Overuse of Over-the-Counter Medications and Associated Health Risks Among Adults in Nigeria

Introduction

Over-the-counter (OTC) drugs are drugs purchased by consumers without a medical prescription which are believed to be relatively safe and are appropriate for use without the supervision of healthcare professionals.¹ Most OTC drugs are legally available and used without prescription.² This leads to abuse of the drugs through self-medication.

Most commonly abused OTC drugs includes:⁴

• Analgesics: Paracetamol, tramadol, codeine, ibuprofen, piroxicam and diazepam
• Antidiarrheal: loperamide
• Antibiotics: flagyl, ciprofloxacin, trimethoprim
• Expectorants: cough syrup
• Others: vitamin C, blood tonic

Prevalence of OTC Drugs

OTC drugs are readily accessible and available. They are sold by unauthorized people in shops on almost every street in Nigeria.⁵ A study conducted in Nigeria shows 62.7% use of OTC drugs.⁵ Another Nigerian study reported that 81.9% purchase OTC drugs without a doctor's prescription.⁴ It also showed higher prevalence in older participants and participants with postsecondary school education.⁴

Contributory Factors and Health Risks

The overuse of OTC medications is largely driven by widespread self-medication. Analgesics such as paracetamol and ibuprofen are among the most commonly used OTC drugs due to their availability and perceived safety. Antibiotics, antimalarials, as well as vitamin C and cough syrups are also frequently obtained without prescription and misused.¹,³

Several factors contribute to this pattern. Financial constraints, lack of health insurance, and the high cost of healthcare services often lead individuals to self-medicate as an affordable alternative. ²,³ Limited access to healthcare facilities and long waiting times also discourage hospital visits. Additionally, prior experience with similar symptoms encourages unsupervised use. Weak legislation and regulatory enforcement allow the continued non-prescription sale of medications, particularly antibiotics.¹ Sociocultural influences, including advice from family and peers, also shape medication practices.

The health risks associated with OTC medication misuse are quite significant. Excessive use of paracetamol may result in hepatotoxicity, while prolonged use of ibuprofen increases the risk of gastrointestinal complications, including peptic ulcer disease, and renal impairment.³,⁴ The misuse of antibiotics contributes to antimicrobial resistance, reducing treatment effectiveness, thereby increasing the burden of infectious diseases.¹–³ Inappropriate use of antimalarials may promote drug resistance and delay accurate diagnosis of other illnesses. These outcomes highlight the broader public health implications of OTC drug overuse in Nigeria.

Recommendations

Addressing the overuse of over-the-counter (OTC) medications in Nigeria requires a multifaceted approach targeting key drivers such as poor health literacy, weak regulatory enforcement, and limited access to affordable healthcare.

1. Public Health Education

There is a need for sustained public health education to address misconceptions about OTC drug safety and the risks of self-medication. Community-based interventions—through schools, markets, religious institutions, and mass media—should emphasize rational drug use and the dangers of antibiotic misuse, as poor knowledge has been identified as a major driver of irrational drug use. ²,⁴

2. Strengthening Regulation and Enforcement

Regulatory bodies, particularly the Pharmacists Council of Nigeria (PCN), should intensify monitoring of drug sales to curb the non-prescription dispensing of restricted medications. Studies have shown widespread access to prescription-only medicines through patent medicine vendors, highlighting the need for stricter enforcement, licensing, and penalties for non-compliance. ²,⁴

3. Improving Access to Affordable Healthcare

Enhancing access to affordable and quality healthcare services is essential to reduce reliance on self-medication. Expansion of the National Health Insurance Authority (NHIA) and strengthening of primary healthcare systems can address financial and accessibility barriers that drive OTC misuse.³

4. Promoting Responsible Healthcare Practices

Healthcare professionals have a critical role in mitigating OTC drug misuse. Pharmacists should provide appropriate counselling and adhere strictly to dispensing regulations, while prescribers should ensure clear communication and discourage informal prescribing practices. This is important given that healthcare system gaps and professional practices influence self-medication behaviors.³

5. Enhancing Drug Regulation and Pharmacovigilance

The National Agency for Food and Drug Administration and Control (NAFDAC) should strengthen efforts to eliminate counterfeit and substandard drugs and improve pharmacovigilance systems. Poor drug quality and weak monitoring systems have been linked to adverse health outcomes associated with OTC drug use.²,⁵

References

1. Nagaraj M. A study on the dispensing pattern of over the counter drugs in retail pharmacies in Sarjapur area, East Bangalore. JCDR 2015.
2. Irrational use and non-prescription sale of antibiotics in Nigeria: A need for change. Olusegun Akinyandenu*, Adeniyi Akinyandenu. https://www.jsirjournal.com/Vol3_Issue2_22.pdf
3. Self‑medication Practices, Drivers, and Implications: A Cross‑sectional Analysis of Adults in Karu Local Government area, Nasarawa State, Nigeria. Fidelis Nwachukwu, Cynthia Chidinma Okedo, Mary C. Obimma, Chimaobi Ihebuzor. https://journals.lww.com/jphp/fulltext/2025/09000/self_medication_practices,_drivers,_and.8.aspx
4. Self-medication with over-the-counter drugs among consumers: a cross-sectional survey in a Southwestern State in Nigeria. Wuraola Akande-Sholabi , Olamide Olubodunde Akinyemi. https://bmjopen.bmj.com/content/13/5/e072059
5. The Use of Over-The-Counter Drugs and Its Health Implications in Awka South LGA, Anambra State, Nigeria. Onyedinefu, Abraham Ozioma, Osuagwu, Gift Ogechi. https://doi.org/10.58421/misro.v3i2.227