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Medication Safety & Interactions

Medicines help most of us live better, but they can also cause side effects, allergic reactions and interactions with other medicines, foods and supplements. Learn how to keep a medicine list, read labels, get a medication review, store and dispose of medicines safely, and when to get help.

Signs of a severe allergic reaction (anaphylaxis)? Call 911. Medicines are one of the most common causes. Warning signs include hives, itching or swelling; swelling of the lips or tongue; tightness in the throat or trouble swallowing; shortness of breath, coughing, wheezing, or chest pain or tightness; a weak pulse, dizziness or fainting; and vomiting or cramps. If an epinephrine auto-injector is available, give the injection right away (MedlinePlus).

Possible overdose or poisoning? Call Poison Help at 1-800-222-1222 right away (MedlinePlus, FDA), or use the free, confidential webPOISONCONTROL tool online. Call 911 if the person collapses, has a seizure, has trouble breathing or can’t be woken up (Poison Control). If opioids could be involved, give naloxone (Narcan) too — it won’t harm someone whose overdose isn’t from opioids — and stay with the person until help arrives (CDC). See our Drug Overdose guide.

Get emergency care for these while taking medicines:

Why medication safety matters

Medicines usually make our lives better, but they can also cause side effects, allergies and interactions (MedlinePlus). When a medicine harms someone — through an allergic reaction, side effect, overmedication or a medication error — it is called an adverse drug event, a serious but preventable problem (CDC). These events send more than 1.5 million people to U.S. emergency departments each year; blood thinners, diabetes medicines such as insulin, and antibiotics are the most common causes (CDC).

This guide is about using medicines wisely, not avoiding them. Never stop a prescribed medicine on your own: some must be stopped slowly, and stopping early can make a condition worse (NIA).

Side effects or an allergic reaction?

Side effects are unwanted effects of a medicine. Most are mild — an upset stomach, dry mouth or drowsiness — but some are serious (MedlinePlus), even life-threatening, such as liver damage. Your age, other medicines and supplements, and kidney or liver conditions all affect who gets them (FDA). If a side effect bothers you, talk with your provider before stopping the medicine; there may be an alternative (NIA).

A drug allergy is a different kind of reaction that can range from mild to life-threatening. Hives and rashes are the most common; anaphylaxis is less common but an emergency (MedlinePlus). Make sure your doctor and pharmacist have an up-to-date list of your allergies and past problems with medicines (NIA).

Many medicines in later life (polypharmacy)

Older adults tend to take more medicines than any other age group, often because they live with several conditions at once (NIA). In a CDC survey from 2015–2016, 34.5% of U.S. adults aged 60 to 79 had used five or more prescription drugs in the past 30 days (CDC, NCHS), and older adults visit emergency departments for adverse drug events more than 600,000 times a year (CDC). Excessive or unnecessary medicines raise the risk of side effects, falls, memory problems and drug–disease interactions, in which a medicine for one condition worsens another (NIA). If you wonder whether you take too many, ask your provider whether any could safely be reduced or stopped (NIA).

Interactions: medicines, food, alcohol and supplements

An interaction can make a medicine weaker, too strong, or cause unexpected side effects (FDA).

  • Drug–drug. A sedating sleep aid plus an allergy antihistamine can slow your reactions and make driving dangerous (FDA); you should not take aspirin if you take warfarin for heart problems (NIA); and opioids combined with benzodiazepines, sleep medicines or muscle relaxants raise the risk of overdose (CDC).
  • Drug–food, including grapefruit. The FDA requires some medicines to carry a grapefruit warning. Grapefruit can let too much of certain drugs into the blood — including some statins, blood pressure and heart rhythm medicines — or, with a few such as fexofenadine, too little. Seville oranges, pomelos and tangelos may act the same way. Not every drug is affected, so ask your pharmacist (FDA).
  • Drug–alcohol. Alcohol can deepen drowsiness, raise the risk of falls and internal bleeding, or make a medicine less effective; older adults are at particularly high risk (NIAAA).
  • Drug–supplement. Herbs and supplements can strengthen or weaken medicines — see Herbal medicine below (NCCIH).

Related guides: Blood Clots (blood thinners); Balance, Dizziness & Vertigo and Fainting (medicines that affect steadiness); and Liver and Kidney.

