Over-the-counter Research Articles

Over-the-counter drug consumption and related factors, evidence from the European Health Interview Survey.

The aim of this work is to find the factors related to over-the-counter drug (OTC) consumption in Europe considering the differences in OTC market regulation. A sample obtained from the European Health Interview Survey (EHIS) of 2019 is used to estimate a logistic regression. This sample includes 286,413 people from 26 countries. The outcome variable is derived from the question about the use of non-prescribed drugs. The independent variables include a set of predisposing, enabling, and need factors. Finally, countries with similar OTC retail market regulations are considered to control for heterogeneity in this regard. The main findings show that OTC market deregulation is not strictly related to the share of OTC consumption. Despite some heterogeneity based on the type of OTC retail market regulation, there is a set of common drivers for its use by people across countries, such as age, gender, education, suffering from chronic disease or pain and being on a waiting list for medical treatment. When considering individual country and cluster of countries controls, there are some relevant results such as the role played by accessibility to pharmacies and OTC retailers; the positive correlation between OTC drugs and prescribed drug consumption, and the positive correlation between unmet health care needs due to financial household constraints and OTC drugs use. There is no clear relationship between OTC drug use and OTC retail market regulation. There are several predisposing, enabling, and need factors that promote the use of OTC drugs. The relevant policies relate to the inequal access to OTC drugs across countries that may result from different market regulations and different consumption drivers.

Impact of Headache and Over-the-Counter Treatment on Pain and Functional and Cognitive Parameters: A Real-World Study across Three Geographies.

Individuals with headache choose over-the-counter (OTC) medications to relieve pain and associated symptoms. This real-world evidence study investigated the effect of three OTC headache treatments on headache intensity and the associated impairment of cognitive and functional parameters in headache sufferers in Germany, Brazil, and Japan. This prospective, multinational, observational eDiary-based study included adults experiencing headache for ≥ 6 months, with ≥ 2 headache episodes per month requiring treatment and using one of the three OTC headache treatments (Germany: ibuprofen 400 mg + caffeine 100 mg; Brazil: dipyrone 1 g; Japan: ibuprofen 100 mg + caffeine 40 mg). The primary endpoint was change in headache intensity (11-point numeric rating scale [NRS]) from baseline (headache onset) to 2 h post-treatment. Secondary endpoints were association between NRS scores for headache intensity and for cognitive and functional parameters and change in these parameters from baseline to 2 h post-treatment. Of the 32,623 individuals screened, 1239 were enrolled in the study, with 607 having their first headache episode treated using one of the OTC treatments. Baseline demographics and characteristics were similar across the cohorts. At 2 h post-treatment, headache intensity significantly improved, with the mean change from baseline being 3.4 (3.1, 3.7, 95% confidence interval), 4.2 (3.9, 4.5), and 3.0 (2.7, 3.3) for German, Brazilian, and Japanese cohorts, respectively. Improvement was observed in all cognitive and functional parameters. The NRS score for headache intensity significantly predicted NRS scores of all cognitive and functional parameters (P < 0.0001). The study shows that headache intensity significantly affects cognitive and functional aspects, as well as overall quality of life, for sufferers globally. It confirms the effectiveness of OTC medications and suggests using headache intensity as a self-assessment tool for symptom severity, highlighting the need for new parameters in the OTC domain to improve public health benefits.

Assessment and Evaluation of Consumer Awareness and Self-Medication Use Practices Towards Over the Counter (OTC) Analgesics. A Cross-Sectional Study in Abha-Saudi Arabia.

To assess and evaluate consumer awareness and common medication use practices towards OTC analgesics, with a focus on the impact of irrational drug use and its implications for public health and safety. This includes identifying gaps in knowledge, evaluating the potential consequences of misuse, and discussing how these findings can inform future educational initiatives and policy development to promote safer medication practices. This was a cross-sectional, semi-quantitative survey of 750 Saudi volunteers both males and females aged between 18 and 65 years. A validated self-administered questionnaire was used among randomly selected volunteers with a history of OTC analgesic use. A total of 750 questionnaires were administered and the response rate was measured to be 75.6%. More than 50% of the study population used OTC analgesics without a prescription and reported using analgesics as soon as they start experiencing any pain. Paracetamol was found to be the most predominantly used analgesic. The most common indication of OTC analgesic use was reported for headache and toothache whereas irrational use of analgesics in terms of dose, frequency and indication was found to be to the extent of 50%. Primary source of information related to OTC analgesic use was obtained from pharmacy personnel (31.7%), and Patient Insert Leaflets (PIL) (28.7%). Majority of the respondents (64.3%) didn't know the safe maximum dose of Paracetamol, whereas 73.3% used to stop medicine only after experiencing some side effects. 52.4% of the respondents were not aware about the most common side effects, and potential interactions of analgesic medications. Our study highlights the menace of self-medication practices and irrational use of OTC analgesic by the study participants. Immediate remedial measure need to be taken to discourage self-medication and improve rational use of OTC drugs which can be achieved by focusing on improving the consumers' awareness of self-medication and the rational use of medications.

