INTRODUCTION:

Over-the-Counter Medicines:

Over-the-counter (OTC) drugs are drugs that can be purchased without a prescription. Some OTC medications relieve aches, pains, and inflammation. Some prevent or treat diseases such as tooth decay and athlete’s foot. Others help treat recurring problems like migraines and allergies.

The Food and Drug Administration determines whether a drug is safe and effective for sale. This allows you to take a more active role in your health care. But you also need to be careful to avoid mistakes. Follow the directions on the medicine label. If you do not understand the instructions, ask your pharmacist or healthcare provider.

Over-the-counter (OTC) drugs are drugs sold directly to consumers without requiring a prescription from a health professional, unlike prescription drugs, which can only be offered to consumers with a valid prescription. In many countries, OTC medicines are regulated by regulatory agencies to ensure that their ingredients are safe and effective when used without treatment. OTC drugs are usually regulated based on the active pharmaceutical ingredient (API) rather than the end product. By regulating APIs instead of specific drug formulations, the government gives manufacturers the freedom to formulate ingredients or combinations of ingredients into proprietary blends.

The term over-the-counter (OTC) refers to drugs that can be purchased without a prescription. On the other hand, prescription drugs require a prescription from a doctor or other health care provider and should only be used by prescribed people. Some medications may be legally classified as over-the-counter (that is, no prescription is required), but can only be dispensed by a pharmacist after evaluating the patient’s needs or providing patient education. Details about where drugs can be sold, who is licensed to dispense them, and whether a prescription is required vary from country to country.^1,2

Regulations by India:

In January 2016, India’s Anti-Narcotics Advisory Committee announced that it had begun defining the definition of over-the-counter drugs. Therefore, the prescription is a general idea that any drug that is not included in the prescription plan can be purchased as an alternative. However, the required definition was not adopted at the beginning of 2018. The lack of a legal definition for OTC drugs resulted in effective deregulation of this $4 billion market segment.²

Some OTC drugs list³:

· Topical antibacterial/antifunal OTC drugs:

1. Bacitracin topical ointment

2. Clotrimazole (vaginal use) Mycelex

3. Clotrimazole (topical use) Lotrimin

4. Miconazole 2% ointment

5. Miconazole vaginal suppositories, cream

6. Triple antibiotic cream

· Pain reliever otc drugs:

1. Acetaminophen tablets, capsules, Suppositories, liquids, drops Tylenol QLL= up to 4 grams APAP/day

2. EC aspirin 81mg, 325mg, aspirin 325mg Ecotrin

3. Ibuprofen Motrin

4. Naproxen

· Topical dermatological (“skin/scalp”) OTC drugs:

1. Capsaicin

2. DOAK TAR DISTILLATE, OIL

3. Hydrocortisone (prescription and OTC forms covered) Ala-Cort/Cetacort/Hytone

4. Permethrin 1% lotion Nix

5. Pyrethrin 0.33%

6. Zinc oxide ointment

· Diabetes OTC drugs:

1. Insulin OTC Vials

2. Humulin 50/50 Vial

3. Humulin N

4. Humulin R (100U/ML Vial)

5. Humulin 70/30 Vial

6. Novolin 70/30 Vial

7. Novolin R Vial

8. Novolin N Vial

Misuse of medication:

Misuse – Misuse of prescription or over-the-counter medications. It is used in medicine only in cases where it is taken for therapeutic purposes and not for ecstasy, pleasure and euphoria. However, some sources claim that drug abuse is more common in cases involving prescription drugs. These are prescription drugs (unlike over-the-counter drugs) that require a prescription to be purchased over the counter. The most commonly used drugs are psychoactive drugs that cause several emotional and mental side effects to the user.

Medicines that patients take to treat common ailments without a doctor’s prescription are known as over-the-counter (OTC) or over-the-counter drugs. OTC medications provide prevention and treatment for a variety of conditions including, but not limited to, headaches, the common cold, muscle pain, allergies, tobacco dependence, and nausea. However, there are always risks with using OTC medications. These include incorrect self-diagnosis, inappropriate dosage, addiction problems and long-term use, adverse drug reactions, and drug interactions. Most patients are not aware of the risks associated with OTC medications because they do not consult their doctors for OTC medications. In addition, direct-to-patient advertising increases drug exposure to patients. As a result, the use of products increases in the absence of professional help. For the purposes of this review, drug abuse is defined as non-prescription drug use for nonmedical purposes. Unlike abuse, which is often intentional, OTC drugs are drugs that are used for medical purposes but are used incorrectly, for example, wrong dosage, lack of knowledge about interactions, proper use of drugs, and long-term wrong use. However, there is growing concern about the potential harm associated with this drug. The purpose of this article is to provide a brief overview of OTC drug abuse, the level of OTC drug use, the role of pharmacists in solving this problem, the concept of drug return (BTC), and the next steps required. Pharmacists and the pharmacy profession must be recruited to influence the issue nationwide. Although there are articles examining OTC drugs and their abuse, very few have examined the obstacles pharmacists face and steps to prevent pharmacy-based approaches. This review provides advice to pharmacists and researchers on the role pharmacists can play in reducing OTC drug use and strategies that can be implemented to further reduce it.^4,5

