Background: Over-the-counter (OTC) medications are widely used for self-care due to their accessibility and affordability. However, inappropriate use of OTC drugs, including self-medication, exceeding dosages, and improper storage, poses significant public health risks. Understanding public attitudes and knowledge regarding OTC medications is essential for promoting safe practices and minimizing adverse outcomes. This study aims to assess the awareness, attitudes, and practices of Shimla residents regarding OTC medications and identify socio-demographic factors influencing these behaviors.Materials and Methods: A descriptive cross-sectional study was conducted among 400 adult residents of Shimla, Himachal Pradesh, over three months (August–October 2024). A structured questionnaire, divided into socio-demographic information and OTC medication awareness and practices, was administered via online platforms. Participants' knowledge was scored across 20 questions, categorized as Very Good (>80%), Good (60–79%), Fair (41–59%), and Poor (<40%). Data were analyzed using Epi Info V7 to determine frequencies, percentages, and associations between socio-demographic factors and awareness levels.Results: The study revealed a moderate level of awareness regarding OTC medications among participants. Most respondents scored "Good" (38.50%) or "Fair" (33.00%), while only 22.00% demonstrated comprehensive knowledge ("Very Good"). Participants showed strong awareness of risks related to misuse (74.50%) and expiration (77.50%) but exhibited misconceptions about herbal supplements being OTC drugs (49.00%) and the proper definition of OTC (44.50%). Rural residents (56.25%) exhibited lower awareness compared to urban participants, and individuals with higher educational attainment demonstrated better understanding. Misconceptions about self-diagnosis (65.50% recognized it as unsafe) and combining OTC with prescription drugs (61.50% acknowledged risks) highlighted critical gaps in knowledge and practices.Conclusion: While foundational knowledge of OTC medications exists among Shimla residents, significant gaps in understanding safe practices, drug interactions, and proper storage persist, particularly among rural and less-educated populations. Targeted public health campaigns, pharmacist-led education, and community outreach are crucial for addressing these gaps and promoting responsible OTC medication use. By fostering informed self-care practices, such initiatives can enhance health outcomes and mitigate risks associated with OTC drug misuse.