OTC medicines
OTC medicines can mask serious health issues since some symptoms vanish quickly. Those could have been warning signs from another medical problem. Image Credit: Shutterstock

Over-the-counter (OTC) medicines often offer convenient treatments without requiring a prescription, but this accessibility can lead to self-diagnosis errors and misuse. Limited expert guidance may overlook underlying health conditions or potential drug interactions, resulting in major health problems. Here are the stories of certain UAE residents who found themselves in serious trouble due to OTC medicines and how they managed to resolve the situation. Additionally, health experts from both modern and alternative medicines share their insights, while residents who have never used OTC medicines explain their reasons for doing so.

‘I was unable to breathe properly after taking OTCs for a long time’

Mina Kiwan, a communications professional based in Dubai, suffers from chronic allergies to pollen and dust, which often results in the blockage of his nasal passages. "I experienced a severe cold that led to almost constant nasal congestion. At times, I resorted to using over-the-counter antihistamines without a doctor's prescription," said Kiwan.

To alleviate his breathing difficulties, Kiwan turned to over-the-counter nasal sprays. "Initially, I used the spray three to four times a day, but eventually, I started using it every 30 minutes," he said.

Subsequently, he encountered a complete loss of sensation in his nasal cartilage. "This condition left me unable to breathe properly and devoid of the sense of smell. The situation escalated to the point where I required hospitalisation for two days. During this time, I underwent a surgical procedure to remove a small growth in my nasal cavity," he added.

Fortunately, Kiwan was connected with a skilled doctor who devised an effective medical regimen for him, and the plan included a safe nasal spray and another one containing cortisone. "Thanks to this competent medical professional and the revised treatment plan, I now experience significant improvements in my health," he said with a smile.

Doctor learns the importance of medical consultation the hard way

Before embarking on his medical career, Dr Syed Mouazur Rahman, a specialised periodontist at Truelife Specialty Hospital in Abu Dhabi, used to resort to over-the-counter medications for ailments ranging from mild to severe, such as headaches and fevers. "I would visit a pharmacist and request painkillers or paracetamol based on my symptoms," Dr Rahman said.

On one occasion, a pharmacist even prescribed antibiotics for his fever (This happened in India). "I confirmed that I was quite ill and took the medicine to save some money," he said. However, shortly after taking the antibiotics, he developed hives. "Intense itching engulfed my body, my breathing was laboured, and I felt like I was losing consciousness. My mother rushed me to the hospital. Turns out, I was allergic to the penicillin present in the antibiotic. I could’ve lost my life that day. Now, I prioritize medical consultations before taking any medication—despite being a doctor myself," revealed Dr Rahman.

'Self-diagnosis is always dangerous,' says UAE-based doctor

While OTCs are generally safe to use, the caveat is that they are so only if used in the right dose, for the right time, and for the right indication, said Dr Sundarrajan Santhanam, Specialist Otolaryngologist at Mediclinic Welcare Hospital, Dubai.

However, even OTC medicines can cause harm if taken in excess doses or for a longer duration, or if they are combined, said Dr Sundarrajan. "You can inadvertently double-dose yourself with paracetamol, as this ingredient is found in many cold and cough medicines, as well as in standalone pain or fever relievers. The same applies to anti-allergics too."

"If a person is on blood thinners and takes a nonsteroidal anti-inflammatory drug like ibuprofen, they can run the risk of bleeding. It is also pertinent to note that herbal and alternative medicines are also classified as OTCs, and there may be interactions between these and allopathic medicines," explained the Dubai-based doctor.

"OTCs also have side effects, and one needs to decide if they are worth tolerating before taking them. Some popular cold and cough medicines can either cause sleepiness or might have the exact opposite effect in different individuals, and they can also cause hyperactivity in younger age groups."

Self-diagnosis is always dangerous, and the same applies to 'Dr Google' or any other AI-based diagnosis, warned Dr Sundarrajan.

OTCs and allergies kept me away from my pet dog

Mangal Suvarnan
Image Credit: Vijith Pulikkal/Gulf News

For over six years, Mangal Suvarnan, a resident of Dubai, had been taking OTC antihistamines at least once a day to cope with his severe allergies. Despite his love for the family dog, a Labrador, he had to maintain a distance from the 10-year-old pet due to the bothersome symptoms it triggered, such as a runny nose, coughing, and even throat closure that made breathing difficult. Nevertheless, he managed the situation.

Matters escalated from manageable to unbearable when his family decided to foster a playful six-month-old golden retriever last summer.

