Provide a comprehensive essential over‑the‑counter medication table that includes indications, contraindications, and dosing information, excluding any agents that are no longer used.

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Essential OTC Medication Reference Table

This comprehensive table prioritizes medications with established safety profiles and clinical utility, excluding obsolete agents. The information is structured for rapid clinical reference, drawing from established guidelines and evidence-based practice 1, 2, 3, 4.

ANALGESICS & ANTIPYRETICS

Acetaminophen (Paracetamol)

  • Uses: Pain relief (mild-moderate), fever reduction
  • Adult Dosing: 325-1000 mg every 4-6 hours; Maximum 4000 mg/day 2, 3
  • Pediatric: 10-15 mg/kg/dose every 4-6 hours
  • Contraindications:
    • Severe hepatic impairment
    • Active liver disease
    • Chronic alcohol use (>3 drinks/day)
  • Key Warnings: Hepatotoxicity risk increases dramatically above 4g/day; many combination products contain acetaminophen—always check total daily intake 3

Ibuprofen

  • Uses: Pain, inflammation, fever, dysmenorrhea
  • Adult Dosing: 200-400 mg every 4-6 hours; Maximum 1200 mg/day OTC (prescription doses up to 2400 mg/day) 2, 4
  • Pediatric: 5-10 mg/kg/dose every 6-8 hours
  • Contraindications:
    • Aspirin/NSAID-induced asthma
    • Active GI bleeding or ulcer disease
    • Severe renal impairment (CrCl <30)
    • Third trimester pregnancy
    • History of coronary artery bypass graft surgery (within 14 days)
  • Key Warnings: GI bleeding risk 1 in 110 for adults >75 years; cardiovascular risk with chronic use; avoid in heart failure 4

Naproxen Sodium

  • Uses: Pain, inflammation, fever, dysmenorrhea
  • Adult Dosing: 220 mg every 8-12 hours; Maximum 660 mg/day OTC 2, 4
  • Contraindications: Same as ibuprofen
  • Key Warnings: Longer half-life than ibuprofen may increase GI and cardiovascular risks; particularly concerning in elderly 4

Aspirin

  • Uses: Pain, fever, inflammation, cardiovascular prophylaxis (prescription indication)
  • Adult Dosing: 325-650 mg every 4-6 hours; Maximum 4000 mg/day 2
  • Contraindications:
    • G6PD deficiency
    • Active bleeding disorders
    • Children/adolescents with viral illness (Reye's syndrome risk)
    • Third trimester pregnancy
  • Key Warnings: Platelet inhibition persists 7-10 days; GI toxicity significant 2

ANTIHISTAMINES

Second-Generation (Preferred—Minimal Sedation)

Cetirizine

  • Uses: Allergic rhinitis, urticaria
  • Adult Dosing: 5-10 mg once daily 1
  • Pediatric: ≥6 months: 2.5-5 mg once daily
  • Contraindications: Severe renal impairment (reduce dose)
  • Key Warnings: 14% sedation rate—less than first-generation but not negligible 1

Loratadine

  • Uses: Allergic rhinitis, urticaria
  • Adult Dosing: 10 mg once daily 1
  • Pediatric: ≥2 years: 5 mg once daily
  • Contraindications: Severe hepatic impairment
  • Key Warnings: Minimal sedation (8%); no significant drug interactions 1

Fexofenadine

  • Uses: Allergic rhinitis, urticaria
  • Adult Dosing: 60 mg twice daily or 180 mg once daily 1
  • Pediatric: ≥6 years: 30 mg twice daily
  • Contraindications: None significant
  • Key Warnings: Least sedating (1.3%); avoid with fruit juices (decreases absorption) 1

First-Generation (Use With Extreme Caution)

Diphenhydramine

  • Uses: Allergic reactions, insomnia, motion sickness
  • Adult Dosing: 25-50 mg every 4-6 hours; Maximum 300 mg/day 1
  • Pediatric: ≥2 years: 1 mg/kg/dose every 6 hours
  • Contraindications:
    • Narrow-angle glaucoma
    • Prostatic hypertrophy/urinary retention
    • Severe asthma/COPD
    • Concurrent MAOIs
    • Elderly patients (relative contraindication)
  • Key Warnings: 50% sedation rate; impairs driving equivalent to alcohol intoxication; anticholinergic effects (dry mouth, urinary retention, confusion); particularly dangerous in elderly—increased fall risk, cognitive impairment 1

Chlorpheniramine

  • Uses: Allergic rhinitis, common cold symptoms
  • Adult Dosing: 4 mg every 4-6 hours; Maximum 24 mg/day 1
  • Contraindications: Same as diphenhydramine
  • Key Warnings: 45% sedation rate; prolonged half-life means bedtime dosing doesn't eliminate next-day impairment 1

