See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/302959170

Self-medication and their consequences: A challenge to health professional

Article  in  Asian Journal of Pharmaceutical and Clinical Research · January 2016

CITATIONS READS

11 16,348

2 authors, including:

Dr. Shyam Baboo Prasad

Central Council for Research in Ayurvedic Sciences, Ministry of Ayush, Goverment of India
46 PUBLICATIONS   204 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

pg students work View project

Ayurveda View project

All content following this page was uploaded by Dr. Shyam Baboo Prasad on 12 May 2016.

The user has requested enhancement of the downloaded file.

 Online - 2455-3891
Vol 9, Issue 2, 2016 Print - 0974-2441
Review Article

SELF-MEDICATION AND THEIR CONSEQUENCES: A CHALLENGE TO HEALTH PROFESSIONAL

KIRANBIR CHOUHAN, SHYAM BABOO PRASAD*

Department of Pharmaceutical Sciences, School of Pharmaceutical Sciences, Lovely Professional University, Phagwara, Punjab - 144 411,
India. Email: [email protected]
Received: 08 January 2016, Revised and Accepted: 17 Febuary 2016

ABSTRACT

The use of medicament without concerning registered medical practitioner is increasing day by day. Unawareness about safe and rational use of
medicine may lead to serious consequences which is difficult to overcome. The adverse consequences of such practices should always be emphasized to
the community and steps to curb it. Rampant irrational use of antibiotics 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. The present review
deals the reason, hazards, and prevention of potential risk associated with self-medication.

Keywords: Self-medication, Antibiotic resistance, Self-care.

INTRODUCTION working in public sectors are in an excellent position to provide

correct information on the use of these drugs to the patients [8,9].
The World Health Organization (WHO) and the International Even for the sale of OTC drugs, the prescription is not required by
Pharmaceutical Federation define self-medication as a run through by the patient, but they can cause adverse drug reactions or side effects
which a human being selects and uses medicines to treat signs/symptoms if taken incorrectly. It is striking that in Brazil, 35% of medicine are
or minor health problems, recognized as such by themselves [1,2]. traded as self-medication [10]. While self-medication can produce good
When done appropriately, self-medication can help the individual’s results and be a useful practice for the patient [1,9,11], but it can also
health and is documented by the WHO as part of self-care [1,3]. cause serious health risks such as bacterial resistance, dependence,
Self-care is understood as what people do by themselves to inaugurate digestive bleeding, antibiotic resistance, tolerance, cross tolerance,
and maintain health, preventing, and dealing with disease. This concept hypersensitivity reactions, drug withdrawal symptoms, adverse
of self-care includes health, nutrition, lifestyle, socio-economic, and drug reactions, as well as increase the risk of neoplasia. In addition
environmental factors, as well as self-medication [1,3]. to these risks, it should be highlighted that the momentary relief
of symptoms may actually mask the underlying disease or cause of
Lately, people have taken greater personal responsibility for their
disease [10,12]. The indiscriminate use of medicines can also increase
health and are seeking more information and facts to make pertinent
the chances of intoxication, according to the National System of
decisions about their treatment either from reliable sources or from
Toxic-Pharmacological Information (Sistema Nacional de Informações
other questionable sources such as health issues related websites [2,4].
Tóxico-Farmacológicas - SINITOX) [13]; medicines are the 2nd-most
In the treatment of minor illness, when problems are self-limited,
frequent causative agents of intoxication in humans.
self-care can be used to take care of them. According to the Winfield
and Richards [5], the principles for considering health problems as a
Medicines are responsible for 26% of intoxication recorded in the country
minor illness include having a limited duration and being perceived in 2005, where only 590 cases were a result of self-medication [13].
as non-threatening to the patient. In the international arena, such as In a self-care context when there is need for medicines to the patient,
in developed countries there is a change in the treatment of these the clinical pharmacist has a key role in assisting to identify the best
minor ailments, i.e. illness, sickness, disorders, etc., through using self- involvement. This may include transfer to another health professional
care, encouraged by drug policies around the countries worldwide. (general physician), suggesting a different non-pharmacological
For government institutions, this can reduce costs and distractions therapy, helping to choose an OTC medicine that is safe and effective,
on minor ailments while allowing health professionals to focus on and ensuring that it is used correctly by patient [1,11,14]. Therefore,
more serious health problems. When this condition occurs of self- responsible self-medication encourages the rational use of medicines.
care, and when the management of these ailments is accomplished According to the WHO, the rational use of medicines is regarded as a
through drugs or medicinal plants, it becomes self-medication. In this situation in which the patient receives the appropriate medicine for
case, pharmacist direction is important to guarantee a responsible their clinical need, at a correct dosage, for an appropriate period of time,
self-medication plan. It is estimated that in the United States, some and at a lower cost to themselves and the community (WHO, 2002).
100-150 million general physician consultations a year are related However, to ensure responsible self-medication practice, it is necessary
to conditions that could be self-treated. In recent decades, the role for pharmaceutical establishments to have a standardized sequence
of pharmacist’s has been changed, being not only as drug dispenser or check on the actions of a particular patient’s care procedure to
at a pharmacy store but acting as part of a multidisciplinary team manage care adequately. An initiative in this direction was taken by the
involved in health care [1,6]. It is essential to highlight the convenience European Union which has developed protocols for minor disorders
of consumers to the pharmacists, those working in either the public that help in the interview and decision-making stages [15].
sector, in private pharmacies and hospital pharmacy. Confirming such
responsibility of pharmacist, Loyola Filho et al. found a significant WORLDWIDE SCENARIO OF SELF-MEDICATION
association between pharmacist consultation and the use of non-
prescribed drugs in Bambuí, Minas Gerais [7]. The concept of self-medication encourages an individual to look after
minor illnesses with simple and effective remedies which has been
Each year, thousands of new products are launched in the drug market adopted worldwide [16]. People hold the view that the medicine should
as over-the-counter (OTC) medicines, and community pharmacists be used in the event of any sickness or discomfort or easiness. In the
 Chouhan and Prasad
Asian J Pharm Clin Res, Vol 9, Issue 2, 2016, 314-317

