Key takeaway
The over-the-counter medicines most often misused are dextromethorphan, a cough suppressant, and loperamide, a diarrhea medicine. Misuse means a wrong dose, using a medicine for its effect, or mixing products. An overdose can slow or stop breathing. If that is happening, call 911 and bring the boxes.
Last updated: Mon Oct 05 2026 00:00:00 GMT+0000 (Coordinated Universal Time)
Someone in the house is taking cough syrup, or anti-diarrhea pills, for the feeling rather than the label. You are not sure whether this is a bad habit or an overdose.
If breathing is slow, someone will not wake, or someone is seizing, call 911. For a mental health crisis, call or text 988.
The two medicines on the sheet
Dextromethorphan and loperamide are the over-the-counter medicines most commonly misused. Dextromethorphan is a cough suppressant. At large doses it can depress breathing and sometimes cause hallucinations, panic, or a racing blood pressure. Many of those bottles also contain acetaminophen, which can damage the liver. Loperamide is a diarrhea medicine. In large amounts, and combined with other substances, it can act more like other opioids, ease withdrawal, and disturb the heartbeat.
Misuse means a dose or a purpose the package did not direct, including taking it to get high, or mixing products to make something new. A labeled dose for a cough is ordinary use.
Call, and bring the boxes
An overdose means enough of the drug for a life-threatening reaction or death. Breathing often slows or stops. Make that call. If breathing has stopped or is weak, begin CPR. Dextromethorphan overdoses can also be treated with naloxone. What naloxone does still leaves the ambulance as the next step. Loperamide can be a heart emergency at the same time. Do not stand in the bathroom deciding which bottle it was.
These medicines are often taken with alcohol or marijuana. When a second drug changes what you see, read polysubstance use. Loperamide is sometimes misused to lessen opioid withdrawal. Do not use it as a home plan. Bring the boxes, the names, and the amounts to a clinician, including prescriptions. That list is the same one in what to bring to rehab. There is no medicine approved specifically to treat addiction to either of these two. Counseling, including cognitive-behavioral therapy, may help.
Search FindTreatment.gov when the pattern is repeated use despite harm. Call or text (800) 653-9376 if you want help finding a program.
Additional Resources
Sources cited on this page:
- NIDA: Over-the-Counter Medicines DrugFacts (December 2017)
- SAMHSA FindTreatment.gov
- 988 Suicide & Crisis Lifeline
Common Questions
What counts as misuse of a nonprescription medicine?
Taking it in a way or dose other than the package directs. Taking it for the effect, for example to get high. Mixing over-the-counter medicines to create a new product. A labeled dose for a cough or for diarrhea is ordinary use. A larger dose, taken for the feeling, is misuse.
Are cough syrup and an anti-diarrhea medicine the main examples?
On NIDA's December 2017 DrugFacts sheet, yes. Dextromethorphan is a cough suppressant in many cold medicines. Loperamide is an anti-diarrhea medicine in tablet, capsule, or liquid form. Those two are the over-the-counter medicines most commonly misused. How often loperamide is misused is unclear. Other products can still harm you.
Will naloxone reverse a cough-syrup overdose?
A dextromethorphan overdose can also be treated with naloxone. The first step is still to call 911. If breathing has stopped or is weak, begin CPR. Loperamide can cause heart-rhythm problems that need other medicines and, if the heart stops, CPR and cardiac support from clinicians. Do not wait to see which bottle it was.
Can someone get addicted to these medicines?
Misuse of dextromethorphan or loperamide can lead to addiction, meaning continued use that causes health problems or failure to meet responsibilities. Withdrawal from either medicine has not been well studied. There are no medications approved specifically to treat addiction to either one. Cognitive-behavioral therapy and contingency management may help.
Why are some cold medicines behind the pharmacy counter?
Pseudoephedrine, a decongestant in many cold products, can be used to make methamphetamine, so those products are sold behind the counter nationwide. A prescription is not required in most states. Some states add a prescription rule, a monthly limit, or a rule that the buyer be 18 or older. Ask the pharmacy what your state requires.