NHS England Over The Counter Items - GP Guide to Self Care 2018 PDF

227 | October 2018 | 2.1 Community Interest Company Over the counter items - GP guide to self care In March 2018, NHS England published guidance for conditions for which over the counter (OTC) items should not...

227 | October 2018 | 2.1 Community Interest Company Over the counter items - GP guide to self care In March 2018, NHS England published guidance for conditions for which over the counter (OTC) items should not routinely be prescribed in primary care. 1 It listed 35 conditions plus probiotics and vitamins and minerals, as areas where self care may be more appropriate. There are, however, some exceptions to this guidance listed below. General exceptions to the guidance There are certain scenarios where patients should continue to have their treatments prescribed. These are: Patients prescribed an OTC treatment for a long term condition, e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease. For the treatment of more complex forms of minor illnesses, e.g. severe migraines that are unresponsive to OTC medicines. For those patients that have symptoms that suggest the condition is not minor, i.e. those with red flag symptoms, for example, indigestion with very bad pain. Treatment for complex patients, e.g. immunosuppressed patients. Patients on prescription only treatments. Patients prescribed OTC products to treat an adverse effect or symptom of a more complex illness. Prescription only medications should continue to have these products prescribed on the NHS. Circumstances where the product licence doesn’t allow the product to be sold over the counter to certain groups of patients. This may vary by medicine, but could include babies, children and/or women who are pregnant or breast-feeding. Community Pharmacists will be aware of what these are and can advise accordingly. Patients with a minor condition suitable for self care that has not responded sufficiently to treatment with an OTC product. This guide covers: The licenced indications of products available OTC and highlights where the licensing exceptions would prohibit self care. The general exceptions for the medicine and exceptions due to product licences for over the counter medicines available to treat the conditions listed in the NHS England guidance. This document is for use within the NHS and is not for commercial or marketing purposes 1 of 38  227. Over the counter items - GP guide to self care 2.1 Contents Items of low clinical effectiveness 1. Probiotics 3 2. Vitamins and minerals 3 Self-limiting conditions 3. Acute sore throat 4 4. Infrequent cold sores of the lip 4 5. Conjunctivitis 5 6. Coughs and colds and nasal congestion 5 7. Cradle cap (seborrhoeic dermatitis – infants) 6 8. Haemorrhoids 6 9. Infant colic 7 10. Mild cystitis 7 Minor illnesses suitable for self care 11. Mild irritant dermatitis 8 12. Dandruff 8 13. Diarrhoea (Adults only) 9 14. Dry eyes/sore (tired) eyes 9 15. Earwax 10 16. Excessive sweating (hyperhidrosis) 10 17. Head lice 10 18. Indigestion and heartburn 11 19. Infrequent constipation 12 20. Infrequent migraine 13 21. Insect bites and stings 14 22. Mild acne 14 23. Mild dry skin 14 24. Sunburn due to excessive sun exposure 15 25. Sun protection 15 26. Mild to moderate hay fever/allergic rhinitis 16 27. Minor burns and scalds 18 28. Minor conditions associated with pain 19 29. Mouth ulcers 20 30. Nappy rash 20 31. Oral thrush 21 32. Prevention of dental caries (dental decay) 21 33. Ringworm/Athletes foot 21 34. Teething/mild toothache 22 35. Threadworms 23 36. Travel sickness 23 37. Warts and verrucae 24 This document is for use within the NHS and is not for commercial or marketing purposes 2 of 38  227. Over the counter items - GP guide to self care 2.1 Items of low clinical effectiveness There is currently insufficient clinical evidence to support prescribing of probiotics within the NHS for the treatment or prevention of diarrhoea of any cause. 