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

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. © 2016, Innovare Academics Sciences Pvt. Ltd. All rights reserved.

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Vol 9, Issue 2, 2016
Online - 2455-3891
Print - 0974-2441
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


Received: 08 January 2016, Revised and Accepted: 17 Febuary 2016

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.
Self-medication, Antibiotic resistance, Self-care.

The World Health Organization (WHO) and the International
Pharmaceutical Federation define self-medication as a run through by
which a human being selects and uses medicines to treat signs/symptoms
or minor health problems, recognized as such by themselves [1,2].
When done appropriately, self-medication can help the individual’s
health and is documented by the WHO as part of self-care [1,3].
Self-care is understood as what people do by themselves to inaugurate
and maintain health, preventing, and dealing with disease. This concept
of self-care includes health, nutrition, lifestyle, socio-economic, and
environmental factors, as well as self-medication [1,3].
Lately, people have taken greater personal responsibility for their
health and are seeking more information and facts to make pertinent
decisions about their treatment either from reliable sources or from
other questionable sources such as health issues related websites [2,4].
In the treatment of minor illness, when problems are self-limited,
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
minor illness include having a limited duration and being perceived
as non-threatening to the patient. In the international arena, such as
in developed countries there is a change in the treatment of these
minor ailments, i.e. illness, sickness, disorders, etc., through using self-
care, encouraged by drug policies around the countries worldwide.
For government institutions, this can reduce costs and distractions
on minor ailments while allowing health professionals to focus on
more serious health problems. When this condition occurs of self-
care, and when the management of these ailments is accomplished
through drugs or medicinal plants, it becomes self-medication. In this
case, pharmacist direction is important to guarantee a responsible
self-medication plan. It is estimated that in the United States, some
100-150 million general physician consultations a year are related
to conditions that could be self-treated. In recent decades, the role
of pharmacist’s has been changed, being not only as drug dispenser
at a pharmacy store but acting as part of a multidisciplinary team
involved in health care [1,6]. It is essential to highlight the convenience
of consumers to the pharmacists, those working in either the public
sector, in private pharmacies and hospital pharmacy. Confirming such
responsibility of pharmacist, Loyola Filho et al. found a significant
association between pharmacist consultation and the use of non-
prescribed drugs in Bambuí, Minas Gerais [7].
Each year, thousands of new products are launched in the drug market
as over-the-counter (OTC) medicines, and community pharmacists
working in public sectors are in an excellent position to provide
correct information on the use of these drugs to the patients [8,9].
Even for the sale of OTC drugs, the prescription is not required by
the patient, but they can cause adverse drug reactions or side effects
if taken incorrectly. It is striking that in Brazil, 35% of medicine are
traded as self-medication [10]. While self-medication can produce good
results and be a useful practice for the patient [1,9,11], but it can also
cause serious health risks such as bacterial resistance, dependence,
digestive bleeding, antibiotic resistance, tolerance, cross tolerance,
hypersensitivity reactions, drug withdrawal symptoms, adverse
drug reactions, as well as increase the risk of neoplasia. In addition
to these risks, it should be highlighted that the momentary relief
of symptoms may actually mask the underlying disease or cause of
disease [10,12]. The indiscriminate use of medicines can also increase
the chances of intoxication, according to the National System of
Toxic-Pharmacological Information (Sistema Nacional de Informações
Tóxico-Farmacológicas - SINITOX) [13]; medicines are the 2nd-most
frequent causative agents of intoxication in humans.
Medicines are responsible for 26% of intoxication recorded in the country
in 2005, where only 590 cases were a result of self-medication [13].
In a self-care context when there is need for medicines to the patient,
the clinical pharmacist has a key role in assisting to identify the best
involvement. This may include transfer to another health professional
(general physician), suggesting a different non-pharmacological
therapy, helping to choose an OTC medicine that is safe and effective,
and ensuring that it is used correctly by patient [1,11,14]. Therefore,
responsible self-medication encourages the rational use of medicines.
According to the WHO, the rational use of medicines is regarded as a
situation in which the patient receives the appropriate medicine for
their clinical need, at a correct dosage, for an appropriate period of time,
and at a lower cost to themselves and the community (WHO, 2002).
However, to ensure responsible self-medication practice, it is necessary
for pharmaceutical establishments to have a standardized sequence
or check on the actions of a particular patient’s care procedure to
manage care adequately. An initiative in this direction was taken by the
European Union which has developed protocols for minor disorders
that help in the interview and decision-making stages [15].

The concept of self-medication encourages an individual to look after
minor illnesses with simple and effective remedies which has been
adopted worldwide [16]. People hold the view that the medicine should
be used in the event of any sickness or discomfort or easiness. In the
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Chouhan and Prasad
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United Kingdom, where on the average 50% of health care takes place
within the realm of self-medication itself [17]. Self-medication is very
common now a days among people, and it is being used worldwide [18].
The % of people using self-medication worldwide is shown in Fig. 1.

Studies on the use of self-medication have showed that the increase in
self-medication was due to a number of factors such as socio-economic
factors, lifestyle, ready access to drugs, the increased potential to manage
certain ailments through self-care, and greater availability of medicinal
goods in the market. The patient serenity with the healthcare provider,
long waiting times, cost of the drugs, educational level, age, and gender
are the other important factors influences self-medication. One of the
most common reasons for indulging in self-medication includes high-cost
fees of private doctor’s consultations. The condition is worst in rural or
distant corners, where the people are deprived socially, economically, and
educationally and illiterate with inadequate health facilities. In another
study, prior familiarity and the non-seriousness of the illness were the
top two reported factors for self-medication and reading materials were
the top reported source of information on self-medication. The patient’s
valuation of his illness has been minor was also identified as one of the
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
are of established efficacy and safety but their inappropriate use due to
lack of knowledge of their side effects and drug interactions could have
a serious consequence, especially in special population groups such as
children, elderly, pregnant, and lactating mothers [26].

