An overview of OTC BTC POM medicines. Including an in-depth description of the families of drugs (e.g. antibiotics, steroids, homeopathic, chemotherapeutic etc) together with details of any known responses relative or potentially relative to hair / scalp.
Medications or drugs come from a variety of sources. Medicines in the past as well as some medicine today is extracted from plants. With the advancement of science, though, some drugs are synthetic and made in labs by mixing different chemicals. Medicines are known as chemicals or compounds used to cure, halt, prevent disease or ease symptoms of diseases.
Medicines come in many forms ranging from ingestible liquids, drops, gels, ointments and creams, nasal sprays or inhalers, tablets (which are absorbed into blood vessels and enter the bloodstream), injections and intravenous injections (inserted into a vein).
Medicines have different functions, including:
- Correcting low levels of chemicals in the body
- stopping cell multiplication (cancer)
- destroying bacteria and viruses
- correcting hormone levels
- reducing pain, inflammation and allergy symptoms and more.
Some drugs have multiple functions, such as is the case with finasteride (Propecia) which is used to treat an enlarged prostate and hair loss. Minoxidil, initially a high blood pressure medication is used to treat hair loss. Aspirin which is used to treat fever pain and inflammation is also used to prevent strokes and heart attack because aspirin prevents blood clotting. Birth control on the other hand prevents both acne and pregnancy.
Drugs are scheduled according to their strength, side effects and whether they have the potential to be addictive or not, so to prevent the misuse of medication, medications are often categorised according to schedules; from schedule 1 to 8.
Drug classes are used to group medicines together that have similar biochemical reactions, their physical effect (how the body responds to the drug) and their chemical structure.
Generic vs brand name
The generic name is the name of the active ingredient.
The brand name is the name given by the company that manufactures the drug.
Drug classes/ categories
Antifungal/ Antimycotic agents:
These treat infections from yeast and bacteria such as ringworm, dandruff, seborrheic dermatitis, thrust and nail fungal infections.
These include corticosteroids and non-steroidal anti-inflammatory drugs (NSAIDs)
For the use of protozoa, flatworms, roundworms and ectoparasites such as ticks, fleas, lice, and mites.
Blood pressure and blood sugar medications include:
- Blood glucose regulators, including insulin and other diabetes medications
- Blood products, including anticoagulants
- Cardiovascular agents, including beta-blockers and ACE inhibitors
Central nervous system (CNS) agents:
- including amphetamines
- Analgesics, including opioids and non-opioids (persistent or severe pain)
- Antiparkinson agents
- Antimigraine agents
- Anxiolytic (anti-anxiety) agents: Reduce anxiety
- Bipolar agents
- Anaesthetics (to create a loss of sensation and pain)
- Anticonvulsants (Seizure medications)
- Antidementia agents (Slow down the progression of dementia)
These treat a wide range of diseases from heavy menstruation, cancer to low hormone levels.
- Hormonal agents (adrenal)
- Hormonal agents (pituitary)
- Hormonal agents (prostaglandins)
- Hormonal agents (sex hormones), including estrogen, testosterone, and anabolic steroids
- Hormonal agents (thyroid)
These are used to prevent or block hormones from speeding up the growth of cancer cells as well as to block various overactive hormones.
- Hormone suppressant (adrenal)
- Hormone suppressant (parathyroid)
- Hormone suppressant (pituitary)
- Hormone suppressant (sex hormones)
- Hormone suppressant (thyroid)
- Immunological agents, including vaccines and disease-modifying anti-rheumatic drugs (DMARDs)
Gastrointestinal agents include:
- Inflammatory bowel disease agents
- Antiemetics (nausea and vomiting)
- Digestive enzymes
- H2 blockers and proton pump inhibitors
- Antineoplastics (used to treat cancer)
- Antitumour agents
- mitotic inhibitors
Other categories include:
- Metabolic bone disease agents
- Ophthalmic (eye) agents
- Otic (ear) agents
- Antidotes and antitoxins (to treat the effects of poison if the body)
- Dental and oral agents
- Dermatological (skin) agents (i.e. antipruritics, topical steroids)
- Enzyme replacement agent
- Genitourinary (genital and urinary tract) agents
- Antimyasthenic agents (Myasthenia gravis – muscle weakness)
- Antimycobacterials (treatment of mycobacterial i.e. TB)
- Antivirals, including HIV antiretrovirals and direct-acting hepatitis C drugs
In South Africa, the medication schedule is as follows:
Schedule 0: Aspirin and paracetamol (OTC)
Schedule 1 and 2: Cold and cough medication (BTC)
Schedule 3 and 4: For diabetes, bacterial infections, hypertension (POM)
Schedule 5: Antidepressants and sedatives, which if not monitored, can lead to substance abuse (POM).