Role of pharmacist in OTC medications:

Patients have easy and free access to pharmacist advice. Pharmacies can easily solve many problems that patients face, such as product selection, OTC brand name confusion, proper use of products, and when to take medications. Therefore, pharmacists have a strong influence on OTC drug purchase and product selection.

Many patients are confused about choosing a product because of the marketing strategy by the manufacturer. A common marketing technique used by pharmaceutical manufacturers is line extension. 5 A large percentage of revenue is spent on promoting OTC drugs and line extensions. Because a manufacturer has a specific brand name, other products are marketed as extensions of that brand. For example, the main brand Tylenol® has many line extensions such as Tylenol PM®, Tylenol Cold and Cough®. This often leads to confusion in the patient’s mind. Often these line extensions have multiple ingredients that cause more confusion. Patient-pharmacist interaction will aid in patient decision-making in these situations advertising is often a driving factor in choosing OTC medications by patients. If advertisements are misleading, patients may be misinformed. 21 Advertisements often emphasize the beneficial effects of drugs with little information about contraindications and safety issues. In this case, pharmacists can provide insight into all aspects of addiction, as well as information about the safe use of OTC medications.⁵

Drugs of abuse are misused:

The potential for misuse of OTC medications is never considered. Their abuse is facilitated by their availability, low cost, reduced awareness of potential harm, and increased public acceptance. Unlike prescription and illegal drugs, drugs that individuals can buy legally without a prescription are considered safer.

They are usually purchased not only from pharmacies, but also from non-medical stores (for example, illegal online sites and the dark web). The Internet can be used to buy unlimited (for example, prescription drugs can be bought without a prescription). Other drugs have been used in addition to potentially harsh OTC products, such as some codeine or cough syrup (e.g., pseudoephedrine) containing dextromethorphan and decongestants. Alcohol and illicit drugs are strongly associated with OTC drug abuse.⁶

Method:

A survey has been created to be completed anonymously. Based on the survey, With minor modifications, Hughes et al. (1999). However, it can be used In Jordan, the questionnaire was translated from English to Arabic and back-translated Two independent research assistants. Final version after minor changes Questionnaires were randomly distributed and collected manually Pharmacists working in the community pharmacy sector (n = 405) North, Central, And South Jordan. A list containing information about the location of the pharmacy was obtained From the Jordanian Pharmaceutical Association. Research assistant requested Visit different areas on different days. They will give the questionnaire to the pharmacist Available at the pharmacy and make an appointment to collect the completed form. Research done It was conducted between November 2005 and January 2006 All information provided by will be kept confidential and used for research purposes only JU and JUST objectives by group.

Pharmacists working in community pharmacies were selected because they represent a significant proportion of the Jordanian pharmacy profession. Pharmacies in Jordan are widespread In rural, urban and suburban areas and in pharmacies operating in these pharmacies In daily communication and service of all levels of society. Background, skills,Their expertise makes them a valuable source of information about drug use. The questionnaire consists of two parts. In the first part, respondents were asked Mention any suspected medications or drugs you have taken in the past 3 months Are the trends of abuse/abuse, abuse/abuse changing in Jordan? Pharmacy staff are asked to indicate whether they suspect abuse/misuse Pharmacy and provide a profile of the usual suspects for each identified product. Respondents were also asked to indicate the number of potential customers Buy drugs for the purpose of abuse/use in the previous 3 months and These customers are ordinary customers or strangers. Pharmacists were also asked to provide information on any systems they had To suspected abusers of products and pharmacies are limited Show that they have contacted other pharmacies in their area about their customers Suspected to be involved in drugs. Pharmacists were also asked in the questionnaire The role may be limited to individual referrals, individual patient organizations (e.g. drug addiction centers) or harm reduction promotion. Program designed to wean drug users out of drug factories⁷.

