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Objective: Consumers increasingly buy pharmaceuticals online. Then, we identified gaps in the published literature to form a comprehensive theory-based agenda for future research. The search strategy identified forty-eight eligible studies. Results: We identified twelve types of factors influencing purchase intentions and behaviors from online pharmacies: demographics, convenience, availability, price, evaluations of the purchase environment, information sources, internet usage, prior experience, perceived risk, health insurance, privacy, and product. Our analysis also revealed differences between OTC and prescription medications in drivers of purchase intentions and behaviors. Conclusion: While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. However, other factors e. An extensive agenda for future research is advanced. Many consumers now prefer to purchase online, including Thus, many consumers are turning to online pharmacies to purchase medications. Online pharmacies sell or dispense pharmaceutical drugs or other government-regulated medical treatments through the internet or electronic media e. Consumer purchases from online pharmacies continue to grow rapidly due to the convenience, accessibility, and cost savings that they provide Limbu and Huhmann, b. For example, purchases by Hungarian consumers from online pharmacies increased over tenfold between and Fittler et al. Online pharmacies include major corporations e. Illicit online pharmacies violate regulations by selling counterfeit, adulterated, or unapproved drugs or dispensing prescription drugs without a valid prescription Limbu and Huhmann, a. Research on online pharmacies has been growing. Reviews of online pharmacies show how the literature documents online pharmacy types and characteristics, the therapeutic classes and quality of drugs available, and risks to patients and public health Orizio et al. Only one review touches on consumer purchases Almomani et al. This narrative review of 17 studies identifies the prevalence of and reasons for prescription medicine purchases using any internet platform, including search engines, social media, and encrypted messaging applications; however, half the qualitative studies reviewed sampled pregnant women, which limits generalizability. Further, it solely focused on studies of prescription medication purchases published between and Although Almomani et al. In addition, it included no studies published prior to or after Our study reviews almost three times as many studies on online pharmacy purchases alone. Unlike earlier reviews, we included studies of consumer purchases of both prescription and over-the-counter OTC medications to determine if the need for a prescription alters why consumers want to acquire medication online. Also, we did not constrain our review to studies published within a limited date range. This allowed us to show how research into this topic has changed over time. Moreover, our review makes an important distinction between influences on consumer purchase intentions and influences on actual purchase behavior. Although some assume purchase intentions predict actual purchase behavior, prior research in many disciplines has found that they are not the same. For example, a consumer may intend to purchase from an online pharmacy, but time or social influence may shift that purchase to a brick-and-mortar pharmacy. Alternatively, a consumer may not intend to purchase from an online pharmacy, but an unexpected situation e. The current review addresses three key research questions: 1 to what extent have consumer purchase intentions and behavior been investigated as they relate to online pharmacies? Hence, our investigation aims to fill a research gap by systematically scoping a body of literature on this topic of growing interest to researchers in healthcare and public policy. In addition, we provide guidance for the direction of future research and the areas that remain uninvestigated or unstudied, as well as those that represent emerging topics that warrant greater investigation. We carried out a scoping review, which is useful to map the literature on evolving or emerging fields or topics Munn et al. PubMed, one of the most commonly used search tools, is a leading database that covers biomedical and life sciences literature. Web of Science and Scopus are the two largest and most widely used bibliographic databases for searching multidisciplinary literature, as covered in our review. To locate more records from this interdisciplinary literature, we also used relevant synonyms and variants of search terms. We limited the search criteria to exclude all literature irrelevant to our study, such as conference proceedings, grey literature, reviews, books, dissertations, and non-English articles. We included qualitative and quantitative studies of the determinants of medication purchase intentions and behavior over the Internet. Restrictions on the publication year and study population were not applied. It summarizes the number of records identified, screened, and excluded, the reasons for exclusion, and the number of studies included in this review Liberati et al. We retrieved 1, records from electronic databases, which consisted of records from PubMed, from Web of Science, and from Scopus. After removing duplicates, records were retained. Next, titles and abstracts were screened by two researchers independently. After screening titles and abstracts, records that did not meet the inclusion criteria were eliminated. Finally, we assessed the remaining 85 full-text articles. Of these, 38 articles did not meet the eligibility