Beyond Prescription: An Examination of Self-Medication Practices in the Indian Population

All searches were limited to a date range: January 2000 - May 2026. This range reflects all current evidence in the modern era but may also include research conducted prior to 2010 that was carried out in a context significantly different from that of today.

2.3 Screening Process

Records retrieved via search of the databases were screened in a two-step process.

Stage 1 - Title and Abstract Screening: Records were screened for relevance by three criteria: (i) the study was conducted in India in whole or in part; (ii) study reported on prevalence, pattern, determinant or consequence of self-medication; and (iii) the study was published in a peer-reviewed journal or as an indexed systematic review or meta-analysis.

Stage 2 - Full Text Review: Full texts of stage-1 eligible records were reviewed to confirm that: there was quantitative prevalence data available or adjusted odds ratios; methodology was adequately reported (study setting, sample size, and design; and data was not duplicated in an included meta-analysis.

An extensive search of the literature, across several scientific databases, yielded some 410 records. After removing duplicate records and a preliminary screening, a representative sample of the relevant studies was analysed in the full text to verify eligibility. In the end, approximately 90 studies and review articles were part of the final synthesis. The review also included evidence from previously published meta-analyses that had reviewed several hundred more records, thus further increasing the overall body of evidence and improving the strength of the conclusions. This review only included studies that met the predetermined inclusion criteria and were relevant to the Indian context.

2.4 Inclusion & Exclusion Criteria

2.5 Quality Assessment

This narrative synthesis did not apply a formal risk of bias assessment based on a standardized tool to individual primary studies, except in the case of cross-sectional studies where the AXIS tool was used and in the case of cohort studies where the Newcastle-Ottawa Scale was used. This is a well-known and well-known constraint, which will be discussed in Section 10.5. However, quality was considered at two levels before a source was incorporated into the synthesis:

We selected the 2024 ScienceDirect meta-analysis (n = 29,873; 66 studies) as the main prevalence anchor for this paper due to the following reasons: it is more recent, it reflects the largest sample size, it used a random effects model with reporting of heterogeneity, it was compliant with the PRISMA criteria, and it covered a broad spectrum of databases. Where it differs from previous meta analyses or single studies, it makes clear its own differences and puts them in perspective.

2.6 Data Extraction & Synthesis

The following data elements were extracted from each included source when reported: prevalence estimates and 95% confidence intervals, sample sizes, geographic settings or demographic groups, drug categories and specific drugs mentioned, conditions or symptoms that are potentially the triggers for self-medication, sociodemographic predictors with adjusted odds ratios (AOR) or prevalence ratios (PR), adverse drug reaction rates, OAM mortality rates and data on the valuation of the OTC market. Thematic synthesis of data was conducted by domain rather than pooling the data and analysing it statistically. Throughout the paper, comparisons of data across studies are presented in tabular format. If studies reported similar results but on different scales or denominators, results are reported as presented (not converted to a common scale) with the source of the results designated.

3. Prevalence of Self-Medication in India

3.1 National-Level Pooled Estimates

A recent and thorough meta-analysis (December 2024) published in ScienceDirect involving 66 studies with 29,873 individuals and a pooled country prevalence was 64.4% self-medication. This is a substantial increase from the previous Bentham Science meta-analysis (2020) of 17 studies (n = 10,248) that found the average prevalence to be 53.57%. The difference between the two indicates a change in the secular trend of self-medication practices in India over the years [6].

• Across all studies (n = 66; 2024) Overall Pooled Prevalence of self-medication in India is 64.4%
• Earlier Meta-Analysis (17 studies, 2020): 53.57% mean prevalence (95% CI reported)
• The prevalence recorded in the study conducted in Urban Delhi was highest at 92.8% (n=236).
• Lowest Regional Prevalence: ~31% in rural northern India (Sahaswan, UP)

3.2 Regional Variation

There is considerable inter-regional variation. No statistically significant difference was found between the other regions in the 2024 meta-analysis the highest pooled regional rate being recorded in the northern region (81.9%). State-level studies show that there are significant differences within each region:

• Maharashtra (urban+rural): 76% (n=400, IJBCP 2024)
• The percentage of urban colony in Delhi is 92.8% as per the study of DY Patil University in 2015.
• Central India (urban tertiary hospital area): 60% (n=400, PMC 2023)
• Andhra Pradesh: 37% urban, 17% rural
• Uttar Pradesh (Sahaswan): ~31% (overall), ~37% (antibiotics)

States with high rates of poverty and low rates of literacy, like Bihar and Odisha, often have higher levels of inappropriate antibiotic use and self-medication, while it would seem that the use of antibiotics is reduced in rural areas, likely because of under-reporting or avoidance of healthcare [7,8,9].

