Review Article

Self‑medication: A current challenge

Abstract

Self‑medication is a global phenomenon and potential contributor to human pathogen resistance to antibiotics.
The adverse consequences of such practices should always be emphasized to the community and steps to
curb it. Rampant irrational use of antimicrobials without medical guidance may result in greater probability
of inappropriate, incorrect, or undue therapy, missed diagnosis, delays in appropriate treatment, pathogen
resistance and increased morbidity. This review focused on the self‑medication of allopathic drugs, their use,
its safety and reason for using it. It would be safe, if the people who are using it, have sufficient knowledge
about its dose, time of intake, side effect on over dose, but due to lack of information it can cause serious effects
such as antibiotic resistance, skin problem, hypersensitivity and allergy. There is need to augment awareness
and implement legislations to promote judicious and safe practices. Improved knowledge and understanding
about self‑medication may result in rationale use and thus limit emerging microbial resistance issues. Articles
which were published in peer reviewed journals, World Self‑Medication Industry and World Health Organization
websites relating to self‑medication reviewed.

Key words:
Allopathic drugs, antibiotic resistance, self‑medication

Introduction Some governments are increasingly encouraging self‑care

of minor illnesses, including self‑medication. Although
Every day, we are practicing self‑medication in the form of responsible self‑medication help to reduce the cost of treatment,
self‑care of our health.[1] Around the 1960’s in the West-self‑care travelling time as well as doctor’s time i.e., consultation time.[1,6]
and self‑medication were regarded as unnecessary and
potentially even unhealthy practices. This paternalistic Major problems related to self‑medication are wastage of
approach to medicine, supported by health systems designed resources, increased resistance of pathogens and causes
to treat sickness (rather than to prevent disease) remains a serious health hazards such as adverse reaction and
familiar aspect of health care in many countries to this day.[2] prolonged suffering. Antimicrobial resistance is a current
problem world‑wide particularly in developing countries
Self‑medication has traditionally been defined as “the taking where antibiotics are available without any prescription.
of drugs, herbs or home remedies on one’s own initiative, or on
[1,7]
Hence, the government should take necessary steps
the advice of another person, without consulting a doctor.”[3] to regulate responsible self‑medication. This can be done
by making availability of safe drugs along with proper
Families, friends, neighbors, the pharmacist, previous prescribed instructions about its use and if in need consulting a
physician.[1,8]
drug, or suggestions from an advertisement in newspapers or
popular magazines are common sources of self‑medications.
Now‑a‑days, self‑medication should be seen as the “desire In India, it is very common to see self‑medication practice and
and ability of people/patients to play an intelligent, independent which is emerging challenge to health care providers.
and informed role, not merely in terms of decision‑making
Extracting and synthesizing data
but also in the management of those preventive, diagnostic and
Articles which were published in peer reviewed journals,
therapeutic activities which concern them.”[3‑5]
World Self‑Medication Industry (WSMI) and World Health
Access this article online
Quick Response Code Darshana Bennadi
Website: Department of Public Health Dentistry, Sree Siddhartha Dental College and
www.jbclinpharm.org Hospital,Tumkur, Karnataka, India
Address for correspondence:
Dr. Darshana Bennadi,
DOI:
Department of Public Health Dentistry, Sree Siddhartha Dental College
10.4103/0976-0105.128253 and Hospital, Agalkote, Tumkur ‑ 572 107, Karnataka, India.
E‑mail: [email protected]

