Pharmacist Role in Monitoring Self Medication and Self-Care with Over-the-Counter Nutritional and Herbal Supplements in Nigeria: A Review

Abstract

This review undertakes a thorough examination of the pivotal role that pharmacists play in Nigeria in the critical activity of monitoring self-medication and self-care practices. This monitoring specifically focuses on the utilization of over-the-counter (OTC) nutritional supplements and herbal remedies. The practice of self-medication in Nigeria is a widespread phenomenon, often fueled by a complex and diverse set of underlying factors. One significant driver of self-medication is the limited availability and accessibility of essential prescription medications for a considerable portion of the population. This accessibility gap compels individuals to seek alternative healthcare solutions and often leads them to engage in self-treatment strategies. Within the healthcare landscape, pharmacists occupy a uniquely advantageous position, serving as the most readily accessible healthcare providers to the general public. Given their widespread presence and ease of access, pharmacists are therefore of crucial importance in promoting responsible self-care practices and ensuring the appropriate and safe use of medications, including both conventional drugs and OTC products. Their involvement is essential to effectively mitigate potential risks and adverse consequences that may arise from inappropriate or unsupervised self-treatment, thus safeguarding public health.

Keywords

Introduction

Self-medication (SM), defined by the World Health Organization (WHO) as treating self-recognized conditions with medication without consulting a healthcare professional, is common worldwide(1,2). Self-care encompasses SM, appropriate use of medicines and supplements, and health-promoting activities like increased exercise(3). Likewise, WHO broadly defines self-care as individuals, families, and communities promoting health, preventing disease, and managing illness with or without professional assistance(3).This behavior is a common health-seeking strategy employed by individuals across the globe, representing a significant aspect of how people manage their health needs(2,4). The reasons behind individuals resorting to self-medication are varied and complex. Inadequate availability of essential medications in certain regions or circumstances further contributes to the practice of self-medication(4,5).  Furthermore, the digital age has brought about a transformation in how individuals access health information. People now have convenient access to the internet, empowering them to easily explore their symptoms and research potential treatment options from the comfort of their homes(5). This readily available information, while potentially beneficial, can also contribute to the rise of self-medication practices. Over the years, the market for dietary supplements operates under significantly different regulations compared to that of pharmaceutical drugs(5). A crucial distinction is that, unlike pharmaceuticals, dietary supplements are not mandated to undergo rigorous testing for either their effectiveness in achieving their intended purpose or their safety for human consumption before they are made available for sale to the public(5,6). This lack of pre-market scrutiny raises considerable concerns regarding consumer safety and the potential for adverse health outcomes(5). A prevalent misconception among the general public is the belief that herbal remedies are inherently safe simply because they are derived from natural sources(7). This unfounded belief can, unfortunately, contribute to the misuse of these products, with individuals potentially exceeding recommended dosages or using them inappropriately for conditions they are not intended to treat(8). Furthermore, the consequences of poor dietary intake, which can sometimes be exacerbated by supplement use, can manifest as negative health effects and even toxicity, posing a significant public health challenge in both industrialized nations and developing countries alike(5). This underscores the importance of a balanced and well-informed approach to dietary supplementation. In the absence of stringent regulations, consumers are particularly vulnerable to unproven cures and unsubstantiated health claims made by manufacturers and marketers of dietary supplements(8). This creates a situation where individuals may be persuaded to spend their money on products that offer little or no actual benefit, or worse, may even pose a risk to their health(9). While dietary supplement labeling requirements do place some restrictions on explicit claims regarding the treatment or prevention of specific illnesses, these products are nevertheless frequently utilized by individuals as complementary and alternative medicine (CAM) treatments(2,5,6). This widespread use of supplements as CAM therapies highlights the need for open and comprehensive communication between patients and their healthcare providers. Monitoring patients' use of nutritional supplements and herbal remedies can yield positive outcomes for both the healthcare system and the patients themselves. Such monitoring allows healthcare professionals to gain insights into individuals' health-seeking behaviors and potential interactions with conventional medications(6). Moreover, for patients, self-medication provides a convenient and cost-effective means to prevent and alleviate minor medical conditions, offering a readily accessible option for managing everyday health concerns(10). This empowers them to take control of their own health management, fostering a sense of responsibility and active participation in their well-being(11). Nonetheless, it is essential to acknowledge the risks associated with self-medication with these agents. These risks include adverse drug reactions, potentially leading to harmful side effects and complications(5). Polypharmacy, the use of multiple medications simultaneously, can also arise, increasing the risk of drug interactions and adverse outcomes(6). Drug interactions, where different medications interfere with each other's effects, can compromise treatment efficacy and safety(5). To reduce the risk of adverse events and drug interactions, patients should inform their doctors or nurses about all medications and supplements they are taking. Given existing workloads, pharmacists can offer collaborative expertise to enhance patient care(5,12). By leveraging their knowledge and skills, pharmacists can play a vital role in supporting healthcare teams and improving patient outcomes. Community pharmacy settings have been recognized as effective sites for health promotion, screening, and chronic disease management, demonstrating their potential as accessible healthcare hubs within communities(12–14). These pharmacies could effectively be utilized in decentralization strategies, bringing healthcare services closer to individuals and reducing the burden on centralized medical facilities(13). Thus, the WHO has recommended expanding the roles of community pharmacists to increase access to HIV services, highlighting their potential to address critical public health needs(6,15). Pharmacists play a crucial role in detecting atypical medication usage or irrational prescription patterns within the public, contributing to medication safety and appropriate drug utilization(6). Moreover, community pharmacists have the ability to dispel misinformation about medications and actively promote responsible self-medication practices among the public, empowering individuals to make informed decisions about their health(6,8). However, pharmacists’ extended role in public health in relation to self-medication has remained under-investigated, indicating a need for further research and exploration of their potential contributions in this area(6). Understanding the full scope of their impact is crucial for optimizing healthcare delivery and ensuring safe and effective medication practices.