3.3 Prevalence Data Summary Table

* Prevalence data refer to the population sample studied and should not be directly compared to other prevalence data, as there may be methodological differences. The most up to date national estimate is from the 2024 ScienceDirect meta-analysis [10,11].

4. Sociodemographic Predictors of Self-Medication

4.1 Urban-Rural Differences

In contrast to what many people think, the formal (allopathic) self-medication rate is much higher among the residents of urban areas than among those of the rural areas. A community-based study conducted in Northern India in 2024 revealed a significant association between urban area and self-medication, with odds being around 9.85 times greater for subjects from urban areas compared to their rural peers (AOR: 9.85; 95% CI: 5.32–18.23). This reflects urbanization near to pharmacies, higher disposable income, social media and time constraints [12,13]. But, use of self-medication is more hazardous in rural areas, due to dependence on unconfirmed sources, inadequate antibiotic courses and higher incidence of unrecognized severe illnesses treated with self-medication initially. The west India cross sectional study showed urban SM being 37% and 17% in rural areas for allopathic drugs respectively, but the difference is decreasing because of the increase of OTC pharmacies in semi urban areas [14].

4.2 Gender

Gender notions of self-medication are complex. The 2024 Northern India study revealed that females are significantly more likely to self-medicate compared to males (AOR: 2.32; 95% CI: 1.18–4.57). Mordor Intelligence market analysis also shows greater self-medication among females for pain associated with menstruation, specifically analgesics. On the other hand, the Sahaswan rural study reported higher prevalence among males who are illiterate, indicating that the effects of gender might be influenced by education level and location [15].

4.3 Education and Occupation

Education shows a paradoxical correlation to self-medication. Graduates and post graduates in urban settings also have high self-medication rates (AOR: 2.06; 95% CI: 1.14–3.37), due to their higher access of information about drugs and self diagnosis. The Delhi study in 2015 revealed that the graduates/Post graduates were found to self-medicate more than others (P = 0.002). There was a positive association between the skilled workers and self-medication that was approximately 5.62 times higher among skilled workers compared to the unemployed (AOR: 5.62; 95% CI: 1.80–17.5), which may be attributed to income availability and time constraints [16,17].

4.4 Income & Socioeconomic Class

According to the Bentham meta-analysis (2020), people from the middle-lower socioeconomic status have the highest level of self-medication (PR: 26.31; 95% CI: 2.02–50.60; P<0.0001). This is due to lack of means to access formal health care consultation, and self-medication as a cost saving strategy. In contrast, being in the middle class of the urban population with income of more than ₹30,000/month is also observed as being associated with higher SM (AOR: 3.21), but not necessarily due to financial need [18].

5. Conditions & Drug Categories

5.1 Most Common Conditions

According to Bentham Science 2020 meta-analysis, minor ailments were most common reasons for self-medication (PR: 42.46; 95% CI: 21.87–63.06). Headache was the single most commonly self-medicated symptom (PR: 41.53; 95% CI: 18.05–65.02). Other studies have similarly found:

• Common cold and upper respiratory tract infections: 61.6%
• Fever and pyrexia: 51.8% most common (fever, cough, cold)
• Muscle pain, back pain: High, particularly when taking analgesics/NSAIDS
• Acidity, diarrhea: major complaints in Maharashtra study

Minor wounds, fungal infections were prevalent in the rural populace [20,21].

