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Over-the-counter (OTC) medicines are an easy way to self-medicate when you need fast relief from some of life’s most common health obstacles, helping you avoid a costly trip to your doctor’s office. But taking shortcuts in the OTC aisle can be a hazard to your health.

It is probably easy to think of a time when you needed a quick solution for a headache or back pain and turned to the OTC aisle for help. However, taking medicine isn’t as carefree or simple as you think. It might surprise you that one in five adults who self-medicate admit to taking more than the recommended dose of an OTC medication, and most adults read only some of the information on product labels. Rarely do they ask a pharmacist or consult their doctor for crucial information on proper use. Making common medication mistakes, especially over long periods of time, can be dangerous to your health.

These medicines are intended to provide relief from headaches, joint or muscle pain. But many people misuse these medicines by using daily or even using too frequently. Furthermore, most people don’t realize that topical pain relievers, such as menthol roll-ons, may contain some of the same active ingredients as NSAIDs, such as ibuprofen, aspirin and acetaminophen.

Some topical pain relievers contain an active ingredient, methyl salicylate (wintergreen oil) that shares the same root compound as aspirin. One teaspoon of methyl salicylate is equivalent to 21 aspirin tablets. Applying a topical pain reliever and taking an NSAID can lead to overmedication of salicylate, and lead to potentially toxic exposure.

Pain relief roll-ons or creams that boast “vanishing scents” also contain a not-so-desirable ingredient, DMDM hydration, and a formaldehyde releaser that can lead to contact allergies. For people with sensitive skin or people who are prone to allergies, these ingredients can lead to increased side effects.

It’s more ideal to look for medicines that have cleaner labels, meaning they are free from inactive ingredients with potential side effects. Genexa’s Pain Crush is a menthol-based topical pain relief roll-on made with organic and non-GMO active ingredients like organic glycerin and organic peppermint oil. It doesn’t contain any artificial dyes or preservatives and has a low-risk for allergic reactions and skin sensitivities. I’m currently serving on the medical advisory board of Genexa, a company that has figured out a way to replace these potentially toxic inactive ingredients with USDA Certified Organic, non-GMO and certified gluten-free ingredients. When it comes to my practice, the starting point to good health is to examine ways we can lower our toxicity, even when it comes to medicine, which is why I’m excited to be working with this innovative company.

Cold season presents a tricky set of challenges when it comes to treating symptoms with OTC medications. Many multi-symptom cold and flu medications contain multiple active ingredients, including acetaminophen. In fact, this pain reliever can be found in more than 600 different OTC medicines. While it can be helpful for reducing aches, pains, and fever, it also comes with increased risks of liver damage and overdose. Exceeding the maximum daily dose of 4,000 milligrams is considered an overdose and can lead to liver damage. People who take these multi-symptom medications often don’t realize that they have already taken a pain reliever and take an additional dose of acetaminophen. Or, they get confused with the “purpose” listed for the ingredient because it’s sometimes listed as a “pain reliever” or a “fever reducer.”

Furthermore, the way the ingredient is listed on the drug facts panel can also cause confusion for shoppers. You may see abbreviations like APAP, AC, or Acetam. Or, it might be listed as “paracetamol,” which is the common name for acetaminophen in other countries. I always recommend that you thoroughly review the drug facts on medicines before you administer them, and make sure to look up any ingredients you aren’t familiar with to ensure you understand the proper dosing and potential interactions. If you have questions or are confused by an ingredient or instruction, you can always call your local pharmacy to get a quick answer.

There is a reason manufacturers are required to put highly regulated directions and warnings on OTC labels. But they can often be confusing or use unfamiliar terms. Although you always want to have a clear understanding of the label, here are the most important sections you should pay attention to when choosing your pain medications:

  • Active ingredients—the therapeutic ingredient in a product, or main ingredient to treat your symptoms, and the amount of active ingredient per unit;
  • Uses—how the product should be used and which symptoms it will address;
  • Warnings—instructions to pay attention to (particularly important for sensitive populations like pregnant women and young children);
  • Directions—how the product should be administered and how often; and
  • Inactive ingredients—the other ingredients in the product that serve as fillers and binders.

