Medication self-management is commonly described as an individual capability, behaviour, or responsibility, yet medicines are often managed through distributed practical, cognitive, relational, and organisational work performed by patients, family caregivers, and health services. This critical interpretive synthesis examined how contemporary medication self-management literature distributes, obscures, or normalises that work and how assumptions of independence shape its representation. Searches were executed on 14 September 2026 using PubMed-indexed web retrieval, publisher and PubMed/PMC verification, and iterative citation and theoretical sampling. Forty-seven records were captured through initial phenomenon-focused searches; seven duplicates were removed, leaving 40 unique initial records. Eighteen additional unique records were identified through theoretical and citation sampling, producing 58 evidence candidates. Ten records outside the contemporary evidence boundary were set aside. Forty-eight contemporary records were assessed for relevance and contribution, of which 24 were excluded and 24 retained as included evidence units. Selection emphasised conceptual contribution to medication work, responsibility, capability, autonomy, caregiving, and visibility rather than journal prestige. Constant comparison identified six interrelated synthetic constructs: distributed medication work, conditional independence, reactive delegation, invisible coordination work, responsibility without integration, and the distinction between routinised workload and experienced burden. The synthesis indicates that medication “self-management” frequently rests on work extending beyond the nominally self-managing individual, although neither caregiver involvement nor treatment burden is universal. The evidence is concentrated in older-adult, multimorbidity, cognitive-impairment, and qualitative contexts, limiting generalisation. Medication self-management is therefore better interpreted as a variably distributed accomplishment whose apparent independence may depend on social and organisational supports that conventional terminology does not always reveal.