Analysis of OTC and Prescribed Drugs Working Against COVID-19 Symptoms in the Context of Humans and Surrounding: A Brief Report on Medications Taken by Patients

Background: Coronaviruses are the genetic series of RNA viruses that infect both organisms mammals and birds. Different varieties of illnesses shown in humans as well as in birds are the most common causes ranging from minor to fatal. Common colds which are included in mild and SARS, MERS, and COVID-19 are caused by fatal. After cell entry, the release of RNA into the cytoplasm occurs, which translates viral proteins followed by processed replication. Objective: The survey was based on a comparison study between the purchase of OTC and prescribed drugs for COVID-19 symptoms, including the volume of pharmacies from different zones of Yamunanagar district, Haryana. Methods: The analytical survey involves the different zones of Yamunanagar the pharmacist used in this report. The numerical data is gathered in a methodical investigation which leads to quantitative research. The data investigation was performed by using Statistical Package for Social Sciences (SPSS) version 20. Results: The north zone area mostly suffered from the COVID-19 pandemic condition from January 2021 to June 2021 in Yamunanagar and found that most of the OTC drugs purchased by consumers were paracetamol (PCM) and Prescribed drugs (HQCS + Azithromycin) by the public regarding covid-19 symptoms. Conclusion: The outcome of this case report reveals that no statistically significant difference exists between the population parameter and sample statistics while the comparison retained the null hypothesis in different zones of Yamunanagar (Haryana), India including the volume of pharmacy and drug category.

Stop Being Shady: How Current Sunscreen Regulatory Processes and Standards Burn Consumer Protection

In the United States, the Food and Drug Administration (FDA) regulates sunscreen as an over-the-counter (OTC) drug and not a cosmetic, subjecting it to the agency’s OTC drug review process. In 1999, the FDA published a final set of standards for marketing sunscreens in the United States, called a monograph. Since its publication, the FDA has tried to amend the monograph with little success. Congress has also acted to ease the procedural burdens and hurdles the FDA faces in updating the monograph, but these attempts brought about little change in sunscreen regulations. The United States’ efforts to properly update the standards for sunscreen pale in comparison to other countries, such as those in the European Union and parts of Asia. There, sunscreens are regulated as cosmetics, and new sunscreen ingredients face a different review process, leading to approval of newer and more effective ingredients on an expedited basis. Meanwhile, the FDA has taken a risk-averse approach to sunscreens, and in particular, approvals of new sunscreen active ingredients, as they have consistently denied approvals for new ingredients due to insufficient safety data. This approach has impeded meaningful progress for sunscreens—the last time the FDA approved a new sunscreen active ingredient to be broadly used in sunscreens was in 1999. Some groups support the FDA’s risk-aversion, but others question whether such stringency actually benefits public health long-term. This Note argues that the FDA’s risk-averse approach improperly balances sunscreen safety with public health. To better serve the FDA’s mission of consumer protection, Congress should step in to fund public research or provide enticing incentives for industry stakeholders to encourage them to take up the costs associated with the rigorous, yet crucial, safety testing.

A brief report of the status of self-medication with over-the-counter drugs: a pilot cross-sectional survey

ObjectiveThe extent of perceived knowledge and usage status regarding over-the-counter (OTC) drugs among Japanese citizens remains unclear. This study aims to assess OTC drug use through a pilot cross-sectional survey.ResultsConducted on April 30, 2023, at the Graduate School of Pharmaceutical Sciences, Osaka University, the survey garnered 180 valid responses. Among these, 76.1% were female and 56.1% aged 16–19 years. Over the past year, 70.6% used OTC drugs, and price (60.0%), effectiveness (50.0%), and ingredients (43.3%) were the top three factors focused on during OTC drug selection. Most respondents (97.2%) were aware of Package Inserts (PI), with 51.7% reading them before purchasing or using new OTC drugs. 10% reported online purchases. However, 17.2% were unaware of expiration dates, and only 43.3% read storage and handling instructions from PI. This study indicates moderate proper use of OTC drugs but highlights risks due to low awareness of storage precautions and expiration dates. Results are preliminary; further research is needed for generalization.

