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The danger of self-medication



Self Medication: What is it?


is neither a definition of self-medication in the Code of Public Health because it is not a treatment but a behavior, practiced by 80% of French in certain circumstances. It is to prescribe self-medication without medical intervention. This guess it feels able to support themselves independently for minor illnesses (colds, headaches, sore throat, constipation, skin problems, hemorrhoids).
Without a precise definition, it is difficult to guarantee the safety of self-medication, even if the drugs called "no-prescription-" have been authorized for placing on the market (AMM) as any drug. This ensures their clinical efficacy, therapeutic and toxicological.


Delayed diagnosis - Loss of chance

Before a health problem, the person analyzing the symptoms, their intensity, duration and decides not to consult and administer self or child treatment, medicated or not, he has (family medicine in the case of a medication) or he acquires without a prescription.

The initial risk serious than taking the user is wrong to equate the new disease to benign disease that seems to recognize and thus to make a misdiagnosis and delaying the introduction of effective treatment.

A second risk is added with the fact that symptomatic treatment may partially mask light or even totally original symptoms and delay diagnosis of a disease, hindering the development of its treatment. Well known example of the risks involved the introduction of antibiotics far too short (end of previous treatment discovered in the family medicine cabinet) not suitable for the causative organism has not been sought, which has been "decapitated" by the initial treatment making it difficult to identify and secondary complications and resistance that may arise. Thus the choice of self-medication can result in some cases a net loss of chance for the patient.

No respect for rules of use

A large number of secondary problems with self-medication practices of misuse comes in part related to the fact that patients do not read or read poorly record regarded as too long or too complex . Educational efforts have been made in recent years, including placement of logos and patterns more accessible to the public.

Main errors to take doses (daily doses unsuitable, poor distribution in the day, not taking into account the mode of administration if individual) and employment without regard to risk factors and precautions. Administration to young children dosage forms with which they are not intended is unfortunately common.
Finally the patient may be judged wrongly cured when the symptoms mend his ways and stop too quickly or too sharply treatment, which can cause rebound reactions and / or render more difficult the medical management of secondary pathology.



Side Effects Medications for self-medication are placed on the market if they have evidence of widespread use safe and whether their use without medical supervision is not a public health problem. Adverse reactions encountered in these conditions should be mild. Classes posing the most problems are the analgesics aspirin considered innocuous and totally unmarked, took ibuprofen dose anti-inflammatory or associated with aspirin and conventional but serious gastrointestinal effects. The absence of medical supervision can lead to misuse and we must insist on the dependencies of some patients (mostly female migraine) to analgesics, situations in which the vicious circle of headache due to analgesic leads to associate them more with the consequences of drug dose escalation and / or synergies of adverse effects.
In some cases the misuse of self-medication can lead to problems for which the patient would consider corrective treatment. It then engages in an escalation of self-medication, a classic example is the absorption of chronic irritant laxatives, followed by irritable bowel syndrome for which the patient s' autoprescrira "dressing tract.
Side effects may also be the consequence of using drugs listed, sometimes serious effects generators, kept in the family pharmacy and taken at doses inadequate. Finally, the side effects most often result in uncontrolled and associations whose risk is not perceived by the user.


Drug Interactions

Three-risk situations are encountered:
- the patient associates himself more drugs to self-medicate,
- the doctor, when establishing a new prescription, asks the coprescription but not drugs taken in self-medication by the patient. Yet it does not think to report treatment he considers trivial (aspirin) or it does not consider a drug (pill, herbal medicine, vitamin supplements ...). In addition, the patient may feel guilty towards his doctor "s'automédiquer" and does not admit the practice.
- The user "forgets" a chronic prescription, "routine" (antihypertensives, lipid lowering, hypo-uricémiants) and no question arises as to the dangers of self-medication is adding to treatment usually prescribed, although this association should be discouraged a priori in the absence of notice of the prescriber.
specific drug interaction alcohol including the loss of vigilance that can cause harm is unknown to the general public and must be frequently recalled for consultation.

iatrogenic risks during pregnancy

surveys published in pregnant women show that many classes are used as self medication. Some are mistakenly regarded as innocuous as commonplace as vitamin supplements, analgesics, while others are symptomatic of diseases common during pregnancy such as drugs or veinotonics of Gastroenterology (antacids, laxatives, anti-nausea).

Mismanagement of the family medicine cabinet

checking expiration dates of stored products is an uncommon practice, besides the drug is often deconditioned and lose both its box and instruction sheet. Moreover, storage conditions (away from heat, light, humidity) are not always followed, nor the obvious set of storage out of reach of children.


What are the OTC?


drugs that are freely available without a prescription. They cover Diabetes Care Products, officinale, tips, specialty consumer and prescription drugs optional. This represents 6.1% of total drug market (figures Afipa 2007).
For example, the elderly consume preferentially self-medication: analgesics to alleviate pain phenomena present in 45 to 70% of them, osteoarticular pain associated with aging in particular, inflammatory, laxatives, sedatives and anxiolytics.



What are the health and legal issues?



practiced at all times, self-medication, the legitimate autonomy or risky attributes to himself as a citizen, is now encouraged by the expansion of patient associations and the delisting of a number of medications (analgesics, syrups, veinotonics). Its apparent advantages (saving medical consultation and non-reimbursement by Social Security) are to be qualified because of the additional adverse drug necessitating costly hospitalization (128 000 cases per year) or a resumption of treatment with the doctor. Self-medication
commits such responsibility of the individual, but also that of the pharmacist in delivering a medication without medical prescription, must recall its proper use (Article R. 5015-1 of the Code of Public Health).


What should you be wary when s'automédique?


The usual risks associated with the prescription were strengthened.
1. The risks of intolerance and drug interactions and are described in the warnings contained in the Vidal ® dictionary of self-medication, or drug records. Adverse effects of drugs are twice more after 65 years, while two thirds are preventable.
2. Poor compliance: it covers half of the elderly.
3. Misuse of a product: 60% of elderly think well use a bronchial inhaler, for example, while only 10% to successfully maneuver.
4. The risk of severe poisoning: a little over 3% of hospitalizations are related to an iatrogenic (caused by an incident care) drug! According APNET (National Educational Association for Teaching Therapeutics), about 109 accidents that led to hospitalization, 8 are related to self-medication: 5 of painkillers (analgesics), 2 of nonsteroidal antiinflammatory drugs.
This is all the more reason to fear that the patient does not specify what his doctor is already taking its own account. The combination drug of the physician and those of the patient is very risky.