2,3 Exceptions 1. Probiotics ACBS approved indication or as per local policy. The ACBS recommends some foods and toilet preparations that may be regarded as drugs for the treatment of specified conditions. If a doctor is satisfied that the product can be safely prescribed, that patients will be adequately monitored and have access to hospital supervision if needed, they can prescribe these products on a prescription endorsed with “ACBS”. There is insufficient high-quality evidence to demonstrate the clinical effectiveness of vitamins and minerals. 4 Vitamins and minerals are essential nutrients which most people can and should get from eating a healthy, varied, and balanced diet. In most cases, dietary supplementation is unnecessary. Many vitamin and mineral supplements are classified as foods and not medicines; they therefore do not have to go through the strict criteria laid down by the Medicines and Healthcare products Regulatory Agency (MHRA) to confirm their quality, safety, and efficacy before reaching the market. It is therefore not deemed appropriate for such preparations to be routinely funded on the NHS. Any prescribing not in-line with listed exceptions should be discontinued. 2. Vitamins and minerals This guidance does not apply to Healthy Start Vitamins, but these are not currently prescribed on an NHS prescription. Exceptions Medically diagnosed deficiency, including for those patients who may have a lifelong or chronic condition or have undergone surgery that results in malabsorption. Continuing need should however be reviewed on a regular basis. NB maintenance or preventative treatment is not an exception. Calcium and vitamin D for osteoporosis. Malnutrition including alcoholism. Patients suitable to receive Healthy Start Vitamins for pregnancy or children between the ages of six months to their fourth birthday. (NB. this is not on prescription but commissioned separately). This document is for use within the NHS and is not for commercial or marketing purposes 3 of 38  227. Over the counter items - GP guide to self care 2.1 Self-limiting conditions Please note the following information about the column headings: Medication - For further advice see product information leaflet Common brands - The lists are not exhaustive and other brands are available which a community pharmacist will be able to advise upon. OTC restrictions - For further advice on restrictions, see product information leaflet Classification - P = pharmacy only GSL = general sales list Condition Exceptions Medication Common brands OTC restrictions Classification Benzydamine 0.15% Difflam®Spray 7 Children under 12 years (oral rinse) mouthwash 5 and P Difflam® Oral rinse 8 Pregnancy, breastfeeding oromucosal spray 6 Diabetes Children under 6 years (Strepsils®) Strepsils® 9 Children under 3 years (Throaties® Tyrozets®) GSL 3. Acute sore Red flag Throat lozenges Throaties® 10 Fructose intolerance, glucose- galactose P throat symptoms Tyrozets® 11 malabsorption or sucrose- isomaltose insufficiency Pregnancy, breastfeeding Children under 6 years Epiglottitis Throat sprays Ultra Chloraseptic® 12 GSL Methaemoglobinaemia Pregnancy, breastfeeding Immuno- 4. Infrequent compromised Virasorb® 14 Immunocompromised and terminally ill cold sores of patients Aciclovir cream 5% 13 Zovirax® 15 GSL the lip Only for face and lips Red flag Lypsyl® 16 symptoms This document is for use within the NHS and is not for commercial or marketing purposes 4 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Chloramphenicol 0.5% Brochlor® 19 5. Conjunct- Red flag eye drops 17 Children under 2 years Golden eye® 20 P ivitis symptoms Chloramphenicol 1% Pregnancy, breastfeeding Optrex® 21 eye ointment 18 Paracetamol 500mg tablets 22 and capsules 23 Severe renal or severe hepatic Anadin paracetamol® 26 impairment Paracetamol 120mg/5ml Mandanol® 27 Long term conditions requiring regular GSL/P suspension (from 3 Panadol® 28 pain relief depending on months) sugar free 24 Hedex® 29 Children under 2 months pack size Paracetamol Calpol® 30 Babies born before 37 weeks 250mg/5ml Babies weighing less than 4kg suspension (from 6 years old) 25 6. Coughs and colds Red flag Long term conditions requiring regular and nasal symptoms pain relief congestion Asthma Unstable high blood pressure Ibuprofen 200mg, Anadin Ibuprofen® 36 Taking anticoagulants 400mg capsules/ Nurofen® 37 Stomach ulcer, perforation or bleeding GSL/P