UW pharmacy faculty urges older adults to review over‑the‑counter meds after citing interaction and misuse risks

Michelle Chewy, a faculty member at the University of Wisconsin School of Pharmacy, told a community presentation that older adults should recheck the over‑the‑counter medications in their medicine cabinets because those products can cause harmful interactions with prescription drugs and lead to emergency care.

"They're still medicines," Chewy said. "What is familiar is not always safe." She summarized research showing that older adults typically take about three OTC products in addition to roughly three prescription drugs and said OTCs contribute substantially to adverse events and hospital visits.

Chewy gave several statistics and practical examples during the presentation. She said an estimated 2,200,000 older adults are at highest risk of an adverse drug event and that about half of those incidents involve an OTC drug interacting with prescription medication. She told the audience that misuse of ibuprofen leads to roughly 80,000 adverse events a year, most commonly gastrointestinal bleeding, ulcers and kidney problems. She also said unintentional acetaminophen (Tylenol) overdose prompts about 14,000 emergency department visits annually and is responsible for a substantial share of acute liver‑failure cases.

Chewy focused on three categories of OTCs frequently implicated in harm to older adults: nonsteroidal anti‑inflammatory drugs (ibuprofen, naproxen and aspirin), acetaminophen (Tylenol) and products containing diphenhydramine (the active ingredient in Benadryl). She warned that many OTCs are combination products with multiple active ingredients and that labeling and marketing can hide those ingredients. "You think NyQuil is one drug; it can be a combination of four or five products," she said.

She described research with a regional retail pharmacy system that has 63 stores on Wisconsin’s eastern side. In the pilot, researchers added visible signage (a green "senior safe" label on recommended products and a red "unsafe for 65+" marker on others), placed some combination products behind the counter so customers would need to speak with pharmacy staff, and trained pharmacists and technicians to prompt older customers to review their medication lists. The intervention measured four types of misuse—drug age (65+), drug–drug interactions, drug–disease contraindications and incorrect label use—and reduced misuse relative to control stores, Chewy said.

Chewy offered examples to illustrate how errors occur: a shopper who picked what she thought was a milder form of acetaminophen but instead chose an extra‑strength formulation; an older adult who bought a laxative rather than the intended stool softener because the boxes looked similar; and the frequent presence of diphenhydramine in nighttime or multi‑symptom products that do not look like the single‑ingredient Benadryl package.

She advised steps older shoppers can take: bring a current medication and supplement list to the pharmacy, ask pharmacists whether an OTC is safe with existing prescriptions, check active ingredients and avoid duplicate ingredients or "PM/extra strength" labels when possible. She also suggested practical tools—using the phone camera to magnify a product label, carrying a medication card, and asking for pharmacist time by phone if the counter is busy.

Audience members asked clarifying questions during the session. When one asked if acetaminophen and ibuprofen are the same, Chewy said no and explained they work differently and have different risk profiles for older adults. A nurse in the audience raised a point about dosing liquids and whether pharmacies provide dosing syringes; Chewy affirmed that dosing tools are part of standard counseling in some cases and recommended asking pharmacists.

Chewy closed by urging older adults to periodically review and discard expired medicines ("If it is expired by at least one year, you should pitch it. Full stop") and to find a pharmacy where staff will take time to discuss medication safety. She said most pharmacists enter the profession to help patients and that pharmacists and pharmacy technicians in the pilot responded positively to the intervention, reporting more productive conversations.

The presentation combined practical advice for individuals with results from a retail pharmacy pilot; it did not record any formal municipal actions or votes. Chewy offered to remain after the talk to answer individualized questions.