‘This over-the-counter drug almost killed me’

Alice Atieno, a resident of Mathare, Nairobi is among thousands of Kenyans who are given wrong drugs to treat wrong diseases. 

She went to a local chemist and explained to the attendant how she was feeling and was given drugs to cure malaria. But things did not get any better after completing the dose a week later. 

“I lost appetite and the fever persisted. My body temperature went high. I had nausea and I could occasionally vomit. One could actually think that I was suffering from malaria. My husband rushed me to the hospital for further checkups,” Alice tells Healthy Nation.  After a few tests , she was diagnosed with Amoeba. “I was given a new set of medication and I recovered within a week,” the 32-year-old recalls. 

Irene Mugo, 30, bought Albendazole – a deworming tablet – from a hawker at Gikomba, Nairobi, not knowing the effect it posed on her unborn baby.  She was just two months pregnant and on her way to the market, she bought the deworming tablet at Sh20.   

“Later, I started having complications and went to visit a nearby clinic. The doctor did several tests and it was revealed that the Albendazole I took was the cause of my pain,” she says.  

The hawker did not caution her that the drug was not supposed to be taken by expectant mothers – probably he was not aware of the consequences.  Buying drugs from local chemists or kiosks, popularly referred to as over-the-counter drugs, without prescription from a qualified physician has become a normal trend among Kenyans largely because they are unaware of the consequences and the health risks of taking non-prescription medicines.

Dr Bethwel Libeya, a Nairobi-based pharmacist, says Albendazole tablets should not be used by pregnant women unless under strict supervision of a qualified doctor, and deworming tablets should be discontinued at least a month before pregnancy.

There are two categories of medicine available in the market; over the counter and prescription only medicine.

Over-the-counter/non-prescription medicines

Dr Libeya says over-the-counter medicine (OTC) can be purchased without a prescription.
“They are safe and effective when you follow the directions on the label and as directed by your health care professional,” he says.
Examples of over-the-counter medicines include paracetamol, Eno powder or antacids , which are a class of medicines that neutralise acid in the stomach. They contain ingredients such as aluminium, calcium, magnesium or sodium bicarbonate, which are used to relieve the symptoms of Gastroesophageal Reflux Disease, heartburn or indigestion.
The only non-prescription drugs that you should buy in kiosks, supermarkets or chemists, according to him, are anti-acid drugs. 
“If symptoms persist, then the patient should visit an authorised clinic,” he advises.

Prescription-only medicines

Prescription-only medicines are treatments that must be prescribed by a doctor and are not licensed for sale to the general public. A prescription medication is a licensed medicine that is regulated by law to necessitate a medical prescription before it can be obtained.
Such medicines should only be issued by a pharmacist upon presentation of a valid prescription.
Dr Libeya says prescription medicines should be issued by qualified professionals and accompanied with a stamp and the doctor’s signature.
“When you have antibiotic infection such as bronchitis, conjunctivitis, ear infection, sexually transmitted infections, skin or tissue infection, strep throat, traveller’s diarrhoea, upper respiratory tract infection and urinary tract infection, then avoid buying over-the-counter medicines. Visit the nearest hospital or authorised clinic for check-ups and seek professional advice,” advises the expert.
He cautions that people should avoid buying and taking drugs such as Diclofenac, Omeprazole and hypertension drugs from local chemists, saying the drugs pose danger to the health of the patient.

The dangers of buying over-the-counter drugs

Antimicrobial resistance is a natural process that occurs when microorganisms such as bacteria, viruses, fungi and parasites develop the ability to survive against the drugs designed to kill them. In such cases, the resistant germs can continue to grow and spread to other people, both through hospitals and community settings.
If your body gets used to a given drug, then it reaches a point where you will be forced to use ‘stronger’ drugs or medication to kill the viruses or the bacteria’s causing ailment.
“If you continually take painkillers for a longer time, your system may get used to the drugs and build a resistance to that particular medicine. Drugs are not sweets. They can interfere with your system,” he says.

Duplication

This is when you take more than one medicines that have similar active ingredients. An example is when you take OTC Ibuprofen (Advil, Motrin) plus a prescription anti-inflammatory medicine. Too much of either an anti-inflammatory or pain reliever can hurt your kidneys or liver. Medicines with active ingredients that have opposite effects on your body can interact. This may reduce the effectiveness of one or both medicines. For example, OTC decongestants may raise your blood pressure. This can work against (cause opposition to) medicines that lower your blood pressure.

Drug-drug interaction

One medicine may change the way your body absorbs, spreads or processes another medicine. For example, aspirin can change the way some prescription blood-thinning medicines work.
“If you see more than one doctor, tell each of them about the medicines you take. Do this even if you take something for just a short time. Include any herbal supplements, vitamins, and minerals you take,” directs Dr Libeya.
“Once a year, take all of your medicines and supplements with you when you see your doctor. You should also do this if your medications change at any time,” he says.

According to Dr Shalini Lynch of the University of California San Francisco School of Pharmacy, OTC drugs can move from a pregnant woman to her foetus primarily through the placenta, and they can be transmitted through breast milk to the baby. “Some drugs can affect or harm the foetus or baby, so pregnant women and breastfeeding women should consult their doctor or pharmacist before taking any OTC drug or medicinal herb,” she cautions.
For children, whose OTC drugs come in liquid form, Dr Lynch warns that a child may be given the wrong dose because the adult in charge uses an ordinary teaspoon.  “The only kitchen spoons accurate enough to measure liquid drugs are measuring spoons. However, a cylindrical measuring spoon is far better for measuring a child’s dose, and an oral syringe is preferred for measuring and squirting a precise amount of drug into an infant’s mouth.” 
She advises that the cap should always be removed from the tip of an oral syringe before use because “a child can choke if the cap is accidentally propelled into the windpipe.”
Care should also be taken when administering OTC drugs to older people because, according to the expert, many antihistamines, such as diphenhydramine, night-time pain relief formulas, cough and cold remedies, allergy drugs, and sleep aids are designated as “sedating” antihistamines and may pose special risks for older people.  “These antihistamines may cause drowsiness or fatigue and may worsen some disorders common among older people, such as closed-angle glaucoma and an enlarged prostate gland. 

• Keep track of any allergies and adverse reactions you have had to OTC medicines in the past. Avoid medicines that contain the same ingredients.

• Check drug facts labels and avoid taking medicines that contain the same active ingredients at the same time. This can help you avoid taking too much of a certain medicine

• Try to limit how often you use OTC medicines. Don’t use them unless you really need them.

• If you take any prescription medicines, ask your doctor before taking an OTC medicine.

•If you don’t understand something about the medicine, ask your doctor or pharmacist.

•When giving medicine to children, use the correct measuring device to make sure they get the right amount. This could be a spoon made for measuring medicine, or a syringe or cup.

• Don’t take capsules apart or stir medicine into your food unless your doctor says it’s okay. This may change the way the medicine works.

•Don’t take medicine with alcoholic drinks.

•Don’t mix medicine into hot drinks unless the label tells you to. The heat may keep the medicine from working as it should.

• Don’t take vitamin pills at the same time you take medicine. Vitamins and minerals can cause problems if taken with some medicines.

• Anytime you take medicine, be aware of changes in your body and how you feel. A certain symptom may be caused by your illness, or it may be an adverse effect from your medicine.

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