5.2 Drug Categories

Most of the self-medication drug utilization includes analgesics and anti pyretics followed by antibiotics and antacids. According to the cross sectional study conducted in Maharashtra (2024), 49.4% of the respondents used painkillers, 23.7% used antacids and 15.3% of them used antibiotics. The study by Central India PMC (2023) reported the use of analgesics and antipyretics in self-medicating respondents as 66.25% and 59.16% respectively [22,23].

5.3 The Antibiotic Self-Medication Problem

Antibiotic self-medication (ASM) deserves attention because of the consequences that it causes for the individual, but also for the society level. Although the Drugs and Cosmetics Act 1945 and Schedule H regulations mandate a prescription for antibiotics in India, enforcement is lax and pharmacists are regularly giving out antibiotics without one [24]. There are several studies reporting antibiotic SM ranging from 15.3% in the Maharashtra urban/rural study to 37% in the rural Sahaswan, UP. In low- and middle-income countries overall, the level of antibiotic SM is 78% among adults. A substantial percentage of antibiotic use in the world is for self-medication, which is affecting antibiotic resistance, and this has been explicitly warned by WHO [25].

6. Motivating Factors for Self-Medication

6.1 Evidence-Based Determinants

A variety of factors at the level of the individual, structure and culture influence the decision to self-medicate. The table below provides a summary of the motivators that have been found in the main studies of India:

6.2 Healthcare Access Barriers

Structural reasons for SMR in India are the systemic deficiencies in public health care. The ratio of doctors to patients in India is still lower as compared to the recommended ratio by the WHO and is heavily skewed towards the urban regions. The combination of long waiting time in the primary health centers, distance to the primary health centers, high costs of out of pocket consultation, and irregular opening hours at primary health centers makes visiting a pharmacy and obtaining drugs without having to go through the formal health care system often more sensible for the patient’s immediate needs [26]. A day off for India's estimated 450 million daily wagers and those in the informal sector can be devastating to their finances. A day's work is lost, or a pharmacist's prescription is obtained, as reported in qualitative research by Aeon (2026), if a worker experiences diarrhoea or a cold or flu, a daily worker must choose to either seek out the pharmacist for a prescription or risk missing a day's pay. This is not about irrationality, it is about rational reactions to structural inequity [27].

6.3 Cultural & Social Factors

In India, there are medical systems that co-exist with allopathic medicine such as Ayurveda, Unani, Siddha and folk medicine. This medical pluralism normalizes the idea that self-treatment and home remedies are a first response to medical problems. There is also an increasing overlap between regulated medicine use and unregulated self-care use as traditional medicine is increasingly being marketed in the formal OTC market, for example during the COVID-19 pandemic as immunity boosting products containing Giloy and Ashwagandha [28]. Social networks are important, peer and family recommendations are always among the most frequently mentioned sources of information for decisions on self-medication. Over the last few decades, pharmaceutical companies have been increasingly promoting their products in television, print and lately, social media, all of which has made consumers more aware of the drugs and more confident in their ability to self-diagnose [29].

6.4 COVID-19 as an Accelerator

The COVID-19 pandemic (2020-2022) was the big turning point in the patterns of self-medication in India. Self-medication was normalized, and at an unprecedented level, due to fear of hospital infection, limitations of mobility, and public health messaging around the monitoring of symptoms at home. Dolo 650 (Paracetamol 650mg, Micro Labs) has released more than 350 crore (3.5 billion) pills since the beginning of March 2020, representing self-medication in the pandemic era. Just like the physical supply chains disrupted, online pharmacies grew in numbers too. The upward trend in the OTC drugs market after the Covid-19 pandemic has been very steep in the last year, expanding its market value from USD 3.7 billion in 2020 to USD 3.9 billion in 2021 at a CAGR of 6.6% [30,31].

7. Clinical & Public Health Consequences

7.1 Antimicrobial Resistance (AMR) 

Self-medication is the worst and most prevalent public health problem in India, due to its role in antimicrobial resistance. India is called by several authoritative sources the ‘capital of antibiotic resistance’ in the world, and the problem is caused by the combination of self-medication, overuse of prescribed antibiotic medicines, use of antibiotics in agriculture, lack of sanitation and wastewater management around antibiotic manufacturing areas [32].

