These educational materials provide information on using over-the-counter (OTC) medicine, including the safe use of daily aspirin therapy, tips for parents, and the safe use of OTC pain relievers and fever reducers.
Today’s medicine cabinets contain a growing choice of over-the-counter, OTC, medicines to treat a growing number of health problems. Common OTC medicines include pain relievers, laxatives, cough and cold products, and antacids. Some OTC medicines however, can affect the way prescription medicines work or are used by the body.
Acetaminophen is an active ingredient in many over-the-counter and prescription medicines that help relieve pain and reduce fever.
More than 600 over-the-counter and prescription medicines contain acetaminophen. Some medicines combine acetaminophen with other active ingredients to treat pain, symptoms of colds, flu, allergy, and sleeplessness. To find out if an over-the-counter medicine contains acetaminophen, look for “acetaminophen” on the Drug Facts label. If a prescription medicine contains acetaminophen, the label may not spell out the whole word or may have the abbreviation “APAP.”
Severe liver damage may occur and may lead to death if you take:
more acetaminophen than directed
more than one medicine containing acetaminophen
acetaminophen while drinking 3 or more alcoholic drinks every day
Most healthy people can take acetaminophen safely by:
• not using more than one medicine containing acetaminophen in a day
• reading and following all the information on the medicine label, or the information given by your doctor
Ask your doctor before using acetaminophen if you:
• have liver disease
• are taking the blood thinning drug warfarin (also known by the brand name Coumadin)
To take acetaminophen safely, make sure you understand:
• how much you can take at one time (dose)
• how many hours you must wait before taking another dose
• how many times you can take it each day
• when you should not take it and talk to your doctor
If you take too much acetaminophen you might have liver damage and not know it. Symptoms may not appear for days and early symptoms may seem like the flu, like loss of appetite, nausea, vomiting, and yellowing of the skin and eyes (jaundice).
The Drug Facts label on medication products, helps choose aspirin for relieving headache, pain, swelling, or fever. The Drug Facts label also gives directions on how to use the aspirin so that it is safe and effective.
Aspirin has been shown to be helpful when used daily to lower the risk of heart attack, clot-related strokes and other blood flow problems in patients who have cardiovascular disease or who have already had a heart attack or stroke. Many medical professionals prescribe aspirin for these uses. There may be a benefit to daily aspirin use if the patient has some kind of heart or blood vessel disease, or evidence of poor blood flow to the brain. However, the risks of long-term aspirin use may be greater than the benefits if there are no signs of, or risk factors for heart or blood vessel disease.
Every prescription and over-the-counter medicine has benefits and risks — even such a common and familiar medicine as aspirin. Aspirin use can result in serious side effects, such as stomach bleeding, bleeding in the brain, kidney failure, and some kinds of strokes. No medicine is completely safe.
Before deciding for a daily aspirin use, the health professional will need to consider:
• The medical history and the history of patient’s family members
• The use of other medicines, including prescription and over-the-counter
• The use of other products, such as dietary supplements, including vitamins and herbals
• Patient’s allergies or sensitivities, and anything that affects the ability to use the medicine
• The benefits from the use of the medicine
• Other options and their risks and benefits
• What side effects the patient may experience
• What is the best dose
• How to know when the medicine is working or not working for this use
There are no directions on the label for using aspirin to reduce the risk of heart attack or clot-related stroke.
Benzocaine is a local anesthetic contained in some OTC products for the temporary relief of pain due to minor irritation, soreness, or injury of the mouth and throat. Benzocaine products are marketed as gels, sprays, ointments, solutions, and lozenges under brand names such as Anbesol, Orabase, Orajel, Baby Orajel, Hurricaine, and Topex, as well as store brands and generics. Prescription local anesthetics include articaine, bupivacaine, chloroprocaine, lidocaine, mepivacaine, prilocaine, ropivacaine, and tetracaine.
