Over-the-Counter Medications to Avoid: Waste of Money or Actually Helpful?
I often tell my friends and family, “That medication actually doesn’t work. Don’t buy it.”
The reasons these medications remain on the shelves vary. Some are still available largely because they have been there historically. Others may once have had some supporting evidence, but later data disproved their benefit.
So this week, I decided to look into the evidence behind over-the-counter (OTC) medications: what works, what does not, and what should be avoided.
Cough and Cold Medications: What Doesn’t Work and What to Use Instead
Cough and cold medications generate $10-12 billion per year in the US,1 but many are ineffective.
Phenylephrine for Congestion: Not Effective
A 2007 meta-analysis revealed that 10 mg of phenylephrine did not reduce nasal airway congestion more than placebo.2
Another study in 2009 compared the effectiveness of phenylephrine and pseudoephedrine versus placebo in relieving nasal congestion. After a 6-hour period, phenylephrine did not improve symptoms.3
In 2015, a citizen’s petition to remove phenylephrine from the OTC nasal decongestant monograph was filed, but the FDA did not remove it.4
Guaifenesin (Mucinex): Limited Evidence for Cough Relief
Guaifenesin is the main ingredient in Mucinex, Robitussin, and several other OTC cough medications. The theory is that guaifenesin hydrates mucus and improves its clearance during coughing.5 However, there is minimal evidence to support its use.4
A 2014 randomized controlled trial found that guaifenesin had no effect on mucus volume or properties.6 A 2015 study confirmed these results.7
Oxymetazoline (Afrin): Effective but Not for Long-Term Use
This one is a bit different. Oxymetazoline, also known as Afrin, is actually quite effective at reducing nasal congestion by temporarily narrowing the blood vessels in the nasal cavity.
However, it should not be used for more than three days. Beyond that, rhinitis medicamentosa (RM) can develop. RM is characterized by chronic nasal congestion, rebound swelling, and tolerance development.8 Chronic use of oxymetazoline can lead to significant tissue damage within the nasal passages.9
For nasal congestion, pseudoephedrine3 and nasal saline8 are evidence-backed alternatives. Honey is also a proven treatment for cough, especially in pediatric patients older than 1 year of age.10
Constipation Medications: Docusate (Colace) Is Not Effective
Docusate sodium is the generic term for Colace, and it doesn’t work.
A 2000 systematic review demonstrated that docusate is no more effective than placebo in preventing or treating constipation.11 A 2015 Cochrane review confirmed these findings.12
A follow-up systematic review found that polyethylene glycol and senna are reliable first-line OTC options that can treat constipation. Magnesium-containing products are also effective.13
Eye and Ear Medications: What to Avoid
Tetrahydrozoline (Visine): Short-Term Relief with Downsides
Tetrahydrozoline, also known as Visine, is not recommended. While it does reduce redness by temporarily narrowing the blood vessels in the conjunctiva, the medication loses its effectiveness with repeated use, leading to rebound eye redness. It also reduces tear production, causes dry eye, and can cause inflammation of the surface of the eye.14
What most people don’t know about this medication is that it is toxic to children. Accidental ingestions can cause CNS depression, a dangerously slow heart rate, low body temperature, and low blood pressure, leading to intensive care admissions.15
For allergic red eye, antihistamine drops reduce redness effectively and have a more favorable safety profile.16 For redness without allergy, preservative-free lubricating artificial tears are recommended as first-line therapy.17
Carbamide Peroxide (Debrox): Effective but Overpriced
Earwax can be a nuisance. It can cause reversible hearing loss, ringing in the ear, itchiness, and can exacerbate cognitive impairment in elderly patients.18
Carbamide peroxide (brand name Debrox) is an effective medication to remove earwax. It costs about $10 for 0.5 ounces.
Guess what else removes earwax just as effectively? Hydrogen peroxide,19 which is about $1 for 32 ounces, and irrigation with tap water,20 which is free.
So while this medication is neither ineffective nor dangerous, it is overpriced marketing nonsense.
Allergy Medications: Benadryl Is No Longer First-Line
Diphenhydramine (Benadryl) is a first-generation antihistamine that is effective in treating allergic reactions.
What most people don’t know is that it is no longer recommended as a first-line therapy for allergic conditions. The American Academy of Allergy, Asthma, and Immunology issued a strong recommendation against the use of first-generation antihistamines when treating allergic conditions.21
This is because of the adverse effects. Diphenhydramine crosses the blood-brain barrier and causes sedation. It also has anticholinergic properties, making overdose a concern.