criteria. Forty-seven studies were included in this scoping review. All abstracts and full texts were screened and reviewed independently by two trained coders, who extracted data including authors, publication year, country, journal, population, sample size, research design, drug type, study objective, determinants of purchase intention and behavior, and key findings. This study included forty-seven studies from twenty-nine countries, including nine studies conducted in the United States, five studies in Saudi Arabia, and three studies each in Australia, China, India, and the United Kindom see Table 2. Twenty-one studies were carried out in Asia, eighteen studies in Europe, eleven studies in North America, three studies in Australia, and two studies in Africa. Interestingly, no research was carried out in South America. All studies, except a longitudinal study by Hawdon et al. Forty-two studies employed survey methodology, four interviewed adult individuals, one used a focus group, and another conducted an experiment Three studies were published in the Journal of Medical Internet Research , and three appeared in the Saudi Pharmaceutical Journal. The included studies recruited 27, respondents, with an average sample size of Thirty-seven studies focused on the general adult population, three on patients, two on women, two on students, and three on other populations. Eight studies focused on prescription drugs, eight studies on OTC medication, and the remainder either included both or did not specify. Figure 2 shows consistently few studies conducted on the topic until Four studies were published in , then the publications sharply fell in and Beginning in , we see a growing wave of publications peaking in , with twelve studies. Our analysis of prior studies revealed some differences between OTC and prescription medication in factors influencing online purchase intentions and behaviors. Intentions toward online purchases of prescription medications were primarily motivated by price, availability, convenience, and education. Prescription drug online purchase behavior was adversely affected by perceived risk. Purchase behavior was positively related to health insurance coverage, information sources, and convenience. Most studies involving OTC medication studied purchase behavior. The major driving forces of consumer purchases of OTC medication online were information sources, availability, internet usage, and convenience. Evaluation of the purchase environment, information sources, and prior experience primarily influenced purchase intentions toward OTC medication online. As shown in Table 3 , education, gender, and income were the most frequent demographic predictors of purchase intentions toward online pharmacies. However, the scoping review reveals some contradictory findings. Higher education was at times associated with increased purchase intentions Holiday-Goodman et al. In contrast, another study indicated that individuals with lower education levels had greater intentions to purchase from an online pharmacy Ivanitskaya et al. Holiday-Goodman et al. In contrast, Hu et al. Online pharmacy purchase intentions also were greater among young, White, and married consumers Holiday-Goodman et al. The most frequent demographic predictors of purchase behavior included age, education, gender, and income. Again, the evidence is contradictory. Five studies reported that more older consumers purchased from online pharmacies Brown and Li, ; Cokro and Arfenda, ; Desai et al. In many studies, higher education was associated with increased purchase e. Three studies showed that males purchased medications online more frequently than females Rajamma and Pelton, ; Szekely et al. Higher income was positively associated with increased medication purchases online Rajamma and Pelton, ; Brown and Li, ; Desai et al. Brown and Li also reported that online pharmacy users were more likely to be married; however, Jairoun et al. OTC medicine was most often purchased online by young consumers living in urban areas than smaller settlements Roblek et al. Convenience was a frequently demonstrated predictor of purchase intentions Holiday-Goodman et al. Convenience-related factors, such as fast delivery, choices of delivery times and addresses, reduced visits to the pharmacy, and easy telephone access to the pharmacist for drug information were common reasons supporting intentions to purchase medications from online pharmacies Alfahad et al. Convenience was also a dominant motivation for purchasing behavior. Consumers who bought medications online indicated that buying drugs online was more convenient Brijnath et al. Other convenience-related motivations included easy access Alwhaibi et al. Moureaud et al. The studies included in this review reveal that the availability of various drug products and more options Little et al. Unavailability in the local market Abanmy, ; Bowman et al. Several studies indicated that price significantly promoted medication purchases online. Nine studies found that lower prices were positively associated with increased purchase behavior Brijnath et al. Similarly, another study found that higher prices were associated with decreased purchase behavior Almomani et al. In addition, some studies explored the effects of sales promotions, which reduced prices. Sales promotions such as deals, discounts, and special offers were common facilitators of intentions to purchase medicine online Little et al. Few studies explored purchase environment evaluations as determinants of purchase behavior. One study showed that people who spent more time online were more willing to purchase medication online Fittler et al. Purchase