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 Bennadi: Self medication

Organization (WHO) websites relating to self‑medication manage (uncomplicated) chronic and recurrent illnesses (not
reviewed. merely short‑term symptoms) after proper medical diagnosis
and with only occasional professional advice, e.g. use of
Trend of “Rx‑to‑Over‑the‑Counter Switch” histamine H2‑receptor blocker, topical corticosteroid,
antifungal and oral contraceptive. They are understandably
The transfer of prescription (“Rx”) medicines to non‑prescription unwilling to submit to the inconvenience of visiting a doctor
or OTC status is known as the “Rx‑to‑OTC switch”. Many new for what they rightly feel they can manage for themselves,
medicines are first introduced as prescription medicines. After given adequate information.[20]
a sufficient time has passed in the use of the medicine by many
patients and large‑scale experience and scientific information Self‑medication is very common and a number of reasons could
has been gathered, for suitable conditions a manufacturer may be enumerated for it.[18] Urge of self‑care, feeling of sympathy
elect to submit an application to the appropriate authority for toward family members in sickness, lack of time, lack of health
the medicine to be given OTC status.[9] services, financial constraint, ignorance, misbelieves, extensive
advertisement and availability of drugs in other than drug
Statistics shops are responsible for growing trend of self‑medication.[19]
Studies carried out on self‑medication states that it is very
common practice, especially in economically deprived The Story of Self‑care and Self‑medication
communities. Self‑medication also has some advantages and (1970‑2010)
dis advantages.[1,10]
1970‑The World Federation of Proprietary Medicine
Now‑a‑days health care services getting costlier and in Manufacturers Association renamed as WSMI with an objective
developing countries health care facilities are not available. to stress for world‑wide regulatory classification of medicinal
Hence, that time self‑medication becomes an obvious choice products into two classes: Prescription and non‑prescription.[21]
of healthcare service.[1,11] Furthermore, it has been noted that
purchase of drugs and many drugs that can only be purchased 1975‑First international symposium on the role of the
with prescription in developed countries are OTC in developing individual in primary care was held at the European Regional
countries. In addition, lax medical regulation has resulted in Offices of the WHO-stress on “self‑care”.[21]
the proliferation of counter free drugs that are in high demand
for the treatment of highly prevalent diseases.[1,12] 1977‑World Health Assembly adopted the resolution
calling for “health for all” by the year 2000 and in 1978, the
Self‑medication is very common now a days and it is being Declaration of Alma‑Ata.[21]
used world‑wide, given in [Figure 1].[13]
1981‑World Medical Association stressed the responsibility of
India people for their own health in a “Declaration on the Rights of
Self‑medication is very common among educated the Patient.”[21]
population.[14‑19] In Punjab, the prevalence of self‑medication
was 73%. 1986‑Ottawa (Canada) and launched “the Ottawa Charter for
Health Promotion”, in which self‑care was identified as one of
Why do People Use Self‑medication? the three key mechanisms for health promotion.[21]

Modern consumers (patients) wish to take a greater role in the A new era of access to modern, effective medicines was heralded
maintenance of their own health and are often competent to in the early 1980s, when medicines which had previously

Figure 1: Prevalence of self-medication

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 Bennadi: Self medication

only been available on prescription began to be switched to Potential benefits

non‑prescription status. Among the first products switched Individual level
to non‑prescription status was ibuprofen for the treatment • An active role in his or her own health care
of pain, in the UK (1983) and the US (1984). In Canada, • Self‑reliance in preventing or relieving minor symptoms
hydrocortisone became available without a prescription in or conditions
1986. A statement of WSMI Policy on Consumer Information • Education opportunities on specific health issues (i.e. stop
and the Role of Labeling was formally approved and released smoking aids and products to treat heartburn)
by the WSMI Board of Directors at the Fifth General Assembly • Convenience
in October 1979 in Australia. The policy emphasizes that • Economy, particularly since medical consultations will be
the role of labeling is “to provide all information necessary reduced or avoided.[26]
to enable an individual without medical training to use the
medicine appropriately.”[21] At community level
Good self‑medication can also provide benefits such as:
The 1990’s-Guiding Principles in • Saving scarce medical resources from being wasted on
Self‑Medication minor conditions
• Lowering the costs of community funded health care
1990’s, there was an increasing recognition in many parts programs
of the world that people were managing or treating a large • Reducing absenteeism from work due to minor symptoms
proportion of their ailments without always consulting a • Reduce the pressure on medical services where health
health professional.[21] care personnel are insufficient
• Increase the availability of health care to populations
1998, Role of pharmacist in self‑medication was explained living in rural or remote areas.[26]
by WSMI and the International Pharmaceutical Federation
(FIP).[21] In a world of scarce government and in many countries
scarce individual resources, responsible self‑medication
1993‑WSMI’s 11th General Assembly in Acapulco, Mexico, should be a cornerstone of healthcare provision and health
where the theme is “Globalization of the self‑medication policy.[26]
market: challenges and opportunities.”[21]
Potential risks
1997‑WSMI publishes its first global review of consumer Individual level
surveys: “Health care, self‑care and self‑medication.”[21] • Incorrect self‑diagnosis
• Failure to seek appropriate medical advice promptly
1999‑A joint statement is produced by WSMI and FIP entitled • Incorrect choice of therapy
“responsible self‑medication”. • Failure to recognize special pharmacological risks
• Rare but severe adverse effects
WSMI’s 13th General Assembly in Berlin, Germany, where • Failure to recognize or self‑diagnosis contraindications,
the theme is “self‑care, a vital element of health policy in the interactions, warnings and precautions
information age.”[21] • Failure to recognize that the same active substance is
already being taken under a different name
• Failure to report current self‑medication to the
2000‑2005-The Benefits of Responsible
prescribing physician (double medication/harmful
Self‑Medication interaction)
• Failure to recognize or report adverse drug reactions
2000‑The WHO publishes “guidelines for the • Incorrect route of administration
regulatory assessment of medicinal products for use in • Inadequate or excessive dosage
self‑medication.”[21] • Excessively prolonged use
• Risk of dependence and abuse
2006‑2010 and the future-A globalizing world. Prevention of • Food and drug interaction
disease through self‑care and responsible self‑medication.[21]