The FDA is warning that over-the-counter (OTC) oral drug products containing benzocaine should not be used to treat infants and children younger than 2 years. FDA is also warning that benzocaine oral drug products should only be used in adults and children 2 years and older if they contain certain warnings on the drug label. These products carry serious risks and provide little to no benefits for treating oral pain, including sore gums in infants due to teething. Benzocaine can cause a condition in which the amount of oxygen carried through the blood is greatly reduced. This condition, called methemoglobinemia, can be life-threatening and result in death. Due to the significant safety risk of methemoglobinemia, FDA has urged manufacturers that they should stop marketing OTC oral drug products for treating teething in infants and children younger than 2 years.
The U.S. Food and Drug Administration (FDA) is alerting the public that certain over-the-counter (OTC) products that are applied to the skin for the relief of mild muscle and joint pain have been reported to cause rare cases of serious skin injuries, ranging from first- to third-degree chemical burns, where the products were applied. These OTC topical muscle and joint pain relievers are available as single- or combination-ingredient products that contain menthol, methyl salicylate, or capsaicin. The various formulations include creams, lotions, ointments, and patches.
When applied to the skin, the products produce a local sensation of warmth or coolness; they should not cause pain or skin damage. However, there have been rare cases of serious burns following their use. Some of the burns had serious complications requiring hospitalization. In many cases, the burns occurred after only one application of the OTC topical muscle and joint pain reliever, with severe burning or blistering occurring within 24 hours of the first application. Based on the reported cases, the majority of second- and third-degree burns occurred with the use of products containing menthol as the single active ingredient, and products containing both menthol and methyl salicylate, in concentrations greater than 3% menthol and 10% methyl salicylate. Few cases reported using a capsaicin-containing product.
Consumers using an OTC topical muscle and joint pain reliever who experience signs of skin injury where the product was applied, such as pain, swelling, or blistering of the skin, should stop using the product and seek medical attention immediately.
Many OTC acne products are available to treat mild to moderate acne or periodic breakouts. They include cleansing lotions, gels, foams, leave-on products, and treatments or kits. The Food and Drug Administration warns that some popular OTC acne products can cause a serious reaction, including throat tightness and swelling of the face, lips or tongue. This type of reaction is quite rare, so don’t confuse it with the redness, irritation or itchiness that may occur where you’ve applied such products.
Acne products work in different ways, depending on their active ingredients. Some OTC acne products work by killing the bacteria that cause acne inflammation. Others remove excess oil from the skin or speed up the growth of new skin cells and the removal of dead skin cells.
Active ingredients in acne products include:
Benzoyl peroxide. This ingredient kills the bacteria that cause acne, helps remove excess oil from the skin and removes dead skin cells, which can clog pores. OTC benzoyl peroxide products are available in strengths from 2.5 to 10 percent. Possible side effects include dry skin, scaling, redness, burning and stinging, especially if you have sensitive skin.
Salicylic acid. This ingredient helps prevent pores from becoming plugged. OTC salicylic acid products are available in strengths from 0.5 to 5 percent. Possible side effects include mild stinging and skin irritation.
Alpha hydroxy acids. Two types of alpha hydroxy acids that are used in nonprescription acne products are glycolic acid and lactic acid. Alpha hydroxy acids are synthetic versions of acids derived from sugar-containing fruits. They treat acne by helping to remove dead skin cells and reduce inflammation. Alpha hydroxy acids also stimulate the growth of new, smoother skin. This helps improve the appearance of acne scars and gives the impression of smaller pores.
Sulfur. Sulfur removes dead skin cells that clog pores and helps remove excess oil. It’s often combined with other ingredients, such as salicylic acid, benzoyl peroxide or resorcinol. Products containing sulfur may cause dry skin.
Over-the-counter consumer antiseptics can generally be broken down into two groups: washes and rubs.
Antiseptic wash products, also known as antibacterial soaps, are intended for use with water and are rinsed off after use, and include hand washes /soaps and body washes.
