You may not think twice about reaching for an over-the-counter headache pain reliever or an over-the-counter antihistamine when seasonal allergies flare up . But experts say you should. “Many older people consider these OTC drugs harmless, but they are drugs, and the older you get, the more susceptible you are to their side effects,” says Dr. Jeffrey Kullgren, associate professor of internal medicine at the Institute for Policy and Innovation. Healthcare at the University of Michigan in Ann Arbor.
So while it’s important for everyone to follow the directions for over-the-counter medications, it’s essential for older adults, he adds. And review all of your medications (prescription, supplements, and over-the-counter) with your primary care physician or pharmacist at least once a year. This can help make sure you’re taking the correct medications in the correct doses, says Dr. David Hochman, an internal medicine physician at USC’s Keck Medicine in Los Angeles. This is key for older adults, who are more likely to use multiple medications. About half of the people between 50 Y 80 years report regular use of at least two over-the-counter medications, a University of Michigan national survey on healthy aging found in 2020. Among those who used five or more prescription drugs , the 32% took five or more additional OTC medications.
It is also important to know that some OTC medications are more appropriate for older adults than others, says Dr. Nina Blachman, assistant professor of medicine and geriatrics at NYU’s Grossman School of Medicine in New York City. Over-the-counter medications that you tolerated well in the past, such as non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen (Advil, Motrin IB) and naproxen (Aleve and others), could become problematic. You may not need medication for a problem like a cough or mild heartburn, but if you choose to take medication, this guide can help you choose the safest options.
Relieve pain or fever
Consider using: For most people, acetaminophen (Tylenol and generic) is best for pain and fever. “I tell my patients that if they were stranded on a desert island, the only drug they would want to have is acetaminophen,” says Hochman. For arthritis pain, another option is diclofenac gel, an over-the-counter NSAID (Voltaren).
Be careful with: Ibuprofen, naproxen and other oral NSAIDs, which can cause side effects like gastrointestinal bleeding with chronic use, says Hochman. Aspirin is generally not recommended as a pain or fever reducer for older adults. (It is advisable to have a small bottle on hand, in case of symptoms that may indicate a heart attack, or to take a low-dose aspirin daily if your doctor recommends it to protect your heart.)
And skip oral pain relievers before COVID vaccine – 19 if your intention is to prevent side effects: “There is some concern that it may decrease the immune response your body will have after receiving the vaccine,” says pharmacist Chad Worz, executive director of the American Society of Consulting Pharmacists. It is also not recommended to take antihistamines before receiving the vaccine to prevent subsequent allergic reactions.
Control a persistent cough
Consider using: Guaifenesin, found in over-the-counter products like Mucinex, thins the mucus in your lungs so you can get it out more easily, says Sunny Linnebur, a doctor of pharmacy and clinical pharmacy specialist at the Senior Clinic at the University of Colorado Hospital at Aurora and a former president of the American Geriatrics Society. Drinking a lot of fluids also helps .
watch out for: Products containing phenylephrine or pseudoephedrine decongestants, such as certain over-the-counter multisymptomatic cough and cold remedies. These ingredients are sometimes not recommended for older adults because they can increase blood pressure, affect sleep and cause problems urinating, Linnebur says.
One ingredient to avoid is antihistamine Diphenhydramine, which is often found in over-the-counter nighttime cough and cold medications and has been linked to dizziness, drowsiness and cognitive decline in older people, Blachman says. Certain over-the-counter cough and cold products also contain acetaminophen, so if you’re already taking acetaminophen alone, “you’re at risk of accidental overdose,” says Blachman.
Reduce allergy symptoms
Consider using: An over-the-counter steroid nasal spray, such as fluticasone (Flonase and generic), triamcinolone (Nasacort AQ and generic), or budesonide (Rhinocort Aqua). These are the first-line treatments for allergies and are considered safe for older people, says Worz. A simple saline spray can also help remove allergens and mucus from your nose.
Be careful with: The over-the-counter antihistamines chlorpheniramine (Chlor-Trimeton and generic) and clemastine (Tavist and generic), unless directed by your doctor. These often cause sedation, especially in older adults, Worz says. Avoid diphenhydramine (Benadryl and generic). It is an anticholinergic, a type of drug that has been linked to an increased risk of dementia in older people.
For constipation and diarrhea
Consider using: Can you help to prevent constipation consuming around 20 to 25 grams of fiber per day, says Blachman. Another option is to take an over-the-counter fiber supplement like psyllium (Metamucil), which gets your GI tract moving. But these can take several days to work. Over-the-counter polyethylene glycol laxative (MiraLax and generic) may offer a quicker solution to constipation. “Be sure to consult with a doctor if you require daily or regular use of a laxative,” says Blachman.
To relieve diarrhea and possibly prevent dehydration it can cause, you can try loperamide (Imodium and generic) as long as your temperature is below 100. 4 ° F and your stools are bloodless, says Worz. (And drink extra fluids that contain water, salt, and sugar, like Pedialyte, to replace what your body has lost.) Note: Call your doctor if your diarrhea is persistent, you have blood in your stools, your urine is dark yellow, you urinate only a few times a day, or you have a fever.
Be careful with: Stimulant laxatives such as bisacodyl (Correctol, Dulcolax and generics) and senna (Ex-Lax, Senokot and generics) they can cause diarrhea and fluid loss if taken too often, Linnebur says. Stool softeners, such as docusate (Colace and generic), may not work better than placebos. For diarrhea, it is best to avoid products with bismuth subsalicylate (Pepto-Bismol and generic). Salicylates are similar to aspirin, which can be problematic for older people, Linnebur says.
Get help for heartburn
Consider using: An over-the-counter antacid with calcium carbonate, such as Tums, or an H2 blocker like famotidine (Pepcid AC and generic) is fine for occasional heartburn, says Linnebur.
Be careful with: Proton pump inhibitors, such as omeprazole (Prilosec OTC and generic) and omeprazole and sodium bicarbonate (Zegerid OTC and generic), without consulting your doctor. These can lead to low levels of magnesium and vitamin B 12 and increase the risk of bone fractures, pneumonia, and severe Clostridioides difficile infection if used for long periods. “Many older adults start taking them and never stop, when in reality they should only take them for a few weeks,” says Linnebur.
Editor’s Note: A version of this article also appeared in the July issue of 2021 by Consumer Reports on Health .
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Consumer Reports has no financial relationship with the advertisers on this site. Consumer Reports is an independent nonprofit organization that works with consumers to create a just, safe, and healthy world. CR does not endorse products or services and does not accept advertising. Copyright © 2021, Consumer Reports, Inc.