Side by side

Six approaches compared

For every condition we look at the same six approaches: what each involves, what it typically costs, and what a patient can realistically expect.

ApproachWhat it involves Estimated costWhat to expect
Conventional medicine (AMA) Regular medication reviews with your doctor or pharmacist; careful prescribing; deprescribing (safely reducing or stopping medicines you may no longer need) done with a clinician — never on your own. Medicare drug plans must offer Medication Therapy Management to people who qualify, at no cost. Part D out-of-pocket drug costs are capped at $2,100 in 2026 ($2,400 in 2027), and Extra Help lowers costs for people with limited income. Fewer surprises and a clearer plan. Deprescribing programs trim medicine counts by a small amount on average; whether they prevent falls is not yet clear.
Chiropractic No role in managing medicines. Tell your chiropractor about every medicine and supplement — especially blood thinners and osteoporosis — before any spinal manipulation. No separate cost: this is a conversation at any visit. In a large Medicare study, injuries after chiropractic visits were uncommon, but more likely in people with osteoporosis or on long-term blood thinners.
Acupuncture No role in managing medicines. Tell your acupuncturist if you take a blood thinner or bleed easily. No separate cost: this is a conversation at any visit. Studies suggest acupuncture is generally safe with blood thinners when needling is done properly, though minor bleeding or bruising may be somewhat more likely.
Herbal medicine Not a substitute for prescribed medicines. The key safety issue: many herbs and supplements interact with medicines — St. John’s wort, ginkgo and goldenseal among them. Tell every clinician what you take. No cost is listed: this section is about safety, not treatment. Supplements are not reviewed by the FDA for safety or effectiveness before they are sold, and “natural” does not mean safe.
Massage therapy No role in managing medicines. Tell your therapist about blood thinners, easy bruising and any recent injections. No separate cost: this is a conversation at any visit. Serious harm from massage is rare and mostly linked to vigorous techniques or untrained practitioners; blood thinners make bruising easier.
MBHA Wellness Coach Building a medicine list, using pill organizers and reminders, planning refills and travel, safe storage, and preparing questions for your pharmacist and doctor. Cost estimate being researched. Practical habits that NIA and CDC recommend for taking medicines correctly — alongside, not instead of, your prescribers’ advice.

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Conventional medicine (AMA)

Medication reviews, including “brown-bag” reviews

At every visit, tell each provider about anything new you take and ask whether you still need all your medicines (NIA). Some people find it easiest to put all their medicines and supplements in a bag and bring them along (FDA); the bottles help your provider check supplement ingredients (NCCIH). In one study of 85 adults aged 60 and over taking five or more medicines, brown-bag reviews found an average of about 4 medicine-related problems per person, and participants had acted on 63% of the recommendations three months later (O’Connell et al., 2015).

Medicare drug plans must offer free Medication Therapy Management to people who qualify — if you take drugs for more than one chronic condition, ask your plan. It includes a full review of your medicines with a pharmacist or provider, a written summary and a medication list (Medicare). Medicare’s yearly “Wellness” visit also includes a review of your current prescriptions (Medicare).

Deprescribing — with your clinician, never on your own

Deprescribing means safely reducing or stopping medicines that may be unnecessary or potentially inappropriate, weighing risks, costs and burden against benefits (NIA). A 2025 review of trials in older adults living at home found deprescribing programs were linked to fewer medicines, though the change per person was very small (Linsky et al., 2025). Some medicines must be stopped slowly, so never stop one on your own (NIA).

Medicines and falls (CDC STEADI)

Some medicines cause dizziness, sleepiness, confusion, blurred vision or a drop in blood pressure on standing. CDC’s STEADI program asks clinicians to review medicines for everyone 65 and older and to stop, switch or reduce risky ones, such as sedatives and sleep medicines, benzodiazepines and opioids, when possible (CDC STEADI). Its STEADI-Rx program helps pharmacists screen for fall risk and work with your doctor (CDC). Ask your doctor or pharmacist to check your medicines for any that might make you dizzy or sleepy (CDC). Evidence that stopping such medicines alone prevents falls is so far inconclusive (Lee et al., 2021), so it works best within a wider plan — see our Balance guide.