Association of over-the-counter mouthwash use with markers of nitric oxide metabolism, inflammation, and endothelial function—a cross-sectional study

IntroductionRegular use of mouthwash can disrupt nitrate reduction by oral bacteria and may affect systemic nitric oxide (NO) levels, which are important for inflammation and endothelial function. We aim to assess the association between over-the-counter (OTC) mouthwash use and nitrate/nitrite, markers of inflammation (IL-6, TNF-α, CRP) and endothelial function (sICAM-1, sVCAM-1) in serum and saliva, and to assess the relationship between nitrate/nitrite levels and these biomarkers, as well as how OTC mouthwash modulated this relationship. We hypothesize that nitrates/nitrites are associated with these biomarkers, and that their associations would vary with the frequency of mouthwash use.MethodOur cross-sectional study used data and specimen from the baseline of the San Juan Overweight Adult Longitudinal Study (SOALS). Robust Gamma regression with log-link function, Spearman correlations and partial correlations adjusted for covariates were used for the analysis.ResultsUsing OTC mouthwash twice a day or more was significantly associated with lower serum nitrite levels compared to less frequent use (β = −0.357, 95% CI: −0.650, −0.064), but not with other markers of inflammation and endothelial function. Mouthwash use differentially impacted the relationship between nitrate/nitrite and TNF-α, sICAM-1 and sVCAM-1. Specifically, in the participants who used mouthwash less than twice a day or no use, TNF-α (β = −0.35, 95% CI: −0.52, −0.18), and sICAM-1 (β = −0.21, 95% CI: −0.32, −0.09) were negatively associated with serum nitrite. In the participants who used mouthwash twice a day or more use, TNF-α was positively associated with serum nitrate (β = 3.36, 95% CI: 2.07, 4.65), salivary nitrite (β = 1.04, 95% CI: 0.39, 1.69) and salivary nitrate (β = 0.48, 95% CI: 0.25, 0.71); sICAM-1 was positively associated with serum nitrate (β = 1.58, 95% CI: 0.86, 2.29). In both subgroups of mouthwash users, sVCAM-1 was positively correlated with serum nitrate and salivary nitrate. In addition, sVCAM-1 was positively correlated with serum nitrite in participants who used mouthwash frequently (ρ_S = 0.18, p = 0.045).DiscussionRegular use of OTC mouthwash was associated with systemic nitric oxide. This raises concerns about its potential effects on the levels of inflammatory and endothelial biomarkers associated with cardiometabolic diseases.

Changes in Support for Advance Provision and Over-the-Counter Access to Medication Abortion

Since Dobbs v Jackson Women's Health Organization (Dobbs) removed federal abortion protections, people's views about alternative models of abortion care may have been impacted, yet research on this topic is limited. To examine changes in national support for and personal interest in advance provision (AP) and over-the-counter (OTC) access to medication abortion. Two nationally representative cross-sectional online surveys were administered to a market research firm's panel members who were assigned female at birth (AFAB) and aged 15 to 49 years from December 2021 to January 2022 (before Dobbs) and June to July 2023 (after Dobbs). Data were analyzed from February 2023 to June 2024. Completion of survey before and after Dobbs. Changes from before to after Dobbs in 4 primary outcome measures were examined: support for and personal interest in AP and OTC access to medication abortion. A total of 6982 AFAB people before Dobbs and 3561 after Dobbs completed at least 1 of 4 primary outcome measures. From before to after Dobbs, 2666 (weighted 31.3%) and 1258 (weighted 30.1%) were aged 30 to 39 years, 1395 (21.4%) and 708 (21.5%) reported their race and ethnicity as Hispanic/Latinx, 594 (13.7%) and 304 (13.6%) as Black non-Hispanic/Latinx, and 4504 (54.6%) and 2270 (54.2%) as White non-Hispanic/Latinx. There was a significant increase from before to after Dobbs in national support for AP (48.9% before; 95% CI, 47.1% to 50.6%; 55.1% after; 95% CI, 52.8% to 57.3%) and OTC access (49.4% before; 95% CI, 47.6% to 51.1%; 55.2% after; 95% CI, 52.9% to 57.5%) and an increase in personal interest in AP (23.6% before; 95% CI, 22.2% to 25.1%; 26.4% after; 95% CI, 24.3% to 28.4%) and OTC access (36.0% before; 95% CI, 34.3% to 37.6%; 42.5% after; 95% CI, 40.2% to 44.7%). Among people living in states with abortion bans, larger increases in personal interest in AP (5.3 percentage points [pp]; 95% CI, 0.5 to 10.3 pp) and OTC access (9.4 pp; 95% CI, 3.9 to 14.9 pp) were observed than among people in states without bans (1.4 pp; 95% CI, -1.7 to 4.6 pp and 5.4 pp; 95% CI, 2.0 to 8.9 pp, respectively). In this serial cross-sectional analysis of people aged 15 to 49 years before Dobbs and 1 year after Dobbs, findings suggested that national support for expanded access to medication abortion has grown. Alternative models of care, such as AP and OTC, have the potential to offer a promising approach to abortion care, particularly for people living in abortion-restricted states.

