Self-medication during Covid-19 pandemic: challenges and opportunities

The World Health Organization (WHO) defines self-medication (SM) as the selection and utilization of medicines to treat self-recognized symptoms or ailments without consulting a physician [1]. It also includes the usage or re-usage of previously prescribed or unused drugs, direct purchasing of prescription drugs without consultation, and irrational use of over-the-counter (OTC) drugs [2]. SM is a significant concern globally, affecting both developed and developing countries [3, 4]. Various studies have indicated that SM is a common practice, with a prevalence of 32.5–81.5% worldwide [5]. The most commonly self-prescribed medications are analgesics, antipyretics, antitussives, antidiarrheals, calcium and vitamin supplements, anabolic steroids, sedatives, certain antibiotics, and many herbal and homeopathic remedies [3]. As of September 21, 2020, there were 30,905,162 confirmed cases of COVID-19 [6], and, to date, no definitive treatments or vaccines are available to treat or prevent this viral infection. This situation has increased the influence of social media regarding misinformation about medications, leading to public confusion and panic and increased use of SM, including home remedies, without established safety and efficacy [7, 8]. Between 7 January 2020 and 1 June 2020, the increase in people’s interest in online SM information during the COVID-19 pandemic is reflected in the Google trend for searches on SM [9]. Suggestions of SM for COVID-19 may come from friends, family, neighbors, pharmacists, previous prescriptions, and the media. In developing countries, such as India, the use of SM with hydroxychloroquine and chloroquine without a prescription to prevent COVID-19 has been documented [12]. Later, the US Food and Drug Administration (FDA) declared the use of hydroxychloroquine and chloroquine as being unsafe in mild-to-moderate COVID19 based on their therapeutic safety profile in COVID-19 patients [13]. Similarly, while UK researchers have declared dexamethasone to be a ‘life-saving drug’ in the treatment of severe COVID-19, the UK Minister of the National Health Service stressed that dexamethasone should only be used in critically ill patients and should not be used as an SM in mild to moderate cases due to its inherent safety problems [14]. Ivermectin is sold OTC in some countries, and people are self-medicating and, more concerningly, self-dosing it for the treatment of COVID-19. Therefore, the WHO has provided several warnings to observe caution when using SM to treat COVID-19, including the irrational use of antibiotics, herbal remedies, and other OTC drugs [15]. Many herbal drugs have been used to treat COVID-19 in China, Pakistan, and other countries worldwide. Such products are readily available to the public without a prescription and are used as SM to avoid hospital visits and admissions, but their use in COVID-19 lacks evidence-based support [7]. In China, three patented herbal products (Lianhuaqingwen capsules and Jinhua Qinggan granules to treat mild conditions, and Xuebijing for severe conditions) were recommended to treat COVID-19. However, their potential effectiveness and safety needs to be confirmed by the results of randomized controlled clinical trials before being used to treat COVID19 [7]. Similarly, there was increased demand and use of Sanna Makki, a herbal plant, by local people in Pakistan due to its claimed efficacy in treating COVID-19 symptoms [16]. * Ali Ahmed ali.ahmed@monash.edu