Opioid safety

Prescription opioids can treat pain but carry serious risks of addiction, overdose and death. Ask about options that don’t involve opioids, and tell your clinician about any personal or family history of substance use (CDC). Never share your medicine (MedlinePlus). Naloxone, which reverses an opioid overdose, has been sold over the counter since 2023 (FDA, 2023); people who take opioids together with benzodiazepines, among others, should carry it and tell others where it is (CDC). See our Drug Overdose guide.

What it costs

  • Reviews: Medication Therapy Management is free for people who qualify (Medicare); the yearly Wellness visit costs nothing if your provider accepts assignment (Medicare).
  • Medicare drug costs: once out-of-pocket spending on covered Part D drugs reaches $2,100 in 2026 ($2,400 in 2027), you pay nothing more for covered drugs that year (Medicare). Extra Help lowers costs for people with limited income and resources (Medicare).
  • Doctor and pharmacist visit prices outside Medicare: cost estimate being researched.

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Approach 2 of 6

Chiropractic

Chiropractic care has no role in managing medicines, but your medicines matter to your chiropractor. Tell them your health history and every prescription and over-the-counter medicine and supplement you take, and if they suggest a supplement, ask how it might interact with your medicines (NCCIH). Serious problems after spinal manipulation are very rare, but may be more likely in people whose health problems raise their risk of injury (NCCIH).

Blood thinners and osteoporosis: say so up front

A study of Medicare data on adults aged 66 to 99 found injuries within a week of a chiropractic spinal manipulation visit were uncommon — less common than after a primary care visit. But among chiropractic patients, injury was more likely in people with a bleeding (coagulation) disorder, osteoporosis, an aortic aneurysm, or long-term blood-thinner therapy (Whedon et al., 2015). A 2026 review of chiropractic care in adults over 55 found mostly mild-to-moderate problems such as soreness and stiffness, though inconsistent reporting limits certainty (Daniels et al., 2026). So before any adjustment, tell your chiropractor if you take a blood thinner, have osteoporosis or take an osteoporosis medicine.

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Approach 3 of 6

Acupuncture

Acupuncture has no role in managing medicines. The safety question is bleeding: tell your acupuncturist if you take a blood thinner or antiplatelet medicine, or bleed easily.

  • A 2015 review found 384 people on anticoagulants (3,974 treatments) in well-reported studies, with one moderate bleeding event, a hip hematoma (a pooled collection of blood). The authors concluded acupuncture appears safe for them, assuming appropriate needling location and depth (McCulloch et al., 2015).
  • A 2018 study of 428 hospital inpatients found blood thinners did not increase mild bleeding or bruising after acupuncture (Lee et al., 2018).
  • A 2023 study of Taiwan’s national insurance records found anticoagulants such as warfarin, newer oral anticoagulants and heparin were linked to more bleeding after acupuncture, while antiplatelet drugs were not; the authors urged practitioners to ask about medicines in detail (Hsieh et al., 2023).

Complications are relatively rare and have mostly come from nonsterile needles or improper technique; the FDA requires sterile, single-use needles, and most states license acupuncturists (NCCIH). Check any herbs your practitioner suggests against your medicines.

Find an acupuncturist in our directory

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Herbal medicine

If you use herbs, this is the most important section of this guide. “Natural” does not always mean safe: herbal medicines don’t go through the testing drugs do, and some interact with prescription or over-the-counter medicines (MedlinePlus).

Supplements are not FDA-approved for safety before sale

Unlike drugs, dietary supplements are not approved by the FDA before they are sold. Manufacturers are responsible for their safety and labeling, and the FDA can act only once a product is on the market (NCCIH, FDA). The FDA does not review supplements for effectiveness (FDA). What’s on the label may not be what’s in the bottle: the FDA has found prescription drugs, including the blood thinner warfarin and the seizure drug phenytoin, in products sold as supplements (NCCIH).

