How to read an over-the-counter drug label

Every over-the-counter (OTC) medicine sold in the US carries a standard Drug Facts label. Read it every time, even for a medicine you have used before, because formulas change.

Section	What it tells you	What to check
Active ingredient	The drug that does the work, and the amount per tablet or dose	Whether any other medicine you take has the same ingredient
Uses	The symptoms the medicine is approved to treat	That it matches your symptom
Warnings	Who should not use it, when to ask a doctor first, side effects, and when to stop	Your conditions (liver, kidney, heart, stomach ulcers, high blood pressure), pregnancy, alcohol use
Directions	How much to take, how often, the maximum in 24 hours, and age limits	The right dose for the person's age (and weight, for children)
Other information	How to store it	Temperature and moisture limits
Inactive ingredients	Dyes, fillers and flavors	Allergies or intolerances, such as to a dye or lactose

The double-dosing trap

The same active ingredient can be in several products. Acetaminophen, for example, is in many cold and flu remedies, sleep aids ("PM" products) and some prescription pain pills. Taking a cold remedy plus a separate acetaminophen tablet can push you over the daily limit without realizing it. Check every label for the active ingredient, and use one product per ingredient.

Using the right measuring tool

Use the cup, syringe or spoon that comes with a liquid medicine. Kitchen spoons vary widely in size. Never mix up milliliters (mL) and teaspoons.

OTC pain relievers compared

Four pain relievers cover most everyday needs. Acetaminophen works differently from the other three, which are NSAIDs (nonsteroidal anti-inflammatory drugs). Always follow the dose on the label.

	Acetaminophen (paracetamol)	Ibuprofen	Naproxen	Aspirin
Common brands	Tylenol	Advil, Motrin	Aleve	Bayer, Ecotrin
Eases pain and fever	Yes	Yes	Yes	Yes
Reduces inflammation	No	Yes	Yes	Yes
How long a dose lasts	4 to 6 hours	6 to 8 hours	8 to 12 hours	4 to 6 hours
Main risks	Liver damage if you take too much or drink heavily	Stomach irritation, ulcers and bleeding; kidney strain; raised blood pressure	Same as ibuprofen; lasts longer, so effects build up	Stomach bleeding; thins the blood for days
Avoid or ask first if you have	Liver disease, or 3 or more alcoholic drinks a day	Stomach ulcers, kidney disease, heart failure, high blood pressure, or take a blood thinner	Same as ibuprofen	Bleeding problems, ulcers, asthma triggered by aspirin, or take a blood thinner
Children	Yes, with children's products dosed by weight or age	Yes from 6 months, with children's products	Not under 12 unless a doctor advises	Never under 19: risk of Reye syndrome
Pregnancy	Generally the preferred choice; use the lowest dose for the shortest time	Avoid from 20 weeks unless a doctor advises	Avoid from 20 weeks unless a doctor advises	Only when prescribed (for example, low-dose aspirin for preeclampsia risk)

Practical points:

For a fever or a headache without inflammation, acetaminophen is often the gentlest option on the stomach.
For sprains, period pain, toothache or arthritis flares, an NSAID often works better because it reduces inflammation. Take it with food.
Do not combine two NSAIDs (such as ibuprofen and naproxen). It raises the risk of stomach bleeding without adding much relief.
Do not use pain relievers more than 2 or 3 days a week for headaches. Frequent use can cause medication overuse headache.
Daily low-dose aspirin for heart protection is a decision to make with your doctor. Current guidelines no longer advise it for most people who have not had a heart attack or stroke, because of bleeding risk.

Stop an NSAID and get medical help for black or bloody stools, vomiting blood, or severe stomach pain. These can be signs of gastrointestinal bleeding.

Drug interactions

An interaction happens when one substance changes how another medicine works. It can make a drug weaker, stronger or more toxic. Interactions can come from other medicines, supplements, food or alcohol.

Combination	Why it matters
Blood thinners (such as warfarin or apixaban) + NSAIDs or aspirin	Much higher risk of serious bleeding
Several medicines that cause drowsiness (opioids, benzodiazepines, sleep aids, some antihistamines, alcohol)	Slowed or stopped breathing, falls, accidents
Some antidepressants + other serotonin-raising drugs (certain migraine drugs, tramadol, St. John's wort)	Serotonin syndrome: agitation, fever, shaking, fast heartbeat
Blood pressure medicines + NSAIDs	NSAIDs can raise blood pressure and strain the kidneys, especially with diuretics
Decongestants (pseudoephedrine, phenylephrine) + high blood pressure or heart disease	Can raise blood pressure and heart rate
Grapefruit juice + some statins, blood pressure drugs and others	Raises blood levels of the drug
Alcohol + acetaminophen	Greater risk of liver damage
Antacids or iron + some antibiotics or thyroid medicine	Reduce absorption; take them hours apart

To protect yourself:

Keep one up-to-date list of everything you take, including vitamins, herbal products and as-needed medicines.
Use one pharmacy if you can, so the pharmacist can check every new prescription against your record.
Ask the pharmacist before adding any OTC medicine or supplement. This advice is free.
Tell every doctor, dentist and surgeon about all your medicines.