FDA supports the CDC’s recommendation to use plain soap and water for washing the hands. When water is not readily available, a hand sanitizer may be a suitable alternative.
Rubs are leave-on products, or hand “sanitizers,” as well as antiseptic wipes. These products are intended to be used when soap and water are not available, and are left on and not rinsed off with water.
Health care antiseptics differ from consumer antiseptics in the following ways:
• They are primarily used by health care professionals in hospitals, clinics, doctors’ offices, outpatient settings and nursing homes.
• Health care antiseptics are not only used to protect the user but also to protect the patient, whereas consumer antiseptics are generally applied to protect the user.
• Health care antiseptics are often used more frequently by health care workers than consumers use consumer antiseptics.
Consumer antiseptics differ from healthcare antiseptics in the following ways:
• Consumer antiseptics are primarily used in the home, schools, daycares or other public settings.
• Most consumer antiseptics are sold in retail establishments like drug stores and grocery stores.
FDA compares the risks and the benefits for active ingredients under specified conditions of their use to help determine whether that active ingredient is generally recognized as safe and effective (GRASE). Since FDA’s 1994 evaluation of OTC antiseptics, many things have changed, including the frequency of use of some products, new technology that can detect low levels of antiseptics in the body, FDA’s safety standards, and scientific knowledge about the impact of widespread use. FDA’s current effort is designed to ensure that the safety and effectiveness evaluations and determinations for active ingredients used in antiseptics are consistent, up-to-date, and appropriately reflect current scientific knowledge and increasing use patterns.
Although dietary supplements are regulated by the FDA as foods, they are regulated differently from other foods and from drugs. Whether a product is classified as a dietary supplement, conventional food, or drug is based on its intended use. Most often, classification as a dietary supplement is determined by the information that the manufacturer provides on the product label or in accompanying literature, although many food and dietary supplement product labels do not include this information.
The label of a dietary supplement or food product may contain one of three types of claims: a health claim, nutrient content claim, or structure/function claim. Health claims describe a relationship between a food, food component, or dietary supplement ingredient, and reducing risk of a disease or health-related condition. Nutrient content claims describe the relative amount of a nutrient or dietary substance in a product. A structure/function claim is a statement describing how a product may affect the organs or systems of the body and it cannot mention any specific disease. Structure/function claims do not require FDA approval but the manufacturer must provide FDA with the text of the claim within 30 days of putting the product on the market. Product labels containing such claims must also include a disclaimer that reads, “This statement has not been evaluated by the FDA. This product is not intended to diagnose, treat, cure, or prevent any disease.”
Today’s dietary supplements are not only vitamins and minerals. They also include other less-familiar substances, such as herbals, botanicals, amino acids, enzymes, and animal extracts. Some supplements may be beneficial, in other instances, they may be risky. Dietary supplements cannot replace a healthy diet. However, the right supplement may be useful.
Vitamins and Minerals
Adults older than age 50
As we get older, especially if we have reached age 65, the body may not be able to absorb calcium and vitamins B-12 and D like it used to. In addition, there’s evidence that a multivitamin may improve the immune function and decrease your risk of some infections.
The best course of action is to adopt healthy eating habits. Taking a multivitamin-mineral supplement also may be reasonable. Likewise, if we don’t eat two to three servings of fish each week, some experts recommend using a fish oil supplement.
Special dietary needs
If the diet is limited because of food allergies or health conditions, a vitamin-mineral supplement may be of benefit. A vegetarian who eats no animal products, may need vitamin B-12. For persons who don’t eat dairy products and don’t get 15 minutes of sun on their skin two to three times a week, they may need to add calcium and vitamin D supplements to their diet.
Women who are past menopause
Some women can find it difficult to obtain the recommended amounts of calcium and vitamin D without supplementation. As we age, bone loss accelerates and calcium needs increase. At the same time, the body’s ability to absorb calcium and process vitamin D decreases. Both calcium and vitamin D supplements have been shown to help protect against bone loss.
