What are the dangers associated with the over-the-counter sale of certain medicines?

Which medicines are concerned?

Definition

Over-the-counter medicines are medicines that are authorised to be sold without a prior medical prescription.

Some medicines can be bought without prescription. These medicines are listed by the FDA and this list sometimes changes in order to guarantee patients' safety.

Some medicines cannot be sold over the counter because they can potentially be harmful when not used properly (high risk of drug interactions, specific characteristics or intended for children and therefore to use cautiously).

What are the criteria for these medicines to be sold over the counter?

To be sold over the counter, medicines must respect some demands to guarantee a safe use. They must treat a benign disease that a patient was able to relevantly self-diagnose. The packaging of these medicines must contain information suited for over the counter access, meaning the instructions must systematically indicate the daily dosage (dosage per intake and number of intakes per day), the hours of intake as well as the interval between each intake. These medicines must be used for short periods of time, and this must be specified on the box/ in the instructions. As soon as this time limit is exceeded, it is advised to refer to a doctor. These medicines are indeed supposed to treat symptoms quickly, within a few days. In addition, these over the counter medicines must be easy to administer: for example, injectable products will never be available over the counter.

Self-medication

This is when any medication is taken without a medical prescription. It is usually used to treat benign symptoms or temporary afflictions that the patient is used to treating on his own. 

These types of medicines are often found 'in front of the counter' or in open access. A pharmacist or pharmaceutical assistant usually advises patients on dosage, pace and duration of the treatment when they buy these medicines.

Furthermore, some medicines are available with or without medical prescription: they are medicines with optional medical prescriptions. They are usually 'behind the counter', allowing pharmacists to make sure the treatment is suited to the patient.

Self-medication also applies to reusing old treatments that are still available at home. This mostly relates to symptomes such as diarrhea, temporary allergies, coughing, cold symptoms, bruises, constipation etc.

What are the potential dangers?

For the patient

The use of medicines without medical advice must be considered carefully. It exposes the patient to a medicine-related illness, to inefficiency risks or to a potentially toxic overdose.

In the event of self-medication, it is essential to:

• make sure to take the right medicine (be sure of the self diagnosis),
  
  
• check the expiration date and storage quality (an out-of-date medicine can be inefficient for example),
  
  
• read the instructions to respect the dosage,
  
  
• not associate medicines without a medical advice,
  
  
• make sure you are not included in the high risk population.
  
  

Furthermore, drug allergies are common and users are not always aware of that. For example, antibiotics intake is highly advised against without a medical prescription because an underlying penicillin allergy can cause cross-allergies with other antibiotics. In addition, the overconsumption of antibiotics has created substantial and preoccupying bacterial resistances directly threatening the potential of this therapeutic class. Antibiotics are recommended to treat bacterial infections and are inefficient when used on viral infections (the most common ones).

For the illness

In the event of an underlying illness, self-medication must be even more supervised. A pre-existing chronic treatment can see it's efficiency decrease because of the simultaneous intake of another medical substance. The opposite effect can also happen, meaning the adverse effects of the chronic treatment can be heightened when another medicine is added. The illness risks not being treated or might even evolve tragically.

For example, people with high blood pressure or heart failure diseases cannot use effervescent tablets, because of the salt they contain. Indeed, these patients have to follow a low-salt diet. Similarly, patients with diabetes should avoid cough syrup with sugar, or any other product that might disrupt their blood sugar level. Pregnant women and children should also avoid products that might contain alcohol, such as some medicines against cold or cough.

What precautions should be taken?

In the event of a chronic disease, medical advice must be sought from a doctor or a pharmacist. Self-medication should always be adapted to a personal situation.

Medicines available on the internet

The main danger of buying medicines online is the lack of verification by a healthcare professional. In that case, the patients do not get any advice or warning about the medicine.

Examples of misuses

Online medicine purchasing from unauthorised websites must be done with caution. These products can be counterfeit medicines whose use may be dangerous or inefficient. The WHO and the FDA report an increase in the sales of 'fraudulently tagged' products to conceal their origin or their identity. Their composition is not to be trusted and exposes patients to health risks.

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