Betaine combined with traditional Chinese medicine ointment to treat skin wounds in microbially infected diabetic mice.

Skin wounds are highly common in diabetic patients, and with increasing types of pathogenic bacteria and antibiotic resistance, wounds and infections in diabetic patients are difficult to treat and heal. To explore the effects of betaine ointment (BO) in promoting the healing of skin wounds and reducing the inflammation and apoptosis of skin cells in microbially infected diabetic mice. By detecting the minimum inhibitory concentrations (MICs) of betaine and plant monomer components such as psoralen, we prepared BO with betaine as the main ingredient, blended it with traditional Chinese medicines such as gromwell root and psoralen, and evaluated its antibacterial effects and safety in vitro and in vivo. The skin infection wound models of ordinary mice and diabetic mice were constructed, and the OTC drugs mupirocin ointment and Zicao ointment were used as controls to evaluate the antibacterial effects in vivo and the anti-inflammatory and anti-apoptotic effects of BO. The MICs of betaine against microorganisms such as Staphylococcus aureus (S. aureus), Candida albicans and Cryptococcus neoformans ranged from 4 to 32 μg/mL. Gromwell root and psoralea, both of which contain antimicrobial components, mixed to prepare BO with MICs ranging from 16 to 64 μg/mL, which is 32-256 times lower than those of Zicao ointment, although the MIC is greater than that of betaine. After 15 days of treatment with BO for USA300-infected ordinary mice, the wound scab removal rates were 83.3%, while those of mupirocin ointment and Zicao ointment were 66.7% and 0%, respectively, and the differences were statistically significant. In diabetic mice, the wound scab removal rate of BO and mupirolacin ointment was 80.0%, but BO reduced wound inflammation and the apoptosis of skin cells and facilitated wound healing. The ointment prepared by mixing betaine and traditional Chinese medicine can effectively inhibit common skin microorganisms and has a strong effect on the skin wounds of sensitive or drug-resistant S. aureus-infected ordinary mice and diabetic mice.

Evaluating the sustained effectiveness of a novel pharmacy-based intervention to reduce older adult misuse of over-the-counter medications: A case for non-significance.

Misuse of over-the-counter (OTC) medications by older adults (age 65+) can comprise Drug-Age, Drug-Drug, Drug-Disease, and Drug-Label types. Pharmacies in the United States are prevalent sources of OTCs and are an apt setting to address OTC misuse. Senior Safe™ is a pharmacy-system redesign for preventing older adult OTC misuse. The redesign uses signage to designate high-risk OTCs and safer products for older adult use, as well as prompting older adults to engage with pharmacy staff around medication safety issue. This study compared misuse in pharmacies with initial Senior Safe implementation (Immediate Effects group) to pharmacies with Senior Safe after 3 months (Sustained Effects group). A non-equivalent group design, involving older adults recruited from matched and randomly-allocated pharmacy sites within a health system, compared the Immediate Effects (n=83) and Sustained Effects (n=65) groups. All participants were recruited outside the pharmacy and were given hypothetical symptom scenarios from which to choose (i.e., cough/cold/allergy, pain, or sleep). Participants were then asked to select an OTC to treat that symptom, and explain their OTC use at symptom onset and if symptoms persisted/worsened. Participants' reported OTC use was evaluated for each misuse type. Multivariate modeling estimated differences in misuse between the Immediate and Sustained Effects groups. No significant differences emerged between Immediate and Sustained Effect groups for any misuse type for which statistical modeling was conducted. Drug-Age misuse was statistically less likely for sleep products (OR=0.170, p=.005) and for adults aged 85+ when compared to the 65-74 and 75-84 age categories (OR=3.979, p=.053; OR=6.900, p=.031, respectively). These non-significant results suggest that the intervention effect was maintained at three months. Overall, then, misuse reductions occurring immediately after intervention implementation did not significantly increase after three months. System buy-in, including assessing costs to implement and maintain Senior Safe, is critical to promote broader adoption.