AMR is now responsible for more deaths than tuberculosis, neoplasms, respiratory infections, diabetes, kidney disease and disorders of mothers and newborns in India alone. The facts are alarming: AMR directly caused some 300,000 deaths in 2019 and indirectly, a further one million deaths. This puts India in the list of the worst affected countries in the world and self-medication with antibiotics is one of the major drivers to this [33].

7.2 Adverse Drug Reactions (ADRs) & Drug Interactions

By definition, self-medication is not a process of self-diagnosis or self-prescription because no one evaluates the patient's risk factors, such as co-morbidities, current medication usage, allergies, age and renal/hepatic function. This provides the opportunity to develop:

• When drugs used at the wrong dose or for a prolonged period of time cause adverse effects.
• Risk of toxicity due to self-medicating with illegal drugs and medicines prescribed by doctors.
• Potential drug-drug interactions if taking illegal drugs while taking medication prescribed by a doctor.
• Allergic reactions, anaphylaxis and organ toxicity due to inappropriate use
• Urgent attention to symptomatic treatment rather than treatment of underlying diseases
• Drug dependence and addiction including dependence on analgesics, benzodiazepines and cough medicines containing codeine

According to the Bentham 2020 meta-analysis, the drug resistance, adverse effects, drug-interactions including death are explicit for the use of SM practices [34].

7.3 Delayed Diagnosis Progression

Diagnostic delay is often overlooked but a serious adverse effect of self-medication. Tuberculosis, diabetes, cancer and chronic kidney disease are common illnesses that often present with symptoms at an early stage that can be treated symptomatically by the individual. Frequent use of self-medications for these symptoms can make it months to years before definitive diagnosis is established, significantly compounding prognosis. It is well established from multiple studies that self-medication often leads to a delay in health care seeking in life-threatening emergencies. There is specific concern for early diagnosis in disease areas such as cancer, HIV and multidrug-resistant tuberculosis [35].

7.4 Pediatric Vulnerability

Young children are a very vulnerable group. To highlight the extent of antibiotic self-medication among children, a systematic review and meta-analysis published in BMC Pediatrics in June 2025 analysed 17 studies that included 7,847 children, with results showing that the pediatric population in India is exposed to antibiotic self-medication. Parents initiate self-medication of children for various reasons including low level of health care services, financial problems, time constraints, and culture. The hazards involve negative effects, resistance to the antibiotic, and lasting effects on the immune system. This is aggravated by the lack of antibiotics being effective against 60,000 neonatal deaths per year, implying transmission of resistant organisms from one generation to the next [36,37].

8. Regulatory & Policy Framework

8.1 Existing Legal Architecture

The regulation of pharmaceuticals in India is mainly governed by the Drugs and Cosmetics Act, 1945 and its Rules, regulated by the Central Drugs Standard Control Organisation (CDSCO) and State drug controllers. Schedule H and H1 drugs, such as all antibiotics, anxiolytics and many NSAID's must be dispensed with a valid prescription from a registered medical practitioner [38]. But this regulatory framework is more of an aspirational goal, something that has not yet been fully established. Enforcement is not always consistent, and in some smaller towns and rural areas, pharmacies might be responsible for providing care for large populations and have only one inspector. The Pharmacy Act, 1948, provides for registration of the pharmacists and professional conduct standards and it requires that pharmacists must be present in the licensing premises; however, licensed pharmacist presence is not universal, particularly in unlicensed drug shops in rural areas of India [39].

8.2 State-Level Initiatives

However, a number of states have made specific regulatory efforts on AMR:

• Kerala: ‘Operation Amrith': Surprise visits to pharmacies to check OTC antibiotic sale. In September 2024, antibiotics be issued in only blue paper bags, along with printed information on AMR [40].
• Andhra Pradesh (2020): In a step to monitor OTC sales of cough, cold and fever medicines during the pandemic, the government of Andhra Pradesh launched ‘Covid Pharma’ mobile app [41].
• Madhya Pradesh (2019): Established a more robust system for inspecting pharmacies as part of AMR action plans [42].

