While it seems like an inconvenience to visit the doctor for the same symptoms you were treated before, one must think twice before self-diagnosing one’s self, no matter how resourceful the internet maybe. Misuse of medicines has drastic effects on one’s wellbeing.
According to the Consultant Physician Dr. Lalindra Dias (MBBS, MD, MRCP(UK), MRCP(London), self-medication, also known as over the counter (OTC) medication is treating one’s illness or condition by himself or herself without consulting a doctor or proper medical personnel.
It may be without a doctor’s prescription or it may be based on a previous prescription given to the patient by a doctor. In the latter case, when the patient is experiencing similar symptoms as earlier, he or she would hand over the old prescription to the chemist. In some cases one would use a previous prescription given to them to treat another patient, often a family member, when they display similar symptoms.
There are several classes of OTC medications and their side-effects may vary accordingly.
Non-Steroidal Anti-Inflammatory Drugs (NSAIDs)
These drugs are commonly used as painkillers for joint pain, muscle pain, headaches, etc. and are used particularly older people for arthritis, back pain and joint pain. Commonly used NSAIDs are Diclofenac Sodium, Indomethacin, Ibuprofen, Celecoxib and Meloxicam.
He said that the long-term use of NSAIDs could cause many side effects such as peptic ulcers, gastric erosions and gastro-intestinal bleeding. “Moreover, these drugs are nephrotoxic (damages the kidney and may ultimately result in kidney failure),” he added. Therefore NSAIDs should be used preferably as a prescription only medicine.
Prednisolone and Dexamethasone are some examples for commonly used steroids. According to Dr. Dias, steroids are mostly misused by patients suffering with Asthma, Wheezing, and COPD (Chronic Obstructive Pulmonary Disease).
Accordingly they may develop Cushing’s syndrome where the patient may suffer from abnormal obesity, osteoporosis of bones, diabetes, hypertension, etc. Therefore, Dr. Dias emphasised that steroids should be used only as prescription only medicines. “But in Sri Lanka, we have seen many patients with side effects of excess steroids due to this self-medication,” he added.
Some of the most commonly used antibiotics are Amoxicillin, Azithromycin, Cloxacillin and Ciprofloxacin. Dr. Dias believes that these antibiotics have been misused very frequently by the patients for conditions like sinusitis, cough, fever, sore throat, diarrhoea and wound infections.
“The danger of misusing antibiotics is the development of antibiotic resistance. Our bacteria is destroyed by a particular type of antibiotics. However, misuse of these antibiotics leads to antibiotic resistance among these microbes. Therefore, when the need arises, those antibiotics become ineffective against the disease causing microbes,” he explained. Dr. Dias believes that this would not only be detrimental for the patient with the disease, but also for the entire community, and the next generation as well.
Since the discovery of first antibiotic – “Penicillin” in 1928 by Sir Alexander Fleming, there had been an increased production of different classes of antibiotics in the next few decades. However, since 1987 there is a “discovery void”, where the new production of antibiotics has not taken the same phase like before, partly due to the increase of antibiotic resistance.
“Therefore, antibiotics should be used carefully, and only by advice of a qualified doctor. Different infections are treated by different classes of antibiotics, and that decision can only be made by a qualified doctor. Antibiotic resistance is an increasing problem, and not being addressed even among the medical paternity. Stakeholders need to take necessary regulatory actions to avoid antibiotics being sold by the chemist, without a valid prescription,” Dr. Dias emphasised.
Diazepam, Alprazolam and Lorazepam are some commonly used sedatives. In Dr. Dias’s experience, sedatives are mostly misused by those suffering from insomnia and anxiety and by drug addicts as well.
“Danger of these drugs is that they affect the respiratory centre in the brain. Patients may end up with respiratory failure. Also they may result in drowsiness causing confusion,” he added. Furthermore, these drugs have addictive properties. Therefore, these classes of drugs should be “prescription only” medicines.
Common examples for Opiates are Morphine, Tramadol and Codeine. They are mostly used as pain killers and are often misused by younger people for their anxiety reducing effect and the pain reducing effects. Dr. Dias said overuse of these drugs may cause drowsiness and respiratory failure. These are also dangerous drugs and should be “prescription only” drugs.
In Dr. Dias’s opinion applications used for skin rashes, acne and cosmetic purposes including steroid creams, anti-fungal creams and antibiotic creams are also misused very often, and inappropriate use may cause drastic effects.
“For an example, for a rash caused by a fungal infection, sometimes people may use steroid application as both types of rashes result in itching. This would cause the infection to get worse,” he explained.
Although this is not a prescription only type of medicine, Dr. Dias believes that people should be concerned about the maximum dose of Paracetamol that can be used according to their body weight. If Paracetamol is taken in higher doses, it may be toxic for the liver. Moreover, long term excessive usage would cause liver damage.
Anti- Hypertensives and Diabetic medications
In Dr. Dias’s experience, many diabetic and hypertensive patients use self-medication for prolonged periods without visiting a doctor. “This may result in very high blood sugar levels and cause complications related to diabetes and hypertension such as kidney failure, heart attacks (Myocardial Infarction) and strokes,” he added. Therefore, he emphasized that diabetic and hypertensive patients should visit a doctor at least every three months.
Dr. Dias discourages anyone from self-medicating themselves and encourages people to seek medical attention. Moreover, he said that medicines should only be sold for a valid prescription.
Dr. Lalindra Dias explains that a valid prescription should mention the date, patient’s name and his/her age. “Moreover, the drugs should be prescribed in a legible form and the doctor should sign it and his name and qualification should be displayed,” he said.
He emphasised that the stakeholders need to take necessary measures to prevent chemists from distributing medicine without a valid prescription. Dr. Dias mentioned that although these rules have been enforced from time to time, they have not been adhered by the chemists.
“Just like we would seek a civil engineer during building a house instead of doing it ourselves, we should seek proper medical personnel during an illness as their expertise lies in that field,” Dr. Dias concluded.