1. Nutritional, Herbal, and Homeopathic Supplements

The National Agency for Food and Drug Administration and Control, widely known as NAFDAC, provides specific definitions for various types of health-related products. According to NAFDAC, nutritional supplements are defined as products, explicitly excluding tobacco products, that are designed and intended to supplement an individual's dietary intake(16,17). These supplements aim to provide additional quantities of essential nutrients, such as vitamins and minerals, or other beneficial dietary substances like herbs and amino acids(1,16). The purpose of a nutritional supplement, as defined by NAFDAC, is to augment the regular diet with these elements(1). In contrast, NAFDAC classifies "Herbal Medicine and Related Products" distinctly. These are defined as finished medicinal products that are intended for therapeutic purposes and contain plant-derived materials as their primary active ingredients(18). The key difference here lies in the claim: herbal medicines, regulated by NAFDAC, make explicit therapeutic claims, implying a capacity to treat or alleviate specific health conditions using the properties of plant extracts(18). Therefore, a herbal supplement regulated under NAFDAC is understood to claim medicinal or therapeutic effects derived from these plant extracts(19). Nutritional supplements, which are also frequently referred to as dietary supplements, are often conceptually linked to the broader field of complementary and alternative medicine, often abbreviated as CAM(19). The category of nutritional supplements encompasses a diverse range of products. The main and most commonly recognized types of supplements include herbal medicines (though these are also regulated separately as mentioned previously), essential vitamins, vital minerals, and homeopathic remedies(1). Beyond these well-known categories, there exists a wider array of other supplements that fall under the nutritional supplement umbrella(1). These include accessory nutrients, such as Coenzyme, which plays a role in cellular energy production. Other supplements include macronutrients, such as essential fatty acids like omega-3 and omega-6 fatty acids, which are crucial for various bodily functions(20). Furthermore, supplements may also include organ tissues, metabolites (the intermediate products of metabolism), and macromolecules, such as glucosamine, which is often used to support joint health(17). NAFDAC places particular emphasis on several key characteristics that define nutritional supplements(20). First, the agency stresses that the primary intention of these products is to supplement or add to an individual’s existing dietary intake(20). Second, NAFDAC highlights that these supplements contain a variety of dietary ingredients, not just a single isolated nutrient(16). Third, the agency emphasizes that nutritional supplements are specifically formulated for oral ingestion, meaning they are designed to be taken by mouth(18). Finally, NAFDAC stipulates that all products intended to be classified and regulated as dietary supplements must be clearly and accurately labeled as such, indicating their intended purpose and composition to consumers(16). Globally, the definition of a dietary supplement varies across developed countries(1). Nigeria's inclusive definition mirrors the U.S. FDA, which regulates supplements as food, albeit differently from conventional food(17). Australia and Canada also have distinct regulations(17). In the EU, regulation is often country-specific and dependent on safety evidence. While China and Japan have long traditions of botanical medicine, China's supplement regulations remain relatively strict(1,17).

