Generic Alternatives to Over-the-Counter Medications (OTCs)

Written by: Dr. Raquel Hammonds
August 13, 2025

Have you ever stood in the pharmacy aisle wondering if the generic version of your go-to medication is “just as good”? You’re not alone, and the short answer is: yes, it usually is.

Generic over-the-counter (OTC) medications are medically equivalent to their brand-name counterparts. They contain the same active ingredients, are available in the same dosage and form, and are held to the same FDA safety and efficacy standards. But they often cost significantly less, sometimes up to 85% less, simply because they don’t carry a brand name or the marketing dollars behind it.¹

Understanding the difference between brand-name and generic OTC medications is a crucial part of health literacy, and making empowered, cost-effective choices.

Why Health Literacy and Label Literacy Matter

Health literacy is more than just understanding medical terms. It’s about knowing how to navigate a healthcare system that’s often complex and expensive. That includes understanding the medications we take every day, from pain relievers to cold remedies, and knowing how to identify affordable, effective alternatives.²

For communities of color, where medical costs can be a barrier to care, understanding generic options can directly support both health and financial well-being. In fact, the National Assessment of Adult Literacy shows that only 12% of U.S. adults are considered “health literate” and this gap is even wider in communities that have been historically underserved or excluded from healthcare systems.²

What Makes a Medication “Generic”?

A generic drug is a medication that has the same active ingredient, strength, dosage form (like pill or liquid), and route of administration as a brand-name drug. The U.S. Food and Drug Administration (FDA) requires that generic drugs demonstrate bioequivalence: meaning they deliver the same amount of medicine into a person’s bloodstream in the same amount of time.1

What might differ?

Inactive ingredients such as coloring agents, preservatives, or binders
The packaging, shape, or taste

But these differences do not affect how the medication works, unless someone has a specific allergy or intolerance to an additive, which is rare.¹

Common Generic Swaps to Know

Navigating the pharmacy aisle can be overwhelming, but when you know what to look for, you can find cost-effective medications that work just as well as their brand-name counterparts. Here’s a breakdown of common over-the-counter medications and their generic versions, plus what you need to know before making the switch.

1. Pain Relievers³

Brand Names ➜ Generic Equivalents

Tylenol → Acetaminophen
Advil / Motrin → Ibuprofen
Aleve → Naproxen sodium

How They Work:

Acetaminophen is effective for reducing pain and fever but does not reduce inflammation, making it a good choice for headaches or mild fevers.3
Ibuprofen and naproxen are part of the NSAID (nonsteroidal anti-inflammatory drug) family. They relieve pain and reduce inflammation, helpful for joint pain, menstrual cramps, and muscle aches.³

Important Notes:

Always follow the dosing instructions on the label to avoid liver damage (acetaminophen) or stomach irritation (NSAIDs).³
NSAIDs should be taken with food to help protect your stomach lining and reduce the risk of ulcers or gastrointestinal upset.³

2. Nasal Decongestants⁴

Brand Names ➜ Generic Equivalents

Sudafed PE → Phenylephrine
Sudafed (behind the counter) → Pseudoephedrine
Afrin → Oxymetazoline (nasal spray)

What to Know:

Phenylephrine is the more accessible option on store shelves but may be less effective for nasal congestion in some people.⁴
Pseudoephedrine, which requires asking the pharmacist due to regulations, tends to be more effective at reducing nasal swelling.⁴
Oxymetazoline, the active ingredient in Afrin, offers quick relief through direct nasal application.⁴

Use with Caution:

Limit nasal sprays like Afrin to no more than three consecutive days. Overuse can cause rebound congestion, making symptoms worse.⁴
Oral decongestants may increase blood pressure or interfere with sleep, speak with a healthcare provider if you have heart conditions.⁴

3. Allergy Relief

Brand Names ➜ Generic Equivalents

Benadryl → Diphenhydramine
Zyrtec → Cetirizine
Claritin → Loratadine

How They Differ:

Diphenhydramine is a first-generation antihistamine, known for quick symptom relief, but it often causes drowsiness and can impair alertness.⁵
Cetirizine and loratadine are second-generation antihistamines, meaning they’re less likely to make you sleepy and better suited for daily use.⁵

Good to Know:

All options reduce sneezing, itching, and runny nose caused by allergies, but the newer generation medications offer longer-lasting relief with fewer side effects.⁵

4. Heartburn & Acid Relief⁶

Brand Names ➜ Generic Equivalents

Prilosec → Omeprazole
Zantac 360 → Famotidine
Tums → Calcium carbonate

How They Help:

Omeprazole is a proton pump inhibitor (PPI). It works by blocking acid production at the source in the stomach. It’s often used for chronic acid reflux (GERD) but should be taken consistently and typically for short durations unless directed by a provider.⁶
Famotidine is an H2 blocker, offering relief for more occasional heartburn and indigestion.⁶
Calcium carbonate (Tums) is an antacid that neutralizes acid on contact providing fast but short-lived relief.⁶

Clinical Tip:

For frequent heartburn, don’t self-treat long-term with PPIs. Chronic use can affect nutrient absorption and bone health. Always talk with your provider if symptoms persist.

5. Cold & Flu Remedies

Symptom ➜ Generic Treatment

Fever or pain → Acetaminophen
Cough → Dextromethorphan
Runny nose or sneezing → Diphenhydramine
Nasal congestion → Phenylephrine or pseudoephedrine

Why This Matters:

Taking combination products can lead to duplicate ingredients, especially with acetaminophen, raising your risk of accidental overdose.⁵
By purchasing individual generic medications, you gain more control and often pay less overall.

Most cold medications you see on the shelf are combinations of multiple active ingredients, but you can save money and customize treatment by buying individual generics that target your specific symptoms.⁵

When the Brand Might Matter

While generics are required by the FDA to be just as safe and effective as their brand-name counterparts, some people do notice subtle differences. Here’s why:

Inactive ingredients: Generic medications may use different fillers, dyes, or binders. For individuals with allergies, sensitivities, or conditions like celiac disease, these differences can affect tolerability, even if the active ingredient is identical.¹
Perception and trust: If you’ve used a brand-name medication for years, your brain may associate it with relief. That psychological comfort (known as the placebo effect) can influence how you perceive the effectiveness of a drug.⁷
Metabolic differences: In very rare cases, some individuals metabolize medications differently. This could make them more sensitive to slight variations in how a generic is absorbed or processed.¹

If you’ve tried a generic and it didn’t work the same for you, you’re not imagining things. But don’t give up, talk to your pharmacist or healthcare provider. They can help you weigh your options, find a suitable alternative, or request a brand-name version when medically necessary.

Be Empowered and Informed

Understanding your over-the-counter medication choices, especially the difference between generic and brand-name drugs, can save you money, confusion, and health risks. Generics are safe, effective, and rigorously regulated, but being aware of ingredients, labels, and your body’s response puts you in the driver’s seat.

At a time when medication costs are rising, health literacy isn’t just helpful—it’s essential. If you’re ever unsure, ask questions. Pharmacists, doctors, and trusted health resources are here to support your health journey every step of the way.