OTC Drugs in the USA: These Common Indian "Prescription" Drugs Are Sold Over-the-Counter in the US, The List You Need to Know.

OTC Drugs in the USA: These Common Indian “Prescription” Drugs Are Sold Over-the-Counter in the US, The List You Need to Know.

by

Traveling between India and the United States exposes a surprising gap: many medicines that are legally prescription-only in India are sold over-the-counter (OTC) in the US. This isn’t about one country being lax and the other strict—it’s about different regulatory philosophies, evidence thresholds, and how risks are controlled. Below is a practical, specific guide to common Indian “prescription” medicines that you can buy OTC in the US, why that is, and what to watch for in strengths, duration, and safety.

Why the same drug can be Rx in India and OTC in the US

US regulators allow a medicine to go OTC only when three things are true: the condition is self-diagnosable, the drug is effective at a low dose, and the label can guide safe self-use without a clinician. When that’s proven in large studies and post-market data, the FDA may approve an “Rx-to-OTC switch” for specific doses and package sizes. Risks are further managed with clear labeling (for example, “do not use longer than 14 days”) and, in some cases, purchase limits (pseudoephedrine).

In India, many of these same drugs fall under Schedule H/H1. They are legally prescription-only, even though pharmacies often dispense them without a written prescription. That mismatch between the law and real-world access is why visiting Indians are often surprised by what sits on US supermarket shelves.

The list: US OTC products that are commonly prescription-only in India

Important: Names below are the active ingredients you’ll see on US labels. Brand names vary.

Allergies and nasal symptoms

  • Cetirizine 10 mg; Levocetirizine 5 mg; Loratadine 10 mg; Fexofenadine 60/180 mg (oral non-sedating antihistamines)
    • Use: Seasonal/perennial allergies, hives.
    • Why OTC in the US: Strong safety record at standard daily doses; adverse effects (like sleepiness with cetirizine/levocetirizine) are predictable and label-manageable.
    • Watch for: Sedation (especially with cetirizine and levocetirizine), alcohol use, and kidney dose considerations. Fexofenadine interacts with fruit juices that lower its absorption.
  • Fluticasone 50 mcg; Triamcinolone 55 mcg; Budesonide 32 mcg (intranasal corticosteroid sprays)
    • Use: Nasal congestion, sneezing, itchy/runny nose from allergies.
    • Why OTC: Very low systemic absorption and strong evidence of benefit for allergic rhinitis.
    • Watch for: Onset takes 12–24 hours; best effect after several days. Nosebleeds if technique is poor—aim the spray slightly outwards.
  • Ketotifen 0.025% (antihistamine eye drops)
    • Use: Itchy, allergic eyes.
    • Why OTC: Low systemic absorption and predictable relief.
    • Watch for: Remove contact lenses before use; persistent pain, light sensitivity, or discharge needs medical review.

Stomach acid and digestion

  • Omeprazole 20 mg; Esomeprazole 20 mg; Lansoprazole 15 mg (proton pump inhibitors, PPIs)
    • Use: Frequent heartburn.
    • Why OTC: Highly effective for reflux symptoms; serious risks are rare with short courses.
    • How they’re sold in the US: Labeled for a 14-day course, once daily. You can repeat every 4 months if needed.
    • Watch for: Alarms (trouble swallowing, vomiting blood, black stools, weight loss). Drug interactions (omeprazole/esomeprazole can reduce clopidogrel activation). Long-term daily use needs clinician oversight.
  • Famotidine 10/20 mg; Cimetidine 200 mg (H2 blockers)
    • Use: Episodic heartburn, acid indigestion.
    • Why OTC: Decades of use; safe at low doses.
    • Watch for: Cimetidine has many drug interactions. Ranitidine is off the US market.
  • Loperamide 2 mg
    • Use: Acute diarrhea; to reduce stool frequency/urgency.
    • Why OTC: Well-tolerated at labeled doses; stays mostly in the gut.
    • Watch for: Do not use with fever, blood/mucus in stool, or suspected food poisoning—see a clinician. Dangerous heart rhythm problems occur with overdoses; stick to label limits.
  • Pyrantel pamoate (dose by weight)
    • Use: Pinworm infection.
    • Why OTC: Single-dose treatment with a well-known safety profile.
    • Watch for: Confirm the diagnosis; treat household contacts as directed; repeat in 2 weeks if needed.

Skin, acne, and minor wounds

  • Hydrocortisone 0.5–1% topical
    • Use: Mild eczema, dermatitis, insect bites.
    • Why OTC: Low potency and low systemic absorption.
    • Watch for: Limit to 7–10 days on the same area; avoid face/groin unless advised; see a clinician if rash worsens or shows infection.
  • Adapalene 0.1% gel (topical retinoid)
    • Use: Mild to moderate acne.
    • Why OTC: Strong efficacy and manageable irritation at 0.1% strength.
    • Watch for: Start every other night, then nightly as tolerated; sunscreen daily; noticeable improvement takes 8–12 weeks. Avoid in pregnancy unless your clinician says otherwise.
  • Triple antibiotic ointments (bacitracin + neomycin + polymyxin)
    • Use: Minor cuts/scrapes to prevent superficial infection.
    • Why OTC: Topical use, low systemic absorption.
    • Watch for: Neomycin allergy is common; stop if redness/itching spreads. Not for deep, large, or animal bite wounds—those need medical care.

