Self-care aware When should you prescribe?

Transcription

1 Self-care aware When should you prescribe? Over-the-counter medicines can only be sold within their licensed indications and in limited quantities in some cases. Below are some examples of instances when a G will be required to write a prescription: OTC condition roduct Restrictions on OTC (therefore must be prescribed) Acne Benzoyl peroxide 5% gel None (Acnecide ) atient < 18 years old Beclomethasone 0.05% Cases of chronic rhinitis (OTC product nasal spray advises patients to consult doctor if using (Beconase ) for than 3 consecutive months) Allergies Athlete s foot Fluticasone 0.05% nasal spray (irinase Allergy ) Clobetasone butyrate 0.05% cream (Eumovate ) Hydrocortisone 1% cream Chlorphenamine maleate 2mg/5ml oral solution Cetirizine 10mg Loratadine 10mg Hydrocortisone 1% & miconazole 2% cream (Daktacort ) Miconazole 2% cream (Daktarin ) Terbinafine 1% cutaneous solution (Lamisil Once ) atients < 12 years old For chronic diagnosed skin conditions. For facial use atient has used OTC product > 7 days atients < 10 years old For chronic diagnosed skin conditions For use on genital areas or face atient has used OTC product > 7 days atient < 1 years old regnancy atients <10 years old OTC license only covers sweat rash & athletes foot For use on genital areas or face atient has used OTC product for > 7 days atient is diabetic (and is using on the foot) OTC license covers single dose treatment of athlete s foot atient is < 18 years old No improvement in 7 days. * (100 doses) (180 doses) (60 doses) (pack sizes 7 or 14 ) (other pack sizes) * (General Sales List) (harmacy only)

2 OTC condition roduct Restrictions on OTC (therefore must be prescribed) Chloramphenicol 0.5% atient < 2 years old eye drops regnancy Bacterial Chloramphenicol 1% conjunctivitis eye ointment OTC license only covers treatment of (Optrex ) bacterial conjunctivitis only Colic Lactase (Colief drops) atient falls within ACBS criteria. Constipation Bisacodyl 5mg GR (Duloclax ) Senna 7.5mg atient < 10 years old Chronic use (as part of a treatment plan atient <12 years old Chronic use (as part of a treatment plan) (pack size 100 ) Coughs & colds Dandruff holcodine 5mg/5ml linctus seudoephedrine Ketoconazole 2% shampoo (Nizoral ) Long term cough or asthma OTC product should only be used for 5 days for treatment of acute nonproductive cough atient < 12 years old atient has hypertension atient requires a product or a combination of products which contain more than 720mg of pseudoephedrine (or 180mg of ephedrine) or they require both pseudoephedrine and ephedrine containing products OTC license covers treatment of dandruff and seborrheic dermatitis (scalp) only Dental hygiene Diarrhoea Dry skin conditions Food items Chlorhexidine gluconate 0.2% mouthwash Dioralyte relief sachets Loperamide 2mg capsules For chronic use in the management of long term condition (e.g. prevention of oral candidiasis in immunocompromised patients) atient < 1 years old atients <12 years old (for diarrhoea) or patients < 18years (for relief of acute episodes of diarrhoea associated with diagnosed IBS) Chronic use (as part of treatment plan) Should only prescribe an emollient for a diagnosed skin condition and product choice should be in line with E N Herts CCG s Emollient Guidelines : (pack size 6) (other pack sizes) The CCG policy excludes some patients with learning disabilities without a carer to aid in managing a gluten-free diet or where prescribers are aware of safeguarding concerns in at-risk adults or children. rescribing of milk products in children < 2 years old with Cow s Milk rotein Allergy should be in line with CCG decision document. * (General Sales List) (harmacy only)

3 OTC condition Fungal Nail Treatment Restrictions on OTC (therefore must roduct be prescribed) E N Herts CCG does not recommend the prescribing of topical antifungal nail preparations. General wellbeing Vitamin D supplements atient requires high doses of vitamin D for deficiency purposes (only if levels <30nmol/L) as per local guidance Haemorrhoids Headlice Anusol cream/ointment /suppositories Dimeticone 4% lotion (Hedrin ) Gaviscon Advance Double Action liquid Gaviscon Double Action liquid Gaviscon Original liquid Chronic use (as part of a treatment plan) atient < 6 months old atient < 12 years old Symptoms are persistent after 7 days atient <6 years old Symptoms are persistent after 7 days (50ml pack) (other pack size) (pack size 150ml & 300ml) Heartburn/ ingestion Esomeprazole 20mg g/r (Nexium control ) Omeprazole 10mg GR antoprazole 20mg g/r (antoloc control ) Ranitidine 75mg (Zantac relief ) atient < 18 years old atient requires a daily dose >20mg regnancy For chronic use (over 14 days) atient < 16 years old atient requires a daily dose >150mg For chronic use (over 14 days) (pack size of 6, 12) * (General Sales List) (harmacy only)

4 OTC condition Short term pain Sore throat roduct Aspirin 300mg Co-codamol 8mg/500mg /soluble Ibuprofen 200mg/400mg Naproxen 250mg g/r (Feminax Ultra ) Restrictions on OTC (therefore must be prescribed) Quantities 96 (quantities 32 sold at the clinical discretion of a pharmacist) For chronic diagnosed pain use atients <12 years regnancy Chronic use (OTC product can be used for a maximum of 3 days) atient requires higher strength of 15/500mg or 30/500mg Quantities 96 (quantities 24 may be sold at the clinical discretion of a pharmacist) Daily doses of > 1200mg required For chronic diagnosed pain use OTC license covers treatment of primary dysmenorrhea for a maximum of 3 days per a cycle only atients <15 years old or >50 years old (pack of 16 ) (pack size of 32 ) : 200mg (pack size of 16 ) : 200mg (pack size 24 ) and 400mg (any pack size) (pack size of16 ) aracetamol Quantities 96 (quantities 32 sold at 500mg the clinical discretion of a pharmacist) (pack For diagnosed chronic pain use size of 32 ) Benzydamine 0.15% oromucosal spray (Difflam ) atient < 12 years old regnancy Sun protection Uvistat No restrictions Aluminium OTC license covers treatment of chloride Sweating hyperhidrosis affecting the armpits (axillae), hexahydrate the hands and feet only (Driclor ) Teething Bonjela teething gel atients <2 months old * (General Sales List) (harmacy only)

5 Threadworms Mebendazole 100mg (Ovex ) OTC license covers treatment of threadworms only atient requires a daily dose >100mg atient < 2 years old regnancy * (General Sales List) (harmacy only)

6 OTC condition roduct Restrictions on OTC (therefore must be prescribed) Clotrimazole 10% atients < 16 years old or >60 years old internal & 2% More than 2 episodes of thrush within 6 external cream months combi Underlying conditions which predisposes (Canestan ) patient to develop thrush Clotrimazole 2% regnancy cream (Canestan Thrush Cream) Thrush Travel protection Clotrimazole 500mg pessary & 2% external cream (Canestan ) Fluconazole 150mg oral capsule (Canestan ) Cinnarizine 15mg atients < 16 years old or >60 years old More than 2 episodes of thrush within 6 months No improvement in symptoms within 7 days Underlying conditions which predisposes patient to develop thrush regnancy atient children < 5 years old OTC license covers treatment of symptoms associated with motion sickness only Verrucas and Warts Bazuka gel OTC license does not cover use near the face, neck, armpits, breasts, bottom or genital regions, or by diabetics or individuals who suffer from poor blood circulation to the hands or feet (Bazuka gel) (Bazuka extra strength) * (General Sales List) (harmacy only)