Awareness level of Headache Medication Side Effects within the General Population of Jeddah City, Saudi Arabia

Background: Medication overuse headache (MOH) is a secondary headache caused by the frequent overuse of acute headache medications. In patients with primary headaches, it is characterized by a frequency of 15 or more days per month and is associated with the use of over-the-counter (OTC) analgesics for a period exceeding three months. Objective: This study evaluated the prevalence of MOH and the level of awareness of adverse medication effects among the general population of Jeddah, Saudi Arabia. Methods: A descriptive cross-sectional study was conducted between March 25 and May 25, 2023, using an online questionnaire administered to the general population. Data were collected from cooperative male and female residents of Jeddah City, Saudi Arabia. Result: The questionnaire was completed by 449 individuals; of them, 388 (86.4%) were females,with 369 (82.2%) being Saudi nationals. According to the study, 39% of participants reported having headaches for one to two days within the previous month, indicating a significant prevalence of headaches. Over half of the participants (54.3%) were unaware of the side effects of headache medications. Paracetamol was the most commonly used drug (62.8%), followed by Solpadeine (10.2%) and NSAIDS (6.9%). Higher educational levels were linked to better awareness of medication side effects. Conclusion: Our study found significant associations between socio-demographics and knowledge of headache medication's side effects, especially high educated females and frequent headache sufferers. We suggest that we need to increase awareness about the side effects of headache medication among the high school educational population in Jeddah City.

Over-the-Counter Hearing Aids: A Nationwide Survey Study to Understand Perspectives in Primary Care.

The expansion of over-the-counter (OTC) hearing aids has raised inquiries regarding primary care physicians' (PCP) knowledge, perspective, and perceived roles. We aimed to understand PCP perspectives on OTC hearing aids via nationwide online surveys. RedCap survey was distributed to PCPs via online forums and public mailing lists. Outcomes included PCPs' attitudes toward, perceived role surrounding, confidence managing, and knowledge of OTC hearing aids. Regression analyses were performed to identify associated factors including demographics and practice characteristics. Cohort included 111 PCPs primarily working in non-rural (83.8%) outpatient academic medical centers (47.5%), with a mean (SD) of 16.9 (11.6) years practicing. Most reported unfamiliarity (61.3%) with OTC hearing aids but viewed them positively (91.9%). They often perceived themselves as poor sources of OTC hearing aid information (63.1%) but desired involvement (90.1%) and believed associated knowledge is important (98.2%). Rural practice environment was associated with less familiarity toward OTC hearing aids (β = -0.72, [95% CI -1.40 to -0.04]). Respondents answered 5.0 (2.4) of 10 OTC hearing aid knowledge questions correctly. Using 5-point Likert scale, participants reported most confidence recognizing signs/symptoms of hearing loss 3.71 (0.84), but less confidence educating 1.68 (0.96) about and determining candidacy 1.72 (1.05) for OTC hearing aids. Participants reported continuing medical education courses and published guidelines would effectively improve their OTC hearing aid knowledge. PCPs displayed positive attitudes toward OTC hearing aids and valued involvement. Addressing unfamiliarity/knowledge gaps surrounding OTC hearing aids through courses and published guidelines may help clarify misconceptions and promote hearing health care. NA Laryngoscope, 135:299-307, 2025.

Microbial flora of the respiratory tract and skin of artisanal municipal solid waste handlers in Aba, Abia State, Nigeria