Schedule 6: Narcotics and painkiller (POM)
Schedule 7: Heroin (not used for medical use)
Schedule 8: Amphetamine, dexamphetamine and nabilone are the only S8 drugs in SA.
Over the Counter Drugs (OTC)
Over the counter drugs are drugs that are used to treat conditions that do not need the supervision of a doctor. Over the counter drugs can be bought off-the-shelf from pharmacies, supermarkets and even convenience stores.
OTC (Over the Counter) Drugs:
- Paracetamol (panado): For fever aches and pains.
- Ibuprofen: Ibuprofen works by blocking the production of prostaglandins, substances that the body releases in response to illness and injury. Prostaglandins cause pain and swelling or inflammation. They are released in the brain, and they can also cause fever.
- Non-steroidal anti-inflammatory drug (NSAID):
- For pain and inflammation: Advil, Nurofen, myprodol, mypaid, Voltaren gel.
- Antihistamine Pills such as Allergex, Polaramine and Benadryl.
- Hydrocortisone cream: Cortaid, Cortizone 10: For mild rashes.
- Antifungal creams and ointments: nystatin, miconazole, clotrimazole, and ketoconazole: Used for dandruff and fungal infections.
- Medicines for diarrhoea: Imodium, Rehydration fluids and bismuth
- Cold medication, sore throat and cough: Cough medication, lozenges and throat sprays.
BTC Behind the Counter Medication
Behind the counter medication allows patients to access medication without seeing a doctor, the drug, however, is dispensed by a pharmacist.
BTC drugs include all medications containing pseudoephedrine, oral (morning after) contraceptives, birth control pills, cold and allergy medication and cough syrups with codeine.
POM Prescription-only medications
These require a medical prescription after a diagnosis by a medical specialist. A pharmacist then dispenses POM medication.
POM (Prescription Only Medications) include:
- Antibiotics for bacterial infections
- Statins (lower cholesterol levels)
- sleeping pills (benzodiazepines)
- diabetes, antihypertensive agents (amlodipine) amongst others.
Medications and their effect on hair
Some drugs cause hair loss while some can cause unwanted hair growth.
Medications or their side effects that may cause hair loss.
Isotretinoin (Accutane/Roaccutane) and tretinoin (Retin-A) used for acne are vitamin A-derived medications which can cause hair loss. Isotretinoin suppresses hormones in the pituitary glands, which negatively affects hormones that contribute to hair growth. This shift causes telogen effluvium. The hair loss is temporary, and the normal growth cycle resumes after ceasing this type of medication. In some cases though, hair may grow back rough, frizzy, brittle and dry.
Antibiotics are prescribed to treat bacterial infections including
- Ear and sinus (hollow cavities in the skull infections
- Skin infections (impetigo, cellulitis, boils and leprosy)
- Dental infections
- Meningitis (swelling of the brain and spinal cord)
- Strep throat (from Streptococcus bacteria)
- Bladder and kidney infections
- Bacterial pneumonia: (an infection that inflames the air sacs in one or both lungs. The air sacs may fill with fluid or pus).
- Whooping cough (respiratory tract infection)
Antibiotics work by breaking down the structure of bacteria or hindering their ability to reproduce. The problem is that antibiotics also destroy good bacteria in our bodies and the gut microbiome. The disruption of the gut microbiome can weaken the immune system, cause IBD, depression, diabetes, obesity, acne, asthma and arthritis. Prescription antibiotics also depleted vitamin B and haemoglobin, which are necessary for healthy blood formation, circulation and hair growth. Low haemoglobin leads to anaemia.
Medications used to reduce yeasts in the following:
- athlete’s foot
- fungal nail infection
- vaginal thrush
- fungal skin infections
- some types of severe dandruff/ seborrheic dermatitis
Antifungal medications come in the form of oral medication, creams, shampoos and foams.
Common antifungal names:
- Clotrimazole: (used to treat ringworm, vaginal infections etc.).
- Miconazole/ Monistat: For vaginal and skin conditions.
