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Review • Braz. J. Pharm. Sci. 61 • 2025 • https://doi.org/10.1590/s2175-97902025e231009 linkcopy

Open-access Profile of drugs used by university students for self-medication in times of the COVID-19 pandemic: A scoping review

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    Abstract

    A significant increase in self-medication was observed during the SARS-CoV-2 pandemic, especially among university students due to their higher level of knowledge and awareness, making them more prone to self-medication. Therefore, in this scoping review we aimed to understand the profile of medications used for self-medication among university students during the pandemic, both for COVID-19 prevention and other reasons. We followed the PRISMA-ScR guidelines in conducting the review. The PICo guiding question was, “What is the profile of medications used for self-medication during the COVID-19 pandemic among university students?” Searches were conducted in the Scielo, PubMed, Embase, EBSCOhost, Web of Science, Scopus, BVS, Google Scholar, and CAPES databases based on MESH and DeCS descriptors. A total of 35 studies were selected, with eight (22.8%) reporting self-medication for COVID-19 prevention/treatment ranging from 14-83%, four (11.4%) reporting self-medication for specific symptoms ranging from 11-95%, 19 (54.4%) reporting several reasons for students self-medicating with a range of 50-100%, and four (11.4%) studies not specifying the reason for medication use in self-medication varying from 3-93%. The included studies revealed that the irrational use of medications is a common practice among university students, with varied prevalence of self-medication observed in this population during the COVID-19 pandemic.

    Keywords:
    Review; Students; Self-Medication; COVID-19; Drug Utilization

    INTRODUCTION

    Self-medication, also known as self-administration, is a worldwide practice (Lei et al., 2018) and can be defined as the selection and use of medications by individuals to treat self-recognized illnesses or symptoms (Brasil, 2012). It is commonly indicated by non-health professionals, such as friends, neighbors, and/or family members, meaning it occurs without medical, pharmaceutical, dental, or qualified healthcare professional guidance (Tavares, Gomes, Freitas, 2020; Silva et al., 2021b).

    It is known that self-medication, often seen as a solution for immediate relief of some symptoms, can have serious consequences, such as delayed diagnosis of diseases, development of comorbidities, incorrect self-diagnosis, allergic reactions, dependence, drug interaction, severe adverse reactions, bacterial resistance, drug poisoning, masking of an underlying disease, and even death (Behzadifar et al., 2020; Brito et al., 2020; Tavares et al., 2020).

    During the SARS-CoV-2 virus pandemic, fear of contracting the virus, misinformation, and limited access to healthcare services due to the pandemic (Brito et al., 2020; Quincho-Lopez et al., 2021) increased the influence of social media regarding misinformation about medications, leading to confusion, public panic, and increased self-medication, including home remedies without established safety and efficacy (Malik et al., 2020). Self-medication is becoming increasingly common and is considered a serious public health problem in both developing and developed countries (Behzadifar et al., 2020).

    The university population has been studied nationally and internationally regarding the practice of self-medication, as they have a higher knowledge and awareness level, making them more prone to self-medicate. For example, an alarming prevalence of self-medication among students was recorded in Saudi Arabia, with approximately 98.2% self-medicating in early February 2020 (Alshammari et al., 2021). In Pakistan, 83% of medical students self-medicated during the COVID-19 pandemic (Yasmin et al., 2022), while 79% of students in Sudan self-medicated with antibiotics during the same pandemic period (Alhaj et al., 2021).

    A recently conducted systematic review by Quincho-Lopez et al. (2021) assessed the prevalence of self- medication to prevent or manage COVID-19. The authors analyzed the medication profile and the reasons that led the population to self-medicate. Five studies included in this review were directed at the general population, one study at hospitalized patients, one at undergraduate students, and one at workers from five sectors (health, air transportation, police, road transportation, and the informal sector).

    In a preliminary literature search, we identified that several studies have been conducted with the aim of assessing the prevalence of self-medication in the university population, as well as the medications used for self-medication during the COVID-19 pandemic, whether for prevention or treatment of the disease or for other reasons (Faria et al., 2020; Maurício, 2022; Santos et al., 2022; Saleem, Butt, Ahmad, 2021; Yasmin et al., 2022; Zeb et al., 2022; Yousaf et al., 2021). Therefore, it is important and relevant to propose the construction of an integrative review on this topic.

