Pharmacy medicines are the middle category: stronger or less predictable than what can be sold in a supermarket, but not requiring a prescription. In South Africa these are the Schedule 1 and Schedule 2 medicines, sold within a pharmacy, with Schedule 2 in particular intended to involve a pharmacist rather than being handed over on request.
That pharmacist step is the safety feature, not an inconvenience. It exists because these medicines have a realistic chance of interacting with something else you take, or being unsuitable for a condition you have. Answering the questions properly is what makes the category work.
Common side effects of this pharmacy medicine or category
The pharmacy category covers a wide range, so effects depend on what you are buying. The groups that most often bring people back with a problem:
- Stronger painkillers, including codeine combinations: drowsiness, constipation, and dependence with regular use.
- Anti-inflammatories: stomach irritation, and effects on kidneys and blood pressure. See NSAID side effects.
- Sedating antihistamines: next-day drowsiness and impaired driving. See allergy tablets and drowsiness.
- Decongestants: palpitations, jitteriness and raised blood pressure. See decongestant side effects.
- Steroid creams: skin thinning with prolonged use. See steroid cream side effects.
Interactions and duplicate-ingredient risks
Codeine-containing painkillers deserve particular attention. In South Africa a number of combination analgesics containing codeine are available from a pharmacy without a prescription, and they are effective, which is part of the problem. With regular use they can cause dependence, and stopping after prolonged use produces withdrawal symptoms that are easily mistaken for the original pain returning.
Two patterns are worth recognising in yourself:
- Medication-overuse headache. Frequent painkiller use for headaches can itself cause headaches, producing a cycle where the treatment sustains the problem.
- Creeping regular use. Buying a packet more often than you used to, using it on most days, or feeling uneasy about running out. None of that requires having done anything wrong; dependence develops from ordinary use.
These products are intended for short-term use, generally a few days at a time. If you have been using one regularly, speak to a pharmacist or doctor rather than stopping abruptly. See codeine side effects and long-term painkiller side effects.
Duplicate ingredients apply here as everywhere: many pharmacy combination products contain paracetamol, so check before adding anything. See taking two medicines with paracetamol.
Children, pregnancy, older adults and chronic medicine cautions
Codeine-containing products are generally not appropriate for young children, and are approached cautiously in pregnancy and breastfeeding. Sedating medicines carry more risk in older adults because of falls and confusion. Anyone on chronic medication should have pharmacy purchases screened against it. See OTC medicines with chronic medication.
Warning signs and overdose concerns
Get emergency help for very slow or shallow breathing, extreme drowsiness or someone who cannot be roused, difficulty breathing or facial swelling, a blistering rash, vomiting blood or black tarry stools, or any suspected overdose even if the person seems well.
Codeine combined with alcohol or with sedatives adds meaningfully to the risk of suppressed breathing.
Questions to ask a pharmacist before using it
- Is there a simpler option that would work for this?
- Does this contain codeine, and how long can I safely use it?
- Is it safe with my prescription medicines?
- Will it affect my driving or my work?
- At what point should I see a doctor instead?
Related OTC and medicine-safety guides
- OTC medicine side effects
- Over-the-counter medicine interactions
- How to read over-the-counter medicine labels
- When to see a doctor about an OTC medicine
- Report an OTC medicine side effect
Medical Disclaimer: This content is for informational and educational purposes only and does not constitute medical diagnosis, prescription, or professional advice. Always read the patient information leaflet and consult a qualified doctor or pharmacist regarding any medicine or health concern.