Second-generation antihistamines, such as cetirizine (Zyrtec), fexofenadine (Allegra), and loratadine (Claritin), are chemically modified to limit transfer across the blood-brain barrier.22 They also have a longer duration of action, allowing for once-daily dosing, and can be safely dosed more frequently if needed.23
Skin and Wound Care: Common OTC Products to Rethink
Neomycin (Neosporin): Risk of Allergic Reactions
Neomycin is one of the ingredients in triple antibiotic ointment (Neosporin) which has fallen out of favor because of contact allergic reactions occurring in about 3% of adults and 4% of children.24
The FDA acknowledged this and warned that chronic skin conditions are particularly prone to sensitization.25
A better OTC option for simple skin wounds is bacitracin, as it causes less contact dermatitis and can effectively treat skin infections.26 However, it is not effective against MRSA infections or impetigo. Mupirocin is the preferred topical antibiotic and is available by prescription.
Topical Diphenhydramine: Not Effective for Itching
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Overpriced OTC Medications: Acetaminophen Formulations
Acetaminophen is both safe and effective, but not all pediatric formulations are priced equally.
Both contain 160 mg of acetaminophen per 5 mL of liquid medication. However, children’s acetaminophen costs around $7-$10 for 4 ounces, while infant acetaminophen costs around $12-$15 for 2 ounces.
It is the exact same medication. The only difference is that the infant packaging comes with a syringe and the other with a medication cup.
My pediatrician gave me a syringe for my kids. Otherwise, they are about $2 to purchase.
Acetaminophen is safe and effective, but don’t waste your money on the infant formulation.
Summary Evidence-Based OTC Alternatives
What’s Out | What’s In |
Phenylephrine | Pseudoephedrine |
Cough Medication | Honey |
Oxymetazoline (Afrin) | Nasal saline |
Docusate (Colace) | Polyethylene glycol, Senna |
Tetrahydrozoline (Visine) | Antihistamine drops, Preservative-free artificial tears |
Carbamide peroxide (Debrox) | Hydrogen peroxide, Water |
Diphenhydramine (Benadryl) | Cetirizine (Zyrtec), Fexofenadine (Allegra), Loratadine (Claritin) |
Triple antibiotic ointment | Bacitracin, Mupirocin |
Topical diphenhydramine | Topical hydrocortisone |
Bottom Line
This is not an all-inclusive list. For example, I did not cover several supplements that market themselves as immune boosters or detoxifiers, such as activated charcoal, because I had to draw a line somewhere. Otherwise, this would be 10 pages long. We can save that for another post.
But this list is still pretty telling. Some of these medications have little to no evidence to support their use, while others have some evidence behind them but are simply not the best option available.
We are spending money on these products at the pharmacy and assuming we are making informed choices. However, the evidence does not support many of them.
Hopefully, you now have the knowledge you need to make better decisions the next time you are standing in that pharmacy aisle.
And as always, please discuss any health decisions with your own healthcare team.
Disclaimer: Even though I’m a doctor, I’m not your doctor—and reading this blog does not establish a doctor–patient relationship. This information is intended for general educational purposes only and should not be taken as personalized medical advice. Always speak with your own healthcare provider before making decisions about your health.
References
- IBISWorld. OTC Cough & Cold Medicine Manufacturing in the US. Accessed March 15, 2026. https://www.ibisworld.com/united-states/industry/otc-cough-cold-medicine-manufacturing/4117/#Faq
- Hatton RC, Winterstein AG, McKelvey RP, Shuster J, Hendeles L. Efficacy and safety of oral phenylephrine: systematic review and meta-analysis. Ann Pharmacother. Mar 2007;41(3):381-90. doi:10.1345/aph.1H679
- Horak F, Zieglmayer P, Zieglmayer R, et al. A placebo-controlled study of the nasal decongestant effect of phenylephrine and pseudoephedrine in the Vienna Challenge Chamber. Ann Allergy Asthma Immunol. Feb 2009;102(2):116-20. doi:10.1016/s1081-1206(10)60240-2
- Hatton RC, Hendeles L. Why Is Oral Phenylephrine on the Market After Compelling Evidence of Its Ineffectiveness as a Decongestant? Ann Pharmacother. Mar 25 2022:10600280221081526. doi:10.1177/10600280221081526
