A medication being available without a prescription does not mean it is safe for every person. As people age, changes in kidney function, liver function, body composition, balance, memory, and medication use can affect how the body responds to nonprescription products. Older adults are also more likely to take multiple medications, increasing the possibility of interactions.
1. Sedating Antihistamines
Products containing diphenhydramine, doxylamine, or chlorpheniramine may cause:
- Drowsiness
- Confusion
- Blurred vision
- Dry mouth
- Constipation
- Difficulty urinating
- Poor balance
- Falls
These ingredients may appear in allergy products, cold medicine, motion-sickness products, and sleep aids.
Diphenhydramine is still sold widely, but that does not make it the best routine allergy or sleep option for every older adult. FDA has also warned that taking more than the recommended dose of diphenhydramine can cause serious heart problems, seizures, coma, or death — a risk that rises with impaired kidney function, which is more common in older adults.1
2. OTC Sleep Aids
Many nonprescription sleep products contain sedating antihistamines rather than a unique “sleep” medication.
The same ingredient may also appear in nighttime pain or cold products, creating accidental duplication.
Possible concerns include next-day grogginess, confusion, falls, urinary retention, and impaired driving.
Ongoing insomnia deserves evaluation rather than indefinite self-treatment.
3. NSAID Pain Relievers
NSAIDs include:
- Ibuprofen
- Naproxen
- Aspirin when used for pain
These medications may increase the risk of:
- Stomach ulcers
- Gastrointestinal bleeding
- Kidney injury
- Fluid retention
- Increased blood pressure
- Cardiovascular complications
Risk may be greater in older adults and people taking blood thinners, corticosteroids, certain antidepressants, diuretics, or blood-pressure medication.
Do not start daily aspirin for cardiovascular prevention without guidance from a qualified healthcare professional.
4. Decongestants
Pseudoephedrine and similar decongestants may cause:
- Increased blood pressure
- Increased heart rate
- Insomnia
- Nervousness
- Difficulty urinating
They may be inappropriate for people with certain heart conditions, uncontrolled hypertension, glaucoma, thyroid disorders, or prostate-related urinary symptoms.
Check combination allergy and cold products carefully.
5. Combination Cold and Flu Products
Combination products may contain:
- Acetaminophen
- A cough suppressant
- A decongestant
- A sedating antihistamine
- An expectorant
Using several products simultaneously can duplicate ingredients and increase side effects.
FDA requires OTC products to provide standardized Drug Facts information to help consumers identify active ingredients, uses, warnings, and directions.2
6. Antacids and Laxatives
Some antacids and laxatives contain magnesium, aluminum, calcium, sodium, or stimulant ingredients.
Potential concerns include:
- Kidney-related accumulation
- Electrolyte changes
- Diarrhea
- Constipation
- Medication interactions
- Excessive sodium intake
- Dependence on stimulant laxatives
Persistent constipation or heartburn should be evaluated rather than repeatedly masked.
7. Products Marketed as “Natural”
Herbal products and dietary supplements can interact with prescription medications.
Potential interactions may involve:
- Blood thinners
- Diabetes medication
- Blood-pressure treatment
- Antidepressants
- Transplant medication
- Seizure treatment
- Cancer therapy
FDA notes that some supplement and medication combinations can have serious or life-threatening effects.
“Natural” describes a marketing category, not a force field.
Ask the Pharmacist Before Purchasing
Bring an updated medication list and ask:
- Does this interact with my prescriptions?
- Could it increase fall risk?
- Will it affect blood pressure?
- Is it safe with kidney or liver disease?
- Does it duplicate another ingredient?
- How long can I use it?
- What symptoms require medical evaluation?
- Is there a safer alternative?
Signs That Require Prompt Medical Attention
Seek help for:
- A fall or fainting episode
- New confusion
- Severe drowsiness
- Black or bloody stool
- Vomiting blood
- Difficulty urinating
- Chest pain
- Trouble breathing
- Facial swelling
- A suspected overdose
- Sudden weakness or neurological symptoms
The Bottom Line
OTC does not mean risk-free. Older adults should be especially careful with sedating antihistamines, sleep aids, NSAIDs, decongestants, combination products, and supplements. A two-minute pharmacist conversation can prevent a much longer conversation in an emergency department.
Frequently Asked Questions
Why is diphenhydramine (Benadryl) riskier for older adults?
It can cause confusion, blurred vision, constipation, difficulty urinating, poor balance, and falls, and these effects tend to be more pronounced with age-related changes in kidney function and sensitivity to sedating medications.
Are OTC sleep aids safe for regular use in older adults?
Most contain sedating antihistamines rather than a unique sleep ingredient, and can cause next-day grogginess, confusion, falls, and urinary retention. Ongoing insomnia is better evaluated than repeatedly self-treated.
Is it safe for an older adult to take ibuprofen regularly?
NSAIDs like ibuprofen carry higher risk of stomach bleeding, kidney injury, and cardiovascular complications in older adults, especially those on blood thinners, diuretics, or blood pressure medication. Check with a pharmacist before regular use.
Are "natural" supplements safer than OTC drugs for seniors?
Not necessarily. Herbal products and supplements can interact with blood thinners, diabetes medication, blood pressure treatment, and other prescriptions. "Natural" is a marketing category, not a guarantee of safety.
Bring your full medication list to the pharmacy counter before buying anything OTC. A quick check for interactions, fall risk, and duplicate ingredients takes two minutes and can prevent a much longer trip to the emergency department.
References
- U.S. Food & Drug Administration. FDA Warns About Serious Problems with High Doses of the Allergy Medicine Diphenhydramine (Benadryl). fda.gov/drugs/drug-safety-and-availability
- U.S. Food & Drug Administration. The Over-the-Counter Drug Facts Label. fda.gov/drugs/understanding-over-counter-medicines/over-counter-drug-facts-label