Self-Medication Safety Behaviours and Recognition of Pharmacological Risks: A Clinical Pharmacology Perspective

BACKGROUND: Safe self-medication with over-the-counter (OTC) medicines requires identification of active substances, recognition of clinically relevant interacting exposures, and awareness of when continued self-treatment is no longer appropriate. Whether self-reported safety behaviours correspond to recognition of the pharmacological risks they are intended to prevent remains insufficiently understood. OBJECTIVE: To examine respondent-level correspondence between self-reported OTC safety behaviours and recognition of conceptually related pharmacological risks among adults without healthcare training, and to translate the observed patterns into a clinical-pharmacology framework for safer self-medication. METHODS: An exploratory secondary analysis was performed using data from a Romanian cross-sectional study of OTC medication risk literacy. The analysis included 206 respondents without a healthcare background. Five conceptually matched knowledge-behaviour comparisons were examined across active-substance duplication, interaction-related risks, and the boundary of self-treatment. Associations were assessed using odds ratios (ORs), 95% confidence intervals (CIs), and two-sided Fisher's exact tests, with Holm adjustment for multiple comparisons. RESULTS: Reported safety behaviour did not invariably correspond to recognition of the related pharmacological risk. Among 143 respondents reporting consistent active-ingredient checking, 22 (15.4%) failed to recognise duplicate paracetamol exposure; recognition was associated with ingredient checking (OR 2.95, 95% CI 1.48-5.88; p = 0.003). Among 143 respondents reporting routine interaction checking, discordance was 14 (9.8%) for the anticoagulant-related scenario, 25 (17.5%) for herbal products and dietary supplements, and 87 (60.8%) for antihistamine-alcohol use. Correspondence was greater for the boundary of self-treatment: only seven (4.3%) of 162 respondents reporting avoidance of prolonged OTC use despite persistent symptoms failed to recognise the need for professional evaluation. Following Holm correction, only the active-substance duplication association remained statistically significant. CONCLUSIONS: Self-reported OTC safety behaviours should not be assumed to represent successful application of the underlying pharmacological reasoning. Correspondence was domain-dependent and appeared less consistent for risks requiring identification and interpretation of pharmacological exposures than for persistent symptoms requiring evaluation. These findings support making the pharmacological reasoning underlying OTC safety recommendations more explicit and informed the proposal of a clinical-pharmacology framework for future OTC safety communication.