Debunking Myths on Over-the-Counter Medication Safety

By Giang Lam, clinical pharmacist at CHOC

Over-the-counter (OTC) medications provide quick access to treatment options for a variety of minor ailments. They enable patients to self-treat many symptoms with relatively low cost, and avoid unnecessary visits to the doctor’s office. Unfortunately, the accessibility and affordability of OTC medications has also led to many misconceptions regarding over-the-counter medication safety.

Many consumers believe that OTC medications are completely safe with no risk of side effects. Since they don’t require a physician visit or a prescription, many people think OTCs are harmless. The truth is many of these OTC medications start out as prescription medications before going over the counter. The way that they work in our body is exactly the same as the prescription version and has the same potential for harmful side effects when not taken properly.

Some consumers believe that it is safe to take larger doses or to take the medication more frequently when the recommended dose doesn’t seem to work, instead of seeking a consultation with their pharmacist or physician. The product is often taken as long as symptoms persist. Active ingredients, warnings, and recommended dosing listed on the product label are often ignored due to the perceived safety of OTC medications. Many OTC medication labels will not provide dosing until your child is a certain age or weight since they are not approved or studied in younger children.

One of the most frequent complications faced when evaluating over-the-counter medication safety is the duplication of ingredients. The same active ingredient can often be found in prescription and OTC formulations. For example, acetaminophen is a common pain reliever and fever reducer that is often combined with other ingredients. It can be found in narcotic pain relievers, cough and cold medications, and sleep aids. Duplicating an ingredient such as this one can result in an accidental overdose with serious and dangerous consequences. Download a copy of A Parent’s Guide to Acetaminophen for Children.

Brand name manufacturers will list all the active ingredients in the product label on the side of the box, but, the ingredients may not always appear on the front label. It is essential to compare product labels when taking multiple OTC and prescription medications to prevent duplicating ingredients. Over-the-counter medication safety is crucial, as they can still have interactions with prescription medications so it is important to discuss with your pharmacist or physician.

Keep these tips in mind to ensure your family is taking medications safely:

  1. Read the product label. Know what you’re taking or giving to your child, how to take it and possible side effects.
  2. Try to avoid products with multiple ingredients or mixing of OTC products if possible.
  3. Discuss risks and benefits of OTC and prescription medications with your pharmacist and physician.
  4. Seek medical attention if symptoms persist or worsen.
  5. Like prescription medications, store OTC medications safely and out of the reach of children.

Related posts:

  • National Prescription Drug Take Back Day is Sept. 26
    With prescription and over-the-counter (OTC) medication abuse remaining one of the fastest growing problems among teens and young adults, it’s important to ensure unwanted, unused and expired medications are removed ...
  • Medication Safety Tips for Summer Camp Counselors and Caregivers
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  • The Dangers of Acetaminophen for Children
    Acetaminophen is a safe, popular pain reliever and fever reducer, but it can have devastating consequences for children if not taken properly, a CHOC pharmacist cautions. Better known as Tylenol, acetaminophen ...

National Prescription Drug Take Back Day is Sept. 26

With prescription and over-the-counter (OTC) medication abuse remaining one of the fastest growing problems among teens and young adults, it’s important to ensure unwanted, unused and expired medications are removed from homes.

From 10 a.m. to 2 p.m. on Sept. 26, Orange County residents can safely, easily and anonymously empty their medicine cabinets at locations throughout the region participating in National Prescription Drug Take Back Day, held in conjunction with local law enforcement and the Drug Enforcement Agency. See below for a list of drop-off sites in Orange County.

Drug safety is important to practice year-round. Here are some tips to help your family take charge of medications in your home:

  • If you have to do something else while taking medicine, such as answer the phone, take any young
    children with you.
  • Be aware of any legal or illegal drugs that guests may bring into your home. Ask guests to store drugs where children cannot find them. Children can easily get into pillboxes, purses, backpacks, or coat pockets.
  • Do not call medicine “candy.”
  • Talk to your teen about prescription and OTC drug abuse. Ensure your teen understands that buying
    or using prescription medication without a doctor’s order is dangerous and illegal.
  • Keep your family’s medications in a secure location and secure the cap completely after each use.
    Set clear rules about taking the correct dosage at the right time. Ask friends and family to keep
    their prescription and OTC medications in a safe place, too.
  • Explain the purpose of each prescribed or OTC medication, including possible side effects. Although
    you may not have prescription medications in your home, your child’s friend or family might. Stress
    that it is both illegal and extremely dangerous to share any kind of medications.
  • Get to know your teen’s friends and their parents. Ensure you are all on the same page when it
    comes to drugs, alcohol and medications.
  • Check with your child’s school. When teaching about substance abuse, does it include prescription
    and OTC medications?
  • Discard all old and unneeded medications properly. Mix medications with used coffee grounds, dirt
    or kitty litter; add hot water; and place in the garbage. Never flush them down a toilet.

