Mortality during the winter flu epidemic--two cases of death associated with self-medication

COVID-19: Is There Evidence for the Use of Herbal Medicines as Adjuvant Symptomatic Therapy?

BACKGROUND

Current recommendations for the self-management of SARS-Cov-2 disease (COVID-19) include self-isolation, rest, hydration, and the use of NSAID in case of high fever only. It is expected that many patients will add other symptomatic/adjuvant treatments, such as herbal medicines.

AIMS

To provide a benefits/risks assessment of selected herbal medicines traditionally indicated for "respiratory diseases" within the current frame of the COVID-19 pandemic as an adjuvant treatment.

METHOD

The plant selection was primarily based on species listed by the WHO and EMA, but some other herbal remedies were considered due to their widespread use in respiratory conditions. Preclinical and clinical data on their efficacy and safety were collected from authoritative sources. The target population were adults with early and mild flu symptoms without underlying conditions. These were evaluated according to a modified PrOACT-URL method with paracetamol, ibuprofen, and codeine as reference drugs. The benefits/risks balance of the treatments was classified as positive, promising, negative, and unknown.

RESULTS

A total of 39 herbal medicines were identified as very likely to appeal to the COVID-19 patient. According to our method, the benefits/risks assessment of the herbal medicines was found to be positive in 5 cases (Althaea officinalis, Commiphora molmol, Glycyrrhiza glabra, Hedera helix, and Sambucus nigra), promising in 12 cases (Allium sativum, Andrographis paniculata, Echinacea angustifolia, Echinacea purpurea, Eucalyptus globulus essential oil, Justicia pectoralis, Magnolia officinalis, Mikania glomerata, Pelargonium sidoides, Pimpinella anisum, Salix sp, Zingiber officinale), and unknown for the rest. On the same grounds, only ibuprofen resulted promising, but we could not find compelling evidence to endorse the use of paracetamol and/or codeine.

CONCLUSIONS

Our work suggests that several herbal medicines have safety margins superior to those of reference drugs and enough levels of evidence to start a clinical discussion about their potential use as adjuvants in the treatment of early/mild common flu in otherwise healthy adults within the context of COVID-19. While these herbal medicines will not cure or prevent the flu, they may both improve general patient well-being and offer them an opportunity to personalize the therapeutic approaches.

Drug interactions related to self-medication: a French pharmacovigilance database study

Self-medication (SM) is a common practice perceived by patients as harmless which can, however, entail health risks. The aim of the study was to identify drug-drug interactions (DDIs) involving SM drugs leading to adverse drug reactions (ADRs) in the National French Pharmacovigilance Database. All ADR reports from 1 January 1985 to 31 July 312018, coded as 'interaction' and 'self-medication', were selected and studied. Patient characteristics, the level and type of interaction, and the therapeutic classes of the drugs were examined. Adverse drug reactions were analysed and classified according to the system organ classes of the Medical Dictionary for Regulatory Activities. One hundred and three reports totalling 158 ADRs (71% severe cases) were included; 153 DDIs (59.5% pharmacodynamic) involving 234 drugs were identified. The latter included 119 SM drugs (51% available on prescription), mainly analgaesics, anti-inflammatory drugs, dietary supplements and antibiotics. Haemostasis disorders and renal failure were the most frequently reported ADRs. The analysis of reference documents raised concerns on the lack of information provided by package leaflets. In conclusion, the present study highlights the risks of medically unapproved re-use of prescription drugs or the consumption of dietary supplements without monitoring possible interactions and ADRs. Patient awareness could be improved by more regular updates of medication package inserts.

Inappropriate self-medication among adolescents and its association with lower medication literacy and substance use

BACKGROUND

While self-medication is common, inappropriate self-medication has potential risks. This study assesses inappropriate self-medication among adolescents and examines the relationships among medication literacy, substance use, and inappropriate self-medication.

METHOD

In 2016, a national representative sample of 6,226 students from 99 primary, middle, and high schools completed an online self-administered questionnaire. Multiple logistic regression analysis was used to examine factors related to inappropriate self-medication.

RESULTS

The prevalence of self-medication in the past year among the adolescents surveyed was 45.8%, and the most frequently reported drugs for self-medication included nonsteroidal anti-inflammatory drugs or pain relievers (prevalence = 31.1%), cold or cough medicines (prevalence = 21.6%), analgesics (prevalence = 19.3%), and antacids (prevalence = 17.3%). Of the participants who practiced self-medication, the prevalence of inappropriate self-medication behaviors included not reading drug labels or instructions (10.1%), using excessive dosages (21.6%), and using prescription and nonprescription medicine simultaneously without advice from a health provider (polypharmacy) (30.3%). The results of multiple logistic regression analysis showed that after controlling for school level, gender, and chronic diseases, the participants with lower medication knowledge, lower self-efficacy, lower medication literacy, and who consumed tobacco or alcohol were more likely to engage in inappropriate self-medication.

CONCLUSION

Lower medication literacy and substance use were associated with inappropriate self-medication among adolescents.

A descriptive study of self-medication practices among Palestinian medical and nonmedical university students

BACKGROUND

The implications of self-medication practices are increasingly recognized around the world; however, little has been reported on the extent of self-medication practiced in Palestine.

OBJECTIVE

To determine the reasons, extent, and correlates of self-medication practices among university students in Palestine.

METHODS

A self-administered questionnaire eliciting self-medication practices was distributed to university students in a cross-sectional design. The 4 variables, sex, type of school, self-care orientation, and medication knowledge, were investigated for possible correlation with self-medication practices. Multiple logistic regression and Chi-square statistics were used in data analysis.

RESULTS

Self-medication practices were reported by 98% of the surveyed students (n=1581). Approximately two thirds of the respondents reported a high self-care orientation and one third reported "good" medication knowledge. Multiple logistic regressions indicted that self-care orientation, medication knowledge, and sex were insignificant predictors of self-medication practices, whereas the type of school (P=.012) was a significant predictor. A significant relation between the 4 variables and the type of therapeutic class used in self-medication was observed. For example, males were more inclined to use antiallergic medications (OR=1.48) than females. Medical students were more likely to use laxatives/antidiarrheal agents (OR=1.49) than nonmedical students. Respondents with high a self-care orientation were more inclined to use headache relievers (OR=2.22) compared to those with low self-care orientation. The most commonly reported reason for self-medication practices was simplicity of the illness encountered.

CONCLUSION

Self-medication practices were common among the university students studied. Sex, type of school, self-care orientation, and medication knowledge are important personal factors that are associated with the selection of certain types of therapeutic classes used in self-medication.