Over-the-counter stimulants are generally taken for energy, to improve focus, or to suppress appetite. While this might be a sign the user suffers from deeper issues — like chronic fatigue, ADHD, or an eating disorder — OTC stimulants aren’t necessarily dangerous when taken as recommended.
If someone has a legitimate need for stimulant medication, it’s best that they discuss the issue with their physician and get a prescription.
OTC stimulants can be purchased without a prescription, usually online or at a drugstore. A stimulant, according to the National Institute of Mental Health (NIMH), is a drug that increases focus and attention. They can give a user heightened energy, and they tend to suppress appetite.
Some common OTC stimulants include caffeine, phenylpropanolamine (PPA), and bitter orange. These are generally marketed to boost energy, increase focus, or suppress appetite (sometimes in combination).
Many of the compounds in these stimulants are being sold using claims that have not been evaluated by the FDA. While this does not make them inherently untrue, any statement made by a manufacturer of a drug or supplement, OTC or not, should not be taken at face value.
Over-the-counter can be a misleading term. Generally, this refers to any drug or supplement that does not require a prescription. Most often, these substances are available in standard drugstores. They usually do not have to be accessed from a pharmacy.
Caffeine is perhaps the most studied and understood OTC stimulant. It is also the most widely consumed. It is present in things many people might argue aren’t “true” OTC stimulants, such as most coffees and teas.
The U.S. National Library of Medicine notes it is not recommended an adult drink more than 400 mg of caffeine a day. It also gives the average amount of caffeine for several common beverages.
The exact source of a caffeine stimulant is less relevant than the amount of caffeine entering the body, although other ingredients may have various other effects as well.
Consuming too much caffeine can negatively impact the body. Caffeine is a diuretic and can cause the body to dehydrate. Additionally, drinking too much caffeine can lead to headaches, dizziness, anxiety, and abnormal heart rhythm.
PPA is a stimulant. While a 1998 Mayo Clinic study showed it was not especially prone to abuse, it has the potential to closely mimic amphetamine use if abused.
Perhaps for this reason, in 2000, the U.S. Food and Drug Administration (FDA) issued a statement urging consumers not to purchase any compound with the drug in it. Many manufacturers voluntarily adjusted compounds that originally had PPA as an ingredient in the period after this statement was made, removing it entirely.
Anyone currently taking a PPA-based stimulant should stop as soon as possible. While the risk is not extreme, it certainly has enough risk of serious addiction and dependence that it should not be consumed.
If you feel you cannot stop taking PPA, or you take enough that it has a notable detrimental effect on your health, consult a professional to address the issue.
Not all weight loss supplements contain stimulants; however, many stimulants can aid in appetite suppression.
Perhaps the most noteworthy one used is synephrine, commonly called bitter orange. Mayo Clinic notes that bitter orange, especially due to its connection to ephedrine, is poorly understood and poorly studied (as are many weight loss supplements).
Ephedrine used to be an OTC supplement, but it was eventually banned by the FDA due to health risks. Synephrine is a very similar, but milder, compound.
The National Center for Complementary and Integrative Health recommends similar wariness in taking any bitter orange. It notes continually that there simply is not enough information to properly recommend or warn against the drug, but consumers should proceed with caution. Pregnant women should never take bitter orange for similar reasons.
The difficulty in deciding whether a weight loss supplement is safe or not is that the FDA does not evaluate them. Manufacturers have much more leeway in how they make their claims and perform research. Even if a manufacturer is not willfully misleading consumers, their statements may not be evidence-based, or they may simply be based on weak evidence.
Like many OTC stimulants, many of these drugs and supplements have a lack of professional research behind them.
Whether one buys an OTC stimulant depends on a number of factors.
Never use a stimulant if you have any heart issues. Before taking any OTC stimulant, you should consult with your doctor to confirm it is safe to do so.
Any product that will affect the body with advertising statements that are not evaluated by the FDA (or the equivalent) is suspect. Unfortunately, many of the compounds currently being used are poorly studied, if they have any research behind them at all.
The average consumer is not usually scientifically or medically literate to properly research if the product they are buying is safe or not. This is especially true if what is available is highly academic research work or poorly sourced sales pitches. For this reason, most OTC stimulants should probably be ignored until better understood.
The most dangerous and obviously addictive OTC stimulants have largely been banned, but this does not guarantee safety of those that remain. Even caffeine has a risk of dependence and withdrawal if taken in large enough quantities.
Research any OTC drug or supplement before purchasing it and putting it in your body. Ask your doctor about it.
Many OTC stimulants have no discernible effect, as is the case with many weight loss supplements, and some may cause damage to internal organs and good health.
Caffeine is the only stimulant that has been researched enough for its risks and recommended dosages to be understood. Coffee and energy drinks, within reasonable dosages, are unlikely to have serious negative health consequences for most people.
Over-the-Counter Stimulants: Abuse and Addiction. Mayo Foundation for Medical Education and Research (MFMER). Retrieved February 2019 from https://www.mayoclinicproceedings.org/article/S0025-6196(11)63394-6/pdf
Caffeine. U.S. National Library of Medicine. Retrieved February 2019 from https://medlineplus.gov/caffeine.html
(October 2016). Phenylpropanolamine (PPA) Information Page. Food and Drug Administration (FDA). Retrieved February 2019 from https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm150738.htm
(December 2015). FDA issues public health warning on Phenylpropanolamine. Food and Drug Administration (FDA). Retrieved February 2019 from from https://www.fda.gov/Drugs/DrugSafety/InformationbyDrugClass/ucm150763.htm
(February 2018). Over-the-Counter Weight-loss Pills. Mayo Foundation for Medical Education and Research (MFMER). Retrieved February 2019 from https://www.mayoclinic.org/healthy-lifestyle/weight-loss/in-depth/weight-loss/art-20046409
Mental Health Medications. National Institute of Mental Health (NIMH). Retrieved February 2019 from https://www.nimh.nih.gov/health/topics/mental-health-medications/index.shtml#part_149861
(September 2016). Bitter Orange. National Center for Complementary and Integrative Health. Retrieved February 2019 from https://nccih.nih.gov/health/bitterorange