Antibiotics: when they help and when they do not

Antibiotics kill bacteria. They do nothing for viruses, which cause almost all colds, flu, most sore throats, most acute bronchitis and many sinus infections. Taking them when they are not needed brings side effects with no benefit and helps bacteria become resistant.

Take antibiotics exactly as prescribed, at evenly spaced times, for the length your prescriber tells you.
Never share antibiotics or take leftovers from a past illness.
Report side effects. Diarrhea is common. Severe or bloody diarrhea, especially in the weeks after a course, can be C. difficile colitis and needs medical care.
A rash or swelling while on an antibiotic may be an allergy. Hives with breathing trouble or swelling of the face is an emergency. See drug allergy.
Some antibiotics interact with blood thinners, birth control and antacids. Ask the pharmacist.

Storing and disposing of medicines

Storage

Keep medicines in their original containers, with the label.
Store them somewhere cool and dry. Bathroom cabinets are often too warm and humid.
Keep all medicines, including vitamins and gummies, up, away and out of sight of children. Child-resistant caps slow children down but are not childproof.
Keep opioids and other medicines that can be misused in a locked place, and count them.
Check expiry dates. Liquid antibiotics, insulin, eye drops and epinephrine auto-injectors lose strength and should be replaced on time.

Disposal

Drug take-back is the best option. Many pharmacies and police stations have drop-off kiosks, and the US Drug Enforcement Administration runs National Prescription Drug Take Back Days.
If no take-back is available, mix medicines (do not crush tablets) with something unappealing such as used coffee grounds or cat litter, seal it in a bag, and put it in household trash. Scratch out personal details on the label.
A small number of medicines, mainly some opioids, are on the FDA "flush list" because one accidental dose could kill a child or pet. Flush these only if take-back is not available soon.
Used needles and syringes go into a sharps container, not loose in the trash.

Medicines and children

Dose by weight when you know it, using the chart on a children's product. Use children's or infant formulas, not cut-up adult tablets.
Never give aspirin or products containing salicylates (including bismuth subsalicylate) to anyone under 19. It is linked to Reye syndrome.
Cough and cold medicines should not be given to children under 4, and are of little benefit in older children. Honey can ease a cough from age 1, but never give honey to a baby under 12 months.
Do not give ibuprofen to babies under 6 months unless a doctor advises it.
Babies under 3 months with a fever of 38 °C (100.4 °F) or higher need to be seen urgently, not given medicine at home. See fever in infants.
Write down each dose and the time when more than one adult is caring for a sick child, so doses are not doubled.

See fever in children for when to treat a fever and when to see a doctor.

Medicines in pregnancy and breastfeeding

Talk to your doctor, midwife or pharmacist before starting or stopping any medicine, including herbal products and supplements.
Do not stop a prescribed medicine on your own when you find out you are pregnant. Stopping some medicines, such as those for epilepsy, depression or high blood pressure, can be riskier than continuing.
Acetaminophen is generally the preferred OTC pain reliever in pregnancy. Use the lowest effective dose for the shortest time.
Avoid NSAIDs (ibuprofen, naproxen, high-dose aspirin) from 20 weeks of pregnancy unless your doctor advises them. They can affect the baby's kidneys and heart.
Take a prenatal vitamin with folic acid, ideally starting before pregnancy.
Many medicines are safe while breastfeeding, but check each one. LactMed, a free database from the US National Library of Medicine, lists what is known.

Medicines in older adults

People over 65 often take several medicines, and the body handles drugs differently with age. The kidneys and liver clear drugs more slowly, so doses that were fine before can build up.

Review all medicines at least once a year with your doctor or pharmacist. Bring every bottle (a "brown bag review") and ask whether each one is still needed.
Watch for drugs linked to falls and confusion: sleeping pills, older antihistamines such as diphenhydramine (found in many "PM" products), muscle relaxants, and some bladder and mood medicines. The American Geriatrics Society Beers Criteria lists medicines that often cause problems in older adults.
Be careful with NSAIDs, which raise the risk of stomach bleeding, kidney problems and heart failure in older people.
Use a pill organizer and a written schedule, and ask for large-print labels or easy-open caps if needed.
New confusion, falls, dizziness or constipation after a medicine change are worth reporting to a doctor promptly.

Questions to ask about any new medicine

What is it for, and how will I know it is working?
How and when do I take it? With food or on an empty stomach?
What side effects are common, and which mean I should stop and call you?
Does it interact with anything else I take, or with alcohol?
How long will I need it? Is it safe to stop suddenly?
What should I do if I miss a dose?

Related reading: treatment options, allergic reaction, drug overdose, and the medical glossary.