OTC Meds: Understanding the Risks and Side Effects

Published by Ginger Hultin, MS RDN CSO

Over-the-counter (OTC) pain medications offer quick relief for mild to moderate pain, from headaches and menstrual cramps to muscle aches, joint, and back pain. While OTC medications may seem harmless because they’re so available, many may come with potential side effects that warrant caution and could have an impact on your health. Understanding these side effects can help you have better conversations with your medical care team as you decide together how and why you’re using pain relievers and considerations to keep in mind while doing so.

Today, we’re breaking down what you need to know from a FoodTrients® perspective as you navigate aches and pains. We hope that this will also help you feel more empowered that you’re doing what’s best for you and your health, and to have a productive partnership with your doctor.

Acetaminophen

One of the most widely used OTC medications is acetaminophen, commonly known by the brand name Tylenol®. It’s commonly used for reducing pain and fever, but keep in mind that it can pose serious risks to the liver if taken in excessive doses or over a prolonged period. The liver metabolizes acetaminophen (and all drugs), but when taken in large amounts, it can cause liver damage over time.

Combining acetaminophen with alcohol or other medications that also affect the liver can further increase the risk of toxicity. It’s essential to follow the recommended dosage and keep your doctor in the loop about how much you’re taking. Avoid exceeding the daily limit listed on the bottle to minimize the risk of adverse effects on the liver. In terms of nutritional status, the liver plays a major role in nutrient metabolism so acetaminophen-induced liver damage can contribute to how the food you eat is utilized in the body.

Antihistamines

Antihistamines like diphenhydramine (Benadryl®) or loratadine (Claritin®) are commonly used to relieve allergy symptoms like sneezing, itching, and watery eyes. While generally considered safe and used by millions of people, antihistamines can cause drowsiness and impair cognitive function, affecting alertness and coordination. This sedative effect can be particularly problematic when driving or operating heavy machinery or when combined with other substances that also cause similar effects (like alcohol!).

Some antihistamines may have anticholinergic properties – blocking the action of the neurotransmitter acetylcholine — which can lead to side effects like dry mouth, constipation, urinary issues, and confusion, especially in older adults. Antihistamine medications could also lead to decreased appetite in some people. Ironically, antihistamines can also cause weight gain. Though it might surprise you, antihistamines have some big nutrition-related considerations so it could be worth asking your doctor for a referral to a registered dietitian nutritionist to discuss these potential challenges if you’re at risk of antihistamine-related side effects.

Cough and Cold Medications

Cough and cold medications often contain a combination of ingredients to reduce symptoms like coughing, congestion, and sore throat associated with colds and flu. While you might not think twice about using them when you’re not feeling well, there actually are several considerations to keep in mind for your health.

Many of these medications contain decongestants which can raise blood pressure and heart rate. People with hypertension, heart disease, or other cardiovascular conditions should use decongestants with caution and consult their healthcare provider before taking them to discuss pros and cons, and considerations for their unique health needs.

Cough suppressants can cause drowsiness and dizziness, particularly when taken in high doses or combined with other depressants like alcohol. It’s important to be aware of how you’re using these medications and plan ahead so that you don’t have to drive or do other tasks that could be dangerous with the side effects of cough medicines.

When you are sick with a cold, it can be hard to stay on top of proper food intake. Cough and cold medications, especially those containing decongestants or antihistamines, can cause side effects such as dry mouth, decreased appetite, and nausea. These effects may result in further reduced food intake and hydration status. It’s important for anyone using these medications to monitor their nutritional intake and ensure adequate hydration to reduce any negative impacts on nutritional status.

Nonsteroidal Anti-inflammatory Drugs (NSAIDs)

Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil®, Motrin®) and naproxen (Aleve®) are other commonly used OTC medications for pain relief, fever reduction, and reducing inflammation. It’s important to know that, over time, NSAIDs can irritate the lining of the stomach and increase the risk of gastrointestinal bleeding or ulcers, or impair kidney function, particularly when taken at high doses. These complications may lead to decreased appetite, altered nutrient absorption, and an increased risk of gastrointestinal inflammation, potentially impacting overall nutrition status and health outcomes. People with a history of stomach ulcers, gastrointestinal bleeding, or kidney disease should definitely use NSAIDs under the guidance of a healthcare professional.

OTC Meds: What You Need To Know

While over-the-counter medications provide convenient relief for symptoms, it’s important to know that they are not entirely without risks. It’s essential to:

Read and follow the instructions on the label carefully.
Adhere to the recommended dosage.
Be aware of potential side effects and how they will affect your nutritional status.
Consult your healthcare professional before starting any new OTC medication, especially for people with pre-existing medical conditions or taking other medications, which can help minimize the risk of negative impacts from their use and ensure safe and effective treatment.
Informed decision-making and responsible use of OTC medications are essential for maintaining nutritional health and optimal well-being.

References:

Montemayor S, Mascaró CM, Ugarriza L, et al. Adherence to Mediterranean Diet and NAFLD in Patients with Metabolic Syndrome: The FLIPAN Study. Nutrients. 2022;14(15):3186.
D’Alessandro C, Benedetti A, Di Paolo A, Giannese D, Cupisti A. Interactions between Food and Drugs, and Nutritional Status in Renal Patients: A Narrative Review. Nutrients. 2022;14(1):212.
Rogers MAM, Aronoff DM. The influence of non-steroidal anti-inflammatory drugs on the gut microbiome. Clin Microbiol Infect. 2016;22(2):178.e1-178.e9.
Bjarnason I, Scarpignato C, Holmgren E, Olszewski M, Rainsford KD, Lanas A. Mechanisms of Damage to the Gastrointestinal Tract From Nonsteroidal Anti-Inflammatory Drugs. Gastroenterology. 2018;154(3):500-514.
PhD MB MD. Over-the-counter cold and flu medicines can affect your heart. Harvard Health. Published March 20, 2019. https://www.health.harvard.edu/blog/over-the-counter-cold-and-flu-medicines-can-affect-your-heart-2019032016220
Antihistamines and weight gain. American Academy of Allergy, Asthma, and Immunology. Aaaai.org. Published 2019. Accessed April 2, 2024. https://www.aaaai.org/allergist-resources/ask-the-expert/answers/old-ask-the-experts/antihistamines-weight-gain

Ginger Hultin, MS RDN CSO

Ginger Hultin MS RDN CSO is a Seattle-based Registered Dietitian Nutritionist and long time contributor to nutrition content on Foodtrients®. She is the owner of the concierge, virtual nutrition practice Ginger Hultin Nutrition where she helps clients with complex health conditions through an integrative approach. She specializes in anti-inflammatory diets for integrative oncology nutrition, people with gastrointestinal disease, and autoimmune issues. Her 10-year partnership with Foodtrients® has focused on evidence-based anti-aging nutrition, healthy recipes, and "top foods" lists in many categories from blood sugar control to healing your gut. Ginger serves as adjunct clinical faculty at the Bastyr Center for Natural Health in Seattle. She is the director of communications at the Washington State Academy of Nutrition and Dietetics, a past Spokesperson for the Academy of Nutrition and Dietetics, and past-chair of the Vegetarian Nutrition Dietetic Practice Group. She has authored two nutrition books: Anti-Inflammatory Diet Meal Prep and the How to Eat to Beat Disease Cookbook. Ginger is a graduate of the University of Washington and Bastyr University and is currently pursuing her doctorate of clinical nutrition at the University of North Florida.