Over-the-counter medications and seniors — the hidden risks

This article is meant to help you understand medication management better. It does not replace medical advice. Always consult with your parent's doctor before making changes to their medications.

Your parent takes a variety of over-the-counter medications without thinking much about them. An antacid for heartburn. Ibuprofen for arthritis pain. A cold medicine when they catch a cold. An allergy medication when their nose is stuffy. Melatonin for sleep. Laxatives for constipation. These are all things they can buy at any drugstore without a prescription. They couldn't possibly be dangerous, right? They're sold to anyone without restriction. Millions of people take them. The risks must be minimal.

This assumption is dangerously wrong. Over-the-counter medications carry real risks for older adults that are often underestimated or completely missed. The same medication that's safe for a younger adult can cause serious harm in someone over seventy. Over-the-counter medications interact with prescription medications in ways that cause heart problems, kidney failure, falls, and bleeding. Over-the-counter medications are used at higher doses than is safe for older bodies, leading to accumulation and toxicity. Most critically, older adults often use over-the-counter medications without telling their doctors, so nobody has a complete picture of what they're taking.

How Over-the-Counter Medications Cause Problems

The most common dangerous over-the-counter medications for older adults are nonsteroidal anti-inflammatory drugs, or NSAIDs. This category includes ibuprofen, naproxen, and related medications. These are sold in every store and used for everything from headaches to arthritis pain. They're available in high doses without prescription.

NSAIDs cause particular problems for older adults. They damage the stomach lining, increasing the risk of ulcers and bleeding. They damage the kidneys, especially in older people with already declining kidney function. They increase blood pressure, problematic for people taking blood pressure medications. They interact dangerously with blood thinners like warfarin, increasing bleeding risk. They interact badly with ACE inhibitors used for heart conditions. An older adult taking a blood pressure medication and using ibuprofen multiple times a week is at real risk of kidney damage and bleeding.

Another dangerous category is anticholinergic medications. These include common over-the-counter allergy medications like diphenhydramine, also known as Benadryl. They also include antihistamines in cold medicines, motion sickness medications, and some over-the-counter sleep aids. Anticholinergic medications cause confusion, constipation, urinary retention, rapid heartbeat, and dangerous overheating. In older adults, these side effects can be severe. Anticholinergics are linked to cognitive decline with long-term use.

Over-the-counter cold medicines often contain decongestants that increase blood pressure and interact with medications for heart conditions. Some contain acetaminophen, which is also in pain relievers and fever reducers sold separately. An older adult not realizing that multiple products contain acetaminophen might unintentionally overdose. Acetaminophen toxicity damages the liver.

Over-the-counter laxatives, used by many older adults for chronic constipation, can deplete minerals like sodium and potassium when used regularly. Severe depletion causes weakness, confusion, and dangerous heart problems. The use of laxatives becomes a vicious cycle: they treat constipation, but their chronic use causes electrolyte problems that should be managed differently.

Herbal remedies sold over-the-counter without prescription interact with prescription medications in serious ways. Ginkgo biloba increases bleeding risk when combined with blood thinners. St. John's Wort reduces the effectiveness of many medications including birth control pills (relevant for older women) and heart medications. These products are sold as dietary supplements, not medications, so they bypass the approval process and safety testing that prescription medications undergo.

Why Older Adults Are Particularly Vulnerable

Older bodies metabolize and clear medications more slowly than younger bodies. A dose of ibuprofen that's safe for a thirty-year-old might accumulate to toxic levels in a seventy-five-year-old. Over-the-counter products are sold with dosing recommendations that work for younger adults. These same doses can be too much for older people.

Older people often have declining kidney function. Medications that are processed through the kidneys accumulate rather than being cleared. Over-the-counter medications don't come with different doses for people with declining kidney function. The person with normal kidney function at age thirty has very different kidney function at age eighty-five, but the bottle's instructions don't account for this.

Older people frequently take multiple medications. Over-the-counter medications interact with prescription medications in ways that individual drug makers don't control or even know about. Your parent's doctor prescribed blood thinner. The drug maker of the blood thinner knows it interacts with NSAIDs. But your parent is buying ibuprofen at the store without the blood thinner's manufacturer knowing. The interaction happens anyway. Nobody catches it unless someone asks about it.

Most critically, many older adults take over-the-counter medications without telling anyone. They don't think over-the-counter medications are important enough to mention to their doctor. They don't realize the doctor needs to know about everything they're taking. They assume the drugs are safe because you can buy them without a prescription. So they pop ibuprofen for pain, take antihistamines for allergies, use laxatives for constipation, all without their doctor knowing.

