taking, or it’s time to get rid of expired medications, knowing where to get rid of them can help keep everyone safe.
Many pharmacies, hospitals, and police stations have drug disposal bins where you can bring used or unused medications. You can search by address or zip code for the nearest location.
Additionally, National Drug Take Back Days occur every year, with the next one taking place on April 25, 2026. During the October 2025 program, over 571,000 pounds of medications were collected.
If you’re unable to drop off your OTC medications at a drug disposal site, not to worry. You can dispose of them in your regular household trash with a few simple steps:
Pour the contents of your medication into a ziplock bag or container and remove any personal identifying information.
Mix with something undesirable, such as cat litter, dirt, or used coffee grounds.
Seal up the contents and discard them in the trash.
The Bottom Line
Over-the-counter medications are easy to buy, but they’re not risk-free. Reading the Drug Facts label, watching for drug interactions, avoiding duplicate ingredients (especially acetaminophen), and storing medications safely can help prevent many common and potentially serious harms. When in doubt, your pharmacist is one of the most accessible resources for quick, evidence-based guidance.
Stay Curious,
Unbiased Science
Reviewed by another Unbiased Scientist, Dr. Amy Gragnolati, PharmD
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Another incredibly useful article. I have deep respect for pharmacists and their knowledge. Thank you for spotlighting the discipline and making people smarter about their health.
Thank you so much!