"Being around two dogs sent my allergies into overdrive, and a single daily pill was no longer sufficient," he said. Suvarnan increased his dosage to two stronger medications a day and invested in an air purifier to help him breathe without experiencing reactions. One night, his allergies were so severe that his face turned purple. He had to stay at a friend's house to sleep without any asthmatic reactions.

The situation worsened when Suvarnan moved to Los Angeles, United States, for work. The combination of springtime hay fever and the effects of his landlord's dogs forced him to take OTC medication at least twice a day to avoid gasping for breath. Realising that his condition wasn't improving, Suvarnan's family insisted he consult with a pulmonologist as soon as possible.

Upon visiting the doctor, he was prescribed a soft mist inhaler and several other antihistamines, which finally provided relief from his symptoms. He said, "I should've sought help much earlier. Now, I can play with our dog without gasping for breath every time I’m around him."

Herbal/alternative medicines should be taken after consulting a registered doctor

Persistent dry cough and how this Filipina found the real cause

Alma Manlulu, a Filipina personal fitness trainer, endured weeks of persistent dry cough. Despite trying various over-the-counter antihistamines, cough, flu, and cold medicines, her condition showed no improvement. "Finally, I sought medical help and discovered I had a severe infection. The doctor prescribed antibiotics, and my health rapidly improved," Alma said. "Following this incident, I resolved to refrain from using over-the-counter medications again. They proved to be both a time and money drain."

Self-medication led this UAE resident to serious health issues

Misguided self-diagnosis lead patients to wrong herbs: Chinese medicine doctor

Traditional Chinese Medicine (TCM) is founded upon the principles of the 12 Meridian Theory, a holistic approach to diagnosing and treating health issues, explained Dr Peng Gao of Beijing Tong Ren Tang Gulf Clinic.

Dr Peng Gao of Beijing Tong Ren Tang Gulf Clinic

China boasts a repertoire of over 20,000 herbs, some of which have been employed in creating conventional medicines, said Dr Peng. Given their shared chemical foundations, the fundamental chemical principles exhibit similarities to those in modern medicine, said the Dubai-based TCM doctor. In each case, a doctor's responsibility encompasses diagnosing before prescribing herbal remedies to patients, according to the doctor.

Drawing from my clinical experience, I've observed instances where patients' misguided self-diagnoses led them to select inappropriate herbs, resulting in harm or even fatality, said Dr Peng, and pointed out that this unfortunate outcome sometimes arises due to a misconceived belief in the absolute safety of herbs.

Traditional Chinese Medicine and 12 Meridian Theory

In TCM, it is believed that there are 12 main meridians, or pathways, that flow through the body, each associated with a specific organ system. These meridians are thought to carry vital energy called "qi" or "chi," which is essential for maintaining physical and emotional well-being.

The 12 Meridian Theory consists of six pairs of meridians, with each pair corresponding to an organ system and its related functions. The pairs are:

• Lung Meridian: Large Intestine Meridian
• Spleen Meridian: Stomach Meridian
• Heart Meridian: Small Intestine Meridian
• Urinary Bladder Meridian: Kidney Meridian
• Pericardium Meridian: Triple Burner (San Jiao) Meridian
• Liver Meridian: Gallbladder Meridian

According to TCM, imbalances or blockages in the flow of qi along these meridians can lead to various physical and emotional disorders. Practitioners of TCM use techniques such as acupuncture, acupressure, herbal medicine, and dietary changes to help restore the proper flow of qi and promote overall health.

These UAE residents will never take OTC medicines

Sandra Martinho, a Portuguese author and homemaker in Dubai, feels strongly against picking medicines off the shelf. "I personally do not agree with this theory. There is a reason why the doctor is there. We are definitely not doctors to self-analyze our health and self-medicate."

She advised against blindly taking medication just because it is popular and used by many.

Tracey Inglis, a freelance events executive and homemaker from New Zealand based in Dubai, shares the same belief. She and her husband avoid using OTC medicines. "My husband, for one, has high blood pressure. We have consulted a doctor and only purchase prescribed medicines. I am definitely not a fan of self-medication."

Inglis said she works hard to stay fit and healthy. "Should I need further assistance with my health, I visit a doctor to address my concerns."

What are the side effects of regular intake of OTC medicines?

Over-the-counter medicines refer to medicine that you can buy without a prescription. They are safe and effective if the directions on the label or leaflet are followed. These medicines as used to treat illnesses and their symptoms, including pain, coughs and colds, diarrhoea, constipation, and acne, among others.

