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Over the Counter Drugs: Side Effects, Detox, Withdrawal, and Treatment

over the counter drugs

What are Over the Counter (OTC) Drugs?

Over the counter (OTC) drugs are medications you can buy at the store without a prescription. According to the Consumer Healthcare Products Association, more than 750,000 retail outlets in the U.S. sell OTC drugs and 8 in 10 consumers use OTC products to relieve their symptoms without having to see a doctor.1

There are many different kinds of over the counter drugs that are used to treat a variety of illnesses and symptoms. However, some OTC drugs contain active ingredients that make them more likely to be abused. They are also very easy to misuse because they are widely available, inexpensive, legal, and have no age requirement or limit on how much can be purchased.

Although current national data doesn’t offer a full picture on the scope of the OTC drug abuse problem in America, the Substance Abuse and Mental Health Services Administration (SAMHSA) reported that about 3.1 million people (ages 12 to 25) used OTC cold and cough medicines to get high.2

Over the counter drugs are safe and effective when they are used properly as directed on the box, but when they are misused by taking higher or more frequent doses than necessary, they can cause physical harm, tolerance, dependence, or addiction.

What is OTC Drug Abuse?

OTC drug abuse has increased in recent years, especially among teenagers and young adults.2,3 Many people will abuse OTC drugs to self-medicate symptoms at home or to get high. Common signs of OTC drug abuse include:

  • Mood swings
  • Memory lapses
  • Changes in appetite and sleeping patterns
  • Lack of interest in hobbies and regular activities
  • Empty medicine bottles in the trash
  • Disappearing medication from the medicine cabinet
  • Regular large purchases of OTC medications when it’s not necessary

The misuse of over the counter drugs can lead to serious physical health problems, dependence, and addiction. Although OTC drugs can be addictive, other prescription drugs and illegal substances are more potent. A person who is misusing OTC drugs may be more likely to move on to other drugs like prescription painkillers or marijuana in search of a stronger high.

Commonly Abused Over the Counter Drugs

Any use of an OTC medication that is outside of what is medically recommended is considered abuse. Here are some of the most commonly abused over the counter drugs in the U.S.

Cough and cold medicine (Dextromethorphan/DXM and Pseudoephedrine) 

OTC cough medicines can produce a high and hallucinations when they are abused. Dextromethorphan (DXM) is an active ingredient found in cough medicines, which can also cause several harmful side effects when taken in large doses. High doses of DXM can cause:

  • Nausea and vomiting
  • Dizziness
  • Hot flashes
  • Sweating
  • Lethargy
  • Coordination problems
  • Panic attacks
  • Seizures
  • Hallucinations
  • Impaired judgment and cognition
  • Hyperactivity
  • Slurred speech
  • Dissociation from body
  • Increase blood pressure
  • Rapid eye movement
  • Skin rashes
  • Racing heartbeat
  • Euphoria
  • Paranoia
  • Disorientation
  • Feelings of floating
  • Altered perception of time4

The misuse of cough medicine is often called “robo-tripping,” “skittling” or “dexing.”

The active ingredient in many cold medicines, pseudoephedrine, can produce stimulant effects and hallucinations when it is abused.5 Pseudoephedrine can also easily be chemically converted to methamphetamine (meth) and crystal meth.6

Anti-Diarrhea Medicine (Loperamide)

Loperamide is an active ingredient found in OTC antidiarrheal medicine as well as medications that treat symptoms like gas. Found in the brand name drug Imodium, loperamide can produce a high when it is taken in large doses and it is often commonly abused by those who are self-medicating for opioid withdrawal symptoms.7

Misusing loperamide can cause serious heart problems as well as other harmful side effects like:

  • Loss of consciousness
  • Rapid heartbeat
  • Abnormal heart rhythms
  • Cardiac arrest

Pain relievers (Acetaminophen)

Acetaminophen is the active ingredient in Tylenol and other OTC pain relievers. In fact, more than 600 OTC and prescription medications contain the active ingredient acetaminophen. Some people may abuse OTC pain relievers to manage chronic pain, but exceeding the daily dosage recommendations of acetaminophen can result in harmful side effects. Chronic abuse of this drug can cause:

  • Nausea
  • Vomiting
  • Stomach cramps
  • Swelling or pain in the upper abdomen
  • Diarrhea
  • Loss of appetite
  • Sweating
  • Confusion
  • Liver damage

Motion sickness pills (Dimenhydrinate)

Dimenhydrinate, marketed as Dramamine and other brands, is a medication that is used to treat motion sickness and vertigo. People often abuse this OTC drug for its psychedelic effects and euphoric high. In very high doses, dimenhydrinate can cause side effects like:

  • Hallucinations
  • Nausea
  • Ringing in the ears
  • Irregular heartbeat
  • Coma
  • Seizures
  • Death9

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OTC Drug Street Names

Certain slang terms or street names may be used to refer to some of the commonly abused over the counter medications listed above.

Street Names/Slang Terms for OTC Drugs
Dextromethorphan DXM, dextro, drix, poor man’s ecstasy, red devils, robo, triple C, Tussin, X
Dimenhydrinate Dime tabs, dime, substance D
Loperamide Poor man’s methadone
Pseudoephedrine Chalk, crank, meth, speed

Side Effects of OTC Drug Abuse

There are many different types of over the counter drugs, so the side effects of abuse will vary greatly. However, most often, the side effects of OTC drug abuse include:

  • Slurred speech
  • Impaired motor coordination
  • Impaired cognitive abilities

Chronic, long-term abuse of OTC drugs can also lead to:

  • Memory loss
  • Heart problems
  • Kidney damage
  • Liver damage
  • Internal stomach bleeding
  • Increased risk for stroke
  • Increased risk for high blood pressure
  • Death

OTC Drug Overdose

Taking large doses of OTC drugs or mixing them with other over the counter medications, alcohol, prescription drugs, or illegal drugs can increase your risk of overdosing. Drug overdose symptoms may vary depending on the drugs that were consumed, but generally, OTC drug overdose symptoms will include:

  • Nausea
  • Vomiting
  • Confusions
  • Delusions
  • Hallucinations
  • Seizures
  • Loss of consciousness
  • Headache
  • Impaired motor skills
  • Bluish skin and fingernails
  • Extreme drowsiness
  • Sweating or chills
  • Irregular heartbeat or blood pressure

Over the Counter Drug Withdrawal Symptoms

Some over the counter drugs may also produce withdrawal symptoms if you abuse them regularly and then suddenly stop or cut back on your use. Depending on the drug that was abused, OTC drug withdrawal symptoms may include:

  • Mood swings
  • Anxiety
  • Irritability
  • Agitation
  • Disorientation

Although a medical detox program may not always be necessary for OTC drug withdrawal, a period of medical monitoring may help to ensure the comfort of the person who is detoxing from over the counter drugs.

Signs of Over the Counter Drug Addiction

Not all over the counter drugs have the potential to cause addiction but some do. According to the National Institute on Drug Abuse, the misuse of OTC drugs like DXM and loperamide can lead to dependence and addiction.10 This is often caused by chronic, long-term abuse and can result in serious health problems, relationship issues, or problems at work or school. OTC drug addiction is also characterized by an inability to stop using the drug despite the negative consequences.

Treatment for OTC Drug Addiction

If you are addicted to certain over the counter drugs, cognitive behavioral therapy and other forms of therapy have been shown to be successful in helping people get sober. An inpatient or outpatient rehab program can also provides structure and ongoing support to help you kick your substance abuse habits for good.

It may feel like you’re trapped by your addiction, but there is a way out and you can recover with the right support. Call today to speak with a Nova Recovery Center representative about your treatment options. We accept most insurance.



  1. https://www.chpa.org/MarketStats.aspx
  2. https://www.aafp.org/afp/2011/1001/p745.html
  3. http://monitoringthefuture.org/pubs/monographs/mtf-overview2018.pdf
  4. http://www.cesar.umd.edu/cesar/drugs/dxm.asp
  5. https://www.everydayhealth.com/drugs/pseudoephedrine
  6. https://www.ncbi.nlm.nih.gov/pubmed/29684907
  7. https://www.knowyourotcs.org/ingredient/loperamide/
  8. https://www.regulations.gov/document?D=FDA-2011-N-0021-0001
  9. https://www.ncbi.nlm.nih.gov/pubmed/26985532
  10. https://www.drugabuse.gov/publications/drugfacts/over-counter-medicines



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