G. P. Pharmacy College, Vaniyambadi Main Road, Mandalavadi, Tirupattur, India 635851
Over-the-counter (OTC) medications are widely used for the relief of minor, self-limiting ailments such as headaches, colds, fever, allergic reactions, and digestive discomfort. Readily available without a prescription, these drugs are often regarded as safe and affordable alternatives to professional medical consultation. When used appropriately, they can facilitate effective self-care and reduce pressure on healthcare systems. However, unsupervised and irrational consumption has emerged as a significant public health concern. Potential consequences include misdiagnosis, postponement of necessary medical evaluation, masking of serious illnesses, adverse drug reactions, and - most alarmingly -the rise of antimicrobial resistance from inappropriate antibiotic use. This review explores the present state of knowledge, attitudes, and practices concerning OTC drug use among the general public and college students, with special attention to pharmacy and medical students. Despite having a healthcare background, these students may still engage in unsafe self-medication. Contributing factors include academic workload, overconfidence in pharmacological knowledge, convenience, financial limitations, peer influence, and exposure to information via digital platforms. The discussion is informed by findings from cross-sectional surveys, observational research, and national reports published between 2010 and 2025. It categorizes commonly used OTC drugs, identifies the primary information sources guiding public choices, and highlights the gap between awareness and practice. In addition, it evaluates associated health risks and offers evidence-based recommendations for promoting rational medicine use. Enhanced public health education, tighter regulations on OTC sales, and targeted curriculum interventions in academic institutions are proposed to encourage safer self-care practices. Addressing both behavioural and systemic determinants is essential for a coordinated approach to the responsible use of OTC medications.
Over-the-counter (OTC) medications are non-prescription drugs frequently used to address minor, self-limiting ailments such as headaches, fever, cough, indigestion, and allergic reactions. Their widespread availability in pharmacies and retail stores has made them a preferred option for individuals seeking rapid relief without consulting a healthcare professional.
According to the World Health Organization (WHO), self-medication refers to the selection and use of medicines by individuals to treat self-recognized symptoms or illnesses without professional medical advice¹. While judicious self-medication forms an important component of self-care and can help reduce the strain on healthcare systems, its uncontrolled or excessive use carries substantial risks.
Among different demographic groups, college students—particularly those enrolled in healthcare programs such as pharmacy, nursing, and medicine—display a relatively higher prevalence of self-medication practices². Their exposure to pharmacological concepts, medical terminology, and easy access to drug-related information often fosters a misplaced sense of confidence, prompting them to bypass professional consultation. Conversely, students from non-medical backgrounds, influenced by advertising, social media, or leftover prescriptions, may unintentionally misuse medicines. Despite differing motivations, both groups face similar risks, including diagnostic errors, incorrect dosing, prolonged misuse, and adverse drug reactions.
This pattern of behaviour, although partly linked to increasing health awareness and personal autonomy, also highlights systemic gaps. In low- and middle-income countries (LMICs) such as India, multiple factors contribute to widespread OTC drug consumption. These include limited healthcare access, high out-of-pocket costs, an unfavourable doctor-to-patient ratio, and lax enforcement of pharmaceutical regulations³. In many instances, pharmacies dispense prescription-only drugs, including antibiotics, without adequate checks, thereby fuelling the problem of antimicrobial resistance?.
As highlighted by Ruiz ME³, the absence of professional supervision in self-medication can have serious repercussions, such as masking underlying illnesses, triggering drug - drug interactions, and causing unnecessary exposure to toxic agents. Beyond individual health, OTC misuse can delay disease diagnosis and facilitate the emergence and spread of drug-resistant pathogens.
A deeper understanding of the behavioural trends, awareness levels, and socio-cultural determinants influencing OTC drug use - particularly among the student population - is crucial. Combating this issue requires a comprehensive approach involving public education, stronger regulatory frameworks, improved healthcare accessibility, and targeted awareness campaigns.
OBJECTIVES OF THE REVIEW
The rising trend of unsupervised over-the-counter (OTC) medication use underscores the need for a comprehensive examination of behavioural, educational, and regulatory influences. This review is guided by the following key objectives:
METHODOLOGY
This review synthesizes secondary data spanning 2010 to 2025, drawing from peer-reviewed articles, official health reports, and international organization guidelines, with emphasis on both global and Indian contexts. Key search terms included “OTC drug use”, “self-medication”, “college students”, “public drug knowledge”, “antibiotic misuse”, and “drug safety awareness,” using databases like PubMed, Google Scholar, Scopus, and Web of Science.
Inclusion criteria:
Exclusion criteria:
Study selection relied on relevance, methodological soundness, and indicators like sample representation and validated tools. Adaptations from the STROBE and PRISMA frameworks guided data extraction and article appraisal.
RESULTS AND DISCUSSION
Multiple studies highlight high rates of OTC use and self-medication, particularly among college and urban populations. For instance, Banerjee and Bhadury? reported that over 78% of Indian medical students had self-medicated in the past six months. Similarly, Nalini? found significant prevalence even among allopathic doctors, suggesting clinical training does not eliminate irrational self-medication. James et al.? noted that confidence in pharmacological knowledge can foster risky behaviours.
Frequently misused OTC drugs include:
Figure 1:Distribution of Commonly Used OTC Drugs Among Students
Figueiras et al.¹? and Klemenc-Ketis et al.¹¹ found that economic pressures, convenience, and perceiving illnesses as minor drive self-medication, with cultural norms and social influence further normalizing it¹²?¹?.
Garofalo et al.¹³ and Ahmad et al.¹? observed that the internet and social media are increasingly trusted health sources, often replacing professional advice and increasing exposure to misinformation. Kasulkar and Gupta¹?, alongside Gyawali et al.¹?, identified a troubling disconnect between knowledge and practice among pharmacy students. James et al.¹? stressed that drug education must emphasize rational use and critical decision-making.
Lukovic et al.¹? highlighted non-compliance with antibiotic courses as a key factor in antimicrobial resistance, while Hughes et al.²? warned that prolonged self-medication may mask serious conditions, delay proper treatment, or foster drug dependence.
CONCLUSION
The literature underscores that OTC self-medication - especially within student and healthcare-trained groups - is common yet hazardous. Although perceived benefits include autonomy, affordability, and convenience, the associated risks - such as toxicity, dosing errors, resistance development, and overlooked illnesses - are significant.
Effective solutions require a coordinated, multi-faceted approach:
Only through combined efforts in education, policy, healthcare access, and cultural shifts can responsible OTC medication use be fostered comfortably into the future.
REFERENCES
Dr. G. Akshaya Sre, V. Abinesh, S. Raghul Dravid, S. Renuga, N. Shajitha, M. Sneha, Evaluation of Knowledge and Practice Regarding Use of OTC Drugs Among Public and College Students, Int. J. of Pharm. Sci., 2025, Vol 3, Issue 8, 1293-1298. https://doi.org/10.5281/zenodo.16814490
10.5281/zenodo.16814490