- Terbinafine: Terbinafine oral granules are used to treat a fungal infection of scalp hair follicles in children who are at least four years old.
- Fluconazole: Oral medication used to treat thrust, oral thrush
- Ketoconazole (i.e. Nizoral shampoo):
- Ketoconazole is the mainstay treatment for seborrheic dermatitis. In some people though, ketoconazole may also cause either oiliness or dryness of the hair or scalp, abnormal hair texture, or discolouration.
- Amphotericin: An injection used for severe fungal infections
- Selenium sulfide.
Antifungal shampoo with selenium sulfide.
The antifungal medication voriconazole which is used to treat serious fungal infections, including internal disorders has been associated with hair loss of the scalp, eyebrows, body hair, facial, eyelashes, axillary, pubic hair and nail changes.
Anti-clotting drugs (anticoagulants):
Heparin and Warfarin are used to thin the blood/prevent blood clots in rare cases (about 1%) can cause TE when taken for more than three months..
Cholesterol-lowering drugs (statins)
The liver makes cholesterol. Cholesterol is found in every cell of the body. It is a fatty, waxy substance that helps us make other hormones, vitamin D and digest food. High cholesterol and be hereditary and can also be caused by unhealthy high-fat diets. Statins lower the level of cholesterol in the blood.
- Atorvastatin (Lipitor)
- Fluvastatin (Lescol)
- Pitavastatin (Livalo)
- Pravastatin (Pravachol)
- Rosuvastatin calcium (Crestor)
- Simvastatin (Zocor)
Some statins like simvastatin (Zocor) and (atorvastatin) Lipitor have been reported to cause hair loss.
These suppress immune activity. They are used for a few purposes ranging from after an organ transplant (to prevent the body rejecting the organ), used for severe eczema (atopic dermatitis), Alopecia areata, psoriasis, lupus, Crohn’s disease (a type of inflammatory IBD), multiple sclerosis and arthritis. They can also help to stop the scratch-itch cycle of eczema, allowing the skin to heal.
There are different types of immunosuppressants ranging from:
- JAK inhibitors
- TOR inhibitors
- Calcineurin Inhibitors: Tacrolimus and Cyclosporine Antiproliferative agents: Mycophenolate Mofetil, Mycophenolate Sodium and Azathioprine.
Corticosteroids are a class of immunosuppressants that lower inflammation in the body and also reduce immune system activity. They are bought on prescription, but some may be purchased OTC.
Corticosteroids come in many forms which are:
- Prednisolone comes in tablet, syrup form and liquids and is used to treat breathing disorders, psoriasis, lupus, ulcerative colitis. Prednisone tablets reduce swelling and inflammation.
- Hydrocortisone comes in cream, lotion and gel form. Hydrocortisone cream is used to treat eczema, psoriasis, contact dermatitis, heat rash, insect bites and stings, nappy rash. Hydrocortisone ointment is used for dry skin.
- Methylprednisolone injections, injected into joints muscles and blood vessels used to treat arthritis; skin, blood, kidney, eye, thyroid, and intestinal disorders.
- Beclometasone and fluticasone, which comes in the form of inhalers and nasal sprays used to treat asthma.
Steroids are designed for short term use as long term use can cause thinning of the skin, stretch marks and rash, gastrointestinal issues, weight gain, irregular menstruation, stunted growth in children. Systemic steroids may cause hair loss, by increasing DHT while some may cause hypertrichosis.
Topical steroids may be used in the treatment of AA – to reduce hair loss.
Chemotherapy and anti-rejection drugs.
Chemotherapy drugs are used for certain cancers, autoimmune diseases and used after organ transplant. These drugs are designed to destroy the fast-growing cancer cells in your body, but they also attack and kill other cells that proliferate, such as the hair follicles. Diffuse hair loss occurs when chemotherapy and radiotherapy disrupt the hair follicles at the anagen phase, leading to anagen effluvium. Hair loss includes body hair, eyelashes, eyebrows and body hair. Regrowth occurs after treatment. There may be a difference in hair texture in the first few months of regrowth. IMDH inhibitors are also used for chemotherapy and anti-rejection.
Medications that prevent seizures, like valproic acid (Depakote) and trimethadione (Tridion), can lead to hair loss in some people.
Blood pressure medications (Beta-blockers and Ace inhibitors)
Beta-blockers: Blood pressure medications reduce blood pressure by causing the heart to beat slower and with less force, which lowers blood pressure. Beta-blockers block the effects of adrenaline (epinephrine). Less adrenaline in the body can restrict blood flow to the hair follicles, causing temporary hair loss.