United Kingdom, where on the average 50% of health care takes place • Fail to recognize or report adverse drug reactions
within the realm of self-medication itself [17]. Self-medication is very • Incorrect route of administration
common now a days among people, and it is being used worldwide [18]. • Excessive dosage
The % of people using self-medication worldwide is shown in Fig. 1. • Excessively prolonged use
• Risk of dependence and abuse
REASONS OF SELF-MEDICATION • Food and drug interaction
• Storage in incorrect conditions or beyond the recommended shelf
Studies on the use of self-medication have showed that the increase in
life [27].
self-medication was due to a number of factors such as socio-economic
factors, lifestyle, ready access to drugs, the increased potential to manage Community level
certain ailments through self-care, and greater availability of medicinal Improper self-medication could result in an increase in drug-induced
goods in the market. The patient serenity with the healthcare provider, disease, tolerance, resistance in the body, and in wasteful public
long waiting times, cost of the drugs, educational level, age, and gender expenditure [27].
are the other important factors influences self-medication. One of the
most common reasons for indulging in self-medication includes high-cost PREVENTION OF POTENTIAL RISKS ASSOCIATED WITH SELF-
fees of private doctor’s consultations. The condition is worst in rural or MEDICATION
distant corners, where the people are deprived socially, economically, and
educationally and illiterate with inadequate health facilities. In another Health professionals are one who has a potential role in preventing
study, prior familiarity and the non-seriousness of the illness were the risks of self-medication in patients who do not know the risks of doing
top two reported factors for self-medication and reading materials were self-medication. This is because health professional is the one who
the top reported source of information on self-medication. The patient’s work on three main therapeutic aspects of professionalism in his daily
valuation of his illness has been minor was also identified as one of the basis practice: Information, therapeutic advice, and education [28].
major factors for self-medication in a study conducted in Nigeria [19-
25]. Although, OTC drugs are intended to be used as self-medication and Information
are of established efficacy and safety but their inappropriate use due to Whenever health professional is prescribing drugs to the patient, he
lack of knowledge of their side effects and drug interactions could have should give proper instructions and explanation for what the drug is
a serious consequence, especially in special population groups such as prescribed for so that it will be helpful for the patient to understand
children, elderly, pregnant, and lactating mothers [26]. and making his own decisions. Given information of drug should be
at patient’s understanding level so that it will be helpful for them to
POSITIVE OUTCOMES OF SELF-MEDICATION understand its management [28].