• OTCs could interact with other medicines, supplements or foods, resulting in unpleasant or dangerous reactions.
• Some people are allergic to certain medicines.
• People with certain medical conditions may not tolerate some OTC medicines. For example, people with high blood pressure should not take certain decongestants, a Medicine Plus report said.
• Many medicines are not safe during pregnancy.
• Many OTC medications are dangerous for children.

OTC medicines
Image Credit: Vijith Pulikkal/Gulf News

What are some examples of medicine-to-medicine interactions?

The human body processes each medicine differently. When two or more medicine are used together, they affect the body in different ways leading to unpleasant effects. The main medicine-medicine interaction types, according to the American Academy of Family Physicians, are:

Duplication: When two medicines have similar active ingredients, it results in excess dosage. When the body gets more medicines than it needs, it can injure the kidneys or liver.

Opposition: When active ingredients in two medicines have opposite effects on the body, it can reduce the effectiveness of both medicines.

Alteration: One medicine may change how the body absorbs or processes another medicine.

So when consulting a doctor, it’s important to tell them about the medicines and supplements you take.

What’s the medicine-food interaction?

When some foods change how the body processes certain OTC medicines, it’s called a medicine-food interaction. In some cases, some medicines are absorbed better into the body after eating food. This is why medicines come with directions to eat before or after food.

Can OTC medicines trigger allergies?

Some people are allergic to certain OTC medicines, so take care when buying medicines you haven’t taken earlier. Some medicines may trigger allergies in some people, so if there are symptoms like itching, rash, hives, and breathing problems, stop using the medicine and see a doctor soon.

How do you know whether an allergy is drug-related?

All medicines can trigger allergies in some people. According to the US-based Mayo Clinic, a drug allergy is not the same as a side effect. A side effect is a known possible reaction to a medicine which is listed on labels.

Symptoms of a drug allergy often occur within an hour after taking the medicine. Other reactions like rashes can occur hours, days or weeks later, and some symptoms may persist.

There’s no sure way of finding out a drug allergy as medicines react with different people differently. Only an allergist can diagnose a drug allergy with the help of tests.

Who is at increased risk from OTC medicines?

Anyone can have an adverse reaction to OTC medicines. But some of these groups are at a higher risk.

• Senior citizens
• Very young children
• Pregnant women
• People taking more than one medicine

People who have the following conditions are also at a higher risk, according to the American Academy of Family Physicians :

1. Asthma
2. Bleeding disorders
3. Blood clotting disorders
4. Breathing problems
5. Diabetes
6. Enlarged prostate glands
7. Epilepsy
8. Glaucoma
9. Gout
10. Heart disease
11. High blood pressure
12. Immune system problems
13. Kidney problems
14. Liver problems
15. Parkinson’s disease
16. Psychiatric problems
17. Thyroid problems

When should you see a doctor?

Seek medical assistance if you suspect allergy symptoms after taking medications. Go to the emergency room or call an ambulance immediately if you have any symptoms of a severe allergic reaction, according to a report on the website of the Ohio-based Cleveland Clinic. These symptoms include:

• Trouble breathing
• Difficulty swallowing
• Sudden weakness or lightheadedness
• Accelerated heartbeat
• Unconsciousness

OTC impact
Image Credit: Vijith Pulikkal/Gulf News

What are the common OTCs?

1) Painkillers

OTC painkillers ease pain from arthritis, tendonitis, muscle strains, headaches, and toothaches, among others. The medicines are generally safe if the directions on the label are followed.

Risks: People with liver or kidney diseases should not take acetaminophen and NSAIDs (nonsteroidal anti-inflammatory drugs), and children under 18 should not take aspirin.

Side effects: Prolonged use of NSAIDs can increase the risk of heart attacks and strokes. They can also increase your risk of bruising, bleeding, stomach upset, and skin reactions.

2) Decongestants

Decongestants help relieve nose blockages caused by a cold virus, flu, sinusitis, or allergies. OTC decongestants are generally safe for short-term use.

Risks: People with high blood pressure and heart disease should use decongestants only under medical supervision. The medicine shouldn’t be used on children under 12.

Side effects: OTC nasal decongestants may cause the following side effects: agitation, dry mouth, insomnia, rapid or irregular heartbeat, nose irritation, headaches, rash, heart palpitations and high blood pressure

3) Antiallergics

Antihistamines have been used for years to treat allergy symptoms.

Risks: People with an enlarged prostate, heart disease, high blood pressure, thyroid problems, kidney or liver disease, bladder obstruction, or glaucoma should only take antihistamines under medical supervision.