Common beta-blockers which may cause hair loss are:
- metoprolol (Lopressor)
- timolol (Blocadren)
- propranolol (Inderal and Inderal LA)
- atenolol (Tenormin)
- nadolol (Corgard)
Used for high blood pressure – to relax veins and arteries may also lead to thinning hair. These include:
- enalapril (Vasotec)
- lisinopril (Prinivil, Zestril)
- captopril (Capoten)
Antidepressants and mood stabilisers
These may cause anagen and telogen effluvium.
paroxetine hydrochloride (Paxil)
Weight loss drugs
In a combination of the weight loss drug phentermine, dieters may end up with nutritional deficiencies that lead to hair loss.
Gout is a common form of inflammatory arthritis that is very painful and causes swollen joints. Gout occurs when extra uric acid in the body forms crystals in the joints. Gout medications such as allopurinol (Zyloprim and Lopurin) have been reported to cause hair loss.
Medications that cause hair growth /hirsutism/ hypertrichosis
Janus kinase inhibitors (JAK Inhibitors):
JAK inhibitors are also immunosuppressants. JAK inhibitors are used to treat AA, vitiligo, arthritis, eczema and used after organ transplants.
- tofacitinib (treat vitiligo, arthritis)
- Calcineurin inhibitors (treats mild to moderate eczema)
- cyclosporine (Cyclosporine is used to prevent organ rejection in people who have received a liver, kidney, or heart transplant
- Testosterone replacement therapy
- Danazol: a medication used in the treatment of endometriosis, fibrocystic breast disease, hereditary angioedema and other conditions
- Anabolic steroids: Female bodybuilders who take anabolic steroids may end up with excessive hair growth.
- DHEA: DHEA (dehydroepiandrosterone) is a hormone that’s naturally produced by the adrenal glands. Levels of DHEA naturally drop after age 30.
- Minoxidil: May cause unwanted facial hair growth
- Phenytoin: An antiseizure medication
Homoeopathic medicine is a medical philosophy based on the belief that the body can heal itself. This system of treatment is based on the belief that to cure the diseases, you must produce symptoms similar to the disease in question.
Homoeopathic medicines are used for cuts, minor wounds, dermatitis, IBS, Rheumatoid arthritis and many more but cautioned against in treating cancer.
Homoeopathic medicine is composed of plants and minerals in pill and liquid forms containing only a little of the active ingredient.
Currently, there is not enough scientific evidence regarding the efficacy of homoeopathic medicine.
Homoeopathic Medicine for Hair Fall:
- Thuja occidentalis: Used to treat hair loss by preventing dry scalp and dandruff. Thuja is believed to stimulate hair growth.
- Natrum muriaticum: Natrum muriaticum is the homoeopathic remedy commonly known as table salt or sodium chloride. It usually used by women after childbirth. It can also be given to women suffering from anaemia.
- Lycopodium (Club moss): Lycopodium used for digestive issues, fatigue and gastric inflammation is also used to treat hair loss after delivery, after menopause, or hair loss due to ovarian dysfunction.
- Flouric acid (Fluoricum Acidum (Folli Plus): Flouric acid is used to treat Alopecia Areata. It’s also used to treat hair loss that occurs are typhoid fever.
- Phosphorus: Phosphorus acts to prevent further greying of hair. It is good for people suffering from grey hair accompanied by hair fall, dandruff, and itchy scalp. It is also useful for the treatment of hair loss is due to change of water, change of climate, and even dandruff.
- Sepia: Sepia is used for severe hair loss after chronic headaches.
- Vinca minor: Is used for hair fall accompanied with significant itching of the scalp and premature greying.
- Kali Sulphuricum: Used for seborrheic dermatitis
- Baryta Carbonica: Used in the case of premature baldness.
- Mezereum: ideal for encouraging hair growth and treating conditions on the scalp such as rashes and psoriasis.
Hair loss treatments
Current mainstay treatments for hair loss include Minoxidil and Finasteride. Minoxidil is also used in treating hair loss from drug side-effects.
Hair loss can occur about 2 to 4 months after taking a drug. Hair regrowth usually resolves after a patient has stopped taking medications. This can be anywhere from 3 months to 6 months but It can take a year to 18 months for hair to return to normal. Patients who are on lifelong medication may experience permanent side effects.