Abuse of Over-the-Counter medicatioN:

Some OTC medications have the potential for abuse. Commonly used medications include antihistamines and sleeping pills Tools, caffeine, ephedrine, pseudoephedrine, antitussives And expectorant, dextromethorphan, laxatives, anabolic Steroids and sildenafil. Laxatives are used for weight loss Loss and high doses of antihistamines are used for euphoria. From a worldwide survey of OTC drug products of abuse, opiate-based combination products, and cough/Cold products containing dextromethorphan, sleep aids, They are antihistamines, analgesics, hypnotics and laxatives Shows the potential for abuse. Cough medicine and Pain medication is the most commonly used medication. OTC codeine or Other herbs and OTC cough and cold remedies Medicine is the most commonly used medicine For abuse. Codeine is not available as OTC in the US.

However, it is a major drug with potential abuse Other countries. Many studies have reported OTC Codeine is the most commonly used type of analgesic. Torture One possible reason for OTC abuse is the increase Access to medicine. This is because of drugs Common ailments available by prescription (Rx) –To-OTC switch. Most switches are controlled by our firm’s patent Expired. However, if you have a prescription for antihistamines Blue Cross and its partners, such as Claritin, Zyrtec, and Allegra, have asked the US Food and Drug Administration for approval. Administration (FDA).Giving patients autonomy, Determine the condition of our patient and The absence of a doctor can lead to a wrong self-diagnosis For example, the availability of dyspepsia masks Possibility of severe gastrointestinal disease Not diagnosed by the patient. Lack of pharmacy skills May lead to long-term use of inappropriate OTC medications And disturb the patient’s health. Drug substitution increases patient autonomy Encourage health care decision making. An estimated $12.9 billion in savings was recorded for the transition Cold/allergy, analgesic, and dermal products. However An increase in the amount of drugs passed OTC status has increased the spectrum of available drugs For abuse. For example, acetaminophen switch OTC prescriptions have led to an increase in serious cases Liver hepatotoxicity.20 If used, acetaminophen results Withdrawal symptoms, in addition to suicidal thoughts and Liver failure.^9,10

CONCLUSIONS:

This study shows that there is a problem of abuse of drugs / drugs that are available for purchase Available in Jordan without a prescription. It is important to limit the use of such drugs Work on law enforcement in community pharmacies through MOH inspectors in collaboration with JFDA. In addition, there is a need to develop and implement practical guidelines on the off-line distribution of drugs for example. At the pharmacy. Faculty of pharmacy in Jordan should play a more active role in education Pharmacy in matters related to substance use/abuse management through adoption Concentration reduction program. The role of pharmacists in management is very important and Jordanian pharmacies have expressed their willingness to actively participate in drug/abuse prevention. This should be done with experience Guidelines for pharmacists in collaboration with regulatory agencies and other health professionals in limiting drug abuse/use eg. Other health care Professionals must be aware of abuse/misuse as a potential problem and must conduct research on assessment methods, identification and treatment.

REFERENCE:

1. https://medlineplus.gov/overthecountermedicines.html

2. https://en.m.wikipedia.org/wiki/Over-the-counter_drug

3. https://www.aetnabetterhealth.com/illinois/assets/pdf/pharmacy/OTC-IL.pdf

4. https://www.slideshare.net/zainebRazzaq/abuse-and-misuse-of-medication

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5774309/

6. https://pharmaceutical-journal.com/article/research/misuse-of-prescription-and-over-the-counter-drugs-to-obtain-illicit-highs-how-pharmacists-can-prevent-abuse

7. https://www.researchgate.net/publication/44637261_Abuse_and_

Misuse_of_Prescription_and_Nonprescription_Drugs_Sold_in_Community_Pharmacies_in_Jordan/link/02e7e52015d998e70c000000/download

8. https://pharmaceutical-journal.com/article/research/misuse-of-prescription-and-over-the-counter-drugs-to-obtain-illicit-highs-how-pharmacists-can-prevent-abuse

9. https://www.researchgate.net/publication/312430790_Abuse_of_

over-thecounter_medicines_a_pharmacist’s_perspective/link
/5a675d74a6fdcc72a58b585b/download

10. Soller RW. Evolution of self-care with over-the-counter medications. Clin Ther. 1998; 20:C134–C140.

Received on 31.10.2022 Modified on 23.11.2022

Res. J. Pharma. Dosage Forms and Tech.2023; 15(1):69-72.

DOI: 10.52711/0975-4377.2023.00012