Municipal solid waste handling carries occupational risk for waste handlers due to exposure to diverse microorganisms and hazardous substances that cause respiratory and skin infections. A cross-sectional study was carried out, and 150 respondents were recruited using a simple random sampling technique. The sociodemographic characteristics, health-related complaints, health-seeking behaviour and the bacterial and fungal microflora of the respiratory tract and skin of artisanal municipal solid waste handlers and some controls in Aba, Nigeria, were determined using a mixed methods research design, involving the use of interviewer-administered structured questionnaires and conventional culture techniques. We analysed the data using IBM SPSS version 25. The results are presented in tables as frequencies and percentages. The majority of artisanal municipal solid waste handlers in Aba are male (95%). Their mean age is 30 years, and the age group of 21–40 years constitutes the highest proportion (65%) of the workforce. Health-related complaints were higher (95%) among the waste handlers compared to the control subjects (4%). The findings show a high prevalence of respiratory (57%), eye (34%) and skin (87%) complaints among the waste workers, compared to 6%, 0% and 2%, respectively, among the control subjects. Seventy-eight (78%) of the waste handlers indulge in self-medication via over-the-counter (OTC) drugs; 17 (17%) access diagnostic laboratories and only 4 (4%) visit hospitals for treatment, as compared to the control subjects, who recorded 1 (2%) for OTC drugs, 46 (92%) for laboratories and 2 (4 %) for hospitals. Acquisition (15%) and use (3%) of personal protective equipment (PPE) were very low amongst the waste handlers. A total of 704 bacterial isolates and 191 fungal organisms were isolated from the study subjects. Among the waste handlers, the percentage distribution of bacteria was almost the same at both sites: respiratory tract, 241 (49.9%) and skin, 242 (50.1%), compared to the control subjects’ respiratory tract, 105 (47.5%) and skin, 116 (52.5%), which showed a slight difference between the sites. S. epidermidis (24%) and B. cereus (13%) were predominant in the respiratory tract, whereas S. aureus (29%) and S. epidermidis (19%) predominated the skin of the waste handlers. Similarly, S. aureus (34.3%) and B. cereus (20.9%) were predominant in the respiratory tract, while B. cereus (37.9%) and S. epidermidis (18.1%) predominated the skin of the control subjects. Candida spp. was the most predominant fungus in the respiratory tract (81.4%) and skin (42.9%) of the waste handlers, as well as in the respiratory tract (85%) and skin (78%) of the controls. The presence of the isolated bacteria and fungi in increased proportions in the waste handlers may be attributed to occupational exposure through direct contact with waste, inhalation of organic dust laden with biological agents and the poor working conditions of the waste handlers. Health education and improvements in working conditions are necessary to mitigate the occupational challenges of waste handlers.

Impact of Surreptitious Glucocorticoids in Over-the-Counter Arthritis Supplements.

Adrenal dysfunction due to over-the-counter (OTC) health supplements containing unlabeled glucocorticoids has been previously reported. Here, we present a case series of 12 patients at an urban safety net medical center evaluated by endocrinology for iatrogenic adrenal dysfunction, Cushing syndrome (CS) and/or adrenal insufficiency (AI), associated with use of OTC arthritis supplements surreptitiously containing glucocorticoids. There were 12 patients using OTC arthritis supplements (Artri King [n = 8], Ardosons [n = 3], Ajo Rey [n = 1]) included. The mean age was 51.6 years and 33.3% were female. Findings of CS were identified in 10/12 (83.3%) patients, including moon facies (66%), central adiposity (66%), and abdominal striae (50%). Symptoms of AI were identified in 8/12 (66.7%) patients, including nausea/vomiting (42%), fatigue (42%), and abdominal pain (33%). Of 10/12 (83.3%) patients initially needing glucocorticoid replacement therapy, 4 continue to require treatment, 3 have successfully discontinued treatment, and 3 have been lost to follow-up. The literature reviewed identified 10 cases in 7 previously published reports, which did not include consistent follow-up data on adrenal function after discontinuation of the supplement. This case series demonstrates possible presentations of CS and/or AI from glucocorticoid exposure in patients taking these OTC arthritis supplements. Including more cases than all previously published reports combined, this series expands data for cortisol levels, cosyntropin test results, and glucocorticoid replacement needs for these patients and highlights the necessity for vigilant identification of supplement sources of exogenous steroids and the recognition of possible AI when such supplements are discontinued.

An educational review on over-the-counter drugs- A Pharmacovigilance-based approach

Over-the-counter (OTC) medicines, a crucial component of the healthcare system, can be sold to the consumer without a registered medical practitioner (RMP) prescription. They are safe and effective when used according to the instructions on the label and as directed by healthcare professionals. OTC medications are effective in treating common ailments. Switching drugs from prescription to OTC has increased worldwide, saving time and reducing the burden on the healthcare system. Many people rely on OTC to treat everyday ailments like headaches, colds, fever, coughs, indigestion, flu, and dermatitis. Therefore, a wide safety margin must be established for the OTC drugs. OTC product benefits must outweigh the risks, and the chances of misuse of it should be low. Consumers think that OTC medicines are safe since pharmacists dispense them without a prescription from a registered medical practitioner. However, OTC has adverse effects and could be misused, abused, or interact with prescription drugs. Failure to comply with directions may lead to serious side effects. For example, an overdose of Acetaminophen has been associated with liver damage. Analgesics increase gastrointestinal tract bleeding even when taken at appropriate doses. Cough products such as Dextromethorphan and Diphenhydramine may be abused due to their euphoric and alcohol-like effects. A distinct Pharmacovigilance system should be implemented to optimize the safe use of OTC drugs.3

