Self-medication with nutritional supplements and herbal over-the-counter products

In recent years,the popularity increased for nutritional supplements and herbal products.Prescription drugs,but not herbal therapies are paid by health insurances.They are sold over-the-counter(OTC)on the patients’own expense.However,there are potential risks of self-medication,e.g.incorrect self-diagnosis,severe adverse reactions,dangerous drug interactions,risk of addiction etc.They are often used by patients at their own discretion without knowledge of and control by their physicians.Certain users are at risk of intoxication.Multiple medications taken by older patients increase the risk for adverse drug reactions,drug-drug interactions,and compliance problems for this age group(polypharmacy).Herbals should be discontinued prior to operations to avoid interactions with anesthetics or anticoagulants.Herbal preparations may also be carcinogenic or interfere with cancer treatments.Pregnant women use various OTC preparations.However,in many cases,it is unclear whether their use is safe for mother or baby.Self-medication with herbals is also largely distributed among anxious and depressive patients,and patients with other conditions and symptoms.The popularity of herbal products has also brought concerns on quality,efficacy and safety.Cases of botanical misidentification,contaminations with heavy metals,pesticides,radioactivity,organic solvents,microbials as well as adulteration with chemical drugs necessitate the establishment of international quality control standards.Hepatotoxic effects have been reported for more than 300 plant species,and some commonly used herbs have been demonstrated to interact with Western medication.Health care professionals have a critical responsibility assessing the self-care ability of their patients.Databases are available for pharmacists with information on action,side effects and toxicities as well as herbdrug interactions.There is a need for established guidelines regarding the correct use of nutritional supplements and herbal OTC preparations(phytovigilance).Physicians,pharmacists,and other health care professionals have to counsel patients and the general public on the benefits and risks associated with herbal drugs.Information centers for consumers and general practitioners are needed,and convincing evidence on safety and efficacy of herbal products has to be demonstrated in placebo-controlled,double blind and randomized clinical trials.

Observational Study of a Multi-Active Ingredient Over-the-Counter Cold Remedy Following Active Pharmacist Recommendation

Real-world user satisfaction with a fixed dose combination over-the-counter cold remedy (Vicks Symptomed Complete Cytrynowy hot drink;VSCC) was evaluated in a prospective, non-comparative, observational study involving 176 pharmacies in Poland from February to April 2015. 1391 participants completed a questionnaire in the pharmacy and several paper questionnaires at home following use of the product at their own discretion. Participants returned their completed questionnaires to the pharmacy. 1356 participants were included in the intent-to-treat analysis. Participants highly valued the advice from their pharmacist (97%, P < 0.0001, important vs. not important) and thought the quality of that advice was good (93%, P < 0.0001, good/very good vs. very bad-fair). 96% of participants found VSCC to be effective in some way against their cold symptoms (P < 0.0001, effective vs. not effective) and 68% of them stated that it was better than any other cold therapy they had used before (P < 0.0001, better/best vs. same/worse). Adverse event reporting was very low.

Gender Differences in Usage of Over-the-Counter Analgesics among Norwegian Adolescents

Introduction: Usage of over-the-counter (OTC) analgesic has increased among Norwegian adolescents since 2001. It has been noted that females tend to have a higher usage compared to males. In this paper we explore this gender difference. Data: Our dataset consists of 284,674 from Norwegian adolescents attending junior high school and high school between 2014 and 2017. Methods: The econometric approach consists of applying ordered logistic regressions with usage of OTC analgesics as the dependent variable and a dichotomous gender variable as the independent variable. Control variables include variables such as frequency of physical and mental health problems and other sociodemographic variables. Results: Gender, physical and mental health problems and various sociodemographic variables are found to have a significant effect on usage of OTC analgesics. Females are predicted to use significantly more analgesics. A large proportion of the gender difference evaporates when controlling for various other determinants. Conclusion: A considerable part of the observed gender difference in OTC analgesic usage can be traced back to differences in frequency and severity of physical and mental health problems. Part of the gender difference in usage, however remains unexplained.

