Self-Medication: When the Pharmacy Is Enough and When You Need to See a Doctor

A runny nose, the occasional headache, heartburn after a heavy meal — for complaints like these you usually don’t need a doctor’s appointment. Self-medication with advice from a pharmacy makes sense as long as it respects its limits: time limits, warning signs and groups of people for whom “over the counter” does not automatically mean “harmless”. This guide shows you when you can help yourself, which time limits apply and when the right path leads to your doctor’s practice — or to 112.

1. What self-medication is — and what “over the counter” means

Self-medication means treating a complaint on your own responsibility with medicines you can get without a prescription. German medicines law (the Arzneimittelgesetz) distinguishes three groups, and the difference matters to you in practice:^¹

The fact that a medicine is available without a prescription means that it is considered sufficiently safe when used as intended, for a limited period and for the complaints stated. These conditions are set out in the package leaflet — and that is exactly where the limits of self-medication lie. How to take in the package leaflet quickly is explained in the guide Understanding the package leaflet.

2. What the pharmacy can do — and what it cannot

For minor complaints, the pharmacy is the first port of call: no appointment, no charge for the advice, often with long opening hours and an out-of-hours service. According to the German Federal Chamber of Pharmacists’ guideline on self-medication, the pharmacy team clarifies in conversation, among other things, who the medicine is for, which complaints have been present and since when, which other medicines are being taken and whether there are pre-existing conditions, a pregnancy or allergies.^² On this basis it recommends a suitable product — or explicitly advises you to see a doctor.

• Assessing — whether a complaint is suitable for self-treatment.
• Checking interactions — works particularly well if the pharmacy knows your medication, for example through a customer card or your medication plan.
• Explaining how to use it — dosage, timing, maximum duration.
• Referring you on — to your doctor’s practice, the out-of-hours medical service or, in urgent cases, to 112.

In addition, many pharmacies offer pharmaceutical services, such as detailed advice if you take many long-term medicines. More on this in the guide Medication review at the pharmacy.

What the pharmacy cannot do: examine you physically, take blood, make a diagnosis or dispense prescription-only medicines without a prescription. As soon as a complaint needs an examination, the sensible scope of self-medication ends.

3. Complaints you can often treat well yourself

The following overview shows common everyday complaints for which self-medication usually makes sense — and the point at which you should seek medical advice. The time limits are based on the information in the package leaflets.^³

To be honest: for many cold remedies, cough syrups and combination products, the evidence of benefit is limited. The complaints usually clear up on their own; medicines can ease them but usually do not shorten the infection. The guide Cold, flu or COVID? helps you work out which infection is behind it. What belongs in a well-stocked home medicine cabinet is listed in the home pharmacy checklist.

4. The most important time limits at a glance

Many mistakes in self-medication are not about the wrong product but about using it for too long. These are the limits you should know:

• Painkillers such as ibuprofen or paracetamol: only a few days without medical advice — the package leaflets usually state three days for fever and three to four days for pain. The guide Painkillers compared offers a comparison of the active substances.
• Headache medicines in general: on no more than ten days a month and for no more than three days in a row. If you take them more often, you risk a medication-overuse headache.^⁴
• Decongestant nasal sprays: usually for a week at most. After that, there is a risk of habituation with a permanently blocked nose — more on this under Nasal spray dependence.
• Loperamide for diarrhoea: in adults, for no more than two days without medical advice.
• Over-the-counter acid blockers (proton pump inhibitors): no more than 14 days at a time. If the complaints do not improve within this period or come back quickly, see your doctor.
• Over-the-counter sleeping pills: only short term and only as stated in the package leaflet. If you have been sleeping badly for a longer time, you need a proper assessment rather than a permanent solution — see Sleeping pills: what really helps?.
• Fever: if it lasts longer than about three days in adults, rises very high or other complaints appear, you need medical advice.

