10 Over-the-Counter Medications That Can Become Risky After 50

3. Aspirin

As with ibuprofen and naproxen, regular aspirin use can increase bleeding risks — and that risk increases with age.

"A lot of people don't think of aspirin as a big serious drug because it’s not a prescription medicine,” says Hedva Barenholtz Levy, a pharmacist and specialist in pharmacotherapy and geriatrics in St. Louis.

But Levy says older adults should be careful about using aspirin properly. It’s no longer recommended that adults 60 and older take a low-dose aspirin daily to prevent a heart event, meaning if you’ve never had a heart attack or stroke, you shouldn’t take the pill to prevent one.

If you have had a heart attack or stroke or are at high risk for one, talk to your doctor to discuss the risks and benefits before starting aspirin therapy, the latest guidelines state.

4. Diphenhydramine (Benadryl)

For over-the-counter allergy medications, watch out for diphenhydramine, commonly found in Benadryl. In addition to causing drowsiness, it “can lead to confusion and decreased memory in older adults,” Levy says.

Diphenhydramine deserves special attention because it’s an ingredient in common over-the-counter sleep products like Tylenol PM and Advil PM.

Instead, choose alternatives “like Claritin, which is less likely to cause some of the side effects,” Gershman says.

5. Pseudoephedrine and phenylephrine

Decongestants containing phenylephrine or pseudoephedrine, like Sudafed, can spike blood pressure, Hester warns, which is especially risky for older adults more prone to high blood pressure.

For example, combining an NSAID and an over-the-counter decongestant could increase the risk of stroke in older adults by raising blood pressure, Hester says. Men with an enlarged prostate should avoid diphenhydramine and decongestants with phenylephrine or pseudoephedrine, as these medications can worsen urinary issues.

Given the recent news that oral phenylephrine decongestants are ineffective, consider a decongestant nasal spray like Afrin, Levy says, which is safer than oral phenylephrine or pseudoephedrine medicines. Just be sure to limit use to three days maximum to avoid rebound congestion.

6. Fluticasone (Flonase) and budesonide (Rhinocort)

Levy highlights concerns with over-the-counter steroid nasal sprays such as fluticasone propionate (Flonase) and budesonide (Rhinocort). She cautions that they can increase pressure in the eye, which can exacerbate glaucoma, a condition affecting eyesight. What’s more, people who use steroid nasal sprays may experience nosebleeds with incorrect use.

7. Omeprazole (Prilosec), esomeprazole (Nexium) and lansoprazole (Prevacid)

Popular over-the-counter medicines known as proton pump inhibitors (PPIs) — like omeprazole (Prilosec), esomeprazole (Nexium) and lansoprazole (Prevacid) — help reduce heartburn, but they require caution.

"Especially with long-term use, older individuals can experience side effects,” Gershman says. These medications reduce stomach acid, which can significantly increase the risk of bone fractures by affecting calcium absorption, she adds. Calcium is essential to maintain healthy bones.

Prolonged use of PPIs may also cause severe diarrhea, an infection of the colon by Clostridium difficile (C. diff) bacteria and pneumonia — all linked to acid suppression.  

Gershman emphasizes that PPIs are designed for short-term use. While prescription PPIs can be used a bit longer, she advises that over-the-counter PPIs are only intended for use up to two weeks. Some older adults end up taking them for years, raising potential risks of side effects.

8. Magnesium citrate, milk of magnesia

Gershman recommends older adults be careful with the over-the-counter laxative magnesium citrate. It can cause changes in electrolytes, like potassium and sodium, potentially leading to irregular heartbeat. Magnesium citrate is sometimes used for bowel preparation before colonoscopies.

Though it also contains magnesium, milk of magnesia is a “safer option” to magnesium citrate, Gershman says. However, she cautions that even milk of magnesia poses risks with long-term use. This is especially concerning for older adults as magnesium can build up to toxic levels in people whose kidneys are not functioning well.

9. Oxybutynin (Oxytrol for Women)

Over-the-counter oxybutynin (Oxytrol for Women) conveniently treats overactive bladders, although the men’s version of the medication requires a prescription. But convenience may come at a cost. Gershman explains that this medication can bring about side effects like dizziness, dry mouth and constipation — particularly concerning for older adults.

Oxybutynin belongs to a class of medications called anticholinergics, which are also linked to a higher risk of dementia among older people.

10. Dietary supplements

Regarding dietary supplements, Hester says older adults should be extra careful.

For example, St. John's wort can increase the sensitivity of your skin and eyes to sunlight; and the sedative herbs valerian and kava, found in calming teas, may affect your liver. What’s more, garlic (in supplement form), ginkgo and ginseng can increase bleeding risk, especially for people who take blood-thinning medications, Gershman says.

Also: Beware of taking too many fat-soluble vitamins, Hester warns. Unlike water-soluble vitamins that get flushed out of the body through urine, fat-soluble types — like vitamins A, D, E and K — are stored in the body. Taking excessive amounts of these can become risky.