8.3 National Policy

In 2017, India's National Action Plan on Antimicrobial Resistance (NAP-AMR) was rolled out with aims of surveillance, stewardship, infection prevention and regulation. The plan would include enhancing pharmacovigilance, reducing the sale of OTC antibiotics and enhancing prescribing practices. Implementation has, however, been uneven and the regulation of drug shops, in particular antibiotics, is a great challenge [43].

8.4 Regulatory Gaps

A number of key regulatory and systemic gaps remain that support the persistence of self-medication, which include:

• Lack of a clear national OTC drug list, which leads to uncertainty over whether a drug is available without a prescription.
• Lack of pharmacist training in counselling and responsible dispensing.
• Growth of unregistered drug shops, especially in the villages and semi-urban areas.
• Poor implementation of the restrictions in Schedule H and H1 at the point of sale.
• The absence of e-pharmacy regulation which enables tracing and control of drug sales without prescription online.
• Lack of incorporation of pharmacovigilance data in the regulatory decision-making process. [44]

9. The Role of Pharmacists

9.1 Pharmacists as De Facto Primary Care Providers

In most parts of the rural and semi-urban India, the community pharmacist is the first and sometimes the last link in the formal health care chain. In contrast to the hospital system, pharmacies are open, affordable, located in different geographic areas and are trusted by the cultural community. Patients come routinely with symptoms to pharmacists and are given a drug recommendation, essentially primary care without the formal consultation process. This is a worrisome situation from an accident statistics point of view, but also a tremendous opportunity. A pharmacist trained to provide careful counselling to the patient, make medical referrals for more serious patients, advise against unnecessary antibiotic use and dispense antibiotics responsibly can be a powerful public health resource [45].

9.2 Pharmacists Education & Intervention

Several Indian researches suggest that pharmacist education and training should be emphasized as an initial measure in the context of responsible self-medication. Specific recommendations include:

• Introduction of compulsory training in AMR stewardship and risks associated with dispensing of OTC antibiotics. Introduction of compulsory training on AMR stewardship and risk of OTC antibiotic dispensing.
• Training for patient counselling of drug use with communication skills.
• Compliance with standard procedures for the recognition and referral of symptoms for a physician visit
• The continuing medical education (CME) requirement for community pharmacists.
• Encouraging availability of cheaper alternatives (generic prescribing) to formal care.

In a 2023 paper published in Springer Nature/Discover Health Systems, it explicitly states that the role of the pharmacist should not just include checking the use of potentially inappropriate OTC medicines, but also to recommend non-pharmacological treatment methods and to encourage cost effectiveness through recommendations for generics [46].

10. Discussion

10.1 The Paradox of Education & Self-Medication

A non-linear relationship between education and self-medication was one of the more striking findings that were synthesized in this review. Self-medication is not necessarily linearly decreased with higher educational attainment, and in urban areas, the more educated people self-medicate more than the less educated. This is the internet and social media age, and educated people have more access to medical information, while they may think they understand it enough to be able to interpret and apply it correctly. There is no systematic health literacy programming in India and health literacy is different from education. Health Literacy (the ability to evaluate health information, understand the risks of medicines, and make informed decisions) is different from education [47].

10.2 The Gendered Dynamics

The results of this study indicate that women and men have different causal pathways, with women having higher SM in urban studies and men having higher SM in rural studies. Urban women's self-medication is an indicator of empowerment, convenience and the constraints on healthcare time. Economic pressure, lack of information and avoidance of healthcare services all contribute to rural male self-medication. Interventions should reflect these unique profiles and not consider self-medication as a single behaviour [48].

10.3 Traditional Medication & the Dual System

The parallel working of traditional medicine systems complicates the scene of self-medication in India. Old remedies like Giloy, Ashwagandha and Kadha were suddenly being used to boost immunity in large numbers and frequently being used along with allopathic self-medication during the COVID-19 pandemic. There are areas of risk that are not studied in detail, such as herb-drug interaction, which involves the simultaneous use of traditional remedies and drugs. The regulation of traditional medicine medicines (AYUSH products) for self-medication is different from allopathic OTC medicines and needs to be treated separately [49].

10.4 Digital Health & Future Trajectory