Some health conditions and treatments make it difficult to digest or absorb nutrients. Examples include diseases of the liver, gallbladder, intestine, pancreas or kidney, or a surgery on the digestive tract. In such cases, the doctor may recommend a vitamin or mineral supplement.
Taking other medications
Antacids, antibiotics, laxatives, diuretics or other medications can interfere with the body uses of nutrients. It’s important to talk with the health care provider before starting a dietary supplement.
Dietary supplements promoted for weight loss encompass a wide variety of products and come in a variety of forms, including capsules, tablets, liquids, powders, and bars. Manufacturers market these products with various claims, including that these products reduce macronutrient absorption, appetite, body fat, and weight and increase metabolism and thermogenesis. Weight-loss products can contain dozens of ingredients, and some contain more than 90. Common ingredients in these supplements include botanicals (herbs and other plant components), dietary fiber, caffeine, and minerals.
African Mango [Irvingia gabonensis]
African mango, or Irvingia gabonensis, is a fruit-bearing tree that is native to western and central Africa. Irvingia gabonensis seed kernel extract has been proposed to promote weight loss by inhibiting adipogenesis, as demonstrated in vitro. In addition, a proprietary extract of Irvingia gabonensis, IGOB131®, reduces serum levels of leptin, a hormone that is positively correlated with body weight and percentage body fat. IGOB131® might also reduce total cholesterol and low-density lipoprotein (LDL) levels.
Beta-glucans are glucose polysaccharides found in bacteria, yeasts, fungi, and cereal grains (such as oats and barley). As soluble dietary fibers, beta-glucans are proposed to increase satiety and gastrointestinal transit time and to slow glucose absorption. Consumption of beta-glucans from barley has been shown to reduce energy intake and appetite in humans.
Bitter Orange [Citrus aurantium L]
Bitter orange is the common name for the botanical Citrus aurantium. The fruit of this plant is a source of p-synephrine (often referred to simply as “synephrine”) and other protoalkaloids. As alpha-adrenergic agonists, synephrine alkaloids can mimic the action of epinephrine and norepinephrine. However, the extent to which bitter orange and synephrine cause similar cardiovascular and central-nervous-system effects to epinephrine and norepinephrine (e.g., increased heart rate and blood pressure) is not clear.
Caffeine, Including Caffeine from Guarana, Kola Nut, Yerba Maté, or Other Herbs
Many dietary supplements promoted for weight loss contain added caffeine or an herbal source—such as guarana (Paullinia cupana), kola (or cola) nut (Cola nitida), and yerba maté (Ilex paraguariensis)—that naturally contains caffeine. Green tea and other forms of tea also contain caffeine. Some weight-loss supplement labels do not declare the amount of caffeine in the product and only list the herbal ingredients. As a result, consumers might not be aware that the presence of certain herbs means that a product contains caffeine and possibly other stimulants.
Caffeine is a methylxanthine that stimulates the central nervous system, heart, and skeletal muscles. It also increases gastric and colonic activity and acts as a diuretic. Caffeine might contribute to weight loss by increasing fat oxidation through sympathetic activation of the central nervous system and by increasing fluid loss.
Capsaicin and Other Capsaicinoids
Capsaicinoids give chili peppers their characteristic pungent flavor. Capsaicin is the most abundant and well-studied capsaicinoid. Capsaicin and other capsaicinoids have been proposed to have anti-obesity effects via their ability to increase energy expenditure and lipid oxidation, attenuate postprandial insulin response, increase satiety, and reduce appetite and energy intake. Other research suggests that capsaicin increases satiety by inducing gastrointestinal distress (e.g., pain, burning sensation, nausea, and bloating, which could all reduce the desire to eat) rather than by releasing satiety hormones.
