The holiday season is rapidly approaching – and more than half of Britons are likely to book at least one trip abroad, according to new research by Travel Weekly.
Any holiday trip offers the chance to buy mementoes – but foreign travel also presents the opportunity to bring back over-the-counter medications that would require a prescription in the UK.
It can be easy to buy these assuming they’re harmless if you’re feeling under the weather or ill on holiday.
And given that some drugs can be up to 90 per cent cheaper abroad, there may also be temptation to stock up and bring treatments back.
But is it really safe to self-prescribe items that aren’t available at home unless sanctioned by a qualified doctor?
‘It might be tempting to go into a pharmacy and buy something off-the-shelf, without a thorough health evaluation, but there are several serious health risks to consider,’ says Dr Naveed Asif, a GP at The London General Practice.
A major consideration is that ‘many symptoms can overlap between various conditions’ he adds, ‘which means you might inadvertently select an unsuitable medication, that may cause side-effects or even exacerbate your original problem’.
Here, we examine some of the commonest medications that people buy without prescription abroad – and experts explain why they’re best left on the shelf.
GLP-1 jabs
Weight loss jabs including Ozempic and Wegovy are available prescription-free in countries like Thailand and India. However incorrect dosage may cause side effects like diarrhoea
These injectable medications, used to manage obesity and type 2 diabetes, regulate blood sugar and increase satiety by mimicking a natural GLP-1 hormone. Popular brands include Ozempic and Wegovy. Some GLP-1 jabs containing the active drug semaglutide are available without prescription in some parts of Thailand, Mexico and India – along with newer, cheaper generic alternatives.
The risk: These require a prescription in the UK because medical supervision is needed to ensure they are used safely – often patients are started on a very low dose and increased gradually over a few months, to minimise side-effects and help them work effectively.
‘The incorrect doses can cause side-effects including nausea, vomiting, diarrhoea and dehydration – and in some cases may lead to more serious complications such as pancreatitis or gallbladder problems,’ says NHS GP Dr Amel Imam, who is also medical director of Pharmulous, a private GP and pharmacy service.
Unsupervised use also brings a higher risk of using the wrong dose – and overlooking any complications or underlying health issues, he adds.
Melatonin pills
The UK prescription medication, used to treat short-term insomnia or jet leg, is readily available as a dietary supplement in countries such as the US
Naturally produced by the brain to regulate our sleep/wake cycle, synthetic versions of this hormone are prescribed to treat insomnia in the UK.
But it’s classified as a dietary supplement in the US, Canada and parts of Asia – so it’s easily available from pharmacies, supermarkets, food shops and even airport vending machines, making it a tempting purchase for anyone with jetlag or sleep problems.
The risk: Over-the-counter melatonin products can contain significantly different amounts of melatonin compared to what’s stated on the product – particularly in the US, where classification as a food product means it’s subject to less strict testing.
A 2017 study found a chewable tablet labelled as containing 1.5mg of melatonin in fact contained nearly 9mg [prescribed adult doses start at 1-2mg], reported the Journal of Clinical Sleep Medicine. High doses and inappropriate use can cause stomach pain, depression and vivid nightmares.
As well as making you sleepy, melatonin can also have profound effects on your internal body clock, says Guy Leschziner, a professor of neurology and sleep medicine at Guy’s and St Thomas’ Hospital.
‘Taking melatonin without supervision can make things worse, bringing chaos to your sleep-wake cycle – potentially making sleep problems worse in the long run. It shouldn’t be doled out unsupervised.’
Melatonin may also interact with many other medications including blood-thinners, diabetes drugs and immunosuppressants, he adds.
Diclofenac
Prescribed for sufferers of osteoarthritis, Diclofenac can be bought over the counter abroad. Yet unsupervised use risks cardiovascular side-effects such as strokes or heart attacks
This non-steroidal anti-inflammatory drug (NSAID) is used to treat inflammation, swelling and stiffness. Oral diclofenac is prescription-only in the UK; a topical gel version, Voltarol, is available over the counter.
But you can buy the oral form over the counter in some European countries, parts of Asia and Latin America.
The risk: One possible problem may be that Britons recognise the brand name Voltarol from the gel we have here – and assume the tablets that also have this name are also safe.
But the risks of using the oral version unsupervised include heart attack and stroke, even with short-term use. In fact, the oral version is prescription-only in the UK following a review in 2013 that found an increase in the risk of cardiovascular side-effects linked to the drug.
It is thought that the drug shifts the body’s natural balance of chemicals that control blood flow and clotting, making blood vessels more prone to constriction and clots forming.
A large Danish study published in The British Medical Journal in 2018 found that people who’d started taking diclofenac tablets were 50 per cent more likely to have a heart attack within 30 days compared with those not taking the drug – and 20-30 per cent likelier than those using the painkillers ibuprofen or naproxen.
Serious side-effects also include gastrointestinal bleeding and ulceration.
‘Taking oral diclofenac is particularly dangerous for patients with pre-existing heart conditions, high blood pressure or a history of stroke, who may not recognise the risks when purchasing the product abroad without medical supervision,’ says Ana Carolina Goncalves, a pharmacist at the online pharmacy Pharmica.