Self-medication also has advantages for healthcare systems as it Therapeutic advice

facilitates better use of clinical skills, increases access to medication Lack of therapeutic compliance to the patient is a serious problem in
and may contribute to reducing prescribed drug costs associated with both acute and chronic treatments and reflects a poorly understood
publicly funded health programs [26]. or incomplete description of the treatment aims being given by the
health professional. If patients are not well informed, they will not use
HAZARDS OF SELF-MEDICATION the medication correctly. However, if the instructions for use and the
Individual level limitations of a given drug are explained, for example, dose, frequency
• Inaccurate self-diagnosis of dose, treatment course, route of administration, etc., then patients
• Failure to inquire about suitable medical advice promptly has a set of guidelines which will help them to use the drug rationally.
• Inaccurate choice of therapy Inappropriate, erratic, and unfit self-medication, along with the lack of
• Fail to recognize unusual pharmacological risks compliance, will only be reduced among patients if they are informed
• Uncommon but severe adverse effects and are made to understand clearly why certain advice has been given
• Fail to diagnosis of contraindications, interactions, warnings, and to them about a certain drug [28].
precautions
• Fail to distinguish that the same active substance is already being Education
taken under a different name Inappropriate self-medication is the result of the medical model
• Fail to report recent self-medication to the prescribing physician from which people have learnt about self-medication. Proper health
(double medication/harmful interaction) education should be given to the patients on a regular basis by the
government. By adopting an educational attitude, we can have an effect
on large sectors of the population who directly influence their friends
and family. This aspect is of particular importance with respect to the
self-medication of children by their parents or caretakers [28].

Role of pharmacist
The pharmacist is one of the key role players in educating the customers
about the proper use of medicines, which are intended for self‑medication
such as OTP drugs. For that necessary steps have to be taken in their
training and practice programs [29]. Pharmacists play an important role in
identifying, solving, and preventing drug related problems for the purpose
of achieving optimal patient health and quality of life. Ambulatory-based
pharmacists have an opportunity and responsibility to foster the safe,
appropriate, effective, and economical use of all medications, especially for
those therapies which patients are self‑selecting. Pharmacists should guide
their customers to consult the physician before taking any medication as
self [30-32]. Unlike above role, pharmacists have the following function as:

Communicator
To address the condition of the patient properly, the pharmacist must
Fig. 1: Percentage of people using self-medication worldwide tell the patient about the key points and pass on relevant information

