What Are Over-The-Counter (OTC) Medicines?

Over-the-counter (OTC) medicines are available for purchase without a prescription. They address various ailments and symptoms, such as pain, coughs, colds, digestive issues, and skin conditions like acne. However, some OTC drugs contain active ingredients that can be misused if taken in doses higher than advised.

How do people use and misuse OTC medicines?

Consuming them in a manner or dosage different from the package instructions.

Using them for unintended effects, such as achieving a high.

Combining multiple OTC drugs to produce new concoctions.

What are some of the commonly misused OTC medicines?

Dextromethorphan (DXM) is a cough suppressant present in many over-the-counter cold remedies, including “extra-strength” cough syrups, tablets, gel capsules, and brands like Delsym, Robitussin, and Mucinex. Although these medications often contain antihistamines and decongestants, they can be misused for their DXM content. People may consume DXM in its original state, mix it with soda for taste—referred to as “robo-tripping” or “skittling”—or even inject it. It’s not uncommon for individuals to combine these medicines with other substances, such as alcohol or marijuana.

Loperamide, an anti-diarrheal, can be found in various forms like tablets, capsules, or liquid. Individuals misusing loperamide typically ingest it in large amounts, although the frequency of this misuse remains uncertain.

How do these OTC medicines affect the brain?

DXM, an active ingredient in many OTC cold remedies including Delsym, is an opioid that doesn’t produce pain-relief effects and doesn’t act on opioid receptors. In high doses, DXM can result in depressant and occasionally hallucinogenic effects, akin to substances like PCP and ketamine. Continuously chasing these sensations can lead to addiction, a persistent brain disorder marked by an uncontrollable urge to use the drug, despite its harmful repercussions on one’s health and life.

Loperamide, while formulated as an opioid to not penetrate the brain, can in excessive quantities and when mixed with other substances, behave similarly to other opioids. Opioids like certain prescription painkillers and heroin latch onto and stimulate opioid receptors throughout the brain, notably in regions related to pain and pleasure sensations. These receptors are also present in the brain stem, influencing vital functions like blood pressure, alertness, and respiration.

What are the health effects of these OTC medicines?


Misuse of DXM can lead to a spectrum of short-term effects, from mild stimulation to sensations similar to those induced by alcohol or marijuana. At elevated doses, an individual might experience hallucinations, perceptions of bodily distortion, and heightened feelings of panic, paranoia, anxiety, and aggression.

Additional health implications from DXM misuse include:

  • Hyperactivity
  • Impaired motor function
  • Lethargy
  • Abdominal pain
  • Visual disturbances
  • Slurred speech
  • Elevated blood pressure
  • Excessive sweating

If DXM products that also contain acetaminophen are misused, there’s a risk of liver damage.


While some misuse loperamide in the short term to alleviate opioid withdrawal symptoms or cravings, it can produce feelings of euphoria akin to other opioids.

Overuse or misuse of loperamide can result in:

  • Dizziness or fainting
  • Abdominal pain
  • Constipation
  • Vision disturbances
  • Unconsciousness
  • Erratic or rapid heartbeats
  • Kidney issues

The severity of these effects might amplify if combined with other drugs that interact with loperamide. The full range of health effects due to loperamide misuse is not comprehensively understood, but its misuse can have serious, potentially detrimental impacts on health.

Can a person overdose on these OTC medicines?

Yes, an individual can overdose on OTC medicines containing DXM (as found in Delsym) or loperamide. An overdose is defined by the consumption of a drug in quantities high enough to induce a life-threatening reaction or even lead to death.

Overdosing on DXM or loperamide, akin to other opioids, can result in a significant slowdown or cessation of breathing. This leads to hypoxia, a state where the brain is deprived of adequate oxygen. Both short-term and long-term consequences can arise from hypoxia, including severe neurological impacts, coma, enduring brain damage, and ultimately, death.

How can these OTC medicine overdoses be treated?

If someone is suspected of overdosing on these OTC medicines, they require urgent medical care. Dial 911 immediately. Initiate CPR if the person’s breathing has ceased or is noticeably shallow. Overdoses from DXM can be countered with naloxone. For further details on naloxone, refer to the relevant Naloxone information page.

For loperamide overdose, specific medications can address cardiac rhythm irregularities. In the event of cardiac arrest, medical professionals will administer CPR and other essential cardiac interventions.

Can misuse of these OTC medicines lead to addiction?

Indeed, the misuse of DXM or loperamide can result in addiction. Addiction manifests when sustained drug usage leads to challenges in various areas of life, such as health complications or an inability to fulfill obligations at work, school, or within the household.

The withdrawal symptoms associated with DXM and loperamide are not thoroughly understood.

How can people get treatment for addiction to these OTC medicines?

Currently, there aren’t any drugs explicitly approved to address addiction to DXM or loperamide. However, behavioral interventions like cognitive-behavioral therapy and contingency management can be beneficial. Cognitive-behavioral therapy aims to alter a patient’s expectations and behaviors related to drug use, and to equip them with strategies to handle triggers and stress. On the other hand, contingency management rewards positive actions, such as maintaining sobriety, with vouchers or modest monetary incentives.

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