To participate in National Prescription Drug Take Back Day, here’s a list of drop-off sites in Orange County:

San Juan Capistrano City Hall
32400 Paseo Adelanto, San Juan Capistrano, CA 92675

Placentia Police Department
401 E. Chapman Ave., Placentia, CA 92870

Villa Park City Hall parking lot
17855 Santiago Blvd., Villa Park, CA 92861

University Hills Community Center
1083 California Ave., Irvine, CA 92617

Costa Mesa Police Department front lobby
99 Fair Drive, Costa Mesa, CA 92627

Buena Park Police Department front lobby
6640 Beach Blvd., Buena Park, CA 90622

Brea Police Department front lobby
1 Civic Center Circle, Brea, CA 92821

Huntington Beach Police Department front desk
2000 Main St., Huntington Beach, CA 92648

Mission Viejo City Hall
200 Civic Center, Mission Viejo, CA 92692

Lake Forest City Hall
25550 Commerce Centre Drive, Lake Forest, CA 92630

Seal Beach Police Department
911 Seal Beach Blvd., Seal Beach, CA 90740

Kaiser Permanente Anaheim Medical Center, office building 1
3460 E. La Palma Ave., Anaheim, CA 92806

Tustin Police Department, front parking lot
300 Centennial Way, Tustin, CA 92780

Buena Park Police Department, Ehlers Event Center
8150 Knott Ave., Buena Park, CA 90620

Santa Ana Police Department, west-end office
3750 W. McFadden Ave., Suite 1, Santa Ana, CA 92704

Orange City Hall parking lot
360 E. Chapman Ave., Orange, CA 92866

Kaiser Permanente Hospital parking lot
6670 Alton Parkway, Irvine, CA 92618

Oasis Senior Center, overflow parking lot
801 Narcissus Ave., Corona del Mar, CA 92625

La Habra Police Department front lobby
150 N. Euclid St., La Habra, CA 90631

Orange County Sheriff’s Department, Yorba Linda service station
20994 Yorba Linda Blvd., Yorba Linda, CA 92887

Fountain Valley Police Department parking lot
10200 Slater Ave., Fountain Valley, CA 92708

Fullerton Police Department drive-through on Highland Avenue
237 W. Commonwealth Ave., Fullerton, CA 92832

Laguna Hills City Hall
24035 El Toro Road, Laguna Hills, CA 92653

Westminster Police Department parking lot
8200 Westminster Blvd., Westminster, CA 92683

Cypress Police Department front parking lot
5275 Orange Ave., Cypress, CA 90630

Garden Grove Police Department
11301 Acacia Parkway, Garden Grove, CA 92842

Medication Safety Tips for Summer Camp Counselors and Caregivers

Summer camp counselors, caregivers and family members alike, can rest assured with these medication safety tips for children under their care. Read below to make sure you’re asking the parent/guardian the right questions about their child’s medications:

• Review the child’s complete medication list with the child’s parent/guardian.
This includes which medications are scheduled (For example:  to be given twice daily at 9 a.m. and 9 p.m.) vs. which medications are only to be given as needed. For as needed medications, make sure you fully understand when it is appropriate to give. For patients with asthma, ask if they have a copy of their asthma action plan.

• Do any medications need to be taken with food or on an empty stomach?

• Can I crush any of these tablets? Do not crush extended release, controlled release or sustained release medications.

• Will any devices be needed to administer the medications?
For example: a spacer will be needed for an inhaler.

• Do any of the medications need to be stored in special conditions such as the refrigerator?

• How do I measure an oral liquid?
For oral liquids, make sure the dose is written in both mg and mL so that you understand how to draw up the dose correctly with an oral syringe. Ask the parents to bring the oral syringe and bottle adapter provided by the pharmacy. Avoid using a measuring cup or household teaspoon/tablespoon as this is not an accurate measurement.

• What is the duration of each medication and do they have stop dates?
For example: if the child is supposed to get seven days of antibiotic, how many days left do they need to take it?

• What are the common side effects your child experiences on these medications?

Lastly, make sure you have a contact number for the family, provider and the Poison Center Hotline (800-222-1222) should any questions arise.

Learn more about pharmacy services at CHOC.


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The Dangers of Acetaminophen for Children

CHOC Children's PharmacyAcetaminophen is a safe, popular pain reliever and fever reducer, but it can have devastating consequences for children if not taken properly, a CHOC pharmacist cautions.

Better known as Tylenol, acetaminophen is the medication most commonly given to American children, with 11 percent of children nationwide using the drug each week, says Ron Snyder, Pharm.D.

