Prescription-to-OTC Switch of Triptans Showed Positive Public Health Impact

Switching triptans from prescription to over-the-counter (OTC) medications exhibited positive public health impacts, including increased patient safety, improved quality of life through expanded pharmacist roles, and enhanced economic benefits. While researchers noted challenges and risks stemming from this switch, it was associated with adding relief to a burdened health care system, according to a study published in the Journal of the American Pharmacists Association.¹

“A prescription (Rx) medication can be reclassified as an OTC product, known as an ‘Rx-to-OTC switch,’” wrote authors of the study. “Despite that, there is a growing global trend toward reclassification to OTC due to benefits such as improved consumer access, enhanced self-medication capabilities, and cost savings for health care payers. However, these advantages come with risks, including misuse, delayed diagnosis, and adverse events.”

In the US, OTC medications exist in a booming market where each American patient spends approximately $120 a year on front-of-store pharmacy products.² These year-over-year sales trends are apparent in patients treating common ailments such as acute pain, coughs and colds, gastrointestinal issues, and skin-related complications. Some of the most common OTC products include non-steroidal anti-inflammatory drugs, motion sickness medications, antihistamines, and many more.³

Researchers conducted a systematic literature review to measure public health impacts of an Rx-to-OTC switch in Germany. | image credit: Netsai / stock.adobe.com

READ MORE: FDA Clears OTC Glucose Monitor for Weight Management

The researchers’ study, however, was conducted in Germany, where prescription and OTC products are classified in 3 categories. First, some medications are noted as prescriptions and require physician approval. Pharmacy-only medications are prescribed by pharmacists after counseling and don’t require a physician’s signature. Finally, Germany has general sales medicines, similar to OTC products, available at pharmacies, supermarkets, and general stores.¹

Furthermore, breaking down Germany’s classification and need for OTC medications, migraines are significantly prominent across German patients, impacting 10% to 15% of the population. While there are many prescription and OTC medications available for treating migraines, triptans have the ability to change how blood is circulated in the brain, leading to improved migraine outcomes.^1,4

“Given the effectiveness of triptan for acute migraine and the patient's affinity to self-medication, OTC availability is essential,” the authors continued.¹ “Therefore, this study aims to evaluate the public health impact of the Rx-to-OTC switch of triptans in Germany.”

Exploring the Rx-to-OTC switch in a highly prominent medication class—4 triptans have switched to OTC products since 2006—researchers conducted a systematic literature review to measure public health impacts in Germany. They sought studies that investigated the Rx-to-OTC switch of triptans in Germany as well as how it impacts the German population and public health as a whole.

To measure the overall impacts of these switches, researchers classified them as positive, neutral, or negative impacts based on previously established alignment criteria. The final analysis included a total of 6 studies.

The key findings highlighted that the Rx-to-OTC switch translated to both improvements and reductions in patient safety. It also demonstrated both a promotion and disruption in the roles of pharmacists and physicians in Germany. Finally, results showed a positive socioeconomic impact of the Rx-to-OTC switch.

“This review found that OTC access to triptans has the potential to improve patient autonomy, reduce health care utilization, and offer economic benefits,” they wrote.¹ “However, these benefits must be weighed against safety risks, especially for high-risk populations. Stakeholder perspectives were diverse, with pharmacists generally supporting the switch and physicians expressing concerns about patient safety and diagnostic accuracy.”

While it would be necessary to consult with the proper pharmacists and health care professionals, the use of OTC medications after the switch from them being prescriptions can have a significantly positive impact on public health. However, with the strain that could stem from increased pharmacist and provider counseling, the Rx-to-switch pathway presents potential challenges.

With almotriptan—the main focus of triptan switches in the study—contraindicated among high-risk populations, its proper OTC use is reliant on pharmacists’ counseling. While some pharmacists may be happy to increase their consultation sessions for OTC medication use, others would not have those capabilities.

Like the introduction of many other public health initiatives, the Rx-to-OTC switch presents many obstacles for patients, providers, and public health leaders. However, with several reports of positive impacts from this switch, all stakeholders involved may be inclined to further understand the integration of OTC medication use and patient counseling. While the Rx-to-OTC phenomenon presents obstacles, the opportunities for public health and economic benefits could be crucial to a community pharmacy industry looking to maximize their billable clinical services. 

“The switch has enhanced patient safety for healthy adults, improved health-related quality of life and quality of care through expanded pharmacist roles, and generated economic benefits,” they concluded.¹ “However, it poses risks for high-risk adults and challenges physicians' roles in the health care system. The switch can relieve the health care system's burden.”

READ MORE: OTC Resource Center

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References

1. Imanuel CA, Atwan Z, Tabche C. The public health impact of the Rx-to-OTC switch of triptan in Germany: systematic review and framework analysis. JAPhA. 2025;65(6):102489. https://doi.org/10.1016/j.japh.2025.102489

2. Trygstad T. OTC market grows alongside consumer preferences. Pharmacy Times. June 18, 2024. Accessed September 2, 2025. https://www.pharmacytimes.com/view/otc-market-grows-alongside-consumer-preferences

3. Jacob D. Over-the-Counter (OTC) medicines: common drug list. RxList. Accessed September 2, 2025. https://www.rxlist.com/over-the-counter_otc_medicines/drugs-condition.htm

4. Triptans. Cleveland Clinic. May 9, 2023. Accessed September 2, 2025. https://my.clevelandclinic.org/health/treatments/24998-triptans