Why are certain medications for minor problems such as dandruff only available with a prescription?



I’ve been having problems with dandruff for the past few weeks. After trying all of OTC shampoos without any results I went to the dermatologist. She prescribed a 2% ketoconazole shampoo (OTC is 1%) and it worked like magic. Why isn’t this medication available for everyone? Why do I have to go to a doctor to get it?

In: Other

It’s a mixture of reasons. OTC drugs usually have to be safe, effective, and importantly *be for conditions that can be managed without a doctor*. Mild pain, dry skin, colds, heartburn, etc. Even if you had a cancer drug that didn’t have any serious side effects, it would never be available OTC because cancer can’t be treated by yourself.

There’s an element of randomness to what’s available OTC, since a lot of drugs were “grandfathered” in–acetaminophen (tylenol), for example, is VERY easy to overdose on, and the overdose can be easily fatal. Ibuprofen and other NSAIDs can cause serious stomach ulcers with heavy use, etc.

You do see this a lot, though–where milder versions of a medication are available for OTC use, but more concentrated or higher-dose versions are prescription-only. Partially this is because side effects are more likely with higher doses, but also I’d imagine it’s because they imagine if the OTC strength isn’t working, it might be worth seeing a doctor because the condition may be more serious.

As for ketoconazole shampoo, I have no idea why 2% is prescription-only specifically vs 1%, but I imagine it’s due to those factors. It seems a bit silly to me, but I’m just a med student and not a dermatologist so what do I know?

Ketoconazole can have dangerous interactions with other medications. I’m surprised there is an OTC dosage permitted at all.