“It’s found in many over-the-counter prescription products, including cough and cold remedies and narcotic pain relievers,” Ron says. “The drug is generally considered safe, but can be toxic if taken in high doses or in certain situations.”

Acetaminophen can be toxic to the liver and is one of the most common causes of unintentional and intentional poisoning in the United States, he says.

Incidences of acetaminophen-related toxicity have increased over the past decade, Ron says. Each year, acetaminophen-associated overdoses account for approximately 56,000 emergency department visits, 26,000 hospitalizations and more than 450 deaths.

Here’s what parents can do to ensure their children use acetaminophen safely:

Read the product labels carefully.

Dosing can be confusing, so read labels carefully and ask for help in determining the correct dose. Parents should also limit the amount of acetaminophen taken per dose and limit the amount taken daily.

Be wary of acetaminophen availability from multiple sources.

If taking multiple medicines, be sure to check that child won’t “double dip” on acetaminophen. A big culprit behind overdoses is unknowingly taking acetaminophen from multiple sources, Ron says.

For example, someone with the flu may take Tylenol for a headache, as well as a cough medicine with acetaminophen. This can be extremely dangerous.

Double check what kind of concentrated liquid acetaminophen you have at home.

Liquid acetaminophen used to come in varying strengths for infants and children. The U.S. Food and Drug Administration found that confusion over these types led to overdoses that made infants seriously ill or die from liver failure.

Because of this, the industry has changed to one liquid strength of acetaminophen. However, older and stronger concentrations of acetaminophen once marketed for infants may still be available or in medicine cabinets. Again, read labels to know what you have and how much to give to a child.

Use the dosing device included with the medicine.

Kitchen spoons aren’t all the same, and a teaspoon and tablespoon used for cooking won’t measure the same amount as the dosing device. Rely on what’s included with the product to ensure proper dosing.

Early symptoms of acetaminophen overdose include vomiting, nausea, stomach pain, paleness and tiredness. If a parent suspects their child has overdosed on acetaminophen, call poison control immediately at 800-222-1222.

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Medication Safety FAQs Every Parent and Caregiver Should Know

To help keep your little ones safe from common medication mishaps, check out the answers to some of the most frequently asked questions about medications, medication safetyprovided by Shannon Bertagnoli, pharmacy safety coordinator at CHOC Children’s.

Why does my child’s medication look different?

A: If your child’s medication looks different in color, shape or size from the last time, make sure to review this with your pharmacist – you should have all your questions answered before going home. Sometimes there are multiple brands for the same medication that can look different, but it’s always good to double check. Some pharmacies are open 24 hours so if you get home and have additional questions, you should be able to reach someone even if it’s a different location where you filled your prescription.

Can I use a teaspoon or tablespoon to measure my child’s medication?

A: Never use a household teaspoon or tablespoon to measure the dose as these can vary in different households. When you are picking up a new prescription or over the counter medication read back the directions to the pharmacist. For example: I will give my child 10 mL of amoxicillin three times a day. If it is a liquid, demonstrate how you will use the dispensing device to your pharmacist. If you are unclear if your child’s medicine comes with a measuring device or a dosing cup, ask your pharmacist to recommend an oral syringe to use.

What should I ask my pharmacist when I pick up a new prescription?

A: Remember to tell your pharmacist if your child has any allergies even if you have already told your doctor. Ask your pharmacist what are the most common side effects of the medication, or if there is anything you should monitor for.

Is the bathroom medicine cabinet the best place to store my medications?

A: This is not the best place to store medications because the heat and humidity from the bathroom can break down the medicines and make them less effective. Instead, select a single and secure location in a cool, dry place that is up, away, and out of reach of children. Avoid storing in purses or drawers that children have access to.

Why does my child need to take multiple tablets to make up one dose?

A: It’s important to know that it’s uncommon to need more than two or three tablets, vials or syringes for a single dose of medication for a child. Before administering more than two or three of anything to your child, first verify with a pharmacist. Explain your concerns and have them double check the dose based on your child’s age and weight.

My youngest child is having symptoms similar to my older child. Is it ok to share medication if they have the same condition?

A: Your child’s individual medical condition and tolerance to the medication may vary. Children’s medication dose also varies based on age and weight. You should never share your children’s medication. It’s important to consult your child’s doctor if you have any questions about this.

Who should you call if you have a question about a potential poisoning?

A: A great suggestion is to keep the Poison Center Hotline readily accessible: 1-800-222-1222. Poison centers provide immediate, expert advice, 24 hours a day, seven days a week. Seek immediate medical attention if advised by the Poison Center or if you have any concerns about your child’s safety.

What should I do if I drop a pill on the floor and cannot find it?

A: Stop and look everywhere until the pill is located. If you don’t find it, your child or pet is likely to. Depending on the medication, we know that even one pill can cause significant harm to a small child or pet.

For additional medication safety guidelines, visit

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