- McGarvey L, Rubin BK, Ebihara S, et al. Global Physiology and Pathophysiology of Cough: Part 2. Demographic and Clinical Considerations: CHEST Expert Panel Report. Chest. Oct 2021;160(4):1413-1423. doi:10.1016/j.chest.2021.04.039
- Hoffer-Schaefer A, Rozycki HJ, Yopp MA, Rubin BK. Guaifenesin has no effect on sputum volume or sputum properties in adolescents and adults with acute respiratory tract infections. Respir Care. May 2014;59(5):631-6. doi:10.4187/respcare.02640
- Bennett WD, Kala A, Duckworth H, et al. Effect of a single 1200 Mg dose of Mucinex® on mucociliary and cough clearance during an acute respiratory tract infection. Respir Med. Nov 2015;109(11):1476-83. doi:10.1016/j.rmed.2015.09.017
- Zucker SM, Barton BM, McCoul ED. Management of Rhinitis Medicamentosa: A Systematic Review. Otolaryngol Head Neck Surg. Mar 2019;160(3):429-438. doi:10.1177/0194599818807891
- Lanier B, Kai G, Marple B, Wall GM. Pathophysiology and progression of nasal septal perforation. Ann Allergy Asthma Immunol. Dec 2007;99(6):473-9; quiz 480-1, 521. doi:10.1016/s1081-1206(10)60373-0
- Oduwole O, Udoh EE, Oyo-Ita A, Meremikwu MM. Honey for acute cough in children. Cochrane Database Syst Rev. Apr 10 2018;4(4):Cd007094. doi:10.1002/14651858.CD007094.pub5
- Hurdon V, Viola R, Schroder C. How useful is docusate in patients at risk for constipation? A systematic review of the evidence in the chronically ill. J Pain Symptom Manage. Feb 2000;19(2):130-6. doi:10.1016/s0885-3924(99)00157-8
- Candy B, Jones L, Larkin PJ, Vickerstaff V, Tookman A, Stone P. Laxatives for the management of constipation in people receiving palliative care. Cochrane Database Syst Rev. May 13 2015;2015(5):Cd003448. doi:10.1002/14651858.CD003448.pub4
- Rao SSC, Brenner DM. Efficacy and Safety of Over-the-Counter Therapies for Chronic Constipation: An Updated Systematic Review. Am J Gastroenterol. Jun 1 2021;116(6):1156-1181. doi:10.14309/ajg.0000000000001222
- Mantelli F, Tranchina L, Lambiase A, Bonini S. Ocular surface damage by ophthalmic compounds. Curr Opin Allergy Clin Immunol. Oct 2011;11(5):464-70. doi:10.1097/ACI.0b013e32834a95c9
- Lowry JA, Garg U. Serum concentrations in three children with unintentional tetrahydrozoline overdose. Clin Toxicol (Phila). Jun 2011;49(5):434-5. doi:10.3109/15563650.2011.586639
- Castillo M, Scott NW, Mustafa MZ, Mustafa MS, Azuara-Blanco A. Topical antihistamines and mast cell stabilisers for treating seasonal and perennial allergic conjunctivitis. Cochrane Database Syst Rev. Jun 1 2015;2015(6):Cd009566. doi:10.1002/14651858.CD009566.pub2
- Winters S, Frazier W, Winters J. Conjunctivitis: diagnosis and management. American Family Physician. 2024;110(2):134-144.
- Schwartz SR, Magit AE, Rosenfeld RM, et al. Clinical Practice Guideline (Update): Earwax (Cerumen Impaction). Otolaryngology–Head and Neck Surgery. 2017;156(1_suppl):S1-S29. doi:10.1177/0194599816671491
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- Aaron K, Cooper TE, Warner L, Burton MJ. Ear drops for the removal of ear wax. Cochrane Database Syst Rev. Jul 25 2018;7(7):Cd012171. doi:10.1002/14651858.CD012171.pub2
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- Bernstein JA, Lang DM, Khan DA, et al. The diagnosis and management of acute and chronic urticaria: 2014 update. Journal of Allergy and Clinical Immunology. 2014;133(5):1270-1277. e66.
- Kolkhir P, Bonnekoh H, Metz M, Maurer M. Chronic Spontaneous Urticaria: A Review. JAMA. 2024;332(17):1464-1477. doi:10.1001/jama.2024.15568
- Jensen MB, Isufi D, Larsen CK, Schwensen JFB, Alinaghi F, Johansen JD. Prevalence of Contact Allergy to Neomycin in Dermatitis Patients: A Systematic Review and Meta-Analysis. Contact Dermatitis. Jul 2025;93(1):1-15. doi:10.1111/cod.14784
- National Library of Medicine (U.S.). Neomycin and polymyxin B sulfates and hydrocortisone otic solution, USP. National Library of Medicine (NIH). Updated November 7 2025. Accessed March 18, 2026. https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=6fff6c70-ea1f-449c-be0c-b989de36bd67
- Dire DJ, Coppola M, Dwyer DA, Lorette JJ, Karr JL. Prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED. Acad Emerg Med. Jan 1995;2(1):4-10. doi:10.1111/j.1553-2712.1995.tb03070.x
- Eschler DC, Klein PA. An evidence-based review of the efficacy of topical antihistamines in the relief of pruritus. J Drugs Dermatol. Aug 2010;9(8):992-7.
- Rupert J, Honeycutt JD. Pruritus: diagnosis and management. American Family Physician. 2022;105(1):55-64.