    Additionally, to the best of the authors’ knowledge, there is currently no integrative, scoping, and/or systematic review that has proposed a synthesis of these findings. Given the above, the objective of this study is to understand the profile of medications used for self-medication among university students during the pandemic for COVID-19 prevention and self-medication for other reasons.

    MATERIAL AND METHODS

    Study design, protocol and registration

    The investigation is a scoping review that followed the recommendations outlined in the PRISMA Extension for Scoping Reviews (PRISMA-ScR) checklist (Tricco et al., 2018) and was added to the scoping review protocol registered on the Open Science Framework on 04 de December 2023 (https://osf.io/5ymjx/).

    Review question

    The research question to guide the present scoping review was: “What is the profile of medications used for self-medication during the COVID-19 pandemic by university students?” Thus, the PICo strategy was employed to address this, with (P) representing university students, (I) representing self-medication, and (Co) representing the COVID-19 pandemic.

    Eligibility criteria eligibility

    Studies conducted with the university population, those reporting self-medication during the COVID-19 pandemic, and original articles with primary data collection without restrictions on study design were included. Grey literature was also considered, including undergraduate theses, theses, dissertations, and preprints. There was no restriction on language and publication period.

    Studies without full access permission and those not granted by authors upon email request, as well as narrative, integrative, systematic, and scoping reviews, mini-reviews, case studies, author notes, letters to the editor, and brief communications were all excluded.

    Information sources and searches

    The PiCo strategy was used for developing the search strategy. Descriptors registered in the Medical Subject Headings (MESH) and in the Health Sciences Descriptors (DeCS), which are controlled, as well as synonyms, singular and plural forms, possible different spellings, and free terms taken from titles, abstracts, and keywords were also used to compose the search strategy. A preliminary search on the research topic was conducted to assist in finding these free terms, contributing to the expansion of the search.

    The terms were combined using Boolean operators “AND” and “OR”. Collaboration with a generalist librarian was sought in creating the search strategy. The developed search strategy was initially tested on PUBMED/MEDLINE and subsequently on other databases (Supplementary files).

    The search for scientific evidence was conducted in the following databases: Scientific Electronic Library Online (Scielo), National Library of Medicine (PubMed), Excerpta Medica Database (Embase), EBSCOhost, Web of Science, Scopus, the Virtual Health Library (BVS), and the Google Scholar search engine. Google Scholar and the CAPES theses and dissertations catalog were also used for searching gray literature. All searches were conducted on September 30, 2022, without the use of filters (Supplementary files).

    Two authors (NAF and WGM) independently conducted the search with prior standardization of the search strategy for each database. The results were subsequently compared, and both authors obtained the same quantity of results in all mentioned databases.

    Selection of evidence sources

    The analysis of the studies was conducted by two researchers (NAF and LFB) using the Rayyan tool (Ouzzani et al., 2016). After removing duplicates, the title and abstract were reviewed. Studies included at this stage were selected for a full-text reading. The selection of studies was performed independently by the researchers based on pre-established inclusion and exclusion criteria. Any discrepancies that arose at each selection stage were resolved through consensus, where researchers agreed 100% on the inclusion or exclusion of the study.

    Data extraction

    The data were extracted from the selected studies, organized, and presented in a Microsoft Excel® spreadsheet, with double-checking performed by the authors. The selected studies were characterized with respect to the author and year of publication, country where the study was conducted, study design, sample size, percentage of students who self-medicated during the COVID-19 pandemic, medications used for self-medication, key conclusions, and reasons that led university students to self-medicate.

    RESULTS

    Selection of studies

    After searching databases and research sources as well as gray literature, 35 studies were included in the integrative review, which are shown in Figure 1.

    thumbnail of FIGURE 1
    FIGURE 1
    Flowchart for selecting studies for the integrative review.

    Characteristics of the included studies

    The characteristics of the included studies with respect to authors, year of publication, country, study design, sample size, percentage of self-medication, main conclusions, and reasons for self-medication are described in Table I (supplementary material).