tablets 31-34 Calprofen® 38 (active or history of) depending on Ibuprofen 100mg/5ml Cuprofen® 39 Children under 3 months pack size oral suspension 35 Anadin Joint pain® 40 Renal impairment Hepatic impairment Cardiac impairment Pregnancy, breastfeeding Avoid the use in chicken pox This document is for use within the NHS and is not for commercial or marketing purposes 5 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Children under 12 years Pregnancy, breastfeeding Sudafed® 41 Severe hypertension or severe coronary Pseudoephedrine or Benadryl® artery disease pseudoephedrine- Allergy Relief Plus Severe renal impairment P containing Decongestant Phaeochromocytoma preparations Capsules 42 Diabetes Galpseud® 43 6. Coughs and Hyperthyroidism colds and nasal Closed angle glaucoma congestion Red flag symptoms Paracetamol 1000mg/ continued Pholcodine 10mg/ Children under 16 years Pseudoephedrine HCL Severe hypertension or severe coronary 60mg in 30ml oral Day Nurse® Oral artery disease solution 44 Solution 44 P Severe renal impairment Paracetamol 500mg/ Day Nurse® Capsules 45 Hyperexcitability Pholcodine 5mg/ Pregnancy, breastfeeding Pseudoephedrine HCL 30mg capsules 45 Capasal TM Therapeutic 7. Cradle cap If causing Shampoo 46 If the cradle cap has spread to the face (seborrhoeic distress to the Emulsifying ointment Dentinox® Shampoo Do not use on broken skin or infected GSL dermatitis – infant and not and shampoo Cradle Cap 47 infants) skin improving Boots Cradle Cap Cream® 48 Anusol® cream 49 Not recommended for children ointment 50 and (Anusol®) 8. Haem- Red flag Zinc oxide suppositories 51 Children under 12 years (Germoloids®) GSL orrhoids symptoms preparations Germoloids® cream 52 Pregnancy, breastfeeding ointment 53 and suppositories 54 Rectal bleeding or blood in stools This document is for use within the NHS and is not for commercial or marketing purposes 6 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Simeticone 40mg/ml 55 Infacol® 55 No restrictions GSL Red flag 9. Infant colic symptoms Dimeticone Fructose, glucose-galactose, or sucrose Dentinox® 56 GSL 42mg/5ml 56 intolerant patients (contains sucrose) Men Children under 16 years Caneoasis cystitis Sodium citrate 4g Diabetes relief granules® 58 GSL sachet 57 Heart disease, hypertension, renal Boots cystitis relief® 59 disease Red flag Pregnancy, breastfeeding 10. Mild cystitis symptoms Potassium citrate 1.5g liquid 60 Cymaclear® 60 Children under 6 years 3g sachet 61 Cystopurin® 61 Renal disease/impairment GSL 1.5g tablet Effercitrate® 62 Pregnancy, breastfeeding (effervescent) 62 This document is for use within the NHS and is not for commercial or marketing purposes 7 of 38  227. Over the counter items - GP guide to self care 2.1 Minor illnesses suitable for self care Condition Exceptions Medication Common brands OTC restrictions Classification Children under 12 years with certain brands however: No routine Emollients »» Eurax® licenced for children over exceptions have Eurax® 63 3 years been identified Crotamiton » » Hc45® Hydrocortisone Cream 11. Mild irritant Eurax-Hc® Cream 64 dermatitis See earlier Steroid-containing Hc45 Hydrocortisone licenced for children over 10 years P for general preparations such as Cream® 65 Pregnancy, breastfeeding exceptions hydrocortisone Broken or inflamed skin Use on the eyes and face Ano-genital region Ketoconazole- Nizoral® Anti-dandruff Pregnancy, breastfeeding GSL containing shampoo shampoo 66 Children under 12 years No routine Polytar® scalp exceptions have shampoo 67 Pregnancy, breastfeeding been identified Children under 12 years 12. Dandruff Capasal TM Therapeutic Coal tar shampoo GSL/P See earlier Shampoo 68 Infected open skin lesions for general Alphosyl® ‘2in1’ Sore or acute pustular psoriasis exceptions shampoo 69 Selenium sulfide Pregnancy, breastfeeding Selsun® Shampoo 70 P shampoo Children under 5 years This document is for use within the NHS and is not for commercial or marketing purposes 8 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification No routine Dioralyte® Relief Children under 5 years exceptions have Oral rehydration Sachets 71 Liver or renal disease been identified solutions/sachets Imodium® Rehydration