Chitosan is a manufactured polysaccharide that is commercially prepared from the exoskeletons of crustaceans. It is purported to promote weight loss by binding to some dietary fat in the digestive tract, preventing its absorption. Chitosan might also decrease cholesterol absorption.
Forskolin is a compound isolated from the roots of Coleus forskohlii, a plant that grows in subtropical areas, such as India and Thailand. Forskolin is purported to promote weight loss by enhancing lipolysis and reducing appetite, possibly by stimulating cyclic adenosine monophosphate (cAMP) production. This increased cAMP production, in turn, is thought to activate lipase and promote the release of fatty acids from adipose tissue.
Fucoxanthin is a carotenoid in brown seaweed and other algae. Results from laboratory and animal studies suggest that fucoxanthin might promote weight loss by increasing resting energy expenditure and fatty acid oxidation as well as by suppressing adipocyte differentiation and lipid accumulation.
Garcinia cambogia is a fruit-bearing tree that grows throughout Asia, Africa, and the Polynesian islands. The pulp and rind of its fruit contain high amounts of hydroxycitric acid (HCA), a compound that has been proposed to inhibit lipogenesis, increase hepatic glycogen synthesis, suppress food intake, and reduce weight gain.
Glucomannan is a soluble dietary fiber derived from konjac root (Amorphophallus konjac) that can absorb up to 50 times its weight in water. Like guar gum, glucomannan has been proposed to increase feelings of satiety and fullness and prolong gastric emptying by absorbing water in the gastrointestinal tract. It might also reduce fat and protein absorption in the gut.
Green Coffee Bean Extract (Coffea arabica, Coffea canephora, Coffea robusta)
Green coffee extract, probably because of its chlorogenic acid content, inhibits fat accumulation in mice and humans by regulating adipogenesis. Green coffee extract also modulates glucose metabolism, perhaps by reducing glucose absorption in the gut. Green coffee beans contain caffeine, although decaffeinated forms are available.
Green Tea (Camellia sinensis) and Green Tea Extract
Green tea (Camellia sinensis) is a popular beverage consumed worldwide that has several purported health benefits. Green tea is present in some dietary supplements, frequently in the form of green tea extract. The active components of green tea that are associated with weight loss are caffeine and catechins, primarily epigallocatechin gallate (EGCG), which is a flavonoid. It has been suggested that green tea and its components might reduce body weight by increasing energy expenditure and fat oxidation, reducing lipogenesis, and decreasing fat absorption. Green tea might also decrease carbohydrate digestion and absorption.
Interactions with medications
Some ingredients in weight-loss dietary supplements can interact with certain medications. For example, glucomannan and guar gum might decrease the absorption of many drugs that are taken orally. Glucomannan has been reported to lower blood glucose levels and, therefore, could interact with diabetes medications. Chitosan might potentiate the anticoagulant effects of warfarin. Green tea could interact with chemotherapy drugs. Garcinia cambogia was associated with serotonin toxicity in a patient taking the supplement together with two selective serotonin reuptake inhibitor medications. Other ingredients, such as caffeine and bitter orange, could have an additive effect if taken with other stimulants. Bitter orange has also been shown to inhibit CYP3A4 activity, leading to increased blood levels of certain drugs, such as cyclosporine and saquinavir.
These are just a few examples of interactions between ingredients of weight-loss dietary supplements and medications. Individuals taking dietary supplements and medications on a regular basis should discuss their use with their healthcare provider.
Laxatives can help relieve and prevent constipation. But not all laxatives are safe for long-term use. Overuse of certain laxatives can lead to dependency and decreased bowel function. before turning to laxatives, lifestyle changes may help with constipation:
• Eating fiber-rich foods, such as wheat bran, fresh fruits and vegetables, and oats.
• Drinking plenty of fluids daily.
• Regular exercise.
Lifestyle improvements relieve constipation for many people, but if problems continue despite these changes, the next choice may be a mild laxative.
