Short Communication
Consideration of an OTC medicines database for disaster preparedness
2024 年 2 巻 1 号 p. 12-15
詳細
2024 年 2 巻 1 号 p. 12-15
This study aims to develop a simulated database that contains information on fields for storing OTC (over-the-counter) medicines during disasters. Evacuees can select the most suitable OTC medicines from the stockpile based on their subjective symptoms brought on by minor health problems that arise after disasters. We referenced a published list of common subjective symptoms during disasters and OTC medicines that are effective for disaster use, matched them with prescription medications, and devised a comprehensive list. In conclusion, inadequate information was identified, requiring further research and database expansion based on the experts’ opinions on disaster relief and past cases.
The disaster-related subjective symptoms (DRSS) enumerated by the “Disaster Communication Support Board” and the “OTC Medicine Collection for Disasters” published by Shikamura et al. were used to compile the necessary data for this database. Based on this, a preliminary database was constructed.
The DRSS currently includes seven subjective symptoms that are treatable with OTC medicines: “pain,” “itchiness,” “coughing,” “fever,” “dizziness,” “diarrhea,” and “insomnia.” These seven symptoms were classified as main categories, and additional symptoms were listed as supplementary symptoms. Furthermore, the symptoms of upper respiratory tract infections frequently include a combination of sore pharynx, fever, nasal discharge, and cough. However, the term “flu” comprises several “cold symptoms”. Consequently, we added it as a separate category.
We referred to the “OTC Medicine Collection for Disaster Response” published by Shikamura et al., which covers 56 types of OTC medicines. These include oral medications, topical medications, disinfectants, and others1). For this database, we focused on the 31 types of oral medications with potential contraindications, precautions, and drug interactions. Among the 31 types, there were 11 types of psychotropic medications, 10 types of digestive organ agents, 7 types of respiratory organ agents, 1 type of nutrients, and 2 types of allergic agents. The approved indications and effects were referenced from the Therapeutic Guidelines 20232) and package inserts.
Based on fundamental subjective symptoms, we considered the items related to disaster-use OTC medicines and the items related to matching prescription medications. As a result, there were 11 items related to disaster-use OTC medicines and 9 items related to matching prescription medications (Table 1).
| Fields for OTC medicines for disaster-use | |
|---|---|
| 1 | OTC Name |
| 2 | Amount of matching active ingredient in prescription medicines |
| 3 | Dosage instructions |
| 4 | Maximum usage limit |
| 5 | Dosage form |
| 6 | Indications and effects |
| 7 | Side effects |
| 8 | Drug interactions |
| 9 | Risk of oral intake for pregnant women* |
| 10 | Risk of oral intake while breastfeeding** |
| 11 | Precautions for use |
| Fields for matching prescription medicines | |
|---|---|
| 1 | Billing code for medical reimbursement |
| 2 | Corresponding prescription medicine name |
| 3 | Amount of active ingredient |
| 4 | Dosage instructions |
| 5 | Maximum usage limit |
| 6 | Drug interactions |
| 7 | Side effects |
| 8 | Precautions for use |
| 9 | Availability for purchase at retail pharmacies |
* The risks related to drug use during pregnancy were assessed based on the classifications defined by the Australian Drug Evaluation Committee. The risks were categorized into seven separate categories identified by the letters A through D and X, arranged in descending order based on the level of risk. Category X specifically pertains to medications with a substantial risk of inducing lasting harm to the fetus and consequently are contraindicated for use in pregnant women or may potentially conceive.
** The classification of risks associated with breastfeeding mothers has been clarified in the publication “Medications and Mother’s Milk 2014”. The classification consists of five categories: L1, referred to as Compatible; L2, as Probably Compatible; L3, as Probably Compatible; L4, as Potentially Hazardous; and L5, as Hazardous6).
After classifying the 31 types of disaster-use OTC medicines according to fundamental subjective symptoms, we found 16 products that remedy a single subjective symptom, 10 products that alleviate two subjective symptoms, and 5 products that do not relieve any subjective symptoms. For fundamental subjective symptoms such as “pain” and “discomfort” we added information related to the affected area and symptoms that were necessary for comparing the indications and effects of disaster-use OTC medicines (Table 2). Among the eight symptoms included in the disaster communication support board that seemed to be relevant to disaster-use OTC medicines, there were no disaster-use OTC medicines effective against the symptom of “dizziness.”