Low potassium/sodium diets GSL See earlier Salts 72 Diabetes 13. Diarrhoea for general (Adults only) Imodium® 74 Inflammatory bowel disease exceptions THIS RECOMMEND- Loperamide 2mg Dioraleze® 75 Post bowel surgery GSL/P ATION DOES capsules 73 Entrocalm® 75 Post pelvic radiation depending on NOT APPLY TO CHILDREN Diafix® 75 Colorectal cancer pack size Tears Naturale® Eye Hypromellose 0.3% 76 Drops 77 Isopto® Plain 78 Viscotears® Liquid No routine Gel 79 Carbomer exceptions have Gel Tears® 80 14. Dry eyes/ been identified Liquivisc® 81 Children under 18 years (Carbomer) sore (tired) See earlier Yellow Soft Paraffin Pregnancy, breastfeeding (check eyes individual brands) P for general BP/ PhEur exceptions Anhydrous Lanolin Simple® Eye Pre-existing eye (Wool Fat) BP/PhEur Ointment 82 conditions Liquid Paraffin BP/ PhEur Optrex® Sore Eyes Distilled witchhazel Drops 83 This document is for use within the NHS and is not for commercial or marketing purposes 9 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Olive oil drops Arachis oil/ chlorobutanol hemihydrate drops No routine Docusate sodium 0.5% exceptions have drops been identified Cerumol® 84 GSL (Olive oil) Acetic acid 2% (not 15. Earwax See earlier for licensed for wax Waxsol® 85 No restrictions P (all other ear general exceptions removal, may help if EarCalm® 86 drops/sprays) Perforated ear ears itch after wax drum removal, however significant itching may indicate infection and this should be confirmed and treated by the GP) No routine 16. Excessive exceptions have sweating Driclor® 87 Broken or infected skin been identified Aluminium chloride (hyper- Anhydrol Forte® 88 External use only hidrosis) See earlier for P general exceptions No routine GSL/P Dimeticone gel, lotion Hedrin® 89 exceptions have Children under 6 months depending on or spray 4% Nyda® 90 been identified Pregnancy, breastfeeding pack size See earlier for Malathion Aqueous Avoid use on broken or inflamed skin Derbac-M® 91 GSL general exceptions lotion 0.5% 17. Head lice Current skin conditions of the Conditioner scalp Various No restrictions GSL Headlice combs Side effects of a severe infestation This document is for use within the NHS and is not for commercial or marketing purposes 10 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Children under 12 years Gaviscon® tablets 92 Renal failure Gaviscon Double Hypercalcaemia GSL action® 93 Sodium alginate Nephrocalcinosis Acidex® 94 Calcium carbonate Kidney stones Sodium bicarbonate Children under 12 months Babies born before 37 weeks Gaviscon Infant® 95 P Children over 2 years No routine Renal impairment exceptions have Children under 18 years 18. Indigestion been identified and Esomeprazole 20mg Adults over 55 years See earlier Nexium Control® 96 GSL heartburn tablets Pregnancy, breastfeeding for general Jaundice or liver disease exceptions Children under 18 years Pantoprazole 20mg Adults over 55 years Pantoloc Control® 97 P tablets Pregnancy, breastfeeding Jaundice or liver disease Children under 16 years Zantac® 99 Ranitidine 75mg Peptic ulceration GSL (pack size Gavilast® 100 tablets 98 Elderly taking NSAIDs 12 tablets) Ranicalm® 101 Pregnancy, breastfeeding This document is for use within the NHS and is not for commercial or marketing purposes 11 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Galactosaemia Duphalac® 103 Gastro-intestinal obstruction, digestive Lactulose 102 P Lactugal® 104 perforation or risk of digestive perforation Acute inflammatory bowel diseases No routine Bisacodyl tablets Severe dehydration GSL/P Dulcolax® 106 exceptions have 5mg 105 Pregnancy and breastfeeding depending on 19. Infrequent been identified Children under 4 years pack size constipation See earlier for general Severe dehydration Senokot® Dual Relief exceptions Senna 107 Children under 18 years Tablets 108 GSL Pregnancy, breastfeeding Fybogel® 109 Ispaghula Husk Children under 6 years Ispagel® 110 Granules Diabetes GSL Manevac® 111 This document is for use within the NHS and is not for commercial or marketing purposes 12 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Impaired liver function Existing blood dyscrasias Epliepsy Prochlorperazine Buccastem® M