DECONGESTANTS

Pseudoephedrine

  • Uses: Nasal congestion (allergic/non-allergic rhinitis)
  • Adult Dosing: 30-60 mg every 4-6 hours; Maximum 240 mg/day 1
  • Pediatric: ≥4 years: 15-30 mg every 6 hours
  • Contraindications:
    • Uncontrolled hypertension
    • Severe coronary artery disease
    • Concurrent or recent (14 days) MAOI use
    • Hyperthyroidism
    • Narrow-angle glaucoma
    • Urinary retention
  • Key Warnings: Behind-the-counter due to methamphetamine precursor status; monitor blood pressure; insomnia, irritability common; avoid evening doses 1

Phenylephrine (Oral)

  • Uses: Nasal congestion
  • Adult Dosing: 10 mg every 4 hours; Maximum 60 mg/day 1
  • Contraindications: Same as pseudoephedrine
  • Key Warnings: Efficacy questionable—extensively metabolized in gut; FDA reviewing effectiveness; significantly less effective than pseudoephedrine 1

COUGH & COLD

Dextromethorphan

  • Uses: Non-productive cough suppression
  • Adult Dosing: 10-20 mg every 4 hours or 30 mg every 6-8 hours; Maximum 120 mg/day
  • Pediatric: ≥4 years: 0.5 mg/kg/day divided every 6-8 hours
  • Contraindications:
    • Concurrent or recent (14 days) MAOI use
    • Chronic cough (asthma, emphysema, smoking-related)
  • Key Warnings: Abuse potential at high doses; serotonin syndrome risk with SSRIs/SNRIs

Guaifenesin

  • Uses: Expectorant for productive cough
  • Adult Dosing: 200-400 mg every 4 hours; Maximum 2400 mg/day
  • Pediatric: ≥4 years: 50-100 mg every 4 hours
  • Contraindications: None significant
  • Key Warnings: Limited evidence for efficacy; adequate hydration essential

GASTROINTESTINAL

Famotidine (H2 Blocker)

  • Uses: Heartburn, acid indigestion, GERD
  • Adult Dosing: 10-20 mg once or twice daily; Maximum 40 mg/day OTC
  • Contraindications: Severe renal impairment (reduce dose)
  • Key Warnings: Safe in pregnancy; less drug interaction than PPIs

Omeprazole (Proton Pump Inhibitor)

  • Uses: Frequent heartburn (≥2 days/week)
  • Adult Dosing: 20 mg once daily for 14 days; may repeat after 4 months
  • Contraindications: Hypersensitivity to PPIs
  • Key Warnings: Long-term use (>1 year) associated with increased fracture risk, C. difficile, hypomagnesemia; take 30-60 minutes before meals; not for immediate relief

Loperamide

  • Uses: Acute diarrhea, chronic diarrhea
  • Adult Dosing: 4 mg initially, then 2 mg after each loose stool; Maximum 8 mg/day OTC (16 mg/day prescription)
  • Contraindications:
    • Bloody diarrhea
    • High fever
    • Acute ulcerative colitis
    • Pseudomembranous colitis
    • Children <2 years
  • Key Warnings: Do not use >2 days without medical evaluation; cardiac arrhythmias at high doses

Bismuth Subsalicylate

  • Uses: Diarrhea, nausea, heartburn, upset stomach
  • Adult Dosing: 524 mg every 30-60 minutes as needed; Maximum 4200 mg/day
  • Contraindications:
    • Aspirin allergy
    • Bleeding disorders
    • Children/adolescents with viral illness (Reye's syndrome)
    • Severe renal impairment
  • Key Warnings: Black stool/tongue (benign); contains salicylate—count toward aspirin dose

Docusate Sodium (Stool Softener)

  • Uses: Constipation prevention, hemorrhoids
  • Adult Dosing: 50-300 mg once daily
  • Contraindications: Bowel obstruction, acute abdominal pain
  • Key Warnings: Not a laxative—prevents hard stools; takes 1-3 days

Polyethylene Glycol 3350

  • Uses: Occasional constipation
  • Adult Dosing: 17 g (1 heaping tablespoon) in 8 oz water once daily; Maximum 7 days
  • Contraindications: Bowel obstruction, known or suspected
  • Key Warnings: Seek medical attention if no bowel movement after 7 days

Senna

  • Uses: Constipation
  • Adult Dosing: 15-30 mg once daily; Maximum 30 mg twice daily
  • Contraindications: Bowel obstruction, appendicitis, inflammatory bowel disease
  • Key Warnings: Stimulant laxative—may cause cramping; chronic use leads to dependence