A study to correlate over the counter drugs and ophthalmologists prescribed osmoprotective drugs among prolonged visual display terminal users

To find out the drug instillation behaviour, the relationship between drug instillation behaviour and subjective symptoms &amp; compliance rate of OTC purchased Osmoprotective drugs and to find the correlation between OTC drugs and Ophthalmologist prescribed drugs among VDT users. A prospective, cross-sectional study included 100 subjects who use OTC-purchased Osmoprotective drugs and have not visited Ophthalmologist recently. The study data were collected by asking one sutured questionnaire to find out the complete scenario of OTC drug usage patterns. Subjects were tested for Schirmer’s II test and according to the diagnosis, Osmoprotective drugs were prescribed. In our study, out of 100 subjects a significant majority (86%) did not visit ophthalmologists in the recent past, therefore the prevalence of OTC drugs has increased. Schirmer’s-II test indicated that most participants experienced mild dry eye symptoms in both eyes (14.26 + 4.21 &amp; 14.37 +4.20). CarboxymethylCellulose emerged as the most commonly used OTC drug (64%). A significant association was observed between the dry eye severity levels before and after treatment (p &amp;#60; 0.000). Only 2 drugs CarboxymethylCellulose (p &amp;#60; 0.003) and Polyethylene glycol and polypropylene glycol (p &amp;#60; 0.000) are commonly given in both OTC and ophthalmologist prescriptions. This work gives a detailed insight into drug usage patterns purchased from OTC and also found the correlation between OTC drugs and Ophthalmologist prescribed drugs.

Hypertonic saline nasal irrigation and gargling for suspected or confirmed COVID-19: Pragmatic randomised controlled trial (ELVIS COVID-19).

In a previous pilot randomised controlled trial conducted on UK adults, we found that hypertonic saline nasal irrigation and gargling (HSNIG) reduced common cold symptoms, the need for over-the-counter medications, viral shedding, and the duration and transmission of the illness. It is unclear whether HSNIG improves outcomes of the coronavirus disease 2019 (COVID-19). Hypertonic saline can be prepared and HSNIG performed at home, making it a safe and scalable intervention, particularly well-suited for low- and middle-income countries. We conducted a pragmatic randomised controlled trial in Pakistan on adults with suspected or confirmed COVID-19, initially within 48 hours of symptom onset, later extended to within five days due to recruitment challenges. Participants were randomised to one of two groups: the intervention group received instructions on preparing a 2.6% hypertonic saline solution for HSNIG, while the control group was instructed on performing ablution for Muslim prayers (wudu), which involves nasal washing and gargling with tap water. Our primary outcome was the time to symptom resolution, measured by two consecutive days of scoring zero on relevant questions from the validated, self-reported, adapted short form of the Wisconsin Upper Respiratory Symptom Survey (WURSS-24). Secondary outcomes included the severity of all symptoms, the severity and time to resolution of individual symptoms, health care contacts (GP/physician, emergency contacts), hospital attendance (and length of stay if admitted), over-the-counter (OTC) medication (frequency and cost), and transmission to household contacts. The analysis was conducted on an intention-to-treat basis. Logistic regression was used to calculate adjusted odds ratios (aORs) of improvement and Cox regression to calculate adjusted hazard ratios (aHRs) for the time to improvement with accompanying 95% confidence intervals (CIs). We randomised 576 people: 279 to the HSNIG group and 297 to the control group. Among those, 10 out of 279 (3.6%) in the HSNIG had symptom resolution, compared with 11 out of 297 (3.7%) in the control group (aOR = 1.20, 95% CI = 0.46- 3.22). The time-to-event analysis also showed no significant benefit (aHR = 1.23, 95% CI = 0.51-2.97). Excluding the 127 participants with no data on the primary outcome (who did not complete the study), 10 out of 222 (4.5%) in the HSNIG group had symptom resolution, compared to 11 out of 227 (4.8%) in the control group. HSNIG was not effective for individuals with suspected or confirmed COVID-19 who began the intervention within five days of symptoms onset and therefore cannot be recommended for use. Further investigation is needed for interventions started within 48 hours of illness onset. ClinicalTrials.gov (NCT05104372).