2. Self Medication with Nutritional and  Herbal Supplements

Self-medication involving supplements refers to the practice of using vitamins, minerals, or herbal products to treat health conditions that an individual has diagnosed themselves, all without seeking professional guidance from a qualified medical practitioner(12). While supplements might offer some potential benefits in certain situations, engaging in self-medication can present a range of potential risks that individuals should be aware of(9). These risks include the possibility of negative interactions with prescription or over-the-counter medications, the potential for a misdiagnosis of the underlying health problem, and the chance of experiencing unwanted side effects from the supplement itself(8). The category  of supplements is quite broad, encompassing a variety of substances such as vitamins, essential minerals, various herbs, amino acids, and enzymes(9). These supplements are available in different forms, including tablets, capsules, powders, liquids, and even gummies, providing consumers with numerous options for consumption(8,9). Some potential benefits associated with supplement use include addressing existing nutritional deficiencies and providing general support for overall health and well-being(15). For example, someone diagnosed with a Vitamin D deficiency might benefit from a Vitamin D supplement, or someone seeking to improve their general health may choose a multivitamin(9). However, it's crucial to acknowledge the potential downsides of supplement self-medication(7). Supplements can indeed interact with other medications a person is taking, potentially diminishing the effectiveness of those medications or even leading to harmful interactions(19). Furthermore, relying solely on self-diagnosis and treatment with supplements can lead to a misdiagnosis of the actual underlying health condition, potentially delaying appropriate and necessary medical care(8). Additionally, supplements, like any substance taken into the body, have the potential to induce adverse reactions or, in some cases, even lead to toxicity if taken in excessive doses(6). This risk is particularly relevant with certain vitamins and minerals that can accumulate in the body to dangerous levels(9). Therefore, it is strongly recommended that individuals consult with a healthcare provider, such as a pharmacist, before starting any new supplement regimen, particularly if they have pre-existing health conditions or are currently taking medications. This consultation is essential to ensure the safety and appropriateness of supplement use in their specific circumstances(6). A healthcare professional can help assess the potential benefits and risks, identify any possible drug interactions, and provide guidance on appropriate dosages(8). Responsible supplement self-care necessitates a thorough understanding of the potential dangers associated with self-medication and the importance of seeking professional medical guidance to make informed decisions about one's health(6,12). Ignoring this advice could lead to unintended and potentially harmful consequences.