Tretinoin cream
Used to treat certain skin conditions, Tretinoin can be bought over the counter in South-East Asia. But self-administering the wrong dosage can carry risks of serious skin inflammation
Tretinoin, or retinoic acid, is a synthetic form of vitamin A often prescribed to treat acne, sundamaged skin, and surface fine lines and wrinkles. It works by changing how skin cells grow, mature, and shed, making a structural difference to the skin.
It is prescription-only in the UK [usually prescribed by a dermatologist]. However, in countries such as Mexico, Thailand, India and other parts of South-East Asia – as well as parts of Southern and Eastern Europe (including Greece, Romania and Bulgaria), tretinoin products are reportedly sold by pharmacies without a prescription.
The risk: Tretinoin is highly effective, but if it’s used incorrectly, it’s very easy to damage the skin, says Dr Tina Tian, a consultant dermatologist at Stratum Dermatology Clinic in Oxford.
‘People often choose the wrong strength or formulation, start too frequently, or escalate too quickly without allowing the skin to adapt.
‘Redness, peeling and even breakouts are typical signs of irritation – not a signal to increase use.
‘Yet many patients mistake this reaction to the treatment for acne – and respond by applying more tretinoin or adding harsher acne treatments.
‘In reality, this is usually a sign of barrier disruption – escalating treatment at that point only drives further inflammation and worsens the skin.’
Tretinoin also makes skin more sensitive to the sun and should not be used during pregnancy, as it can potentially cause birth defects.
Corticosteroids
Corticosteroids can be used to treat asthma and allergies. But incorrect use may cause weakened bones. In South-East Asia the medication can be obtained without prescription
These powerful, fast-acting medications – commonly used to treat asthma, allergies, eczema, rheumatoid arthritis and Crohn’s disease – reduce inflammation and stop the immune system attacking the body. In the UK, all oral corticosteroid medications for these conditions are prescription-only.
But steroids such as prednisolone and dexamethasone can be easily purchased without prescription in pharmacies in South-East Asia, the Middle East, Africa and Latin America, often marketed as suitable for treating allergies, inflammation and pain.
The risk: Incorrect use over time can suppress the body’s natural hormone production and weaken bones, reducing bone formation, increasing bone breakdown and lowering calcium absorption – which together lead to decreased bone density and a higher risk of fractures.
Other side effects can include raised blood sugar levels, mood changes and weight gain, says pharmacist Ana Carolina Goncalves.
By suppressing the body’s immune response, the drugs may potentially increase the risk of severe infections, such as sepsis.
Another major concern of unsupervised use is if someone stops taking the drugs suddenly after long-term use.
‘The body can struggle to restart its own steroid production, which can trigger an adrenal crisis – a potentially life-threatening emergency which can cause extreme low blood pressure, severe vomiting, and potential organ failure,’ says Ana Carolina Goncalves.
Antibiotics
Oral antibiotics are prescription-only in the UK. Their overuse can lead to antibiotic resistance, which is a major global health concern
Used to treat bacterial infections, oral antibiotics are prescription-only in the UK – but are widely available without prescription in parts of South-East Asia, the Middle East, Africa and Latin America.
The risk: Antibiotic resistance – when bacteria evolve to survive the drugs designed to kill them – is a major threat to global health, according to the World Health Organisation.
Patients who buy these drugs over the counter can often use the wrong drug at the wrong dose for the wrong duration – with many using antibiotics for viral infections that they are not designed to help, according Dr Ilan Lieberman, a consultant in anaesthesia & pain medicine at The University Hospitals of South Manchester NHS Trust.
‘This is particularly true with respiratory or urinary tract infections.
‘The result is not only will symptoms not improve, but also we have a shrinking armoury of antibiotics for the serious infections such sepsis, pneumonia, and post-operative infection – where we genuinely rely on antibiotics.’
If you do have a bacterial infection, there are also risks – using the wrong antibiotic, dose, or for the wrong duration may improve symptoms temporarily but the infection won’t clear and may get worse.
Meanwhile, overuse can also upset the balance of the gut microbes allowing harmful bacteria to dominate. This could cause severe diarrhoea, colitis and even life-threatening complications such as sepsis.
Metamizole
Banned in the UK due to its risks of immune system collapse, pain and fever drug Metamizole is available over the counter in certain Eastern European nations
Used to treat severe pain and fever this drug has been completely banned in the UK since 1963 due to concerns it can cause agranulocytosis, a sudden and catastrophic collapse of the immune system.
‘Patients lose the white blood cells that fight infection – within days an ordinary bug can become fatal sepsis,’ says Dr Lieberman.
However, it is available over the counter in some Eastern European countries.
The risk: What makes metamizole particularly insidious is that the early warning signs of agranulocytosis, a sore throat, mouth ulcers, an unexplained fever, look like the start of any winter virus, says Dr Lieberman.
‘Most people don’t connect them to the painkiller they bought a fortnight ago on holiday. By the time they realise, they are critically ill.’
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