Self-medication and non-prescription medicines

The term self-medication refers to the treatment of certain conditions or symptoms of disease on the initiative of the patient, thereby enabling a more active role of the patient in caring for their health. In addition, it enables an easier and quicker access to medicines that can be taken without medical supervision, known as non-prescription or over-the-counter (OTC) products. Sounds like an easy and quick way to solve problems, right? But is it all as harmless as it seems and is there a possibility that the perception of patients about the safety of non-prescription medicines is not fully justified?

Non-prescription medicines undergo all quality control procedures as prescription medicines during the registration process. Efficacy and safety are tested, so the dangers (mainly) result from their inadequate use. It is quite understandable that patients do not have enough knowledge about side effects and drug interactions; taking medicines on their own can thus cause serious consequences. This applies especially to elderly patients and children, but also in certain physiological processes such as pregnancy and lactation. Here are just some of the most commonly used non-prescription medications and the possible dangers associated with their use.

The majority of us have probably had non-steroidal anti-inflammatory drugs (“painkillers”) in our home pharmacy, bag or even pocket. However, this drug class should not be used in people with gastric ulcers, while caution is needed in elderly people, especially those with hypertension, heart or kidney disease, and people with asthma. Furthermore, in case of younger patients, drug dose is dependent on the age/weight of the child, while acetylsalicylic acid is contraindicated in children under the age of 16.

People increasingly consume fast-food products due to a fast-paced lifestyle, tight daily schedule and, in general, lack of time. With the addition of daily stress, it is no surprise that the second most commonly used non-prescription medications are so-called “heartburn medicines” or antacids. Taking these medications and postponing a doctor’s visit carries a risk of masking symptoms of a potentially serious illness. Additionally, it is important to point out a very common clinically significant interaction, which is the concomitant use of antacids with certain types of antibiotics (norfloxacin, doxycycline, ciprofloxacin), that leads to a reduced effect of antibiotics.

Medications for relieving flu and cold symptoms are certainly popular during the winter: a headache, clogged nose and fatigue put you out, while your work is put on hold! In such cases people usually opt for combined preparations that alleviate their problems. However, many of these preparations contain sympathomimetics (most commonly pseudoephedrine), which may pose a hazard to persons of any age suffering from hypertension, diabetes, heart or thyroid disease. In addition, nasal drops containing nasal decongestants (“decongestants for a stuffy nose”) should not be used for self medication in persons with the aforementioned illnesses, but only under medical supervision. Prolonged (i.e. longer than five days) and excessive use of such nasal drops should be avoided due to a possible reduction in therapeutic effect and rebound congestion of the nasal mucosa, which can result in the obstruction of the upper respiratory tract and lead to a repeated or permanent administration of the product.

Self-medication is not limited to synthetic products but also includes herbal medicinal products, although patients often do not consider them to be medicines. Nevertheless, these products have their own pharmacological activity, including the possibility of side effects and interactions with other drugs. The most popular herbal medicinal product among the elderly population is surely ginkgo biloba, even though ginkgo-containing products can increase the susceptibility to bleeding. In patients receiving anticoagulant therapy, this medicine should only be taken after consultation with a physician because it interacts with a number of drug classes, especially those most prescribed to elderly patients (e.g. antipsychotics, non-steroidal anti-inflammatory drugs, antidiabetic agents, antihypertensive agents etc.).

If you are confused or even worried about everything you should be wary about when buying non prescription/herbal medicines after reading this information, you shouldn’t be: on the opposite side of the drugstore desk are drug specialists; pharmacists are experts for pharmaceuticals and will help you choose the products that best suit your symptoms and will also tell you whether you should visit a doctor or conduct self-medication at home. You should however provide them with enough information about your condition and the medicines you are taking. Finally, and perhaps most importantly, it is reassuring for patients to know that, in today’s fast-paced style of living, pharmacists are available throughout the day without prior notice in every pharmacy, always ready to provide you with the help you need.

Lucija Bedeniković, Mpharm/ Junior Pharmacovigilance Associate