behavior was influenced by frequency of internet usage Roblek et al. Some information source-related factors enhancing purchase behavior included word-of-mouth from friends Almomani et al. Three dimensions of perceived risk -- that is financial, physical, and source risks i. Research shows that prior experience of purchasing goods online Fittler et al. Research showed that people without health insurance coverage were more likely to demonstrate purchase intentions toward online pharmacies Cicero and Ellis, Similarly, another study reported an inverse association between Medicaid insurance coverage and purchase behavior Brown and Li, However, two other studies found that health insurance coverage motivated consumers to engage in online medication purchase behavior Brown and Li, ; Desai et al. Cicero and Ellis showed that perceived anonymity could be a primary reason that consumers intended to purchase from online pharmacies that dispensed Tramadol, a prescription medication, without a prescription. In terms of behavior, Alwhaibi et al. For example, many consumers bought sexual enhancers online because they did not want to discuss their condition with their physician Koenraadt and van de Ven, As shown in Table 3 , two studies reported a positive association between product quality and behavioral intentions Holiday-Goodman et al. In two other studies, product variety motivated purchase behavior from online pharmacies Alwhaibi et al. This scoping review sought to understand the current landscape of empirical research on the drivers of consumer purchase intentions and usage behavior of online pharmacies. Scholarly interest in this topic has been growing exponentially over the last few years. Using rigorous scoping review methods, forty-eight articles published to date met the inclusion criteria, including 12 published in Although we sought qualitative and quantitative studies that applied various methodological approaches, the existing literature was mostly limited to surveys. In terms of sample populations, however, the existing literature exhibits greater diversity in both population types e. However, Latin America has been ignored in the existing literature, including the major markets of Mexico, Brazil, Chile, Colombia, and Argentina. This scoping review identified twelve general factors, which include many individual facilitators and inhibitors of consumer purchase intentions and behavior that have been studied so far Table 3. Of these, the greatest amount of research has investigated the demographics of consumers who purchase or intend to purchase from online pharmacies. Due to the conflicting results, few implications can be gleaned from the prior research related to demographics or the role of health insurance coverage. However, higher-income consumers, White American consumers, and more educated consumers in nine of ten studies had higher online medication purchase intentions and behavior. The implication for researchers and practitioners from the income and education findings seems to be that greater financial and cognitive resources help consumers navigate the online environment to find medications for purchase. Policymakers seeking to dissuade purchases from rogue or illegitimate online pharmacies should target messages and campaigns to these demographic groups. Convenience and availability factors more consistently influenced online medication purchase intentions and behavior. Consumers intended or chose to purchase from online pharmacies due to faster and more convenient delivery, ease of use and gathering information, accessibility, the ability to bypass healthcare providers or regulatory gatekeepers, availability outside of store hours, and access to medications unavailable locally. A practical implication for brick-and-mortar pharmacies is that enhancing their convenience e. Price was also a consistent influence on online medication purchase intentions and behavior. Factors that lowered prices or increased price savings and value received from online medicine purchases tended to attract consumers. To better challenge online pharmacies, brick-and-mortar pharmacies should become more price competitive. A policy implication is that public policymakers and regulators attempting to control the illicit dispensing of medicine online should consider regulation reductions, subsidies, or other ways to lower prices through legitimate pharmacies. Favorable evaluations of the purchase environment also consistently benefitted purchase intentions and behavior across many types of evaluations, such as attitudes, trust, emotional response, aesthetically pleasing and functional design evaluations, enjoyment, and satisfaction. Thus, it appears that many consumers who purchase from or intend to purchase from online pharmacies do so because they hold positive evaluations of those pharmacies. An important implication of this finding is that policymakers, regulators, and brick-and-mortar pharmacies interested in discouraging online medication purchases must engage in attitude change campaigns before expecting consumers who purchase online to alter their intentions or behavior. Attitude change can take time as it requires learning new information and responses through repeated exposure to counterinformation or social influence from family, friends, or trusted others, such as experts or celebrities. This scoping review summarized prior research findings in which social influence and other information sources motivate online medication purchase intentions and behavior. Intentions and behavior were influenced by information and recommendations from expert sources, such as healthcare providers and websites with drug