Side effects: First-generation antihistamines can make people sleepy. Other side effects include dry mouth, drowsiness, dizziness, nausea and vomiting, restlessness or moodiness, trouble urinating, blurred vision and confusion.

4) Cold and flu combination medicines

Cough and cold combinations are used mainly to relieve the cough due to colds, influenza, or hay fever, and not for chronic cough. This combination of products contains more than one ingredient, such as an antihistamine (anti-allergy medication), a decongestant (to clear a stuffy nose), an analgesic (pain reliever), and a cough medicine.

Risks: OTC cough and cold medicines can be life-threatening for children under 6 years of age. Some drugs can be unsafe for people with health issues. For example, pseudoephedrine, phenylephrine and ephedrine could increase blood sugar levels, so diabetic patients must be very careful when using them. The risk of medicine-medicine interaction is also high.

Side effects: The combination medicines are also associated with increased blood pressure in patients with hypertension, hyperthyroidism or heart disease. So take medical advice before using them.

5) Cough mixtures

There are two types of OTC cough medicines: antitussives (cough suppressants) and expectorants (mucous thinners). Antitussives suppress cough by blocking the cough reflex, and expectorants thin mucous to help clear the mucus from the airway. Some cough mixtures may also contain pain relievers, decongestants, or antihistamines. The combination medicines are used for temporary relief from cough, sneezing, or runny nose due to the common cold, hay fever or other upper respiratory allergies.

Risks: The risks are similar to cold and flu combination medicines. People with diabetes should ensure the medication doesn’t spike blood sugar. So also people with hypertension, hyperthyroidism or heart disease.

Side effects: Healthy people don’t usually experience side effects, but some medicines can cause irritability, sleepiness, or dizziness. But prolonged use is not advisable for people with health problems and the elderly.

6) Medicines for acidity

OTC medications that can help relieve heartburn, indigestion or gastric acidity are antacids, histamines or H2 blockers and proton pump inhibitors (PPIs). Antacids help neutralise stomach acid, while H2 blockers and PPIs reduce stomach acid.

Risks: People with liver or kidney disease, heart disease, high blood pressure and pregnant women should consult a doctor before taking antacids. PPIs are not advisable for older people, people with immune system problems and postmenopausal women.

Side effects: Antacid complications are mostly found in infants or people over 65, according to the Ohio-based Cleveland Clinic. Side effects could include constipation or diarrhoea, gas or flatulence, headache, nausea and vomiting, stomach cramps or pain in the abdomen. Frequent or overuse of antacids could lead to complications like acid rebound (the body produces more acid), neurotoxicity (affects the nervous system), iron deficiency, weakened bones and too much calcium in the blood.

7) Laxatives

Laxatives help relieve constipation and promote regular bowel movements. They are used to treat constipation (infrequent, difficult or painful bowel movements).

Risks: OTC laxatives shouldn’t be used if the person has irritable bowel syndrome (IBS), ulcerative colitis, kidney disease or diabetes. A doctor’s advice is required for lactose-intolerant people and those who have had intestinal surgeries. So is the case for women who are pregnant or breastfeeding.

Side effects: It includes bloating, flatulence (gas), vomiting, diarrhoea, nausea, dehydration, headache and loss of normal bowel function. Excessive or prolonged use of laxatives can cause diarrhoea, intestinal obstruction and unbalanced levels of salts and minerals in your body.

8) Herbal products

Herbal medicines are products derived from plants to treat and prevent diseases. Also called phytomedicines, its active ingredients are natural compounds from leaves, bark, roots, seeds, or flowers.

Risks: It may not be suitable for people taking other medicines, people with severe health conditions, pregnant or breastfeeding women, the elderly and children. People who plan to undergo surgery should avoid herbal medicines as some interfere with anaesthesia and blood clotting.

Side effects: According to Medical News Today, some herbal medicines may cause nausea, dizziness, headache, swelling, upset stomach, breathing difficulty or an allergic reaction.

9) Multivitamins

Multivitamins contain a wide range of vitamins and minerals to plug any nutritional gaps in the diet. It’s also helpful for people over 65, vegans and vegetarians, who may miss out on some vitamins.

Risks: High amounts of vitamins and minerals can harm some people. There’s also the risk of exceeding the daily intake if the dosage is followed by a nutrient-rich meal.

Side effects: Constipation, diarrhoea, or upset stomach may occur temporarily. Serious allergic reaction is rare.

Like it or not, OTC medicines are here to stay. People should be cautious about using them. If symptoms persist, see a doctor. A doctor’s prescription is the best medicine.