Dangerous Over-the-Counter (OTC) Products

in Addiction
Published May 24, 2021
otc products

Over-the-counter (OTC) medications are medications that are available without a prescription. OTC products and medicines are widely used by many people to treat minor pain and other health issues for their convenience and to help avoid unnecessary doctor visits. OTC products and medications are often considered harmless, and when used as directed, they are generally safe. However, misuse of any medication can lead to health problems, and some can even lead to dependence. 

How Are OTC Products Commonly Misused?

OTC products and medicines are generally safe when taken as directed. Unfortunately, sometimes people will misuse these medications, which can cause dangerous health problems or even death. Three ways that people commonly misuse OTC medications are:

  • Taking medicine in a way or dose other than directed on the package
  • Taking medication for the effect it causes
  • Mixing OTC medicines to create new products


Commonly Misused OTC Products

Sleep aids such as diphenhydramine and doxylamine succinate are a common category of misused OTC medications. Many people take more than the suggested dosage or take them for a more extended period than directed. They are considered “non-habit forming.” However, Dr. Carl W. Brazil, the director of the Epilepsy and Sleep Division at Columbia University’s Department of Neurology, told Consumer Reports that these medications could cause psychological dependence even though they are not addictive in a physical sense. 

Due to potential effects such as elevated mood, increased energy levels, and mild euphoria, there have been cases of diphenhydramine misuse reported, as people have used it to “get high.” Research has shown that Diphenhydramine does affect Dopamine, leading to misuse of the medication. Misuse may be challenging to identify, and Diphenhydramine overdose symptoms mimic acute psychosis. Diphenhydramine misuse can cause sinus tachycardia, xerostomia, mydriasis, blurred vision, ileus, urinary retention, CNS depression, agitation, hyperactivity, psychosis, dependence.

OTC stimulant medications are also subject to misuse. Although the addictive potential of these drugs is still not often discussed, there is a widely held belief that amphetamine-like medications do have the potential for misuse. Common medications that have stimulant ingredients are appetite suppressants, bronchodilators, energy pills, and nasal decongestants. As early as 1998, the article Over-the-Counter Stimulants: Abuse and Addiction in Mayo Clinic Proceedings Volume 73, issue 10, P 977-982, reported that there are research findings, “amphetamine-like drugs are reinforcing and therefore can be addictive.” Even though results are mixed, and some studies show that OTC stimulants have low misuse potential, seven patient cases were looked at in the Mayo Clinic studies. They provided clinical support for research findings showing high misuse potential. Some dangers of OTC stimulant misuse are hypertension, elevated body temperature, heart dysrhythmias, agitation, irritability, anxiety, paranoia, tolerance, dependence.

Two of the Most Commonly Misused OTC Medications

Dextromethorphan (DXM) and Loperamide are two of the most commonly misused OTC medications. Dextromethorphan is a cough suppressant found in many OTC cold medications. Medications containing Dextromethorphan often contain antihistamines decongestants. The most frequently misused sources of Dextromethorphan are extra-strength cough syrups, gel capsules, and tablets. It is swallowed in its original form or mixed with soda, called “robo-tripping” or “skittling.” Dextromethorphan is often used with other drugs like marijuana or alcohol. 

Loperamide is an anti-diarrheal that comes in liquid, capsule, or tablet form. It is misused by taking large quantities of the medication orally.

Both medications are opioids. Dextromethorphan does not act on opioid receptors and does not reduce pain. Taken in large doses, it has a depressant effect. Sometimes it can cause a hallucinogenic effect that is similar to the effects of PCP or Ketamine. Loperamide is an opioid but is not designed to enter the brain. However, when taken in large doses, Loperamide may start to act like other opioids, affecting feelings of pleasure. It can also affect areas that control blood pressure, respiration, and arousal. 

Side Effects of OTC Medication

Misusing Dextromethorphan can cause serious health problems. The short-term effect of use can cause mild stimulation or alcohol or marijuana-like intoxication. Dextromethorphan can also lead to:

  • Liver damage when used with acetaminophen-containing products
  • Elevated blood pressure
  • Paranoia
  • Anxiety
  • Aggression
  • Excitability
  • Poor motor control
  • Sweating
  • Blurred vision
  • Stomach pain

Loperamide can cause feelings of euphoria similar to those of other opioids. Loperamide misuse can cause:

  • Heart dysrhythmias
  • Kidney problems
  • Fainting
  • Stomach pain
  • Constipation
  • Eye changes

These effects can be even more severe if Loperamide is taken with other medications. Other effects have not been thoroughly studied.

Is Overdose Possible With Dextromethorphan and Loperamide?

It is possible to overdose on both of these medications. Similar to overdose on other opioids, Dextromethorphan and Loperamide overdose can cause a person to stop breathing or breathe ineffectively. The person’s brain becomes deprived of oxygen, which can lead to effects on the nervous system, coma, or death. If a person overdoses on either medication, 911 should be called. If the person is not breathing, CPR should be started. Naloxone can be used to treat an overdose. 

Treatment for Substance Use Disorder

There are no medication protocols for treating substance use disorders for OTC medications. However, behavioral therapies such as cognitive-behavioral therapy (CBT) can be helpful. CBT helps modify the patient’s drug-use expectations and behaviors and effectively manage triggers and stress.

The first step in recovering from OTC medication misuse is medical detox. During medical detox, the body goes through its natural process of restoring balance while the withdrawal symptoms that accompany this process are managed. At Gallus Medical Detox Centers, we implement The Gallus Method to help patients detox, which includes IV Therapy, 24/7 medical supervision, cardiac and video monitoring, and more. 

A substance use disorder is not a moral failing or a weakness. It is a disease that needs proper treatment from people who are experts and leaders in the field of addiction science. At either of our locations at Gallus Medical Detox Centers, treatment is provided by expert staff with years of experience in ER, critical care, and addiction care. There is no shame here, just compassion and empathy. Come to Gallus Medical Detox Centers and experience the comfort that our evidence-based Gallus Method of detox can bring. A medical detox does not have to be painful or scary. We will keep you or your loved one comfortable in our upscale home-like environment. If you think you or a loved one may have a substance use disorder, reach out to Gallus Medical Detox Centers at (866) 296-5242. We can help you determine whether a medical detox may be necessary to get you started on the path to recovery.