    Thumbnail
    TABLE I
    Characteristics of the included studies

    The 35 selected studies revealed the profile of self- medication in the university population for preventing COVID-19 and other reasons across four different continents. A total of 16 studies were conducted in the Americas (Alves, 2022; Andrade, Moreno, Ortiz, 2021; Faria et al., 2020; Maurício, 2022; Santos et al., 2022; Silva et al., 2021a; Souza, 2022; Cienfuegos et al., 2022; Miñan-Tapia et al., 2020; Rojas-Miliano et al., 2022; Escobar et al., 2022; Sapana et al., 2021; González et al., 2022; Roblero et al., 2022; Sarango et al., 2020; Witteveen, 2021). In addition, two studies were conducted in Africa (Bello et al., 2022; Alhaj et al., 2021), three in Europe (Cvitković, 2021; Silva et al., 2021b; Sljivo et al., 2022), and 14 studies were conducted in Asia (Saleem, Butt, Ahmad, 2021; Yasmin et al., 2022; Zeb et al., 2022; Yousaf et al., 2021; Palikhey et al., 2021; Shrestha et al., 2021; Subedi, 2021; Alduraibi, Altowayan, 2022; Qahtani et al., 2022; Mannasaheb et al., 2021; Alahendra et al., 2021; Johora et al., 2021; Misli et al., 2021; Armillo et al., 2022).

    The studies included between 33 to 2,401 participants, and were conducted between March 2020 and April 2022. All studies involved health science students, but four of them mentioned students from physics, mathematics, engineering, arts, and law (Maurício, 2022; Rojas-Miliano et al., 2022; Silva et al., 2021b; Subedi, 2021). All studies were observational, but three studies did not inform the study design (Zeb et al., 2022; Silva et al., 2021b; Witteveen, 2021).

    Self-medication for COVID-19 prevention/ treatment

    The reasons for self-medication among university students were identified in 31 included studies. Among these, eight studies revealed that the motive for self- medication was the pursuit of prevention/treatment against COVID-19, with the prevalence of self-medication in the population ranging from 14% to 83% (Alves, 2022; Andrade, Moreno, Ortiz, 2021; Souza, 2022; Rojas-Miliano et al., 2022; Yasmin et al., 2022; González et al., 2022; Bello et al., 2022; Johora et al., 2021); the studies reported the consumption of: vitamin C, D or multivitamins; azithromycin; ivermectin; paracetamol; hydroxychloroquine; and chlorine dioxide (Table I).

    Self-medication for other reasons

    Among the included studies, four addressed the practice of self-medication for the control of specific symptoms, such as relief of muscle pain, improvement of difficulty concentrating and focusing, regulation of insomnia and sleep difficulties, and resolution of the common cold. Regarding the study that addressed self- medication for muscle pain, 74% of this population used paracetamol or ibuprofen for symptom relief (Roblero et al., 2022). In the study that reported self-medication due to difficulty sleeping, it was observed that 4% of the studied population used herbal medicines (Silva et al., 2021b). Regarding the use of medications to improve focus or academic performance, 11% self- medicated with Adderall®, Ritalin® (Methylphenidate Hydrochloride), Vyvanse® (Lisdexamfetamine), or Dexedrine® (Dextroamphetamine) (Witteveen, 2021). Alhaj et al. (2021) found that 79% of participants self- medicated with antibiotics to treat the common cold and as prophylaxis for it.

    Furthermore, a total of 20 studies addressed different justifications for the practice of self-medication, including rapid relief of symptoms, non-aggravating symptoms, previous experience with the medication, knowledge about the drug, lack of time to see a doctor, recommendation from a friend or family member, difficulty accessing health services and exemption from medical fees. The prevalence varied from 50% to 100% among the research participants, and the main medications used by students were analgesics, antipyretics, anti-inflammatories, antibiotics, antiallergics, and antihistamines (Palikhey et al., 2021; Shrestha et al., 2021; Subedi, 2021; Alduraibi, Altowayan, 2022; Qahtani et al., 2022; Sarango et al., 2020; Santos et al., 2022; Miñan-Tapia et al., 2020; Saleem, Butt, Ahmad, 2021; Mannasaheb et al., 2021; Armillo et al., 2022; Silva et al., 2021a; Misli et al., 2021; Maurício, 2022; Cienfuegos et al., 2022; Sapana et al., 2021; Escobar et al., 2022; Alahendra et al., 2021; Alves, 2022; Zeb et al., 2022).