Asking the Right Questions

When you visit your parent, specifically ask about over-the-counter medications. Ask what they take for pain. Ask what they take for heartburn. Ask what they take for constipation, diarrhea, or digestive problems. Ask what they take for allergies or cold symptoms. Ask what herbal remedies or supplements they use. Ask how often they take each medication. Ask the doses.

Look in their medicine cabinet. Make a list of every over-the-counter product you find. Include dosages. Bring this list to your parent's doctor. Ask the doctor whether each product is safe for your parent given their other medications and conditions.

Pay special attention to pain management. Older people suffering with chronic pain sometimes turn to over-the-counter NSAIDs because they're readily available and inexpensive. Ask your parent's doctor whether a prescription pain medication might be safer than chronic NSAID use. Ask whether acetaminophen is a safe alternative for your parent's pain.

Ask about sleep aids. Many older adults use over-the-counter sleep aids without realizing these medications contain anticholinergics that increase confusion and cognitive problems. Ask your parent's doctor about safer approaches to sleep problems.

Ask about laxatives and constipation treatments. Constipation is common in older people, often related to pain medications or medications for other conditions. But chronic laxative use isn't the answer. There are safer approaches.

Having the Conversation

Most older adults have never had a detailed conversation with their doctor about over-the-counter medications. They don't realize these medications matter. They don't think to mention them. You need to initiate this conversation.

Start by gathering information. Ask your parent what over-the-counter medications they use and how often. Make a list. Bring the list to an appointment and ask the doctor to review it with your parent specifically. Ask about each medication: Is this safe for your parent? Could it interact with their prescription medications? Is the dose appropriate for their age and kidney function? Are there safer alternatives?

Your parent might feel defensive. They might feel like you're criticizing their choices. Frame it carefully. Say something like: "I want to make sure all the medications you're taking, prescription and over-the-counter, are working well together and keeping you safe. Can we go over everything with your doctor?" This frames it as collaboration and safety, not criticism.

The right doctor will take this seriously. They'll review each product. They might recommend stopping some, changing doses of others, or switching to different medications. They might recommend treating underlying problems differently rather than managing symptoms with over-the-counter medication.

Your parent might resist some of these recommendations. They've used ibuprofen for years. They've used an antacid regularly. They assume these are safe because they're available without prescription. Your job is to help them understand that over-the-counter doesn't mean risk-free, especially for older bodies. The goal is helping your parent feel better and stay safe, not forcing them to follow doctors' orders. But working with the doctor to find safer approaches to pain management, constipation, allergies, and sleep is worthwhile.

The Reality of Over-the-Counter Misuse

Many older adults use over-the-counter medications at doses higher than recommended. They figure if some is good, more is better. They increase doses because they feel the medication isn't working. They take multiple products that contain the same active ingredient without realizing it.

These practices increase risk dramatically. Overdosing on acetaminophen causes liver damage. Excessive ibuprofen causes kidney damage and bleeding. Overdosing on laxatives causes severe electrolyte imbalances. Your parent needs to understand that over-the-counter doesn't mean safe at any dose. The recommended dose exists for a reason.

Ask your parent about the doses they're taking. Make sure they're not exceeding recommendations. Make sure they're not combining products that contain the same active ingredients. Help them understand that more medication isn't better medication.

Building Safety Into Over-the-Counter Use

For over-the-counter medications your parent does take, make sure they're doing so safely. Ask whether they've read the warnings on the package. Ask whether they understand the recommended dose. Ask whether they've checked for interactions with their prescription medications.

Keep a list of all over-the-counter products and supplements your parent uses. Update it regularly. Bring it to every doctor appointment. Make sure each healthcare provider knows about everything.

Consider limiting over-the-counter medication choices. Instead of having a medicine cabinet full of different products, keep only a few trusted options. Label them clearly. Make sure your parent knows which product to use for which symptom.

If your parent has difficulty reading labels or understanding instructions, read the labels together. Make sure they understand the dosing, frequency, and any warnings. Create written instructions in large print that your parent can reference when taking the medication.

The Transition to Safer Alternatives

As you identify over-the-counter medications your parent is using unsafely, work with their doctor to find safer alternatives. If your parent takes ibuprofen regularly for pain, ask the doctor about prescription options that might be safer. If your parent uses frequent laxatives for constipation, ask about dietary changes or alternative treatments.

Often safer options exist. They might require a prescription. They might cost more initially. But they prevent the serious complications that come from chronic over-the-counter medication misuse.

Your parent deserves to know what's safe and what's risky, and to make informed choices about what's worth taking and what's better to avoid.

This article is meant to help you understand medication management better. It does not replace medical advice. Always consult with your parent's doctor before making changes to their medications.