14. OTC MEDICATION

Most people use home remedies or (over-the-counter) OTC medicines to treat minor health problems. Self-medication means selecting and using medicines on your own for simple, self-recognised symptoms. It is an old and widely practiced method all over the world.

The World Health Organization (WHO) supports responsible self-medication in places where medical services are not easily accessible. OTC medicines are considered safe for minor illnesses when used correctly.

Definition

OTC medicines are medicines that are considered safe and effective for treating minor ailments and can be sold by a pharmacist without a valid prescription.

Medicine categories in many countries include:

  • Prescription medicines – require a valid prescription
  • Pharmacist-only medicines – require pharmacist’s judgment
  • OTC medicines – available in pharmacies, stores and supermarkets

Advantages of Having an OTC Medicines List

  • Considered safe and effective for minor ailments
  • Do not require consultation fees
  • Often more economical
  • Saves time (no waiting for doctor consultation)
  • Pharmacist can dispense without prescription

OTC Medications List (India – Examples)

Different countries use WHO’s Anatomical, Therapeutic and Chemical (ATC) classification to select OTC medicines. Below are common OTC categories and examples used in India:

1) H₂ Receptor Antagonists

Used at lower doses for heartburn and acidity. Not approved for children; use for max 2 weeks.

  • Cimetidine 200 mg twice daily
  • Famotidine 10–20 mg daily
  • Nizatidine 75 mg twice daily
  • Ranitidine 75 mg twice daily

2) Acne Preparations

  • Benzoyl peroxide 2.5%, 5%, 10% (apply once or twice daily)

3) Allergy and Cold Preparations

Antihistamines relieve allergic rhinitis symptoms. Some cause more drowsiness than others.

  • Chlorpheniramine 4 mg every 4–6 hrs
  • Brompheniramine 4 mg every 4–6 hrs
  • Clemastine fumarate 1.34 mg every 12 hrs
  • Diphenhydramine 25–50 mg every 4–6 hrs
  • Combinations with decongestants (phenylpropanolamine, pseudoephedrine)

4) Analgesics and Antipyretics

  • Aspirin 300–600 mg every 4–6 hrs
  • Acetaminophen 300–600 mg every 4–6 hrs
  • Ibuprofen 200–400 mg every 4–6 hrs
  • Naproxen 200 mg every 8–10 hrs
  • Ketoprofen 12.5 mg every 4–6 hrs

5) Antacids

Common combinations: Magnesium hydroxide + Aluminium hydroxide.

6) Anthelmintics

  • Pyrantel pamoate 11 mg/kg

7) Anti-diarrheal Agents

  • Bismuth subsalicylate 600 mg four times daily
  • Loperamide (4 mg initially, then 2 mg after each loose stool; max 16 mg/day)

8) Antifungal Topical Preparations

  • Clotrimazole 1% cream
  • Tolnaftate 1%
  • Miconazole 2% cream

9) Anti-inflammatory Topical Preparations

  • Hydrocortisone 0.5–1% cream or spray

10) Anti-seborrheal Agents

  • Selenium sulfide 1–2%
  • Zinc pyrithione 1–2%

11) Anti-tussives

  • Codeine 10–20 mg every 4–6 hrs
  • Dextromethorphan 10–20 mg every 4 hrs

12) Decongestants

  • Oxymetazoline (topical)
  • Xylometazoline (topical)
  • Phenylephrine (topical)
  • Pseudoephedrine 60 mg every 4 hrs

13) Expectorants

  • Guaifenesin

14) Laxatives

  • Bulk forming agents
  • Stool softeners (Docusate sodium)
  • Saline laxatives (short-term use only)

15) Pediculicides

  • Permethrin 1%
  • Pyrethrum + piperonyl butoxide

16) Sleep Aids

  • Diphenhydramine 25–50 mg at bedtime

17) Smoking Cessation Aids

  • Nicotine
  • Nicotine gum (nicotine polacrilex)

OTC Counseling Questions

Counseling for OTC medicines requires open-ended questions to understand the patient’s condition.

Examples:

  • What symptoms are you experiencing?
  • Which medications (prescription / OTC / herbal) do you use?
  • Have you taken this OTC medicine before?
  • Did you experience any side effects?

Patient Counseling Steps for OTC Medicines

Step 1

  • Introduce yourself as the pharmacist
  • Make the patient comfortable
  • Explain what help you can offer

Step 2

  • Collect demographic details (age, gender, pregnancy status, allergies)
  • Ask about present illness and symptoms
  • Collect medical and medication history
  • Counsel on drug name, dose, route, administration and precautions
  • Explain self-monitoring techniques
  • Discuss storage, interactions and warnings
  • Demonstrate inhalers, patches, drops or ointments if required
  • Provide written instructions when needed

Counseling Points for Specific OTC Drug Classes

1) NSAIDs (Paracetamol, Ibuprofen, Diclofenac)

  • Take with food and plenty of water
  • Avoid chronic use due to gastric irritation and renal risk
  • Avoid if asthmatic unless doctor approves
  • Inform doctor if you use aspirin
  • Watch for swelling, confusion, or low urine output

2) Antibiotics (when used incorrectly as OTC)

  • Should be taken only under medical supervision
  • Complete full course (5–7 days)
  • Store properly and keep away from children
  • If you miss a dose, take soon but do not double dose
  • Ask pharmacist about interactions

3) Anti-cold and Cough Suppressants

  • May cause drowsiness — avoid driving
  • Cause dryness of mouth and nose
  • Decongestants may disturb sleep — avoid late-night dose
  • Can pass into breast milk — caution in nursing mothers
  • Avoid with MAO inhibitors or other CNS depressants

Role of Community Pharmacist

  • Educate patients on safe use of OTC medicines
  • Help select appropriate product for minor ailments
  • Ask about clinical condition before dispensing
  • Check for interactions with prescription medicines
  • Avoid harmful combinations (e.g., decongestants in hypertensive patients)
  • Provide gap advice (e.g., antacids with ciprofloxacin)
  • Monitor therapeutic outcomes and provide follow-up advice

Detailed Notes:

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