Tab Parkinson’s Disease P maleate 3mg 112 Protastic hypertrophy Narrow angle glaucoma Pregnancy, breastfeeding Children under 18 years Paracetamol 500mg tablets 22 and capsules 23 Anadin paracetamol® 26 Long term conditions requiring regular pain relief GSL/P No routine Paracetamol Mandanol® 27 Children under 12 years depending on exceptions have 500mg/5ml oral Panadol® 28 Severe renal or severe hepatic pack size 20. Infrequent been identified solution 113 Hedex® 29 impairment migraine See earlier Paracetamol 500mg for general soluble tablets 114 exceptions Long term conditions requiring regular pain relief Asthma Ibuprofen 200mg, Unstable high blood pressure 400mg capsules and Anadin® Ibuprofen 36 Taking anticoagulants tablets 31-34 GSL/P Nurofen® 37 Stomach ulcer, perforation or bleeding depending on Ibuprofen 100mg/5ml Calprofen® 38 (active or history of) pack size liquid/suspension Cuprofen® 39 Renal impairment sugar free 35 Hepatic impairment Cardiac impairment Children under 12 years Pregnancy, breastfeeding This document is for use within the NHS and is not for commercial or marketing purposes 13 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification No routine exceptions have Infrequent Co-codamol 8/500mg Migraleve® Yellow Children under 12 years been identified P (up to 32 migraine tablets, capsules, tablets 115 Severe liver disease continued See earlier effervescent tablets tablets) Paracodol® 116 Pregnancy, breastfeeding for general exceptions Mepyramine maleate Anthisan® Bite & Sting Broken or infected skin 2% cream 2% 117 Children under 2 years GSL No routine Lidocaine Children under 12 years exceptions have Savlon® Bites & Stings hydrochloride/zinc Animal bites GSL been identified Pain Relief Gel 118 21. Insect bites sulphate/cetrimide Broken or infected skin and stings See earlier for general Calamine/zinc Calamine lotion 119 Broken or infected skin exceptions oxide 119 GSL Chloroxylenol/ Dettol® Antiseptic Dermatitis, eczema or other skin GSL triclosan/edetic acid Cream 120 complaints No routine exceptions have Pregnancy, breastfeeding Benzoyl peroxide- Acnecide® 121 been identified Damaged skin 22. Mild acne containing Duac® Once Daily 122 P See earlier Elderly preparations Quinoderm® 123 for general Children under 12 years exceptions Balneum Plus® 124 Broken or inflamed skin See earlier Cetraben® 125 Emollients, creams E45 for children over 1 month old 23. Mild dry skin for general Dermol® 126 GSL and ointments Cetraben® Cream and lotion over 1 exceptions E45® 127 year olds Oilatum® 128 This document is for use within the NHS and is not for commercial or marketing purposes 14 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification 24. Sunburn due See earlier Various including to excessive for general After sun products No restrictions GSL calamine lotion 119 sun exposure exceptions ACBS approved indication of photo- dermatoses (i.e. where skin 25. Sun protection Sun protection Various No restrictions GSL protection should be cream/ sprays/gels prescribed) See earlier for general exceptions This document is for use within the NHS and is not for commercial or marketing purposes 15 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Children under 6 years –tablets, children under 1 years - solution Pregnancy, breastfeeding Adult or children taking monoamine oxidase inhibitors within the last 14 Chlorphenamine 4mg days tablets 129 Caution in epilepsy; raised intra- ocular Piriton® 131 pressure including glaucoma; prostatic P Chlorphenamine hypertrophy; severe hypertension or 2mg/5ml solution 130 cardiovascular disease; bronchitis, bronchiectasis or asthma; hepatic impairment; renal impairment No routine Rare hereditary problems of galactose exceptions have intolerance, Lapp lactase deficiency or 26. Mild to been identified glucose-galactose malabsorption moderate hay fever/ See earlier Children under 6 years - tablets, allergic for general children under 2 years – syrup rhinitis Loratadine 10mg exceptions Pregnancy, breastfeeding GSL/P tablets 132 Clarityn Allergy® 134 Liver impairment depending on Loratadine 5mg/5ml pack sizes Rare hereditary problems of galactose syrup 133 intolerance, the Lapp