315
 Chouhan and Prasad
Asian J Pharm Clin Res, Vol 9, Issue 2, 2016, 314-317

to him or her → e.g., How to take the medicines, frequency of doses and of antibiotics. We are on the edge of sword whether to promote
how to deal with safety issues [28,33]. self‑medication or not. Hence, it is recommended that holistic approach
should be taken to prevent this problem, which includes proper awareness
Quality drug supplier and education regarding the self‑medication and strictness regarding
The pharmacist must ensure that the products which the patient is pharmaceutical advertising. Dispensing modes in the needs to be improved
purchasing are from reputable sources and of good quality [28,33]. through proper education, strict regulatory, and managerial strategies to
make health care easily accessible and cost‑effective. Health professionals
Trainer and supervisor have to spend some extra time in educating patients regarding the same.
To achieve this, the pharmacist must develop a protocol for a referral to Improved knowledge and understanding about self‑medication may
the pharmacist, protocols for community health workers involved with result in rationale use and thus limit emerging microbial resistance issues.
the handling and distribution of medicines [28,33,34].
REFERENCES
Collaborator
It is authoritative that pharmacists develop quality collaborative 1. World Health Organization. The Role of the Pharmacist in Self-Care
and Self-Medication. Hangue: World Health Organization; 1998. p. 17.
relationships with the other health care professionals such as
2. Federation International de Farmacia. The World Self- Medication
with doctors and nurses, national professional associations, the Industry. Joint Statement: Responsible Self-Medication; 1999.
pharmaceutical industry, governments (local/national), patients and Available from: http://www.wsmi.org/pdf/fip.pdf. [Last accessed on
general public, and hospitals [28,33,35]. 2015 Oct 24].
3. World Self-Medication Industry. WSMI Declaration on Self-Care and
Health promoter Self Medication, 2006a. Available from: http://www.wsmi.org/pdf/
As a member of the health‑care team, the pharmacist must participate boarddeclarationselfcare.pdf. [Last accessed on 2015 Oct 28].
in health screening to identify health problems and those at risk in 4. Barros JA. Pharmaceutical Policies: Service of Health Interests?
the community, participate in health promotion campaigns to raise Brasília: Unesco; 2004. p. 270.
awareness of health issues and disease prevention in public and 5. Winfield AJ, Richards RM. Pharmaceutical Practice. 2nd ed. Hong
provide advice to individuals to help them make informed health Kong: Churchill Livingstone; 1998. p. 523.
6. Petty D. Drugs and professional interactions: The modern day
choices [28,33].
pharmacist. Heart 2003;89:31-2.
7. Loyola Filho AI, Uchoa E, Guerra HL, Firmo JO, Lima Costa MF.
PROMOTION OF RESPONSIBLE SELF-MEDICATION Pharmaceutical policies: Service of Health Interests? Rev Public Health
2002;36(1):55-62.
The OTC Committee of the Organization of Pharmaceutical Producers of
8. Blenkinsopp A, Paxton P, Blenkinsopp J. Symptoms in the Pharmacy:
India is working toward the promotion of responsible self-medication
A Guide to the Management of Common Illness. 5th ed. Oxford:
with a view to growing the OTC sector in the market. It is aiming to get Blackwell Science; 2005. p. 291.
supervisory support for issues such as the accessibility of household 9. Covington TR. Nonprescription drug therapy: Issues and opportunities.
TC remedies and increasing the awareness of the importance Am J Pharm Ed 2006;70(6):137-41.
of responsible self-medication with the general public and the 10. Aquino DS. Why rational drug use deveser one priority? Ciênc Public
government [34]. Many healthcare organizations have made important Health 2008;13:733-6.
statements on self-care and self-medication, singly or jointly with 11. World Self-Medication Industry. Responsible self-care and
WSMI. Some selected illustrations only are given here [35]. The WHO: self-medication: A worldwide Review of Consumer Surveys.
“It has become widely accepted that self‑medication has an important Ferney-Voltaire: WSMI; 2006b. p. 16. Available from: http://www.
wsmi.org/pdf/wsmibro3.pdf>. [Last accessed on 2015 Nov 01].
place in the health care system. Recognition of the responsibility of
12. Vilarino FJ, Soares CI, Silveira CM, Rödel AP, Bortoli R, Lemos RR.
individuals for their own health and awareness that professional care Profile of self-medication in a city in southern Brazil. Rev Health
for minor ailments is often unnecessary has contributed to this view. Public 1998;32(1):43-9.
Improvements in people’s general knowledge, level of education and 13. Bochner R. Casos registrados de intoxicação humana e envenenamento:
socio-economic status in many countries form a reasonable basis for Uma Análise; 2005. Available from: http://www.fiocruz.br/
successful self-medication” [35]. The FIP: “To have good health, people sinitox/2005/umaanalise2005.htm>. [Last accessed on 2015 Nov 01].
are becoming more responsible, getting proper information as much as 14. Wazaify M, Shields E, Hughes CM, Mcelnay JC. Societal perspectives
possible to decide in their own care. Pharmacists and the manufacturers on over-the-counter (OTC) medicines. Fam Pract 2005;22(2):170-6.
of non‑prescription medicines share the common goals of providing 15. Cordero L, Giorgio F, Fernández-Llimós F, Cadavid MI, Gato A,
high-quality service to the public and encouraging the responsible use Loza MI. Protocols for minor disorders Del TESEMED project:
Constipation. Pharm Care Esp 2001;3:155-74.
of medicines” (Joint Statement by The FIP and the WSMI, 1999) [35].
16. Sinclair HK, Bond CM, Hannaford PC. Long term follow-up studies
The international council of nurses (ICN): “Self-medication is a key of users of nonprescription medicines purchased from community
component of self-care that is particularly significant in an era of pharmacies. Drug Saf 2001;24(12):929-38.
increasing chronic illness and well-informed health care consumers. 17. Afolabi AO. Factors influencing the pattern of self-medication in an
Optimizing responsible self-medication is an important and underused adult Nigerian population. Ann Afr Med 2008;7(3):120-7.
resource for health and provides an opportunity for collaboration and 18. Available from: http://www.abimip.org.br/uploads/material_de_
consultation among consumers, nurses, pharmacists, and physicians” apoio/1296056417_792.pdf/. [Last accessed on 2015 Nov 02].
(Joint Statement by the ICN and the WSMI, 2003) [35]. 19. World Health Organization: The Role of the Pharmacist in Self-Care
and Self-Medication. Report of the 4th WHO Consultative Group on
CONCLUSION the Role of the Pharmacist. The Hague; 1998. Available from: http://
www.who.int/medicines/library/dap/who-dap-98- 13/who-dap-98-13.
Self‑medication of antibiotic is an alarming concept. This survey pdf. [Last accessed on 2015 Nov 02].
focused on the self‑medication of allopathic drugs, their use, its safety, 20. Hebeeb GE, Gearhart JG. Common patient symptoms: Patterns of
and reason for using it. It would be safe and if the people who are using self-treatment and prevention. J Miss State Med Assoc 1993;34:179-81.
it, have sufficient knowledge about its dose, time of intake, side effect 21. Sharma R, Verma U, Sharma CL, Kapoor B. Self-medication among
urban population of Jammu city. Indian J Pharmacol 2005;37:40-3.
on over dose, but due to lack of information, it can cause serious effects
22. Abay SM, Amelo W. Assessment of self-medication practices among
such as antibiotic resistance, skin problem, hypersensitivity, and allergy. medical, pharmacy, and health science students in Gondar University,
Ethiopia. J Young Pharm 2010;2(3):306-10.
Hence, developing country like India where we have poor economic 23. Omolase CO, Adeleke OE, Afolabi AO, Afolabi OT. Self medication
status, education status as well as poor health care facilities. People have amongst general outpatients in a Nigerian community hospital. Ann
less knowledge regarding risks associated with their self‑medication Ibadan Postgraduate Med 2007;5(2):65-8.