information; personal sources, such as friends and family; independent sources, such as social media influencers and reviews by other consumers; and non-personal sources, such as social media marketing. One implication is that pharmacists, healthcare providers, policymakers, and regulators should be able to indirectly influence consumer behavior toward online medicine purchases if they tap into the social and normative influence of one or more of these information sources. Perceived financial, physical, or source risks inhibit online medicine purchase intentions and behavior, whereas greater health literacy and experience with online pharmacies, online shopping in general, and the internet or social media encourage online medicine purchasing. The benefits of online pharmacies e. An implication is that brick-and-mortar competitors or public policymakers should heighten consumer awareness of these risks if they wish to discourage consumer online medicine purchases. Further, legitimate online sellers can highlight risks to differentiate their verified online pharmacies from illicit or rogue online pharmacies. Finally, this scoping review documented other factors that had been investigated sparingly see Appendix A. For example, some studies have begun to investigate how consumer personality predisposes some consumers toward e. Other studies have begun to investigate situational influences on consumer online medication purchase intentions and behavior e. Individually, these other factors have been studied so rarely that it is difficult to confidently predict the general effect on purchase intentions and behavior without future research. These other influences are listed in the Appendix A. The analyzed literature indicates several gaps in the literature and future research directions that could be addressed. Thus, a systematic review or meta-analysis that incorporates the post studies will likely be able to be conducted within the next decade once sufficient research has been published. This should further our understanding of the factors that facilitate and inhibit online medication purchasing as well as help determine the relative strength of different influences. Most studies The remainder includes a handful of qualitative studies and a single experiment. Future research employing methods other than surveys e. Similarly, future research should advance the understanding of online purchase drivers by using more generalizable and diverse samples, patient rather than general adult samples, and samples that permit cross-cultural comparisons. Third, this scoping review finds that a vast majority of the prior research did not specify whether online purchases of OTC or prescription medication or both were being studied. Future research should specify this because the current review shows differences in the drivers of online OTC and prescription drug purchase intentions and behavior. Fourth, demographics e. As noted in previous reviews Tugwell et al. Thus, rather than relying on demographics, future research should attempt to identify the underlying explanatory determinants to better predict purchase intentions and behavior from online pharmacies. Studies, including moderation or mediation tests, could also help better understand the mechanisms at work. Once the underlying explanatory determinants associated with a demographic variable such as age or gender have been identified, the indirectly related demographic variables can serve to identify likely target audiences for public health campaigns and patient education materials regarding online pharmacies. For example, psychographic variables, such as personality, perceptions, attitudes, beliefs, lifestyle, interests, and values, can offer the potential to identify deeper motivations and could better identify why some consumers buy medications online whereas others do not. To direct future research into other uninvestigated or underinvestigated areas, Table 4 lists some research questions that warrant exploration to better understand the driving influences on consumer purchase intentions and behavior. Finally, the prior literature uncovered by this scoping review tends to be atheoretical and exhibits a general lack of definitions for key constructs posited as factors influencing consumer purchase intentions or behavior. To aid pharmacology researchers and investigators from other fields, the research questions in Table 4 are linked to theories and well-defined constructs in the literature from psychology, consumer research, advertising, health communication, and marketing. For example, Fittler et al. Using the constructs from the marketing literature of search engine optimization and search engine marketing, how can legal sellers take action against these rogue sites and use search engine results to promote medication purchases from legitimate online and brick-and-mortar pharmacies? While demographic factors tended to be the most often measured influences on intentions and behavior, their role was generally inconsistent, with many contradictory results. These findings of our scoping review should aid verified online pharmacies and brick-and-mortar stores in understanding ways to encourage consumer medication purchases. Further, our scoping review revealed a general lack of definitions for constructs studied and a paucity of theoretical justification as to why certain factors or individual influences should affect purchase intentions or behavior. This research agenda should help future studies in this area move beyond descriptive analysis to theory-testing and discovering the underlying explanations of how specific influences affect online medication purchase intentions