Laxatives work in different ways, and the effectiveness of each laxative type varies from person to person. In general, bulk-forming laxatives, also referred to as fiber supplements, are the gentlest and safest to use long term. Metamucil and Citrucel fall into this category.
Type of laxative (brand examples)
How they work
Oral osmotics (Phillips’ Milk of Magnesia, Miralax)
Draw water into the colon to allow easier passage of stool
Bloating, cramping, diarrhea, nausea, gas, increased thirst
Oral bulk formers (Benefiber, Citrucel, FiberCon, Metamucil)
Absorb water to form soft, bulky stool, prompting normal contraction of intestinal muscles
Bloating, gas, cramping or increased constipation if not taken with enough water
Oral stool softeners (Colace, Surfak)
Add moisture to stool to allow strain-free bowel movements
Electrolyte imbalance with prolonged use
Oral stimulants (Dulcolax, Senokot)
Trigger rhythmic contractions of intestinal muscles to eliminate stool
Belching, cramping, diarrhea, nausea, urine discoloration with senna and cascara derivatives
Rectal suppositories (Dulcolax, Pedia-Lax)
Trigger rhythmic contractions of intestinal muscles and soften stool
Rectal irritation, diarrhea, cramping
Oral laxatives may interfere with the body’s absorption of some medications and nutrients. Some laxatives can lead to an electrolyte imbalance, especially after prolonged use. Electrolytes — which include calcium, chloride, potassium, magnesium and sodium — regulate a number of body functions. An electrolyte imbalance can cause abnormal heart rhythms, weakness, confusion and seizures.
The Food and Drug Administration (FDA) is warning consumers that some of the over-the-counter (OTC) laxatives they may turn to for relief are potentially dangerous if dosing instructions or warnings on the Drug Facts label are not properly followed or when there are certain coexisting health conditions. In fact, there have been dozens of reports of serious side effects associated with the use of sodium phosphate laxatives.
The label of sodium phosphate laxatives states that they should be used as a single dose taken once a day, and the products should not be used for more than three days. Equally important, consumers who do not have a bowel movement after taking an oral or rectal dose should not take another dose of the product.
In addition, labeling instructs adults and children to ask health care professionals before using these products if they have kidney disease, heart problems or dehydration.
Getting a good night’s sleep can be challenging for older adults with chronic medical conditions, which often interfere with sleep. As a result, many older adults turn to over-the-counter (OTC) sleep aids, that is, products with diphenhydramine or doxylamine. However, these products are indicated only for occasional difficulty with sleep, not for chronic use; and their safety and efficacy has not been well established in general and in older adults specifically.
To engage national stakeholders in a discussion of OTC sleep aids in older adults, the Gerontological Society of America (GSA) convened a multidisciplinary workgroup. The Workgroup examined differences between younger and older adults in sleep health and use of OTC sleep aids using data from the National Health and Wellness Survey; assessed the pharmacologic properties and medication effects of OTC sleep aids; and worked with stakeholders to promote strategies for safe and effective use. Older adults are more likely to take diphenhydramine or doxylamine products 15 or more days in a month, an indicator of inappropriate use. The Workgroup recommends research to investigate the ways older people use OTC sleep aids. The goal should be reduction in inappropriate use and associated risks, such as daytime sedation, compromised cognitive function, and falls. In addition, the Workgroup recommends a greater role for community pharmacists in counseling older adults on appropriate use of OTC sleep aids.
Most over-the-counter sleep aids contain antihistamines. Tolerance to the sedative effects of antihistamines can develop quickly — so the longer you take them, the less likely they are to make you sleepy. In addition, some over-the-counter sleep aids can leave you feeling groggy and unwell the next day. This is the so-called hangover effect.
Medication interactions are possible as well, and much remains unknown about the safety and effectiveness of over-the-counter sleep aids.
Over-the-counter sleep aids are widely available. Common choices and the potential side effects include:
Diphenhydramine (Benadryl, Aleve PM, others). Diphenhydramine is a sedating antihistamine. Side effects might include daytime drowsiness, dry mouth, blurred vision, constipation and urinary retention.
