When to Refer and What to Watch For: OTC Safety Tips

Pharmacy Times interviews Renee’ Acosta, R.Ph., M.S., on how pharmacy technicians can better identify when patients should be referred to a pharmacist or physician rather than managing symptoms with over-the-counter (OTC) products, as well as how to prevent risks associated with combination OTC therapies. She explains that technicians should first assess whether a patient’s symptoms are appropriate for self-treatment by considering duration, severity, and response to prior OTC use. If symptoms are persistent, worsening, or not improving after a reasonable period, referral to a higher level of care is warranted.

Acosta emphasizes the importance of evaluating patient-specific risk factors, particularly underlying health conditions such as diabetes, immunocompromised status, or complications involving sensitive areas like the feet, where self-treatment may be inappropriate or unsafe. Patients with multiple comorbidities or complex medication profiles are generally poor candidates for self-care and should be referred for pharmacist or physician evaluation.

A major focus of the discussion is the growing complexity of OTC combination products and the risk of therapeutic duplication. Acetaminophen and antihistamines are common examples of ingredients that appear across multiple products, often leading patients to unknowingly double-dose when combining multi-symptom products with single-ingredient therapies. Acosta highlights that patients frequently rely on brand names rather than active ingredients, which can obscure the fact that different products may contain the same therapeutic components.

She also points to the challenge of “product line extensions,” where familiar OTC brands introduce new formulations with different active ingredients, making it difficult for both patients and healthcare workers to keep up with changes. Because of this evolving landscape, pharmacy technicians play a key role in educating patients to read labels carefully, verify active ingredients, and understand potential overlaps between products.

The interview underscores that technicians are essential in early identification of referral needs and in preventing medication errors through careful assessment, patient education, and attention to labeling and product composition.