    Lastly, four studies did not inform the reason for the practice of self-medication, being that the self-medication prevalence varied between 3% to 93%, and these studies reported the use of lorazepam, diazepam, bromazepam, phenobarbital, zolpidem, alprazolam, antibiotics, analgesics/antipyretics, non-steroidal anti-inflammatory drugs, antiallergics, antihistamines and corticosteroids (Sljivo et al., 2022; Cvitković, 2021; Faria et al. 2020; Yousaf et al. 2021)

    DISCUSSION

    The present study provides scientific evidence regarding the medication profile used during the pandemic for COVID-19 prevention and other reasons. Major databases, research sources, and grey literature were analyzed without language or publication period restrictions, given the current relevance of the topic.

    A systematic review with meta-analysis that estimated the overall prevalence of self-medication in the COVID-19 pandemic found that the prevalence of self- medication among the general population was 48%, while among COVID-19 patients it was 41.7%, for students it was 54.5%, and in health professionals it was 32.5% (Kazemioula et al., 2022). It can be seen that the highest prevalence of self-medication in this study was related to students. The authors of the study compared their findings to those of a previous systematic review with meta-analysis in the Ethiopian population, in which the prevalence of self-medication among students prior to the pandemic was 49.5% (Fetensa et al., 2021), indicating that the prevalence of self-medication among university students seems to have increased during the pandemic, with this finding being attributed to the higher education level of students compared to the general population (Kazemioula et al., 2022).

    According to medications used for COVID-19 prevention, it is concerning that even among university students who presumably have access to reliable information sources, there was a notable consumption of medications such as antibiotics, hydroxychloroquine, ivermectin, paracetamol, vitamin C, and chlorine dioxide. These medications are not recommended for this purpose and lack scientific evidence of their effectiveness against the virus. Thus, the use of these medications is considered irrational (WHO, 2022; IDSA, 2022; Souza et al., 2021; OPAS, 2020; Tritany, Tritany, 2020).

    Sales of these medications in Brazil increased significantly during the COVID-19 pandemic. For example, ivermectin sales rose from R$ 44 million in 2019 to R$ 409 million in 2020, hydroxychloroquine and chloroquine prescriptions increased from R$ 55 million in 2019 to R$ 91.6 million in 2020, and azithromycin saw a 30.8% increase, with 12 million boxes sold in 2019 and over 16 million in 2020 (Melo et al., 2021).

    It is essential to highlight that irrational or inappropriate medication use is a global problem (Brasil, 2013). Using medications without guidance from a healthcare professional and lacking evidence of indication poses various health risks (Brasil, 2020b). The population has been using medications inappropriately during the COVID-19 pandemic. The fear generated by the pandemic may have led to a regression to empiricism and off-label medication use. In the context of COVID-19 prevention, the latter does not align with rational medication use which is based on Evidence-Based Medicine, emphasizing the most current and robust scientific evidence in choosing pharmacotherapy with the best cost-benefit profile, tailored to the individual’s health condition and proven safety and efficacy in adequate studies (Tritany, Tritany, 2020; WHO, 2002; Brasil, 2013).

    The prevalence of self-medication for COVID-19 prevention in the studies included in this review ranged from 14% to 83%. A study in Jordan demonstrated an 80% prevalence of self-medication in the general population, primarily using medications such as vitamin C and paracetamol (Elayeh, Akour, Haddadin, 2021). Self-medication prevalence during the pandemic in the general population in Nigeria was found to be 36.3% and 41%, according to studies by Okoye et al. (2022) and Wegbom et al. (2021), respectively. The most commonly used medications for COVID-19 prevention were vitamin C, antimalarials, and amoxicillin (Wegbom et al., 2021). In addition to these medications, a study observed that 5.7% of healthcare professionals from three hospitals in southern Nigeria used hydroxychloroquine for COVID-19 prevention (Okoye et al., 2022)

    Aiming to mitigate misinformation, it is worth noting that the Ministry of Health in Brazil clarified that there is no vitamin, alternative therapy, or licensed medication capable of preventing contagion or treating COVID-19 (Brasil, 2020a). In turn, paracetamol is the recommended first-line drug for hyperthermia or fever particularly associated with SARS-CoV-2 infection, if there are no contraindications (Brasil, 2020a; Remião, 2020).

