I T'S an easy reference check you can do open the medicine box you have at home and count the number of drugs you actually bought on prescription. Chances are that all the antidotes you have in there, for fever, cold, cough, indigestion, headache, constipation, painkillers etc, were bought over the counter.
A few other antibiotics in the box may remind you of the indiscriminate advice on dosage your friendly neighbourhood chemist gave you. Worse is when the chemist doesn't hesitate to administer a full course of medication over the counter, just as doctors do.
Well, if you thought that you don't really need to consult a doctor for common ailments it might help to read on.
In India, according to a study done by Kerala Sastra Sahitya Parishad, fever, headache, general body pain, knee-joint pain, vomiting and asthma are some of the illnesses for which people take medicines on their own.
"Only a few drugs such as antipyretics, antacids, multi-vitamins, and cough suppressants belong to the OTC (over-thecounter) category. Most others, like antibiotics, tranquillisers, cardiac drugs, hypnotising drugs and several analgesics or painkillers, belong to Schedule H category, and therefore shouldn't be sold without prescription," says Sushum Sharma, HoD, Preventive Health Program and senior consultant Internal Medicine at Max Healthcare in Delhi. He adds that even OTC drugs should be used only in an emergency and that too in the lowest possible denominator. The doctor must be contacted soon after.
Self-medication becomes risky when some disease, unknown to the patient, gets suppressed for a long time. For instance, what you consider to be fever, can turn out to be dengue, a recurring headache can actually be meningitis, what you perceive as simple knee pain might be a severe orthopaedic problem, says Sharma.
"Parents need to be particularly careful in case of administering drugs to children below the age of two. Most people, for instance, take cough and cold casually. Even nonconcentrated cough and cold formulations are easily available over-the-counter. In the US these medications have been linked to a significant number of adverse effects like convulsions, rapid heart rates, and unconsciousness and several deaths. The Food and Drug Administration (FDA) has recommend against their use for children less than two years old," says Rajiv Chabbra, Consultant Paediatric and Neonatal Intensivist, Artemis Health Institute.
In fact, more than 40% of parents use cough syrups for children younger than two, even though it is not recommended, nor proven effective for this age group.
Though persistent cough is the body's mechanism for shedding viruses and the duration of a cough is commonly two weeks in children and three weeks in adults, it's better to exercise caution.
Research scholar Misel Trajanovska from the University of Melbourne found 98% of the respondents purchased an over-the-counter medication in the past year and Paracetamol was the most commonly used drug (95.9%).
The implications are startling: 16% of poisonings reported in the emergency department were due to Paracetamol and 11% were caused by cough and cold medicines.
A lot more is happening globally. Earlier this week the US FDA imposed an urgent warning on Cipro and similar antibiotics, citing risks that they can cause tendon ruptures, a serious injury that leaves some patients incapacitated.
Indiscriminate use of medicines should also be avoided because the sensitivity levels of people vary - what might be an appropriate dose for one might be an overdose for another.
There's also the possibility of different drugs reacting to each other.
Adults need to be as careful. It is important to go beyond the symptoms and investigate the real cause, says Dr Khusrav Bajan, Head of Internal Medicine department in P D Hinduja, Mumbai. "A person having cardiac or hypertension history needs to be extra cautious. For example a person, already on medication for blood pressure, can suffer from increased BP and even a cardiac arrest if he pops in the wrong pill. A medicine taken for mild giddiness can cause severe swelling. Antibiotic overdose can result in resistant bacteria. There are several combinations of the same drug available under different names and you need to pick the right thing," adds Bajan.
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