Treating yourself with over-the-counter medication? Here's what you must be aware of.
Chong Pei Lan
Pharmacist
With rising healthcare costs, self-medication is one way to save on healthcare bills. However, self-medication is potentially dangerous as most people do not fully understand the working of the medicines available to them and may use medicines in a risky and uncritical way. Here is a quick guide to the do's and don'ts of self-medication: 
First, identify your symptoms as accurately as possible
Ensure that you have made the right choice of medication for the particular symptom. For example, if you have a colicky abdominal pain with diarrhoea from food poisoning, you should not take antacids which are meant for gastric pain.
Secondly, know how to take the medication
Medications today come in various forms and they have to be taken in a specific way to achieve its therapeutic effect. There are instances where patients given the right medication, fail to get better as they have taken the medicines incorrectly.
Oral Medication: these come in a variety of forms including tablets, capsules and liquids.
Chewable tablet: the tablet has to be chewed before swallowing to enhance its effect in the gut. An example is antacids
Sublingual tablet: the tablet is placed under the tongue so that it is absorbed directly into the blood stream
Effervescent tablet: the tablet has to be dissolved in water first before consuming
Enteric-coated tablet: the tablet has a special coating to protect it from the acidic environment in the stomach. The drug will be released further down the gut. It is important not to co-administer these medications with drugs that can alter the gastric acidity e.g. antacids.
Slow-release tablets: these tablets release the drug over a period of time. Therefore, they must be taken less frequently. It is important to take the medication at the same time everyday.
Other Forms of Medication
A suppository is shaped like a bullet and is to be inserted into the rectum. The drug is released into the rectum and absorbed into the blood stream.
A pessary is also shaped like a bullet, but is usually smaller than a suppository. It is to be inserted into the vagina. Usually an applicator is provided to aid proper insertion.
Preparations for ears and eyes are in the form of drops and ointments and have to be applied directly into the eye or ear canal. Avoid contact between the tip of the dropper and the skin to prevent contamination.
The Do's You Have To Know
How long do you have to take the medication?
When you are taking medication for self-limiting conditions such as the common cold, you may stop taking the medication when the symptoms have disappeared. However, for anti-fungal preparation, it is advisable to continue treatment for a minimum of one week.
How frequently do you have to take the medication?
A medicine with a label that says, "to be taken three times a day" has to be administered three times a day. This will ensure that the drug level in the blood remains within the therapeutic range. A medicine that is taken too frequently will lead to toxic or even lethal blood levels. On the other hand, a medicine that is taken too infrequently will lead to sub-therapeutic blood levels and the desired effect will not be achieved.
Do you know how to store your drug?
Some people keep all their medication in the refrigerator. This is not necessary and may even be potentially dangerous as young children can easily mistake them as sweets. Read the product leaflets and store them appropriately.
Have you checked the expiry date?
Medicines that are exposed to air after opening will deteriorate with time and they will lose their potency and effectiveness. Therefore, it is important to check the expiry date and discard the medicine if the expiry date has been reached.
Have you checked with someone in the know?
When in doubt, always consult your doctor or pharmacist. They will be able to tell you how to administer the medication, how frequent to take the medication and whether or not you can take a certain medication.
You have to be careful to check, there is no doubt about this. Some non-prescription medications, especially painkillers containing aspirin, acetaminophen and ibuprofen can cause damage to the kidneys. Talk to your doctor if you are taking painkillers on a frequent basis, such as on a monthly basis for period pains.
What You Must NOT Do
Offer medicines to other people
Do not insist that your family members or friends should take a particular medication just because it has worked well for you. They may have co-existing diseases of which you are not aware. The same goes to you if well-meaning friends offer you medicines.
Practise polypharmacy
Different brands of medication meant for the same condition might contain identical active ingredients. Ingesting them together would mean overdosing and is dangerous as in the many cases of paracetamol poisoning in children. Always read the product information leaflet to find out what the active ingredients are.
Mix Western medicine with altermative medicine
As in the above case, alternative medicines may contain active ingredients similar to those in proprietary medicines. Or they may contain chemicals which could result in unwanted drug interactions within the body. Do not underestimate the effects of your herbs and supplements.
Delay seeking professional help
If symptoms persist or new symptoms such as skin rashes, breathlessness or swelling of the eyes appear, seek medical attention immediately.
Determine own dosage
Do not miss any dose of the medication you are taking. If you have inadvertently missed a dose, do not double the next dose without consulting your doctor or pharmacist first.
A person may also have predisposing medical conditions that make him unsuitable to take certain drugs. The following category of people would do well to consult the pharmacist when they seek to purchase medicines over the counter.
Self-Medicating By People Under Special Conditions
Pregnant women
Most drugs can cross the placenta freely and thus, no drug is completely safe to the developing foetus. Therefore, it is advisable to avoid taking medication during pregnancy, especially during the first trimester of pregnancy. Medicines should only be taken if the expected benefit to the mother is thought to be greater than the risk to the foetus.
Breastfeeding mothers
Almost all drugs taken by a lactating mother are excreted in her breast milk to some extent. Therefore, it is advisable to seek the advice of medical professionals before taking any form of medication.
Children
Children generally require a reduction in dose based on their body weight. They are also more sensitive to the effects of drugs and extra caution should be taken. Never assume what works for you will work for your infant, even if it's for a drug like paracetamol.
The elderly
Elderly people are also more sensitive to effects of drugs due to the decreased liver and kidney metabolism with advancing age. Drug dosages should therefore be reduced accordingly.
Those with co-existing diseases
People with co-existing diseases such as severe asthma, chronic obstructive lung disease, ischaemic heart or heart failure are more prone to the effects of certain classes of drugs. People with renal impairment, liver disease or undergoing dialysis are also more likely to develop adverse effects to drugs as the metabolism of drugs is affected.
There is a variety of medications that are available over the counter and from the pharmacists which one can easily purchase to treat common ailments. You can only get the best results if you are careful and responsible to check that the your use of the drugs is appropriate.
References:
- Bird C., Carol J. Self Administration of Drugs: A Guide to Implementation. Scutari Press, 1993
- Parish P. Medicines: A Guide for Everyone (3rd Edition). Penguin Books, 1981
- Henry JA. Hazards of Self-medication. Br J Clin Pract 1994; 48(6): 285
- Health Guide Singapore 1998
Date reviewed: 26 April 2005