5. Warning signs: these complaints need a doctor

Some complaints are not a case for self-medication — not because they are always dangerous, but because they need an examination. Make an appointment promptly if you have:

• blood in your stool or black, tarry stools, or blood in your urine
• unintended weight loss, persistent night sweats or unexplained fever
• persistent difficulty swallowing, or a cough that has lasted longer than about three weeks
• pain that does not improve despite treatment or keeps coming back
• new lumps, swellings or skin changes that are changing
• complaints that appeared after starting a new medicine

Outside surgery hours you can reach the out-of-hours medical service anywhere in Germany on 116117 — for complaints that should not wait until the practice’s next working day but are not an emergency.^⁵

6. Who should not self-treat without checking first

For certain groups the limits of self-medication are narrower. This does not mean they may never take over-the-counter medicines — but it does mean that getting advice beforehand should be a must.

Pregnant and breastfeeding women

Many over-the-counter medicines have not been studied sufficiently in pregnancy and breastfeeding or are unsuitable in certain phases — anti-inflammatory painkillers in the last trimester, for example. Ask at the pharmacy or your practice before taking anything. The Embryotox advice centre at the Charité in Berlin provides freely accessible information on how well individual active substances are tolerated.^⁶ The guide Medications during pregnancy gives an overview.

Babies and children

Children are not small adults: doses depend on weight and age, and many products are not approved for children. Fever in babies in the first months of life should always be assessed by a doctor. Aspirin is intended for children and adolescents with feverish illnesses only on a doctor’s instructions. Details in the guide Children and medications.

Older people

In older age, active substances are broken down more slowly, and side effects carry more weight. Over-the-counter sleep and travel sickness remedies containing diphenhydramine or doxylamine can promote confusion, constipation and falls; anti-inflammatory painkillers put a strain on the stomach and kidneys. More under Medications in old age.

People with chronic illnesses

• Heart, kidneys, liver: anti-inflammatory painkillers can worsen heart failure and kidney function; with liver disease, paracetamol is only suitable with caution.
• Asthma: in some people, anti-inflammatory painkillers trigger asthma attacks.
• High blood pressure: cold combination products with vasoconstricting ingredients can raise blood pressure.
• Glaucoma or an enlarged prostate: medicines with an anticholinergic effect, such as older antihistamines, can raise eye pressure, especially in narrow-angle glaucoma, and make urinary retention worse.
• A history of stomach or duodenal ulcers: anti-inflammatory painkillers only after consulting a doctor.

If you have kidney or liver disease, you will find further information in the guide Medications in kidney and liver disease.

7. The most common interaction traps with over-the-counter medicines

The greatest risk of self-medication rarely comes from the over-the-counter product alone, but from combining it with your long-term medication. Some traps come up particularly often:^³

Herbal remedies belong in this equation too. Why St John’s wort in particular has so many interactions is explained in the guide Herbal medicines; you will find further combinations under Avoiding drug interactions.

8. Step by step: how to make the right decision

1. Assess the complaint. What exactly, since when, how severe? If there is a warning sign from section 5, self-medication is not an option.
2. Check your own risk profile. Are you pregnant, treating a child, older, chronically ill or taking long-term medicines? Then getting advice is a must — and whether an over-the-counter product suits your ongoing treatment is, if in doubt, decided by your treating practice.
3. Tell the pharmacy everything. Name all your medicines, including herbal products and food supplements, as well as pre-existing conditions and allergies. The easiest way is to show your medication plan.
4. As little as possible, for as short a time as necessary. Take the lowest effective dose and stick to the maximum duration in the package leaflet. Where possible, choose single-substance products rather than combination products.
5. Set a time limit. Note the start date. If the complaint has not improved after the stated period, it is time to see your doctor.
6. Document it. Enter over-the-counter products in your medication plan too — they are just as relevant for your practice and pharmacy.
7. Take repetition seriously. If you keep reaching for the same product, for example every week for heartburn or headaches, there may be something behind it that should be investigated.

9. Common misconceptions about self-medication

The last point in particular matters: leftover antibiotics have no place in self-medication. The guide Taking antibiotics correctly explains why.

10. How brite helps you with self-medication

Treat yourself, but keep track — with brite

Over-the-counter products in your medication plan, interactions checked, time limits in view. Free of charge.

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