| No | Major categories of disaster related subjective symptoms | Additional information for matching of OTC for disaster use | Number of medicines |
|---|---|---|---|
| 1 | Cough and/or fever | Cold symptoms | 4 |
| Cough | None | 4 | |
| 2 | Pain | Affected area (throat, mouth/throat, head, stomach, abdomen) |
7 |
| Pain and/or fever | Affected area (head, joints, muscles, wounds, etc.) |
5 | |
| 3 | Diarrhea | None | 1 |
| 4 | Pain and/or diarrhea | Pain: affected area (abdomen) Diarrhea: threw up |
1 |
| 5 | Discomfort | Abdominal bloating/loose stools Nasal congestion |
2 |
| 6 | Insomnia | None | 1 |
| 7 | Itching | None | 1 |
| No applicable symptoms* | 5 |
* Constipation and fatigue were identified as symptoms for which over-the-counter medications lacking appropriate symptom indications were suggested.
Among the 31 products, only two had maximum usage limits specified, e.g., a maximum intake of 6 times for a 5 mL–10 mL dose of Kids’ Bufferin Syrup® for cough and fever: max of 20 mg Gaster 10® for stomach pain, etc. Including interactions in the database required ingenuity: OTC drugs may have multiple medicinal effects, and individuals may unknowingly take multiple doses of the same substance from different medicines. To prevent such instances, the same type of medication was categorized as “antipyretic analgesic” or “common cold remedy” etc., and it was clarified which category it should not be overlapped with. Other specific interactions were included in the detailed list. Risk classifications for pregnant and breastfeeding women were determined using the tables. An extensive list of precautions for use was provided for infants and children, and others were listed in a table format. In the matching of OTC medicines and prescription medications, products for headaches and constipation did not have prescription medications with the same ingredients. Furthermore, 12 products were available for purchase at retail pharmacies.
Selected Subjective SymptomsIt was found that no OTC medicines for disaster-use were available for the commonly occurring symptom of “dizziness.” “Dizziness” can be addressed with the OTC medication Travelmin®, and it is possible to add it to the list of disaster-related OTC medicines, and to include prescription medications with the same active ingredient. On the other hand, it was also found that DRSS did not include symptoms such as “constipation” and “fatigue,” which are indications for OTC medicines. For symptoms commonly associated with digestive disorders, such as “nausea/vomiting,” neither the DRSS nor the list of OTC medicines were included. Consequently, it is necessary to reconsider which subjective symptoms and corresponding disaster-related OTC medicines should be included.
While basic subjective symptoms arising from health issues are crucial for selecting disaster-related OTC medicines, it became evident that directly linking them to medication selection based solely on the fundamental subjective symptoms listed on the Communication Support Board can be challenging. To make appropriate selections of disaster-related OTC medicines for fundamental self-aware symptoms like “pain” and “discomfort,” additional information such as the affected body part or characteristics is necessary. It was considered necessary to thoroughly organize and examine the additional information required for the proper selection of disaster-related OTC medicines.
Integrating OTC Medicines and Prescription MedicationsThe expected rise in the availability of appropriate OTC medicines can be attributed to individuals’ verification of the safe use of prescription medications for minor health ailments in previous instances. For OTC medicines, many formulae contain multiple active ingredients, making it challenging to find them with the same active ingredient and dosage as prescription medications. The analysis of the simulated database reveals that the matching process between OTC medicines with prescription medications, which contain the same active ingredient and dosage as currently and previously consumed, presents a challenge.
Inclusion of Retail Pharmacy ItemsA retail pharmacy refers to a medical establishment where prescription medications can be purchased without a prescription. It is a system that has been conditionally approved by the Ministry of Health, Labor and Welfare since 20053). Medications available for purchase at retail pharmacies are prescription medications; therefore, they can be considered as one of the options for stockpiling.
Utilization of the DatabaseDuring disasters, residents must choose suitable OTC medicines from stockpiles for minor symptoms. The highest risk arises when patients needing medical attention self-treat with OTC medicines. Ideally, an algorithm should help individuals assess symptom urgency, ensuring OTC use for mild illnesses.
The Fire and Disaster Management Agency of the Ministry of Internal Affairs and Communications has published an Emergency Visitation Guide (Home Self-assessment) for residents to assess the need for emergency visits on their own4). Additionally, several municipalities, including Tokyo, have published household self-assessment algorithms as web applications, which can serve as valuable references for future research5).
We believe that this database should be utilized by individuals who stockpile OTC medications and pharmaceutical experts such as pharmacists, both during peacetime and after disasters, and improved based on user feedback. We are considering the development of a multifunctional application that supports multilingual display for future use. This aims to make it a tool that is easily accessible and user-friendly for everyday use and a wide range of users, facilitating feedback as well.
The authors declare no conflicts of interest.