    Regarding the use of chlorine dioxide, the Food and Drug Administration (FDA) clarified that this product and its derivatives are not safe or effective for treating COVID-19 (FDA, 2020). These products and their derivatives are usually used as disinfectants in various industrial processes (Mostajo-Radji, 2021). However, two studies demonstrated that chlorine dioxide was used for COVID-19 prevention through self-medication (Rojas-Miliano et al., 2022; González et al., 2022). It is known that this compound is not safe for human consumption, and exposure to high doses can cause thyroid suppression, DNA damage, and neurotoxicity (Mostajo-Radji, 2021). Rojas-Miliano et al. (2022) revealed that students who used chlorine dioxide attributed adverse effects, especially throat irritation. The prevalence of self-medication with this compound was 8.3%, aligning with another study in the general population where 8% practiced self-medication with chlorine dioxide, although this study did not address adverse effects (Soriano-Moreno et al., 2021).

    Concerning ivermectin, it is known that this medication is an antiparasitic indicated for the treatment of various conditions caused by worms or parasites. Some studies in this review showed that ivermectin has been commonly used for COVID-19 prevention. However, there is no available evidence regarding the action of ivermectin for preventing SARS-CoV-2 infection (Popp et al., 2022; Marra et al., 2020). The indiscriminate use of this medication can lead to moderate to severe adverse effects, and in toxic doses it can cause gastrointestinal symptoms, hypersalivation, drowsiness, muscle weakness, tachycardia, hypotension, ataxia, agitation, rhabdomyolysis, and coma (Wong, 2020).

    Next, the studies included in this review addressed antibiotic use for the treatment of sore throat, prolonged fever, lung infections, common cold, common cold prophylaxis, and COVID-19 prevention without the prescription of a qualified professional. Alhaj et al. (2021) assessed the misuse of antibiotics and revealed that many participants did not have proper behavior regarding antibiotic use, possibly due to decreased awareness of the adverse effects of antibiotic therapy. Qahtani et al. (2022) demonstrated that students had adequate knowledge of antimicrobial resistance and the consequences of irrational antibiotic use, yet 25% of these students’ practiced self- medication with antibiotics. Two studies in Table I related knowledge levels to self-medication, concluding that higher medication knowledge was associated with a higher prevalence of self-medication, typically starting after the pharmacology discipline (Silva et al., 2021a; Sapana et al., 2021).

    As a common practice throughout the population, self-medication with antimicrobials is a cause for concern as it contributes to resistance to these medications spreading (Grigoryan et al., 2006). Antimicrobial resistance represents a growing threat to global public health, jeopardizing human health, increasing treatment costs, raising hospitalization rates, and mortality levels (Fiocruz, 2019). Furthermore, certain antibiotic classes can cause comorbidities and other adverse effects, such as pseudomembranous colitis, dryness of the mouth and eyes, nervous system alterations, and severe allergic reactions (de Moraes et al., 2018).

    It is crucial to emphasize that actions taken by healthcare professionals are essential in the context of the rational use of antimicrobials. Actions such as counseling on the proper use of these medications and identification of major health issues make healthcare professionals partners in health promotion. The pharmacist plays a fundamental role in the prevention and guidance on the rational use of antimicrobials, given their extensive knowledge in the field, allowing them to mediate usage by providing information on consumption, major side effects, and guidance on treatment duration, emphasizing the importance of strictly following medical advice (Guedes, Álvares, 2017; Albuquerque et al., 2022; Silva Júnior et al., 2018).

    A study conducted by the Federal Pharmacy Council in Brazil showed that there was an almost 14% increase in the sales of antidepressants and mood stabilizers from January to July 2020 compared to the same period in 2019. These medications are used in the treatment of affective disorders such as depression, dysthymia (neurotic depression), and bipolar affective disorder (CFF, 2020). Studies revealed the use of benzodiazepines and other sedatives through self-medication among university students, with the prevalence of self-medication ranging from 3% to 19%. The COVID-19 outbreak was associated with anxiety symptoms, leading to a deterioration in mental health and the practice of self-medication. This practice can expose students to undesirable side effects, the development of dependence, and health risks (Dantas, 2023).