and behaviors. To accomplish this, these future research directions are based on theories and concepts developed in other areas focused on stimulating intentions or prompting behaviors e. Investigating research questions based on this agenda should help healthcare providers, public policymakers, and regulators design more effective interventions to promote more positive individual patient and public health outcomes as well as benefit researchers interested in this topic of increasing interest and economic importance. The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher. Abanmy, N. The extent of use of online pharmacies in Saudi Arabia. Saudi Pharm. Adjie, E. User switching intention from E-marketplace to E-pharmacy: the Influence of push, pull, and mooring factors. Unlocked 43, Ahmed, S. Determining the intention to use app-based medicine service in an emerging economy. Alfahad, N. Perception and knowledge to online pharmacy services among consumers in Riyadh, Saudi Arabia: a pilot survey. Google Scholar. Alhabash, S. Effects of fear and humor appeals in public service announcements PSAs on intentions to purchase medications via social media. Public Health 19 19 , Almohammed, O. Almomani, H. Reasons that lead people to end up buying fake medicines on the internet: qualitative interview study. JMIR Form. Reasons that lead people to buy prescription medicines on the internet: a systematic review. Alsadoun, A. The effect of perceived risk, technology trust, and technology awareness on the consumer's behavioural intention to adopt online pharmacy. Alwhaibi, M. Anis, M. Arksey, H. Scoping studies: towards a methodological framework. Ashames, A. Public perception toward e-commerce of medicines and comparative pharmaceutical quality assessment study of two different products of furosemide tablets from community and illicit online pharmacies. Bioallied Sci. Bansal, S. A preliminary study to evaluate the behavior of Indian population toward E-pharmacy. Indian J. Bowman, C. Consumer internet purchasing of medicines using a population sample: a mixed methodology approach. Brijnath, B. Investigating patient perspectives on medical returns and buying medicines online in two communities in Melbourne, Australia: results from a qualitative study. Patient Patient-Centered Outcomes Res. Brown, J. Characteristics of online pharmacy users in a nationally representative sample. Cicero, T. Health outcomes in patients using no-prescription online pharmacies to purchase prescription drugs. Internet Res. Cokro, F. Profile of online drug purchasing in marketplace by students at a faculty of medicine and health sciences in jakarta, Indonesia. Cote, J. Effects of unexpected situations on behavior-intention differences: a garbology analysis. Consumer Res. Desai, K. Health care use amongst online buyers of medications and vitamins. Fittler, A. Attitudes and behaviors regarding online pharmacies in the aftermath of COVID pandemic: at the tipping point towards the new normal. Prevalence of poisoned Google search results of erectile dysfunction medications redirecting to illegal internet pharmacies: data analysis study. Consumers turning to the internet pharmacy market: cross-sectional study on the frequency and attitudes of Hungarian patients purchasing medications online. Gharaibeh, L. Practices, perceptions and trust of the public regarding online drug purchasing: a web-based survey from Jordan. BMJ open 13 10 , e Global Market Insights E-Pharmacy market - by product OTC products, prescription medicine , by region, growth potential, competitive market share and global forecast, — Hamdan, I. The perceived influence of COVID lockdown on the circulation of counterfeit drugs and medical supplies through the electronic market. Health Serv. Han, L. The influence of price value on purchase intention among patients with chronic diseases in medical e-commerce during the COVID pandemic in China. Public Health 11, Hawdon, J. Changes in online illegal drug buying during COVID assessing effects due to a changing market or changes in strain using a longitudinal sample design. Justice 47 4 , — Holiday-Goodman, M. Investigation of consumer choice of community, mail order, or internet pharmacies. Holtgrafe, C. Health Inf. Hu, J. Transformations Bus. Ivanitskaya, L. Dirt cheap and without prescription: how susceptible are young US consumers to purchasing drugs from rogue internet pharmacies? Jairoun, A. Online medication purchasing during the Covid pandemic: potential risks to patient safety and the urgent need to develop more rigorous controls for purchasing online medications, a pilot study from the United Arab Emirates. Policy Pract. Klarna Share of consumers that would prefer to shop mostly online or mostly in-store worldwide in , by country. Hamburg, Germany. Koenraadt, R. The Internet and lifestyle drugs: an analysis of demographic characteristics, methods, and motives of online purchasers of illicit lifestyle drugs in The Netherlands. Drugs Educ. Policy 25 4 , — Lee, W. Effects among product attributes, involvement, word-of-mouth, and purchase intention in online shopping. Asia Pac. Liberati, A. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: explanation and elaboration. Limbu, Y. Illicit online pharmacies: a scoping review. Public Health 20, Online but unlawful sales of unapproved and misbranded prescription drugs: internet pharmacy compliance with Food and Drug Administration warning letters. Consumer Aff. Little, A. Factors that influence online medication purchasing behaviour in pregnancy: a qualitative study. Based Midwifery 30 2 , — Long, C. Online pharmacies selling prescription drugs: systematic review. Pharmacy 10, Ma, L. Mackey, T. Digital danger: a review of the global public health, patient safety and cybersecurity threats posed by illicit online pharmacies. Mekawie, N. Procedia Comput. Moureaud, C. Purchase of prescription medicines via social media: a survey-based study of prevalence, risk perceptions, and motivations. Health Policy 11 , — Morwitz, V. When do purchase intentions predict sales?. Munn, Z. Systematic review or scoping review? Guidance for authors when choosing between a systematic or scoping review approach. BMC Med. Ndem, E. Office for National Statistics Internet access — households and individuals. Great Britain: Newport, U. Orizio, G. Quality of online pharmacies and websites selling prescription drugs: a systematic review. Rajamma, R. An empirical investigation of consumers' procurement of pharmaceutical products via online retail channels. Roblek, V. To click or to buy over the counter drugs: exploring the behaviour of Slovenian customers. Sabbir, M. Understanding the determinants of online pharmacy adoption: a two-staged SEM-neural network analysis approach. Policy Manag. Schmid, P. Barriers of influenza vaccination intention and behavior — a systematic review of influenza vaccine hesitancy, — Sheeran, P. Intention-behavior relations: a conceptual and empirical review. Sinclair, M. An assessment of pregnant women's knowledge and use of the Internet for medication safety information and purchase. Soboleva, M. Problems of purchasing pharmacy products through online orders. Srivastava, M. Statista Consumer Insights Consumer Insights E-commerce. Hamburg, Germany: Statista. Szekely, P. Attitude of patients and customers regarding purchasing drugs online. Farmacia 63 1 , 93— Tang, G. Analysis of Japanese consumers' attitudes toward the digital transformation of OTC medicine purchase behavior and eHealth literacy: an online survey for digital experience design. Digital Health 5, Tugwell, P. Is health equity considered in systematic reviews of the cochrane musculoskeletal group? Arthritis and Rheumatism 59, — Van Buskirk, J. Characterising dark net marketplace purchasers in a sample of regular psychostimulant users. Drug Policy 35, 32— Varghese Assin, T. Perceived risk and online purchase intention of E-pharmacy: examining the moderating role of online trust in the Indian context. From purely physical to purely online pharmacies: exploring different shopper profiles and discussing some widespread beliefs. Webb, T. Does Changing behavioral intentions engender behavior change? A meta-analysis of the experimental evidence. Wiedmann, K. Online distribution of pharmaceuticals: investigating relations of consumers' value perception, online shopping attitudes and behaviour in an e-pharmacy context. General barriers and website-specific barriers Almomani et al. Note: Italicized text indicates reported findings that are negatively related to purchase intentions or behavior. Keywords: online pharmacy, scoping review, over-the-counter OTC medication, prescription drug, purchase intention, purchase behavior. A scoping review. The use, distribution or reproduction in other forums is permitted, provided the original author s and the copyright owner s are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Limbu, limbuy montclair. Disclaimer: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. Top bar navigation. About us About us. Sections Sections. About journal About journal. Article types Author guidelines Editor guidelines Publishing fees Submission checklist Contact editorial office. Drugs Outcomes Research and Policies. Yam B. Huhmann 2. Illicit online pharmacies violate regulations by selling counterfeit, adulterated, or unapproved drugs or dispensing prescription drugs without a valid prescription Limbu and Huhmann, a Research on online pharmacies has been growing. TABLE 1. Search stratetegy. TABLE 2. Characteristics of studies included in this review. Number of studies by year. TABLE 3. Factors influencing purchase intention and behavior from online pharmacies. TABLE 4. Future research agenda and research questions.

Saudi Arabia is becoming the drug capital of the Middle East

Riyadh buying MDMA pills

Official websites use. Share sensitive information only on official, secure websites. Medications usage has become a significant part of contemporary life. Many studies indicate that there is an excessive use and a considerable waste of medicines. This descriptive study aims at identifying the most used medicines in Saudi Arabia from to according to the statistics of specialized companies in the field. Comparison of the most commonly used drugs with those in the United States aims at clarifying similarities and differences. The results showed that the use of antibiotics and analgesics still accounted for the bulk, followed by proton pump inhibitors and anti-diabetics respectively, then anti-hyperlipidemic agents and erectile dysfunction treatments. The causes of this overuse vary according to the studies concerned between the self-medications and the over-prescription of the medication and the failure of the diagnostic and treatment procedures malpractice. The recommendations are the strict application of prescribed and non—prescribed dispensing systems and the further establishment and application of national guides in the diagnosis and treatment of communicable diseases. The repetition of such studies is useful in reviewing health policies and regulations related to health practice in general and pharmacological policies in particular. The utilization of pharmaceutical medications has become an essential part of our standard of living all round the world. Prescription drugs, particularly, are