P132 Psoriasis and health economic impact in a developing country like Nepal

Abstract Introduction Psoriasis is a chronic, inflammatory skin disorder affecting millions globally. In low-income countries like Nepal, the economic burden of managing psoriasis is compounded by limited healthcare resources, inadequate access to treatments, and socio-economic constraints. Aim To assess the prevalence and severity of psoriasis in Nepal. To evaluate the direct and indirect economic costs associated with psoriasis management. To identify gaps in healthcare infrastructure and access to treatment. To propose cost-effective strategies to improve psoriasis care and reduce its economic impact. A mixed-methods approach was employed for a year, including:Epidemiological analysis: Reviewed existing literature and health records to estimate psoriasis prevalence and severity in Nepal.Cost analysis: Calculated direct costs (medical expenses, hospital visits, medications) and indirect costs (loss of productivity, absenteeism) through patient surveys and healthcare data.Qualitative interviews: Conducted in-depth interviews with healthcare providers, patients, and policymakers to understand the barriers to effective psoriasis management.Policy review: Analysed national health insurance policies and their effectiveness in addressing psoriasis care. Results Prevalence: Approximately 2–3% of the Nepalese population is affected by psoriasis, with varying degrees of severity. Economic burden: The average annual cost per patient is significant, encompassing medical expenses, travel costs for treatment, and loss of income due to reduced work capacity. Healthcare gaps: Limited availability of dermatologists, high cost of biologic treatment which is not easily available, taking OTC drugs and lack of public awareness are major barriers. Patient impact: Psoriasis patients in Nepal face considerable socio-economic challenges, including stigma, reduced quality of life, and mental health issues. Conclusion The findings indicate that psoriasis imposes a substantial economic burden on both individuals and the healthcare system in Nepal. The lack of specialized care in rural areas and high treatment costs exacerbate this burden. There is an urgent need for integrated healthcare approaches, increased health insurance facility for psoriasis care, and public health initiatives to raise awareness and reduce stigma. Addressing the health economic impact of psoriasis in Nepal requires a multifaceted strategy, including policy reforms, improved access to affordable treatments, and enhanced healthcare infrastructure. By implementing cost-effective and sustainable interventions, it is possible to alleviate the economic burden of psoriasis and improve the quality of life for affected individuals.

A community-based analysis of security practices regarding over-the-counter skincare products in nationwide retail drug stores.

Access to over-the-counter (OTC) skincare products is critical for managing a wide range of dermatologic conditions, yet recent trends in urban retail stores may jeopardize this accessibility and exacerbate healthcare disparities. However, the emerging trend of securing skincare products behind security glass in urban retail environments poses significant risks to healthcare equity and accessibility. Herein, we aim to quantify the prevalence of skincare products behind security glass in pharmacies within a 25-mile radius of Times Square, New York City. An observational, cross-sectional study was conducted, selecting 50 pharmacies from a total of 389 identified in the target radius. Digital photographs of skincare product aisles were taken, and the percentage of products secured behind glass was calculated for various categories and brands. The study found significant disparities in the availability of skincare products, with significantly higher percentages of products behind security glass in pharmacies located in urban areas compared to suburban regions. Among the four brands analyzed, Olay, L'Oréal, La Roche-Posay, and Vichy, there was no significant difference in the proportion of products behind security glass. Barriers to accessing skincare products, such as physical restrictions, time constraints, stigma, and privacy issues, may hinder individuals from obtaining necessary treatments, leading to potential delays in care and poorer health outcomes. Our study underscores the urgent need for dermatologists and healthcare policymakers to advocate for alternative security measures that do not compromise product accessibility. Facilitating easier access to OTC skincare products could dramatically improve treatment adherence and patient outcomes, particularly in urban settings where disparities are most pronounced.

Over-the-counter dermatology supplements- a practical guide to authenticity labels and reputable sources.

Over-the-counter (OTC) oral supplements are increasingly used by consumers and recommended by dermatologists for managing various dermatologic conditions. Despite their popularity, these supplements often lack standardized regulation, potentially posing risks to both patients and clinicians. This review examines the importance of evaluating OTC oral supplements in dermatology, focusing on the prevalence and consequences of adulterated products and the implications of different authenticity labels for consumer education and clinical practice. Various authenticity labels are discussed, such as USP, NSF, ConsumerLab.com, and UL, which aim to verify supplement quality and safety. However, these labels have different criteria and methods for testing, leading to further confusion about their meanings and comparisons. This review provides practical guidance on evaluating OTC oral supplements and interpreting authenticity labels, aiming to help dermatologists and consumers make informed decisions and improve outcomes.