Sources Table 1: List of drugs used for self‑medication

The common sources of self‑medication are previous
Category Drugs
prescription, friends, advertisements, chemist shop and
books.[14‑17] Cough and cold D‑cold total, corex, benadryl, glycodin
Analgesics Saridon, disprin, diclofenac, nimesulide,
Factors influencing paracetamol, ibuprofen
Self‑medication is influenced by many factors such as Antipyretics Calpol, crocin
education, family, society, law, availability of drugs and Antiseptic Dettol, boroplus
exposure to advertisements.[1,22,23] Table 1 shows list of drugs Antibiotics Ciprofloxacin, norfloxacin, amoxicillin, cefadroxil
used for self‑medication.[24,25] Others Dabur chyawanprash

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 Bennadi: Self medication

• Storage in incorrect conditions or beyond the self‑selecting. Pharmacists should guide their customers to
recommended shelf life.[26] consult the physician before taking any medication by self.[28,29, 30]
Unlike above role, pharmacists have following function as a:
Community level
Improper self‑medication could result in an increase in drug Communicator
induced disease and in wasteful public expenditure.[26] In order to address the condition of the patient appropriately
the pharmacist must ask the patient key questions and pass
Prevention of Potential Risks Associated with on relevant information to him or her (e.g. How to take the
Self‑medication medicines and how to deal with safety issues).[3,31]

Role of health profession Quality drug supplier

Health professionals are one who has potential role in preventing The pharmacist must ensure that the products he/she
risks of self‑medication. Because he is the one who work on purchases are from reputable sources and of good quality.[3,31]
three main therapeutic aspects of professionalism in his daily
practice: Information, therapeutic advice and education.[3] Trainer and supervisor
To achieve this pharmacist must develop a protocol for
Information referral to the pharmacist, protocols for community health
Whenever health professionals are prescribing drugs, he workers involved with the handling and distribution of
should give proper instructions and explain for what it medicines.[3,25,31]
is prescribed so that it will be helpful for the patient to
understand and making his own decisions. Given information Collaborator
should be at patient’s comprehension level so that it will be It is imperative that pharmacists develop quality collaborative
helpful for them to understand its management.[3] relationships with the other health care professionals,
national professional associations, the pharmaceutical
Therapeutic advice industry, governments (local/national), patients and general
Lack of therapeutic compliance is a serious problem in both public.[3,31,32]
acute and chronic treatments and reflects a poorly‑understood
or incomplete description of the treatment aims. If patients Health promoter
are not well‑informed they are unlikely to use medication As a member of the health‑care team, the pharmacist must
correctly. However, if the directions for use and the participate in health screening to identify health problems
limitations of a given drug are explained-for example, dose, and those at risk in the community, participate in health
frequency of dose, treatment course, how to take it, etc., then promotion campaigns to raise awareness of health issues and
patients have a set of guidelines which will help them to use disease prevention, provide advice to individuals to help them
the drug correctly, both now and in the future. Inappropriate make informed health choices.[3,31]
and erratic self‑medication, along with lack of compliance,
will only be reduced if patients are informed and understand Promotion of Responsible Self‑Medication
clearly why certain advice has been given.[3]
The OTC Committee of the Organization of Pharmaceutical
Education Producers of India is working toward the promotion of
Inappropriate self‑medication is the result of the medical responsible self‑medication with a view to grow the OTC
model from which people have learnt. Proper health education
sector. It is aiming to get regulatory support for issues such as
should be given to the patients. By regularly adopting an
the accessibility of household TC remedies and increasing the
educational attitude we can have an effect on large sectors
awareness of the importance of responsible self‑medication
of the population, on people who, in turn, may directly
with the general public and the government.[33]
influence their friends and family. This aspect is of particular
importance with respect to the self‑medication of children by
their parents or takes cares.[3] Many healthcare organizations have made important
statements on self‑care and self‑medication, singly or jointly
Role of pharmacist with WSMI. Some selected illustrations only are given here: [9]
He is one of the key role players in educating his customers
about the proper use of medicines, which are intended for The WHO: “It has become widely accepted that
self‑medication. For that necessary steps have to be taken in self‑medication has an important place in the health care
his training and practice.[27] system. Recognition of the responsibility of individuals for
their own health and awareness that professional care for
Pharmacists play a valuable role in identifying, solving and minor ailments is often unnecessary has contributed to this
preventing drug‑related problems for the purpose of achieving view. Improvements in people’s general knowledge, level of
optimal patient outcomes and quality of life. Ambulatory education and socio‑economic status in many countries form
based pharmacists have the opportunity and responsibility a reasonable basis for successful self‑medication.” (Guidelines
to foster safe, appropriate, effective and economical use for the regulatory assessment of medicinal products for use in
of all medications, especially those therapies patients are self‑medication. 2000).[9]

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 Bennadi: Self medication

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