Acetaminophen: A Liver Risk Hiding in Plain Sight
Acetaminophen (Tylenol, Paracetamol) is the leading cause of acute liver failure in North America. The maximum daily dose is 4,000 mg, but a slight excess can be dangerous. A 2022 study published in Hepatology found that accidental overdoses account for 48% of acetaminophen-related liver injuries.
What people do wrong:
- Mixing medications unknowingly – Acetaminophen is in over 600 products, including cold and flu medications, prescription pain relievers, and even some sleep aids (National Institutes of Health).
- Ignoring alcohol warnings – Even moderate drinking triples the risk of liver damage when combined with acetaminophen.
- Taking it “just in case” – Many people take extra doses preventively, which increases toxicity risk without additional pain relief.
How to fix it:
- Check every label – do not exceed 1,000 mg per dose or 4,000 mg per day.
- If you drink alcohol regularly, reduce your maximum dose to 2,000 mg/day (American Liver Foundation).
- Use a different pain reliever if taking acetaminophen-containing multi-symptom meds.
Ibuprofen & Naproxen: Pain Relief at the Cost of Your Stomach and Heart
NSAIDs like ibuprofen (Advil, Motrin) and naproxen (Aleve) are effective but come with serious risks when misused. The American Gastroenterological Association estimates that over 100,000 hospitalizations and 16,500 deaths annually in the U.S. are linked to NSAID-related gastrointestinal bleeding.
What people do wrong:
- Taking on an empty stomach – Increases ulcer risk and reduces absorption.
- Using long-term for chronic pain – NSAIDs raise blood pressure, kidney failure risk, and stroke likelihood (American College of Cardiology, 2023).
- Combining with aspirin – Ibuprofen reduces aspirin’s heart-protective effects if taken together.
How to fix it:
- Always take NSAIDs with food or milk to protect the stomach lining.
- Limit use to 10 days for pain, 3 days for fever—longer requires doctor supervision.
- If on daily aspirin, take ibuprofen at least 8 hours before or 30 minutes after aspirin.
Pseudoephedrine: A Decongestant That Can Spike Your Blood Pressure
Pseudoephedrine (Sudafed) is a common nasal decongestant but also a stimulant. It can increase blood pressure, cause insomnia, and lead to rebound congestion if overused.
What people do wrong:
- Using it for too long – More than 3 consecutive days causes rebound congestion (rhinitis medicamentosa).
- Ignoring cardiovascular risks – Raises blood pressure and heart rate, making it unsafe for people with hypertension or heart disease.
- Taking at night – Leads to restlessness and insomnia due to stimulant effects.
How to fix it:
- Limit use to 3 days max – after that, switch to a saline spray (Mayo Clinic).
- Avoid if you have high blood pressure – use antihistamines instead for congestion relief.
- Take in the morning or early afternoon to prevent sleep disturbances.
Diphenhydramine: The “Safe” Sleep Aid That Isn’t
Diphenhydramine (Benadryl, Unisom) is widely misused as a sleep aid, despite serious drawbacks. A JAMA Internal Medicine study found that regular diphenhydramine use in older adults increased dementia risk by 54%.
What people do wrong:
- Using it nightly for sleep – Tolerance develops quickly, reducing effectiveness.
- Giving it to children for sedation – Can cause paradoxical reactions (hyperactivity instead of drowsiness).
- Long-term use in older adults – Increases cognitive decline and fall risk.
How to fix it:
- For sleep, use melatonin or cognitive behavioral therapy (CBT-I) instead.
- For allergies, switch to second-generation antihistamines like loratadine (Claritin) or fexofenadine (Allegra).
- Avoid in older adults unless prescribed for specific conditions.
Proton Pump Inhibitors (PPIs): The Heartburn Fix That Wrecks Gut Health
PPIs like omeprazole (Prilosec) and esomeprazole (Nexium) are among the most overprescribed medications. Long-term use increases fracture risk, vitamin deficiencies, and infection susceptibility.
What people do wrong:
- Taking indefinitely for mild heartburn – PPIs should only be used for 4–8 weeks unless directed by a doctor (American Gastroenterological Association).
- Stopping suddenly – Causes acid rebound, worsening symptoms.
- Using for occasional heartburn – PPIs take days to work, making them ineffective for immediate relief.
How to fix it:
- For short-term use, limit to the recommended duration (4–8 weeks max).
- To stop, taper off gradually with H2 blockers like famotidine (Pepcid).
- For occasional reflux, use antacids or H2 blockers instead.
Dextromethorphan (DXM): The Cough Suppressant That Can Harm Your Brain
Dextromethorphan (DXM), found in Robitussin and Delsym, suppresses coughing but is often overused. High doses can cause hallucinations, serotonin syndrome, and addiction.
What people do wrong:
- Taking too much – Some people take double or triple doses hoping for stronger relief.
- Mixing with antidepressants – DXM interacts with SSRIs, increasing serotonin toxicity risk.
- Using for “recreational” effects – High doses cause dissociation, hallucinations, and cognitive impairment.
How to fix it:
- Use only when necessary and never exceed recommended doses.
- If on antidepressants, avoid DXM-containing products entirely.
- For persistent cough, see a doctor rather than self-medicating for weeks.
Key Takeaway
Most OTC medication errors happen due to misunderstanding dosing, interactions, or long-term effects. Always check active ingredients, follow dosing limits, and ask a pharmacist if unsure. Small mistakes can have serious consequences – use these medications correctly, not just conveniently.