Common herb–drug interactions (NCCIH)

  • St. John’s wort has a high overall risk of interactions (NCCIH) and can interact in dangerous, sometimes life-threatening ways with many medicines (NCCIH). It can weaken some antidepressants, the transplant drug cyclosporine, some seizure, heart, HIV and cancer medicines (NCCIH), warfarin and certain statins (NCCIH), and birth control pills (FDA). With certain antidepressants, it may cause serotonin-related side effects that can be serious (NCCIH).
  • Ginkgo taken with warfarin is linked to a higher risk of major bleeding (NCCIH). Warfarin, ginkgo, aspirin and vitamin E can each thin the blood, and taking them together may raise the chance of internal bleeding or stroke (FDA).
  • Goldenseal has a high overall risk of interactions; in one study it lowered blood levels of the diabetes drug metformin by about 25% (NCCIH).
  • Green tea in high amounts can lower blood levels of the heart and blood-pressure drug nadolol, and green tea extract can lower levels of atorvastatin (NCCIH).
  • Glucosamine may strengthen warfarin, raising the risk of serious bruising and bleeding; ashwagandha may add to the effects of sedatives and anti-anxiety drugs (NCCIH).
  • Over-the-counter medicines too: black cohosh and St. John’s wort may interfere with the allergy medicine fexofenadine, and goldenseal, kratom and CBD may interact with many medicines (NCCIH).

When interactions matter most

Interactions are of special concern with medicines that have a narrow therapeutic range, where even a small change in blood level can be dangerous — examples include warfarin, digoxin, cyclosporine, carbamazepine and phenytoin — and before surgery, when some supplements can raise bleeding risk or affect anesthesia (NCCIH). People being treated for cancer or HIV should discuss every supplement with their provider (NCCIH).

Tell every clinician — and your pharmacist — about every herb, vitamin and supplement you take, including ones you use only now and then (NIA, NCCIH). Check with your doctor before starting a new supplement (NIA), and don’t take more than the label recommends (MedlinePlus). We don’t list doses here. Safety concerns about a supplement can be reported through the U.S. Health and Human Services Safety Reporting Portal (NCCIH).

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Massage therapy

Massage has no role in managing medicines, but a few medicines matter to your therapist.

Blood thinners and bruising

Easy or unusual bruising can happen with blood thinners such as warfarin and is a symptom to report to your doctor (MedlinePlus, MedlinePlus). We found little research on massage for people taking blood thinners. Overall, the risk of harm from massage appears low; rare serious problems such as a blood clot, nerve injury or fracture have been reported, some with vigorous techniques such as deep tissue massage or in people at higher risk of injury, such as older adults (NCCIH). A review of reported harms, including hematomas, found most were linked to unusual techniques or untrained people rather than massage therapists (Ernst, 2003). Tell your therapist if you take a blood thinner or bruise easily.

Recent injections

Some injected medicines come with instructions not to rub the injection site — for example, the blood thinner enoxaparin (MedlinePlus). Tell your therapist about any recent injection and where it was. In the 45 states (and D.C.) that regulate massage therapy, therapists must be licensed or certified (NCCIH).

Find a massage therapist in our directory

Approach 6 of 6

MBHA Wellness Coach

An MBHA Wellness Coach helps with the everyday habits that make medicines safer — alongside, not instead of, your prescribers and pharmacist.

  • One up-to-date medicine list. Include every prescription and over-the-counter medicine, vitamin, supplement and herb, with how much and when you take it, the prescriber and the reason. Show it to all your providers, including dentists, and keep a copy in your wallet (NIA). Add medicines that caused allergies or problems (MedlinePlus), and bring it to every appointment or hospital visit (Medicare).
  • Routines and pill organizers. Tie medicines to meals or bedtime, or use weekly pill boxes, calendars, timers or reminder apps; turn on a light before taking medicine; and never take extra hoping it will work better (NIA, CDC).
  • Refills. Ask whether a refill needs a follow-up visit or test first, and check expiration dates (NIA).
  • Travel. Carry your list and your doctors’ and pharmacists’ numbers, keep medicines in your carry-on, take extra in case you stay longer, keep them out of heat and sun, and ask about adjusting for time zones (NIA).
  • Talking with your pharmacist. Use one pharmacy if you can, so it can spot a problem with a new drug (NIA). Prepare questions: why am I taking this, what side effects should I watch for, can I take it with everything on my list, and should I avoid certain foods or alcohol (MedlinePlus)? Bring a friend or relative if it helps you remember (NIA).