Did you know that most OTC medicines contain only 10 percent of the active ingredients needed for your ailment? Nearly 90 percent of the medicine is made up of inactive ingredients, or the fillers and binders used to manufacture the medicine. While using binders and fillers is absolutely necessary, the ingredients many OTC medicines use are not. Many fillers in OTC pain medications could be harmful to your health. Some potentially inactive ingredients to look for on your medicine labels:

  • Parabens (methylparaben and propylparaben)—mimic natural hormone estrogen and is of special concern to women because estrogen can trigger and drive the growth of estrogen-positive breast tumors.
  • Artificial dyes (FD&C dyes)—have been linked with attention deficit disorder (ADD), and attention-deficit/hyperactivity disorder (ADHD), increase in allergic reactions and autoimmune disorders.
  • Phthalates—can damage the liver, kidneys, lungs and reproductive system—particularly the developing testes – and research suggests they may increase waist circumference and BMI.
  • Talc (magnesium silicate)—has been linked to stomach and lung problems.

With allergies on the rise in both children and adults, it’s more important than ever to know and understand the ingredients in your medicines. The US Centers for Disease Control and Prevention reports that the prevalence of food allergy in children increased by 50 percent between 1997 and 2011. More than 170 foods have been reported to cause allergic reactions, with gluten and lactose being some of the most common.

While many people are trying to avoid these ingredients in food and beverages, they don’t realize that some of them may be lurking in their OTC medicines as fillers and binders. A recent news report revealed that 90 percent of people who thought they were allergic to the drug penicillin weren’t actually allergic at all; they were reacting to the inactive ingredients.

People with gluten and dairy sensitivities might find they have more side effects when they take OTC medicines. To avoid this, they should be on the lookout for ingredients containing the words “starch” or “lactose.” Better yet, look for certifications such as Certified Vegan or Certified Gluten-Free, which indicate that the medication has passed rigorous tests to ensure the formula is free of these common allergens.

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  2. Ellenhorn, M. J. a. B., D.G. (1988). “Medical Toxicology, Diagnosis and Treatment of Human Poisoning.” New York, NY: Elsevier Science Publishing Co., Inc.
  4. National Library of Medicine. Pillbox: Identify or Search for a Pill. Bethesda, MD: National Library of Medicine, National Institutes of Health. November 4, 2013.
  6. Dodge, L. E., Kelley, K.E., Williams, P.L., Williams, M.A., Hernandez-Dias, S., Missmer, S.A., & Hauser, R. (2015). Medications as a Source of Paraben Exposure. Reproductive toxicology(52), 93–100.
  7. Vojdani, A., Vojdani, C. (2015). Immune Reactivity to Food Coloring. Alternative Therapies in Health & Medicine, 21(1), 52–62.
  8. Education, F. A. R. Facts and Statistics. Retrieved from

Amy Shah, MD

Amy Shah, MD, is a double board-certified medical doctor in internal medicine and allergy immunology who received her medical training from three of the top schools in the country: Cornell, Harvard, and Columbia universities. Shah is a wellness and nutrition expert who utilizes her specialized skill-set in Eastern and Western medicines to focus on hormones, allergies and gut health to help the body heal from the inside out. Shah found her medical calling after a car accident led to her belief of a strong mind-body connection and her philosophy that life is short, so live it well—an insight she shares with all her patients. Shah operates a medical practice in Arizona where she sees more than 5,000 patients each year. She helps busy professionals implement diet and lifestyle plans that work around their schedules and acts as a coach to help keep them accountable for the healthy choices they are making.

Website: and follow at: @Amyshahmd on Twitter @dramyshah on Instagram.