Motion sickness and sleep

  • Meclizine 25 mg
    • Use: Motion sickness, vertigo-related nausea.
    • Why OTC: Predictable sedation at labeled doses.
    • Watch for: Drowsiness; avoid alcohol and driving until you know your response.
  • Doxylamine 25 mg (nighttime sleep aid)
    • Use: Short-term insomnia.
    • Why OTC: Long history of use; risks are chiefly next-day drowsiness and anticholinergic effects.
    • Watch for: Dry mouth, constipation, urinary retention (especially in older adults or with prostate issues). Avoid combining with other sedatives.

Urinary and gynecologic care

  • Phenazopyridine 95–100 mg
    • Use: Urinary burning and urgency relief while you arrange proper UTI treatment.
    • Why OTC: Symptom-only relief; not an antibiotic.
    • Watch for: Turns urine and tears orange; limit to 2 days unless directed. Always arrange evaluation for possible UTI.
  • Miconazole (vaginal) 1-day/3-day/7-day kits
    • Use: Uncomplicated vaginal yeast infection (typical itch, cottage-cheese discharge, no fever/pelvic pain).
    • Why OTC: Self-recognition is reliable in recurrent uncomplicated cases; topical therapy is localized.
    • Watch for: If first episode, pregnant, or symptoms of bacterial STI/UTI, see a clinician. External burning is common but usually mild.

Colds and congestion

  • Pseudoephedrine (immediate-release and extended-release)
    • Use: Nasal and sinus congestion.
    • Why OTC but restricted: Effective decongestant with stimulant effects; US law requires it to be sold “behind the counter” with ID and purchase limits.
    • Watch for: Raises blood pressure and heart rate; avoid with uncontrolled hypertension, severe coronary disease, or glaucoma. Not for late-day use due to insomnia.

Weight management

  • Orlistat 60 mg
    • Use: Modest weight loss alongside diet; blocks fat absorption.
    • Why OTC: Local gut action; main risks are gastrointestinal and label-manageable.
    • Watch for: Oily stools, urgency, fat-soluble vitamin loss—take a multivitamin at bedtime, not with the dose. Avoid if you have chronic malabsorption or cholestasis.

Key differences to keep in mind

  • US OTCs often have specific strength limits and time caps. Examples: PPIs are labeled for 14-day courses; phenazopyridine for 2 days; hydrocortisone for 7–10 days. The same ingredient at higher strength may still be prescription-only.
  • Combinations common in India may not exist OTC in the US. Example: montelukast + levocetirizine is popular in India; in the US, montelukast remains prescription-only, so that combo is not an OTC option.
  • “Behind-the-counter” is still OTC in the US. Pseudoephedrine requires ID and has monthly purchase limits due to misuse risks, but no prescription is needed.
  • What’s off the US market stays off. Ranitidine was withdrawn due to contamination concerns; expect famotidine or PPIs instead.

When to avoid self-treatment and see a clinician

  • Alarm symptoms such as chest pain, black stools, blood in vomit or stool, severe abdominal pain, high fever, confusion, shortness of breath, or sudden vision changes.
  • Recurring, worsening, or prolonged symptoms despite correct OTC use (for example, heartburn needing PPIs beyond the labeled 14 days).
  • Pregnancy, breastfeeding, infants, older adults with multiple conditions, or anyone on complex medication lists—interactions and risk profiles differ.
  • Suspected bacterial infections. OTCs can mask symptoms; they don’t cure infections.

How to shop OTC in the US without guesswork

  • Read the active ingredient first. US shelves are crowded with brands and line extensions. The ingredient tells you what it actually does.
  • Match the strength and the label directions. If your doctor advised 20 mg omeprazole, don’t buy a 10 mg product and double up unless the label permits it.
  • Check age limits and duration. Many labels have strict age cutoffs and time caps for self-care.
  • Ask the pharmacist. In the US, pharmacists routinely help with product selection, interactions, and when to escalate care—no appointment needed.

What you still won’t get OTC in the US

Some medicines that are often handed out casually in India remain strictly prescription-only in the US because the risk-benefit profile demands clinician oversight. That includes oral antibiotics, systemic steroids, strong pain medicines, montelukast, and most antidepressants and anti-anxiety medications. If you rely on any of these, plan a doctor visit or bring enough supply when you travel.

Bottom line

The US makes a wide range of low-risk, well-studied medicines available OTC at specific doses so people can manage common, self-limiting problems quickly. India’s legal framework classifies many of these as prescription-only, even if they’re frequently sold without a script. If you’re moving between the two systems, focus on the active ingredient, the US-labeled dose and duration, and safety flags that mean it’s time to seek care. When unsure, a five-minute chat with a pharmacist will keep you on the safest path.

Leave a Comment