Another approach

Reading labels and avoiding hidden double doses

The Drug Facts label

Every over-the-counter medicine carries a standard Drug Facts label, in the same order: active ingredients (what makes it work), purpose and uses, warnings (when not to use it, when to ask a doctor or pharmacist first, interactions, side effects and when to stop), directions, and other information such as storage and inactive ingredients. Read it every time: makers sometimes change ingredients or warnings, and similar brand names can contain different active ingredients (FDA). Don’t take an over-the-counter medicine longer, or in larger amounts, than the label recommends (MedlinePlus). For prescriptions, read the pharmacy label, warning stickers and any Medication Guide (FDA), and ask for larger type if the label is hard to read (NIA).

Hidden acetaminophen

Acetaminophen (Tylenol) is in hundreds of over-the-counter and prescription products, alone or combined with other ingredients; prescription labels may shorten it to “APAP” or “Acetam”, and abroad it is called paracetamol (FDA). It’s common to take too much by accident (MedlinePlus). The FDA advises:

  • Use only one acetaminophen-containing product at a time, and never take more than the label says, even if pain or fever continues — too much can cause liver failure and death.
  • Ask a health care professional first if you have liver disease; severe liver damage may occur if you have three or more alcoholic drinks a day while using it.
  • Ask whether a new prescription contains acetaminophen.
  • If you think you have taken too much, get medical help or call Poison Help at 1-800-222-1222 right away (FDA).

The same rule applies to any active ingredient: don’t take a cough syrup containing acetaminophen with a pain reliever that also contains it (NIA). See our Liver guide.

Another approach

Safe storage and disposal

Storing medicines

Unintentional medicine overdoses are the leading cause of emergency visits in young children. Put medicines, vitamins and supplements — gummies included — up, away and out of sight after every use (CDC), and check that safety caps are locked (CDC). Keep medicines away from pets too, and keep prescription pain medicines such as opioids in a locked cabinet or drawer (NIA).

Getting rid of unused medicines

  1. Best: a drug take-back location — often a pharmacy or police station — or a prepaid mail-back envelope (FDA). The DEA’s National Prescription Drug Take Back Days let you turn in medicines safely and anonymously, and its locator finds authorized collectors near you (DEA).
  2. If take-back isn’t available and the medicine is on the FDA flush list — medicines sought after for misuse that can kill with one dose if taken by the wrong person, such as many opioids — flush it. Don’t flush anything not on the list (FDA).
  3. Otherwise: mix the medicine (don’t crush it) with dirt, cat litter or used coffee grounds, seal it in a plastic bag, put it in the trash, and scratch out personal information on empty bottles (FDA).

Another approach

Reporting side effects and getting help

Report problems to FDA MedWatch

MedWatch is the FDA’s safety reporting program for health professionals, patients and consumers, covering prescription and over-the-counter medicines among other products (FDA). The FDA encourages you to report side effects, using a plain-language consumer form; questions go to 1-800-332-1088 (FDA). Medication errors can be reported too (FDA).

Your pharmacist is a resource

Pharmacists are a bridge between you and your prescriber. They can answer questions about directions, warnings and interactions with drugs and foods, and say whether a pill can be crushed. Tell them everything you take, your allergies and past side effects, and any trouble swallowing pills, opening bottles or reading labels. The FDA’s drug information pharmacists answer public questions at 1-855-543-3784 and can help identify a pill (FDA).

Saving money safely

  • Generics work the same way and carry the same benefits and risks as the brand, and are typically sold at substantially lower prices (FDA).
  • Ask and compare: tell your doctor if cost worries you, compare pharmacy and mail-order prices, and look for pharmacy, drug-company, nonprofit or state assistance programs — but don’t skip or cut back prescription doses to save money (NIA). With Medicare, Extra Help, State Pharmaceutical Assistance Programs and drug-company assistance programs can lower costs (Medicare).
  • Online pharmacies: fake ones can sell ineffective or dangerous medicines. Use one that requires a valid prescription, is licensed in your state and has a pharmacist available (NIA); the FDA’s BeSafeRx campaign explains the warning signs (FDA).

Member stories

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This page is for education only and is not medical advice. Costs are typical U.S. ranges and estimates; yours will depend on your provider, location and insurance. Talk with your doctor before starting, stopping or combining any treatment. In an emergency, call 911. See our disclaimer.

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