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Commonly Abused Over-The-Counter (OTC) Medications

Dr. Richard Foster, LICDC-CS

Medically reviewed by

Dr. Richard Foster, LICDC-CS

March 8, 2019

Certain over-the-counter medications can be very dangerous when abused. This is especially true when they’re combined with alcohol or other drugs, a common practice in patterns of abuse and addiction. It is important to know the dangers of these medications so you can avoid a possible addiction.

Many people may believe over-the-counter medications are safer than abused prescription medications or illicit drugs. Yet abuse of these drugs can lead to a variety of physical and mental health problems, and in certain instances, addiction and overdose.

Frequently Abused Over-The-Counter Medications

Dextromethorphan (DXM), a cough suppressant, and loperamide, an anti-diarrheal, are the two most commonly abused OTC medications, according to the National Institute on Drug Abuse (NIDA). Both of these medications are opioids, and abuse of either can lead to addiction, withdrawal, and overdose.

Beyond these, a variety of other OTC medications are commonly abused:


Loperamide, the active ingredient in Imodium products, is often taken in large quantities by opioid abusers who are trying to reduce cravings or symptoms of withdrawal. In high amounts, loperamide may also produce a euphoric state.

Risks of loperamide abuse include becoming faint, changes to the eye, constipation, and stomach pain. More serious dangers include addiction, irregular heartbeat, a loss of consciousness, withdrawal, and overdose.

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Antihistamines And Motion Sickness Pills

Antihistamines are used to treat the symptoms of colds, allergies, and motion sickness, and in certain forms they may be used as sleep aids.

Diphenhydramine, the active ingredient in Benadryl, and dimenhydrinate, the active ingredient in Dramamine, may produce hallucinations or psychedelic effects, prompting some individuals to abuse these drugs.

Using an antihistamine in large quantities can induce agitation, cardiac arrhythmias, convulsions, delirium, tachycardia (faster than normal heart rate) and in the worst cases, overdose or a coma. CBS News reports that “some studies have linked diphenhydramine to an increased risk of developing dementia or Alzheimer’s disease.”

Cold Medicines

Cold medications are misused either for the purpose of obtaining a high or to create a new drug. Pseudoephedrine, a common ingredient in cold medicines (such as Sudafed), is frequently misused due to its stimulating effects.

Increased energy and euphoria are two sensations individuals seek when they abuse these drugs. Some athletes, students, and professionals may use pseudoephedrine as a performance- or cognitive-enhancing drug. Pseudoephedrine is also used to create methamphetamine, a dangerous and highly addictive stimulant drug.

Pseudoephedrine can cause abnormal heart rates, agitation, breathing difficulties, cardiovascular distress, excitability, hallucinations, hypertension (high blood pressure), priapism (a prolonged erection of the penis), seizures, and overdose.

Cough Medicines

Dextromethorphan-containing cough medications, such as Coricidin and Robitussin, are highly abused for their depressant, and at times, hallucinogenic and dissociative (out of body feelings) effects. “Extra-strength” cough syrup, tablets, and gel capsules are the forms most frequently abused.

The depressant effects of DXM may be similar to those accompanying alcohol and marijuana abuse, while the hallucinogenic effects have been compared to those brought about by PCP and ketamine.

When abused, an individual may take the drug orally or mix it with another substance, like soda or alcohol. This is often referred to as “robotripping” or “skittling.” Some individuals may even inject DXM. Abuse of cough syrup runs high in adolescents and teens, a danger further compounded when these youths mix cough syrup with alcohol.

Signs of dextromethorphan abuse include changing body temperatures, hyperexcitability, lethargy, loss of control over body movements, slurred speech, sweating, and uncontrollable eye movements. Dangers of dextromethorphan abuse include addiction, withdrawal, aggression, anxiety, hallucinations, hypertension, intense panic, paranoia, seizures, and overdose (including that which is fatal).

Diet Pills

In significant quantities, diet pills may generate a buzz, heightened energy, and a mild euphoric state. In addition to these effects, diet pills may cause sleep disruption, dizziness, gastrointestinal distress, irregular heart rate, and nervousness.

Laxatives And Diuretics: Laxatives (medications which loosen stool) and diuretics (medications which increase urine output) are abused by some, especially those who are striving to lose weight. Persons struggling with eating disorders (which often occur with addiction) may use them for this purpose.

Some people, such as opioid drug abusers, may use a laxative to relieve constipation caused by drug abuse. Dehydration and electrolyte imbalances are side effects of these forms of abuse, while laxative abuse has been linked to irritable bowel syndrome (IBS) and colon cancer.

Pain Relievers

Acetaminophen (Tylenol) and aspirin-containing products are frequently abused OTC pain medications. Some individuals may progress from OTC pain reliever abuse to abuse of prescription opioid painkillers.

Though these drugs are not typically taken to elicit a high, when abused for their pain-relieving effects at greater than directed dosages, a person could suffer major health issues. While acetaminophen is not addictive, a person could experience gastrointestinal distress, major kidney and liver damage, and/or overdose.

Sleep Aids

Sleep aids may be abused in an attempt to self-treat insomnia or as a way to produce a mind-altering effect. Some versions of Unisom, a popular OTC sleep aid which is frequently abused, contain diphenhydramine, an antihistamine. Advil PM, Excedrin PM, Tylenol PM, and ZzzQuil, also contain this antihistamine.

Side effects and dangers include those listed for diphenhydramine, in addition to accidents caused by excessive drowsiness. Some of these, including Advil PM, Excedrin PM, and Tylenol PM, contain painkillers, each of which hold additional side effects when abused.

Why Do People Use Over-The-Counter Drugs?

Individuals of varying ages abuse over-the-counter medications for their psychoactive properties or to self-medicate.

Drug abuse can start young, and over-the-counter medications entice many adolescents and teens due to the accessibility and decreased stigma surrounding their use. Research shows that individuals who begin abusing drugs at young ages face a greater risk of developing a serious substance use disorder down the road.

The NIDA notes three ways that OTC drug misuse occurs:

  • using the medication in a manner or dosage other than indicated by the medication’s directions.
  • consuming the medication to achieve a specific feeling, such as for a high.
  • combining more than one OTC medication to produce a new substance.

Each of these patterns of abuse has the potential to cause self-harm, and in many cases, profound physical and/or mental health issues.

Some individuals may use OTC medications in an attempt to escape feelings of fear or despondency associated with anxiety or depression, while others may abuse OTC medications in an attempt to self-treat pain or to lose weight.

Over-the-counter drug abuse often occurs as a person tries to obtain a feel-good effect. Certain drugs may also be abused for the purpose of creating a highly energized state or buzz.

Over-the-counter drug abuse is many people’s first experience with substance abuse. A significant portion of these individuals may progress to abuse of illicit drugs and/or prescription medications. On the other hand, individuals who already abuse illicit or prescription drugs may turn to OTC medications when they are unable to find their usual drug of choice or to reduce or enhance certain side effects.

Getting Treatment For Over-The-Counter Drug Abuse

Over-the-counter drugs such as dextromethorphan and loperamide may forge mild to severe addictions. Individuals struggling with these concerns may require drug addiction treatment.

The exact method and intensity of treatment, for these and other forms of OTC drug abuse, will vary and be dependent on the drug(s) of abuse, the duration and severity of abuse, the presence of a physical dependency, and the existence of any health and medical conditions.

For more information on treatment of over-the-counter drug abuse, contact us today.

American Family Physician - Abuse of Over-the-Counter Medications Among Teenagers and Young Adults

NIDA - What are over-the-counter (OTC) medicines?

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