Self-medication also has advantages for healthcare systems as it
facilitates better use of clinical skills, increases access to medication
and may contribute to reducing prescribed drug costs associated with
publicly funded health programs [26].


• Inaccurateself-diagnosis
• Failuretoinquireaboutsuitable medical advice promptly
• Inaccuratechoiceoftherapy
• Failtorecognizeunusualpharmacologicalrisks
• Uncommonbutsevereadverseeffects
• Failto diagnosisofcontraindications, interactions,warnings, and
precautions
• Failtodistinguish thatthe sameactivesubstanceisalreadybeing
taken under a different name
• Failto reportrecent self-medicationtothe prescribingphysician
(double medication/harmful interaction)
• Failtorecognizeorreportadversedrugreactions
• Incorrectrouteofadministration
• Excessivedosage
• Excessivelyprolongeduse
• Riskofdependenceandabuse
• Foodanddruginteraction
• Storageinincorrect conditionsorbeyondtherecommendedshelf
life [27].

Improper self-medication could result in an increase in drug-induced
disease, tolerance, resistance in the body, and in wasteful public
expenditure [27].


Health professionals are one who has a potential role in preventing
risks of self-medication in patients who do not know the risks of doing
self-medication. This is because health professional is the one who
work on three main therapeutic aspects of professionalism in his daily
basis practice: Information, therapeutic advice, and education [28].

Whenever health professional is prescribing drugs to the patient, he
should give proper instructions and explanation for what the drug is
prescribed for so that it will be helpful for the patient to understand
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
understand its management [28].

Lack of therapeutic compliance to the patient is a serious problem in
both acute and chronic treatments and reflects a poorly understood
or incomplete description of the treatment aims being given by the
health professional. If patients are not well informed, they will not use
the medication correctly. However, if the instructions for use and the
limitations of a given drug are explained, for example, dose, frequency
of dose, treatment course, route of administration, etc., then patients
has a set of guidelines which will help them to use the drug rationally.
Inappropriate, erratic, and unfit self-medication, along with the lack of
compliance, will only be reduced among patients if they are informed
and are made to understand clearly why certain advice has been given
to them about a certain drug [28].

Inappropriate self-medication is the result of the medical model
from which people have learnt about self-medication. Proper health
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].

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:

To address the condition of the patient properly, the pharmacist must
tell the patient about the key points and pass on relevant information 

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tohimorher→e.g.,Howtotakethemedicines,frequencyofdosesand
how to deal with safety issues [28,33].

The pharmacist must ensure that the products which the patient is
purchasing are from reputable sources and of good quality [28,33].

To achieve this, the pharmacist must develop a protocol for a referral to
the pharmacist, protocols for community health workers involved with
the handling and distribution of medicines [28,33,34].

It is authoritative that pharmacists develop quality collaborative
relationships with the other health care professionals such as
with doctors and nurses, national professional associations, the
pharmaceutical industry, governments (local/national), patients and
general public, and hospitals [28,33,35].

As a member of the health-care team, the pharmacist must participate
in health screening to identify health problems and those at risk in
the community, participate in health promotion campaigns to raise
awareness of health issues and disease prevention in public and
provide advice to individuals to help them make informed health
choices [28,33].

The OTC Committee of the Organization of Pharmaceutical Producers of
India is working toward the promotion of responsible self-medication
with a view to growing the OTC sector in the market. It is aiming to get
supervisory support for issues such as the accessibility of household
TC remedies and increasing the awareness of the importance
of responsible self-medication with the general public and the
government [34]. Many healthcare organizations have made important
statements on self-care and self-medication, singly or jointly with
WSMI. Some selected illustrations only are given here [35]. The WHO:
“It has become widely accepted that self-medication has an important
place in the health care system. Recognition of the responsibility of
individuals for their own health and awareness that professional care
for minor ailments is often unnecessary has contributed to this view.
Improvements in people’s general knowledge, level of education and
socio-economic status in many countries form a reasonable basis for
successful self-medication” [35]. The FIP: “To have good health, people
are becoming more responsible, getting proper information as much as
possible to decide in their own care. Pharmacists and the manufacturers
of non-prescription medicines share the common goals of providing
high-quality service to the public and encouraging the responsible use
of medicines” (Joint Statement by The FIP and the WSMI, 1999) [35].
The international council of nurses (ICN): “Self-medication is a key
component of self-care that is particularly significant in an era of
increasing chronic illness and well-informed health care consumers.
Optimizing responsible self-medication is an important and underused
resource for health and provides an opportunity for collaboration and
consultation among consumers, nurses, pharmacists, and physicians”
(Joint Statement by the ICN and the WSMI, 2003) [35].

Self-medication of antibiotic is an alarming concept. This survey
focused on the self-medication of allopathic drugs, their use, its safety,
and reason for using it. It would be safe and 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.
Hence, developing country like India where we have poor economic
status, education status as well as poor health care facilities. People have
less knowledge regarding risks associated with their self-medication
of antibiotics. We are on the edge of sword whether to promote
self-medication or not. Hence, it is recommended that holistic approach
should be taken to prevent this problem, which includes proper awareness
and education regarding the self-medication and strictness regarding
pharmaceutical advertising. Dispensing modes in the needs to be improved
through proper education, strict regulatory, and managerial strategies to
make health care easily accessible and cost-effective. Health professionals
have to spend some extra time in educating patients regarding the same.
Improved knowledge and understanding about self-medication may
result in rationale use and thus limit emerging microbial resistance issues.

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