Doxylamine succinate (Unisom SleepTabs). Doxylamine is also a sedating antihistamine. Side effects are similar to those of diphenhydramine.
Melatonin. The hormone melatonin helps control your natural sleep-wake cycle. Some research suggests that melatonin supplements might be helpful in treating jet lag or reducing the time it takes to fall asleep — although the effect is typically mild. Side effects can include headaches and daytime sleepiness.
Valerian. Supplements made from this plant are sometimes taken as sleep aids. Although a few studies indicate some therapeutic benefit, other studies haven’t found the same benefits. Valerian generally doesn’t appear to cause side effects.
- Food and Drug Administration (FDA). Educational Resources: Understanding Over-the-Counter Medicine, 2018. Available at: https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/ucm277845.htm
- Food and Drug Administration (FDA). Careful: Acetaminophen in pain relief medicines can cause liver damage, 2018. Available at: https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/SafeUseofOver-the-CounterPainRelieversandFeverReducers/ucm234272.htm
- Food and Drug Administration (FDA). Aspirin for Reducing Your Risk of Heart Attack and Stroke: Know the Facts, 2017. Available at: https://www.fda.gov/Drugs/ResourcesForYou/Consumers/BuyingUsingMedicineSafely/UnderstandingOver-the-CounterMedicines/SafeDailyUseofAspirin/ucm291433.htm
- Food and Drug Administration (FDA). Oral Over-the-Counter Benzocaine Products: Drug Safety Communication – Risk of Serious and Potentially Fatal Blood Disorder, 2018. https://www.fda.gov/safety/medwatch/safetyinformation/safetyalertsforhumanmedicalproducts/ucm608612.htm
- Food and Drug Administration (FDA). FDA Drug Safety Communication: Rare cases of serious burns with the use of over-the-counter topical muscle and joint pain relievers, 2-16. Available at: https://www.fda.gov/drugs/drugsafety/ucm318858.htm
- Mayo Clinic. Over-the-counter acne products: What works and why, 2018. Available at: https://www.mayoclinic.org/diseases-conditions/acne/in-depth/acne-products/art-20045814
- Food and Drug Administration(FDA). Topical Antiseptic Products: Hand Sanitizers and Antibacterial Soaps, 2917. Available at: https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm444681.htm
- National Institutes of Health (NIH). Dietary Supplements, 2011. Available at: https://ods.od.nih.gov/factsheets/DietarySupplements-HealthProfessional/
- Mayo Clinic. Nutrition and healthy eating, 2016. Available at: https://www.mayoclinic.org/healthy-lifestyle/nutrition-and-healthy-eating/in-depth/are-dietary-supplements-right-for-you/art-20232605
- National Institutes of Health (NIH). Dietary Supplements for Weight Loss, 2017. Available at: https://ods.od.nih.gov/factsheets/WeightLoss-HealthProfessional/
- Mayo Clinic. Over-the-counter laxatives for constipation: Use with caution, 2017. Available at: https://www.mayoclinic.org/diseases-conditions/constipation/in-depth/laxatives/art-20045906
- Food and Drug Administration(FDA). Use Certain Laxatives with Caution, 2014. Available at: https://www.fda.gov/forconsumers/consumerupdates/ucm379440.htm
- Steven M. Albert et al. Sleep Health and Appropriate Use of OTC Sleep Aids in Older Adults—Recommendations of a Gerontological Society of America Workgroup. The Gerontologist, 2015; 57(2):163–170, https://doi.org/10.1093/geront/gnv139
- Mayo Clinic. Sleep aids: Understand over-the-counter options, 2018. Available at: https://www.mayoclinic.org/HEALTHY-LIFESTYLE/ADULT-HEALTH/IN-DEPTH/SLEEP-AIDS/ART-20047860