8 Common OTC Medicines the FDA Says Older Adults Should Use With Caution

The bottle of allergy pills or nighttime pain medicine in your cabinet may not be as harmless as it looks. Many older adults take over-the-counter products regularly without realizing that age, chronic conditions, and interactions with prescription drugs can change how those medicines affect the body.

The FDA says age-related changes in kidney and liver function, along with other factors, can alter how medications work. Some familiar products may lead to dizziness, confusion, stomach bleeding, or other problems, especially when they are used alongside prescription treatments.

The American Geriatrics Society’s Beers Criteria lists medications that adults 65 and older may need to avoid or use carefully, depending on their health. These suggestions are not a broad ban, and they are not the same as an FDA recall or a newly issued safety alert.

For retirees trying to protect both their health and their budgets, reviewing these eight common medicines may help avoid unnecessary purchases and possible complications.

1. Diphenhydramine (Benadryl and Some PM Sleep Aids)

Diphenhydramine is a first-generation antihistamine found in some allergy products, nighttime pain relievers, and over-the-counter sleep aids. The American Geriatrics Society advises most older adults to avoid regular use because its anticholinergic effects can cause confusion, constipation, dry mouth, and a higher fall risk. If a sleep product contains diphenhydramine, lingering drowsiness may continue into the next morning and make tasks like driving or using stairs harder. The Health in Aging Foundation points to newer antihistamines and non-drug sleep strategies as options to discuss with a healthcare professional. Before buying another sleep aid, check whether you are already taking a product with diphenhydramine and ask a pharmacist whether a different approach would be safer.

2. Ibuprofen and Naproxen (Advil, Motrin, and Aleve)

Over-the-counter pain relievers such as ibuprofen and naproxen are nonsteroidal anti-inflammatory drugs, or NSAIDs. They can ease pain and inflammation, but long-term use may raise the risk of gastrointestinal bleeding, kidney injury, and worsening blood pressure, especially in older adults. The American Geriatrics Society recommends avoiding chronic oral NSAID use in many older patients unless other options do not work and protective steps are taken. People who take blood thinners, corticosteroids, or certain other medications may face added risks, so a pharmacist’s review can be especially useful. Rather than repeatedly buying oral pain relievers without addressing the source of the problem, ask whether a topical product, physical therapy, or another pain-management plan would be better.

3. Omeprazole and Other Proton Pump Inhibitors (Prilosec, Nexium, and Prevacid)

Proton pump inhibitors, or PPIs, lower stomach acid and can be helpful for frequent heartburn and certain digestive conditions. Still, the American Geriatrics Society advises against routine scheduled use beyond eight weeks for many older adults unless there is a clear medical reason to continue. Concerns include possible links to complications such as Clostridioides difficile infection and bone-related issues, although individual risk depends on the person. Over-the-counter PPI products are generally meant for a 14-day course, and repeated or long-term use should be reviewed with a healthcare professional. If you have been buying heartburn medicine every month, it is worth asking whether you still need it, whether another treatment would work, and whether ongoing use is justified.

4. Pseudoephedrine and Oral Phenylephrine (Certain Cold and Sinus Medicines)

Decongestants deserve extra caution for older adults who have high blood pressure, heart disease, or other cardiovascular problems. Pseudoephedrine can raise blood pressure and heart rate, so it is important to speak with a pharmacist before using products that contain it. Oral phenylephrine raises a different issue because the FDA proposed removing it as an over-the-counter nasal decongestant after concluding that the evidence did not show it was effective at recommended doses. That proposal was based on effectiveness, not on a new determination that oral phenylephrine is unsafe at labeled doses. Before spending money on a multi-symptom cold product, read the Drug Facts label and ask whether a saline spray or another option would better match your symptoms without extra ingredients.

5. Doxylamine (Unisom and Certain Nighttime Cold Medicines)

Doxylamine is another first-generation antihistamine often used in over-the-counter sleep aids and some nighttime cold products. Like diphenhydramine, it has anticholinergic effects that can lead to confusion, dry mouth, constipation, and next-day drowsiness in older adults. The Beers Criteria lists doxylamine among medications generally recommended to avoid in adults 65 and older because of these concerns. Someone taking both a sleep aid and a nighttime cold medicine could unknowingly double up on sedating ingredients, increasing the chance of unwanted side effects. If trouble sleeping keeps returning, ask a healthcare provider about the underlying cause and whether cognitive behavioral therapy for insomnia or another non-drug option might help.

6. Bismuth Subsalicylate (Pepto-Bismol)

Bismuth subsalicylate is commonly used for occasional diarrhea, nausea, and upset stomach, but its salicylate content deserves attention. People who take blood thinners, aspirin, or certain other medicines should ask a pharmacist about possible interactions before using it. Those with a history of gastrointestinal bleeding, ulcers, or kidney problems may also need extra caution depending on their situation. Too much or too long of a use can lead to salicylate-related effects such as ringing in the ears, and persistent digestive symptoms may point to a condition that needs medical evaluation. Instead of repeatedly buying stomach remedies, keep track of how often symptoms happen and discuss ongoing problems with a healthcare professional who can recommend the right treatment.

7. Magnesium Citrate (Saline Laxatives)

Magnesium citrate is an over-the-counter saline laxative sometimes used for occasional constipation. It can work well when used as directed, but people with reduced kidney function may have trouble clearing excess magnesium from the body. Overuse can contribute to dehydration, electrolyte imbalance, and potentially dangerous magnesium buildup, especially in those with kidney disease. Older adults who deal with constipation often should talk with a healthcare professional about symptoms and medications rather than depending on repeated laxative use. Depending on the cause, changes in fiber intake, fluid consumption, physical activity, or a different bowel routine may be a better long-term answer.

8. Chlorpheniramine (Certain Allergy and Multi-Symptom Cold Medicines)

Chlorpheniramine is another older antihistamine that appears in allergy tablets and combination cold medicines. The American Geriatrics Society includes it among first-generation antihistamines that most adults 65 and older should avoid because of anticholinergic side effects. Those effects can include sedation, confusion, constipation, and urinary problems, which may be especially difficult for people already managing several health concerns. The Health in Aging Foundation suggests discussing newer antihistamines such as loratadine or fexofenadine, or other allergy treatments, with a healthcare professional. Because many brand-name cold medicines contain several active ingredients, checking the label can help prevent accidental overlap of medicines that cause similar side effects.

How a Medication Review Could Help Protect Retirement Savings

Over-the-counter medicines may seem inexpensive one by one, but repeated purchases can add up for retirees living on fixed incomes. For example, spending $15 a month on a sleep aid and another $20 on recurring heartburn treatment would total $420 a year, before prescription drugs or doctor visits are even considered. Even more important, medication-related dizziness, falls, gastrointestinal bleeding, or other complications can lead to extra appointments, emergency care, and out-of-pocket costs. A pharmacist can help spot duplicate ingredients, possibly unnecessary products, and interactions that may make a less costly or more appropriate option worth discussing with a doctor. Bring a full list of prescriptions, over-the-counter drugs, vitamins, and supplements to the next medication review, and never stop a prescribed medicine without medical advice.

The point is not to stop taking every familiar product just because you are older. It is to make sure each one still has a purpose, fits current health needs, and does not create avoidable risk. Spending a few minutes reviewing the medicine cabinet can be one of the simplest ways to protect both health and retirement finances.