lactase deficiency or glucose- galactose malabsorption Children under 12 years Adults over 65 years Pregnancy, breastfeeding GSL/P Acrivastine 8mg Benadryl Allergy Renal impairment depending on capsules 135 Relief® 135 Rare hereditary problems of galactose pack sizes intolerance, the Lapp lactase deficiency or glucose-galactose malabsorption This document is for use within the NHS and is not for commercial or marketing purposes 16 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Children under 6 years - tablets, children under 2 years - solution Zirtek Allergy (depending on the brand) Cetirizine 10mg Relief® 138 Renal impairment GSL/P tablets 136 depending on Piriteze Allergy® 139 Rare hereditary problems of fructose pack sizes Cetirizine 1mg/ml Benadryl Allergy® 140 intolerance solution 137 Pregnancy, breastfeeding Epilepsy No routine exceptions have Mild to moderate been identified GSL/P hay fever/allergic Children under 18 years Beconase Hayfever® 141 depending on rhinitis continued See earlier Beclomethasone Pregnancy, breastfeeding for general 0.05% nasal spray pack sizes exceptions Allercrom® 142 Children under 6 years Sodium cromoglycate Optrex Hayfever GSL Pregnancy, breastfeeding 2% eye drops Relief® 143 This document is for use within the NHS and is not for commercial or marketing purposes 17 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification See earlier for general exceptions No routine exceptions have been identified However more serious burns Pregnancy, breastfeeding Betadine® Dry Powder always require Children under 2 years Spray 144 GSL professional Lithium therapy medical attention. Burns requiring hospital A&E 27. Minor burns treatment Antiseptic burn cream and scalds include but are Cooling burn gel not limited to: all chemical and electrical burns; Germolene® Antiseptic large or deep Cream 145 burns; Germolene® Antiseptic burns that Ointment 146 cause white or GSL charred skin; Savlon® Antiseptic Broken or infected skin Cream 147 burns on the face, hands, Sudocrem® Antiseptic arms, feet, legs, Healing Cream 148 or genitals that cause blisters. This document is for use within the NHS and is not for commercial or marketing purposes 18 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Paracetamol 500mg tablets 22 and capsules 23 Long term conditions requiring regular Paracetamol Anadin paracetamol® 26 pain relief 120mg/5ml Mandanol® 27 Children under 2 months Babies born GSL/P suspension (from 3 Panadol® 28 before 37 weeks Babies weighing less depending on months)/sugarfree 24 Hedex® 29 than 4kg pack size Paracetamol Severe renal or severe hepatic Calpol® 30 250mg/5ml impairment suspension (from 6 years old)/sugar 28. Minor conditions free 25 associated No routine Long term conditions requiring regular with pain, exceptions have pain relief discomfort been identified and fever, Asthma e.g. aches See earlier Unstable high blood pressure Ibuprofen 200mg, and sprains, for general Anadin Ibuprofen® 36 Taking anticoagulants 400mg tablets, headache, exceptions capsules, liquid Nurofen® 37 Stomach ulcer, perforation or bleeding GSL/P period pain, back pain capsules Calprofen® 38 (active or history of) depending on Ibuprofen 100mg/5ml Cuprofen® 39 Children under 3 month pack size liquid/suspension Anadin Joint Pain® 40 Renal impairment sugar free Hepatic impairment Cardiac impairment Pregnancy, breastfeeding Not for use in chicken pox Co-codamol 8/500mg Children under 12 years Migraleve® Yellow tablets, 149 capsules, 150 P (up to 32 tablets 115 Severe liver disease effervescent tablets) Paracodol® 116 Pregnancy, breastfeeding tablets 151 This document is for use within the NHS and is not for commercial or marketing purposes 19 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification 28. Minor conditions No routine associated exceptions have with pain, Fenbid® 153 Children under 14 years been identified discomfort and Ibuprofen 5% gel 152 Ibuleve® 154 Pregnancy, breastfeeding GSL fever, e.g. aches See earlier Nurofen® 155 Broken/infected skin and sprains, for general headache, period exceptions pain, back pain Lidocaine hydrochloride/ No routine chlorocresol/ exceptions have cetylpyridinium Bonjela® 