continuously considered as complicated issue: talk of pharmaceutical company endorsements, the rising cost of drugs and doctors over-prescribing their patients. Needless to say, that these drugs have an enormously affect on the life of the individual and community. For example, the misuse of antibiotics may lead to serious complications that can affect the patient and increase multi-resistant organisms within the community. Moreover, mean medication wastage was estimated to be Meaningful the most utilized drugs amongst the population in Saudi Arabia may open new areas of research. It may also help legislative and executives authorities in Saudi Arabia to improve the policies and regulations regarding the distribution and consuming of pharmaceutical drugs. Reviewing the available literature in Saudi Arabia indicates that this issue has not been previously investigated deeply. The first step in this regard is to determine drug utilization pattern in KSA with actual figures. The main aim of this study is to determine the top ten used drugs in Saudi Arabia. Furthermore, comparing these significant figures to other world leading countries like the USA United States of America in regards of most utilized drugs amongst the population will give more realistic picture. Finally, recommendations based on the results will be provided. IMS Health is an American company that provides information, services and technology for the healthcare industry. It is the largest vendor of U. The firm uses its own data to produce syndicated reports such as market forecasts and market intelligence. Focusing on prescribing drugs not OTC is the main objective of this study from the year till Our choice of comparison is the US as it is a leading country in healthcare services and many published papers regarding this subject have been covered in their country, therefore, it is ideal for evaluation Lindsley, , Kantor et al. It is appeared in Fig. Diclofenac products were amongst top four drugs from to In years from to the top prescribed medication amongst all types of drugs and analgesics was the original brand of diclofinac. However, the local generic especially G1 product of diclofenac showed gradual increasing in usage throughout the years which result in leading analgesics class in and after while the original brand usage dropped heavily in The trend of the top 10 sold drugs in KSA during the years — the volume unit is Million. Amoxicillin plus clavulanic acid complex was the only antibiotic in the top ten list represented by two generic products. The local generic G1 was the 3rd in the top ten list of the most commonly used antibiotic from to with steady increase. There are an antibiotic close to top ten list showed a notable increasing in usage which is ceftriaxone. The use of two proton pump inhibitors pantoprazole and esomeprazole was high in Saudi from to and shared the same level of consuming in and In and , pantoprazole was higher in consuming than esomeprazole. However, esomeprazole was the higher in A combination of metformin plus sitagliptin became one of the top 10 utilized medications starting from The two remaining drugs on the list were: tadalafil and atorvastatin respectively with notable increasing, and closely to them sildenafil came with notable increasing. The noteworthy result was that no antibiotics or analgesics were listed on the most utilized drug list of till in the United States of America. The pattern of the top 10 prescribed drugs in USA during the years — the volume unit is Million. The present study illustrated the utilization pattern of drugs in Saudi Arabia during the years — We are unaware of any previously published study focused on such aspect. Results showed that analgesics represent most utilized drug class in Saudi Arabia, in particular the potent non-steroidal anti-inflammatory drug NSAID diclofenac. It is common in the society to use the OTC form of this drug like ointments and jells Cooper, , Sharma et al. However, the public use of analgesics can be explained, partially, by self medication Suleiman, , and the over prescribing of analgesics can be linked to poor control of prescription drugs in community pharmacies in Saudi and the loss of proper national guidelines Khan, One of key element in good prescribing practice is conserving the need and objectivity of the patient. In the USA, there were no analgesics in the list of top ten prescribed drugs. Over-utilization of diclofenac is worrisome since this drug has been linked to risk of cardiovascular disease especially when used with high doses and for long duration Antman et al. It has been noticed from study results that two antibiotics consistently appeared in the top 10 utilized drugs in Saudi. On the contrary, antibiotics were not found in the top 10 used drugs in USA, although USA had a similar concern before and it has been solved by controlling the prescription of antibiotics Roumie et al. However, irrational use of antibiotics evolved in both developing and developed countries Morgan et al. Irrational use of antibiotics has two dimensions, improper prescribing and dispensing. Some doctors prescribe antibiotics to patients based on incorrect diagnosis for instance, viral upper respiratory tract infections Stone et al. This can be even complicated by lack of adherence to the prescribed antibiotic therapy by some of patients, increasing risk of antibiotic resistance Bebell and Muiru, A cross-sectional study investigated selling pattern of antibiotics in community pharmacies in Riyadh, the capital city of Saudi Arabia. The researchers found that more than three quarters of visited pharmacies sold antibiotics to consumers without