TOPICAL PREPARATIONS

Hydrocortisone 1%

  • Uses: Minor skin irritations, itching, rashes, eczema
  • Adult/Pediatric Dosing: Apply thin layer 2-4 times daily; Maximum 7 days without medical supervision
  • Contraindications:
    • Viral skin infections (herpes, varicella)
    • Fungal infections
    • Tuberculosis of skin
    • Rosacea
  • Key Warnings: Do not use on face, groin, or axillae without medical advice; skin atrophy with prolonged use

Bacitracin/Neomycin/Polymyxin B (Triple Antibiotic)

  • Uses: Minor cuts, scrapes, burns (infection prevention)
  • Dosing: Apply thin layer 1-3 times daily
  • Contraindications: Deep/puncture wounds, animal bites, serious burns
  • Key Warnings: Neomycin allergy common (contact dermatitis); do not use >1 week

Clotrimazole 1%

  • Uses: Athlete's foot, jock itch, ringworm, yeast infections
  • Dosing: Apply twice daily for 2-4 weeks depending on condition
  • Contraindications: Hypersensitivity
  • Key Warnings: Complete full course even if symptoms resolve; nail infections require prescription therapy

OPHTHALMIC

Artificial Tears

  • Uses: Dry eyes, eye irritation
  • Dosing: 1-2 drops as needed
  • Contraindications: None significant
  • Key Warnings: Preservative-free formulations preferred for frequent use (>4 times/day)

Ketotifen (Antihistamine Eye Drops)

  • Uses: Allergic conjunctivitis
  • Dosing: 1 drop in affected eye(s) every 8-12 hours
  • Contraindications: Contact lens wear during treatment
  • Key Warnings: Remove contacts before instillation; wait 10 minutes before reinserting

SPECIAL POPULATIONS CONSIDERATIONS

Pregnancy 5, 6

  • Safe: Acetaminophen (all trimesters), diphenhydramine, famotidine
  • Second trimester only: Ibuprofen, naproxen
  • Avoid: NSAIDs (1st and 3rd trimester), aspirin (3rd trimester), decongestants (1st trimester)
  • Contraindicated: Bismuth subsalicylate

Elderly 1, 4

  • Avoid entirely: First-generation antihistamines (fall risk, cognitive impairment, anticholinergic burden)
  • Use with extreme caution: NSAIDs (GI bleeding risk 1 in 110 for >75 years)
  • Reduce doses: Pseudoephedrine (cardiovascular risk), famotidine (renal clearance)

Children

  • Avoid <2 years: Cough/cold medications, antihistamines
  • Avoid <4 years: Loperamide
  • Avoid <6 years: Aspirin (Reye's syndrome with viral illness)
  • Weight-based dosing essential: Never use adult formulations

CRITICAL DRUG INTERACTIONS

NSAIDs 4

  • Anticoagulants: 5-6× increased bleeding risk
  • Antihypertensives: Reduced efficacy (especially ACE inhibitors, diuretics)
  • Lithium: Increased lithium levels
  • Methotrexate: Increased toxicity

Antihistamines (First-Generation) 1

  • Alcohol/sedatives: Additive CNS depression
  • Anticholinergics: Additive anticholinergic effects
  • MAOIs: Prolonged anticholinergic effects

Decongestants 1

  • MAOIs: Hypertensive crisis (contraindicated within 14 days)
  • Stimulants: Additive cardiovascular effects
  • Caffeine: Increased nervousness, tachycardia

PPIs

  • Clopidogrel: Reduced antiplatelet effect (especially omeprazole)
  • Methotrexate: Increased toxicity
  • Warfarin: Increased INR

COMMON PITFALLS TO AVOID

  1. Combination products: Many contain acetaminophen—always calculate total daily dose across all products
  2. "Non-drowsy" doesn't mean safe: Second-generation antihistamines still cause sedation in 8-14% of users 1
  3. Oral phenylephrine: Likely ineffective—consider intranasal alternatives or pseudoephedrine 1
  4. NSAID duration: Never exceed 10 days for pain or 3 days for fever without medical evaluation 4
  5. PPI overuse: Not for immediate relief; requires 1-4 days for effect; long-term risks significant
  6. Elderly and antihistamines: First-generation agents are high-risk medications per Beers Criteria—avoid entirely 1
  7. Pregnancy timing matters: Ibuprofen safe in 2nd trimester only; contraindicated in 1st and 3rd 5, 6

References

1
Guideline

the diagnosis and management of rhinitis: an updated practice parameter.

Journal of Allergy and Clinical Immunology, 2008

2
Guideline

management of the acute migraine headache.

American family physician, 2002

4
Guideline

nsaid prescribing precautions.

American family physician, 2009

5
Guideline

diagnosis and management of migraine in ten steps.

Nature Reviews Neurology, 2021

6
Research

Over-the-Counter Medications in Pregnancy.

American family physician, 2014

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Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.