The Level of Knowledge, Behaviors, and Attitudes on Rational Use of Drugs of Patients Who Applied to the Family Health Center in Istanbul, Türkiye: A Cross-Sectional Study

Background: This study, it was aimed to determine the level of knowledge, attitudes, and behaviors of patients who applied to a family health center about the rational use of drugs. Irrational use of drugs is a major problem worldwide. WHO reports that half of the patients do not use their drugs correctly. Methods: This cross-sectional study was conducted between 1 October 2017 and 30 November 2018 at Istanbul Fatih Family Health Center No 7. The sample size was determined as 301 people selected by systematic sampling method from patients aged 18 and older. Results: The mean age of the participants was 53.8% ± 16.8%, 59.8% were female, 62.5% were married, and 52.5% were primary school graduates. 63.9% of the participants knew the names of the drugs they used, and 79.9% of them knew the indication for use. 89% of individuals check the expiry date of the drugs before using them, and 83.1% read the drug prospectus. 84% of the participants support the prohibition of using over-the-counter drugs. Conclusion: The level of knowledge of the participants about the rational use of drugs is above the societal average. However, some issues need more awareness. The high level of rational use of drugs awareness of physicians and pharmacists will also strengthen the rational use of drugs and indirectly increase the awareness of the public.

Utilization effects of Rx-OTC switches and implications for future switches

We examined the effect of over-the-counter (OTC) conversion of prescription drugs on utilization at the drug class level using monthly drug utilization data from the US for the period 1999-2010 for 9 drug classes: antihistamines, benign prostatic hyperplasia medication, cholesterol control drugs (statins), analgesics (triptans), contraception medications (emergency contraception), antiulcerants (proton pump inhibitors) non-sedating antihistamines, weight-loss remedies and erectile dysfunction remedies. We performed interrupted time series analysis to detect a break in the trend of drug utilization following OTC introduction. We found that the introduction of the first OTC drug increased drug utilization at the class level by an average of 30% or more. We concluded that OTC switches can be an important policy tool for improving public health in drug classes where a significant proportion of the population is untreated and where consumers can effectively manage treatment with limited physician supervision.

Assessment of Counselling for Acute Diarrhoea in North-Eastern German Pharmacies—A Follow-Up Study Using the Simulated Patient Methodology

Aim: As the primary aim of this study, we analysed whether the quality of advice provided by pharmacies in the period between 2014 (baseline study) and 2017 (follow-up study) could actually be increased using a single written performance feedback given to each pharmacy in 2014. The secondary aim of the follow-up examination was to analyse whether the quality of advice differed depending on the professional group providing the advice. Methodology: To ensure the least possible distortion in the comparison between the baseline and the follow-up studies, the study design used for the follow-up examination in 2017 was not changed compared to the baseline examination in 2014. The data for the follow-up examination were therefore collected using the simulated patient method in all 21 pharmacies in a city in the north-east of Germany. Three female and two male test buyers used four different scenarios for self-medication of acute diarrhoea in all of the pharmacies (a total of 84 test purchases). Results: There were significant differences between the overall results from the baseline study (2014) and the follow-up study (2017) (Wilcoxon signed rank test;z = &ndash;2.065, p = 0.039, r = 0.225). In the overall average, the pharmacies in 2017 achieved only 2.7 (30%) of 9 possible points whereas in 2014 they achieved 3.3 (37%). The quality of advice between the professional groups did not show any significant differences (Kruskal-Wallis test: χ2(2) = 1.946;p = 0.378, r = 0.027). Conclusions: The quality of advice for acute diarrhoea in adults declined over time. A written performance feedback intended to improve the quality proved ineffective. Interventions with a far greater impact are required to achieve an improvement in the quality of advice provided.

Self-Medication Practice among Pharmacists in UAE

Objectives: The purpose of this study was to determine the incidence of self-medication behavior among practicing pharmacists in UAE. Methods: This anonymous questionnaire-based study was conducted between October and December 2014, using a prepiloted questionnaire. The questionnaire was distributed to a total of 168 pharmacists. Data were analyzed using SPSS and results were expressed as number of respondents and percentage of total participants. Results: The questionnaire was completed by 149 pharmacists, and response rate was 89% with 53% of respondents being Arabs. Out of the 149 pharmacists respondents, 71 (47.7%) are males, and 78 (52.3%) are females. The mean age among pharmacists was 28. Large number of pharmacists practiced self-medication (96.6%). The majority obtained their medication from pharmacies (92.6%). Most respondents were aware of bacterial resistance and the concept of rational drug use. However, 69 (43%) of pharmacists had used antibiotics without consultation in the past year. The main reasons for self-medication were that their health problem is not serious (42%) and their knowledge on drugs and diseases helps (31%). Reasons against self-medication included risk of misdiagnosis of illness and risk of adverse effects. Pharmacists tended to seek medical consultation mostly in case of symptoms lasting for more than one week or when symptoms were worsening. Discussion: The frequency of self-medication among pharmacists is high. The professional exposure to drugs and knowledge of illness and treatment choice remains the fundamental contributors to self-medication practice among pharmacists. Interventions to promote rational self-medication among practicing pharmacists are required and pharmacists must be encouraged to enter the patient role.