prescriptions. They also reported that majority of those who dispensed antibiotics without prescription recommend the antibiotics to the patients without direct request from them Bin Abdulhak et al. This behavior has been confirmed in another city in Saudi Arabia Al-Mohamadi et al. Another study showed that most commonly sold drugs without prescriptions in Riyadh were antibiotics and analgesics Aljadhey et al. Two thirds of all antibiotics are sold without prescription, through unregulated private sectors Holloway and Van Dijk, Even in those countries where over-the-counter delivery of antibiotics is not permitted, patients use antibiotics without prescription Suda et al. Moreover, Low adherence levels by patients are common; many patients take antibiotics in under-dose or for shortened duration Ranji et al. Low adherence can be referred to many causes, and Table 1 summarized major predictors of poor adherence to medicine Dimatteo, , Osterberg et al. Investigators found that irresponsible self-medication is common in Saudi Arabia and most participants had poor knowledge, and negative perceptions regarding self-medication. Generally, antibiotic prescriptions were Similarly, In Saudi Arabia, Practitioners tend to prescribe antibiotics frequently in winter and people tend to use antibiotics during this season and their attitude toward common cold management related to their level of education AlKhamees et al. Adapted from Osterberg et al. However that does not reflect the proper utilization of this class of medications. This improper prescribing pattern of PPIs, particularly by non-gastroenterologist, was observed earlier in another tertiary teaching hospital Alzahrani et al. Such studies indicating that Saudi Arabia, like other countries, suffers from widespread misuse of PPIs in hospital practice Jones et al. Collaboration between pharmacists and physicians to Implant correct measures of prescribing and develop evidence-based practice guidelines and adherence to it will produce improvement in this regard. The other drug classes in the list such as antidiabetics and antihyperlipidemic may reflect the current situation of chronic disease in Saudi Arabia Alqurashi et al. For instance, the presence of diabetes treatment for type 1 and type 2 in USA list of the top ten utilized drugs should be noticed. The increase in the prescribing of drugs used to chronic disease is expected due to the increase in the prevalence of disease treated by these agents. On the other hand, the effect of insurance coverage in type and number of medication should be considered. The influence of insurance coverage in prescribing behavior is a common problem in other countries. Starting from , there was an interesting increase in the utilization of erectile dysfunction agents. Two reasons can explain such results; the high prevalence of type 2 diabetes mellitus in Saudi and self-medication. It has been estimated that almost one-quarter of Saudi Population suffer from type 2 diabetes mellitus Al-Daghri et al. The latter is a well-established risk factor for macro- and microvascular complications including sexual dysfunction Maiorino et al. Over the counter selling of erectile dysfunction is common in community pharmacies. Recent study investigated the use of phosphodiesterase 5 inhibitors PDEIs in a sample of Saudi men and reported that vast majority of PDEIs users bought them without prescription Alshahrani et al. Finally, the list of top ten for Saudi Arabia reflects the notable using of local generic drugs beside the original drugs indicating probably good awareness of prescribers about the comparable effectiveness of generic and original drugs Ahire et al. Our study has some limitations. Results showed that analgesics were the highest class of drugs used in Saudi Arabia followed by antibiotics as the second largest group with 2 antibiotics in the list of top ten throughout the years the study was conducted. Activation of an electronic tracking system will help observing that inappropriate medications prescription and dispensing by health professionals which can be a major factor in the over and misuse of those medications. This paper shows alarming increase in utilization of antibiotics and hence regulatory actions are needed to combat antibiotics misuse for better impact on the society. National guidelines for the management of common diseases are essential to minimize unnecessary over utilization of certain medications in health facilities. Finally more prescribing patterns within each specialty will help in that regard. Hopefully, this study will initiate a platform for further research on the use of pharmaceutical drugs and prescribing patterns in Saudi Arabia. In addition it may help directly the public awareness. As a library, NLM provides access to scientific literature. Saudi Pharm J. Box , Riyadh , Saudi Arabia. Find articles by Osama A AlKhamees. Find articles by Khaled A AlNemer. Find articles by Mohammed W Bin Maneea. Find articles by Faisal A AlSugair. Find articles by Bassam H AlEnizi. Find articles by Adel A Alharf. Open in a new tab. Patient-related limitations Barriers to care or medicine Psychological problems, particularly depression Poor relationship between patient and provider Cognitive impairment Missed appointments Asymptomatic disease Lack of health insurance Inadequate follow-up or discharge planning Cost of copayment or coinsurance Side effects of medicine Complexity of treatment Patient lacks belief in benefit of treatment Access restrictions e. Peer review under responsibility of King Saud University. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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