3. Pharmacist role in monitoring self-medication and self care of nutritional and herbal supplements in Nigeria

Pharmacists play a crucial role in guiding patients toward safe and effective self-medication using herbal and nutritional supplements(12). Recognizing the increasing popularity of these supplements, pharmacists are uniquely positioned to assist individuals in making informed decisions about their health. Instead of relying solely on personal beliefs or anecdotal evidence, pharmacists leverage their knowledge and expertise to help patients navigate the often-complex world of supplements(14). This guidance encompasses a range of services, from providing individualized consultations to meticulously checking for potential medication interactions and advising patients about potential side effects(2). Ultimately, pharmacists empower patients to make well-informed choices that contribute to improved health outcomes(2). The World Health Organization (WHO) further elaborates on the multifaceted roles of pharmacists in this context, highlighting their responsibilities as communicators, quality medicine suppliers, health promoters, and collaborators with other healthcare professionals(21). As communicators, pharmacists must actively engage with patients to gather comprehensive pharmaceutical information(21). This involves asking pertinent questions to gain a thorough understanding of the patient's health status, current medications, and reasons for considering herbal or nutritional supplements(21,22). A study examining pharmacists' knowledge and views emphasized the importance of their understanding supplement benefits, potential hazards, interactions with other medications, and appropriate usage guidelines(4). Armed with this knowledge, pharmacists can clearly explain the supplement's intended usage, recommended dosage, potential side effects, and any relevant warnings to patients(12). They play a vital role in assisting patients with self-care practices and ensuring the safe and effective use of supplements(22). Furthermore, pharmacists are ethically bound to maintain patient confidentiality, creating a safe and trusting environment for open communication(3). In their capacity as quality medicine suppliers, pharmacists are responsible for providing well-stored and reliable product(17). This ensures that patients have access to supplements that meet quality standards and are properly maintained to preserve their efficacy(19). Beyond dispensing medications, pharmacists also serve as health promoters and educators within the community(21). They provide exceptional service by offering valuable information and guidance on various health-related topics, including the appropriate use of herbal and nutritional supplements(14). Finally, pharmacists recognize the importance of collaboration with other healthcare professionals and patients(21). By working together, they can ensure coordinated and comprehensive care for individuals seeking to improve their health with supplements(21). A critical aspect of a pharmacist's role is performing thorough drug interaction checks(22). A research study focusing on pharmacists' attitudes and behaviors strongly recommended that they vigilantly monitor for potential interactions between supplements and prescription or over-the-counter medications(6). Such interactions can lead to adverse effects or reduced effectiveness of medications, underscoring the importance of careful screening(21). Reviewing a patient's medical history is another essential step in ensuring safe supplement use(21). According to a survey of pharmacists' knowledge and attitudes, they should carefully check the patient's medical history for any contraindications or sensitivities to specific supplements(5). This proactive approach helps to identify potential risks and prevent adverse reactions. Pharmacists also play a vital role in adverse event reporting(14). Research on pharmacists' knowledge, beliefs, and behaviors emphasizes their responsibility to report any adverse occurrences or interactions related to supplement use(14). This reporting system contributes to the ongoing monitoring of supplement safety and helps to identify potential risks associated with their use(12). Collaboration with physicians is crucial for providing complete patient care(21). As highlighted in research on pharmacists' knowledge, views, and behaviors, pharmacists should actively collaborate with doctors to ensure that patients receive comprehensive and coordinated care, particularly when using herbal or nutritional supplements(5). This collaboration ensures that all healthcare providers are aware of the patient's supplement use and can factor it into their overall treatment plan(7). When advising patients on supplement use, pharmacists should rely on proof-based information rather than personal opinions(21,22). A study on community pharmacists' usage, perception, and understanding of nutritional supplements advised them to utilize evidence-based resources(2,5). This ensures that patients receive accurate and reliable information to guide their decisions. Pharmacists also play a key role in encouraging rational use of supplements(14,21). A comprehensive assessment of self-medication practices during the COVID-19 pandemic recommended that pharmacists encourage patients to use supplements intelligently, avoiding unnecessary or excessive consumption and supporting a balanced approach to health and well-being(4,23). This guidance helps patients to make informed choices that are based on scientific evidence and tailored to their individual needs(12).

4. CONCLUSION

In conclusion, pharmacists play a vital role in promoting safe and effective self-medication using nutritional and herbal supplements. By providing individualized counsel, checking for medication interactions, advising patients about potential side effects, encouraging rational use, collaborating with other healthcare professionals, and reporting adverse events, pharmacists contribute significantly to improving patient outcomes and overall health. Their expertise and guidance empower patients to make informed decisions about supplement use and to achieve their health goals safely and effectively.

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