316
 Chouhan and Prasad
Asian J Pharm Clin Res, Vol 9, Issue 2, 2016, 314-317

24. Worku S, Mariam AG. Practice of self medication in Jimma town roles in guiding self medication of over the counter therapy in Qatar.
Ethiopian. J Health Dev 2003;17(2):111-6. Patient Prefer Adherence 2010;4:87-93.
25. Murray MD, Callahan CM. Improving medication use for older Adults: 31. General Information WHO Drug Information. Vol. 14. No. 1,
An integrated research agenda. Ann Intern Med 2003;139:2425-9. 2000. Available from: http://www.apps.who.int. [Last accessed on
26. Hughes CM, McElnay JC, Fleming GF. Benefits and risks of 2015 Nov 11].
self-medication. Drug Saf 2001;24(14):1027-37. 32. Role of the Pharmacist in the Health Care System. Available from:
27. WHO. Guidelines for the Regulatory Assessment of Medicinal Products http://www.apps.who.int. [Last accessed on 2015 Nov 15].
for use in self-Medication. Geneva: WHO; 2000. 33. Ruiz ME. Risks of self medication practices. Curr Drug
28. Hernandez Juyol M, Job Quesada JR. Dentistry and self‑medication: Saf 2010;5:315-22.
A current challenge. Med Oral 2002;7:344-7. 34. Available from: http://www.indiaoppi.com/IndiaOTCpharmaProfile2011.
29. Available from: http://www.apps.who.int. [Last accessed on pdf. [Last accessed on 2015 Nov 15].
2015 Nov 04]. 35. Available from: http://www.wsmi.org/news/news_113.htm. [Last
30. Wilbur K, Salam SE, Mohammadi E. Patient perceptions of pharmacist accessed on 2015 Nov 22].

317

View publication stats