    Most studies included in the review assessed self- medication for various reasons, with the prevalence of self-administration reaching 100% in some cases. The main medications used by these students were analgesics, antipyretics, anti-inflammatories, antibiotics, antiallergics, and antihistamines. Self-medication with analgesics and anti-inflammatories can result in drug poisoning, drug- induced hepatitis, perpetuation of pain, nephropathies, ulcers, and gastritis, depending on the quantity and usage frequency (de Moraes et al., 2018).

    One study addressed the use of medication through self-medication to improve focus or academic performance. About 11% of participating students self- medicated with Adderall, Ritalin (Methylphenidate Hydrochloride), Vyvanse (Lisdexamfetamine), or Dexedrine (Dextroamphetamine). Two studies conducted before the pandemic showed that approximately 30% of investigated students used methylphenidate through self-medication to improve focus (Cândido et al., 2019; Fallah et al., 2018). Thus, it cannot be asserted that the COVID-19 pandemic influenced self-medication with these medications, as there is evidence that such practice existed even before the pandemic period.

    The integration of the pharmacist is necessary when analyzing the occurrence of inappropriate self-medication reported in studies included in this review, which resulted in adverse reactions, drug interactions, intoxications, and health-damaging effects. It is evident that a joint effort of the healthcare team is necessary for control of these substances, which are a fundamental therapeutic resource in the recovery and maintenance of population health, with the pharmacist playing a crucial role in providing correct guidance, systematic monitoring of individual drug treatments, assessment, and ensuring the safety and efficacy of properly indicated medications, promoting rational use (Nobre Junior, Andrade, 2022; Mendes, 2008; Lima, Guedes 2021).

    Some limitations were identified in the construction of this review, such as studies with small sample sizes and all studies including health science students. Unlike systematic reviews, scoping reviews generally do not include an assessment of the quality of the evidence in the studies. For this reason, the studies included in this review were not assessed for their methodological rigor. However, we recognize that by describing and summarizing the evidence without analyzing the quality of the evidence, we may have overlooked some aspects of self-medication by university students during the COVID-19 pandemic presented in this review.

    Despite these challenges, it is emphasized that the construction of this integrative review was conducted with careful observation of the research methodology predominant in scientific literature, based on systematic search creation through the formulation of the research question, development of the search strategy, database search, study selection by two independent reviewers, and descriptive analysis of included studies. This systematic approach enabled clarifying and synthesizing the available evidence, bringing to light the profile of medications used through self-medication by university students during the COVID-19 pandemic.

    Detailing the reasons for self-medication by university students during the COVID-19 pandemic is a notable aspect of the results presented in this review, as it can stimulate creation and implementation of educational strategies that promote rational and safe self-medication and health literacy.

    CONCLUSIONS

    This scoping review was able to identify that the irrational use of medications is a common practice in university students among the included studies, despite being a population with access to reliable information. It is noteworthy that a high prevalence of self-medication by students during the COVID-19 pandemic was observed in various countries around the world.

    The reasons that led students to self-medicate during the pandemic are diverse, often related to the relief of symptoms they consider mild, recommendations from friends and/or family members, improvement in academic performance, prevention of COVID-19, among others. The classes of medications used are associated with the symptom and/or the associated reason. Another relevant point observed in some studies is that knowledge about medication is interconnected with self-medication, making students in health-related courses more prone to self- medication.

    Considering that the main medications used for COVID-19 prevention were vitamin C, paracetamol, azithromycin, ivermectin, and hydroxychloroquine, and that there is currently no scientific evidence supporting their use in this context, it is important to consider strategies and policies that can mitigate this misinformation and truly assist in promoting rational medication use.

    The analysis of the studies included in this review highlights the need for information and education for university students regarding the rational use of medications and the harms of self-medication practices, especially concerning the risks of serious adverse effects and the lack of indication or proven efficacy for a particular health condition.

    ACKNOWLEDGMENTS

    We thank the generalist librarian Welerson Gregório Macieira for assisting us in developing the search strategy.

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    Edited by

    • Associated Editor:
      Silvya Stuchi Maria-Engler

    Publication Dates

    • Publication in this collection
      31 Jan 2025
    • Date of issue
      2025

    History

    • Received
      21 Dec 2023
    • Accepted
      17 July 2024
    Creative Common - by 4.0
    This is an open-access article distributed under the terms of the Creative Commons Attribution License
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