156 Children under 16 years 29. Mouth ulcers been identified chloride Anbesol® 157 Active peptic ulceration GSL See earlier Choline salicylate/ Orajel® 158 Pregnancy, breastfeeding for general cetalkonium chloride exceptions Benzocaine Titanium dioxide/ No routine Metanium® Nappy titanium peroxide/ No restrictions exceptions have Rash ointment 159 GSL titanium salicylate been identified 30. Nappy rash See earlier Zinc oxide/ for general benzyl alcohol/ Sudocrem® Antiseptic No restrictions exceptions benzylbenzoate/ Healing Cream 149 GSL lanolin This document is for use within the NHS and is not for commercial or marketing purposes 20 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification No routine exceptions have Children under 4 months been identified Miconazole 2% oral Pregnancy, breastfeeding 31. Oral thrush Daktarin® Oral Gel 160 P See earlier gel 15g 160 Patients taking warfarin for general Liver dysfunction exceptions No routine exceptions have been identified Prescription only Mouthwashes such 32. Prevention medicines need of dental as chlorhexidine to be re-directed gluconate Corsodyl® 161 Children under 12 years GSL caries (dental decay) to the dentist to prescribe Fluoride toothpaste See earlier for general exceptions Miconazole 2% cream 162 Daktarin® 162 Diabetes P (cream) Lymphoedema or Miconazole powder Daktarin Powder 163 163 Pregnancy, breastfeeding GSL (powder) history of lower Miconazole 0.16% Daktarinaktiv® 164 33. Ringworm/ limb cellulitis spray powder 164 Athletes foot See earlier Lamisil® AT cream, 165 for general gel, 166 spray 167 Children under 16 years exceptions Terbinafine Scholl® Athlete’s Diabetes GSL hydrochloride 1% Foot powder, 168 spray Pregnancy, breastfeeding liquid 169 This document is for use within the NHS and is not for commercial or marketing purposes 21 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Paracetamol 500mg tablets, capsules, effervescent tablets Long term conditions requiring regular Anadin Paracetamol® 26 pain relief Paracetamol 120mg/5ml Mandanol® 27 Children under 2 months GSL/P suspension (from 3 Panadol® 28 Babies born before 37 weeks depending on months) sugar free Hedex® 29 Babies weighing less than 4 kg pack size Paracetamol Calpol® 30 Severe renal or severe hepatic 250mg/5ml impairment suspension (from 6 years old) sugar free Long term conditions requiring regular pain relief No routine Asthma 34. Teething/ exceptions have Unstable high blood pressure mild been identified toothache Ibuprofen 200mg, Anadin Ibuprofen® 36 Taking anticoagulants See earlier 400mg capsules and Nurofen® 37 Stomach ulcer, perforation or bleeding GSL/P for general tablets 31-34 Calprofen® 38 (active or history of) depending on exceptions Ibuprofen 100mg/5ml Cuprofen® 39 Children under 3 months pack size liquid sugar free 35 Anadin Joint Pain® 40 Renal impairment Hepatic impairment Cardiac impairment Pregnancy, breastfeeding Avoid the use in chicken pox Babies under 2 months Bonjela® 156 Teething gel Heart disease GSL Dentinox® TeethingGel 170 Liver disease This document is for use within the NHS and is not for commercial or marketing purposes 22 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification No routine exceptions have 35. Thread- been identified Mebendazole 100mg Children under 2 years Ovex® 171 P worms See earlier tablets Pregnancy, breastfeeding for general exceptions Parkinsons People with fructose or galactose intolerance, Lapp lactase deficiency, glucose- galactose malabsorption Cinnarizine tablets Stugeron® Tablets or sucrase- isomaltase insufficiency, 15mg 15mg 172 should not take this medicine because it P contains lactose and sucrose No routine Porphyria exceptions have Children under 5 years 36. Travel been identified Pregnancy, breastfeeding sickness See earlier Children under 3 years (Joyrides®) for general Joy-Rides® Tablets under 4 years (Kwells®) exceptions Chewable 150mcg 173 Epilepsy Hyoscine Kwells 300mcg Glaucoma hydrobromide tablets P tablets 174 Pregnancy, breastfeeding 150mcg Kwells Kids® Tablets Paralytic ileus, pyloric stenosis, 150mcg 175 prostatic enlargement Myasthenia gravis This document is for use within the NHS and is not for commercial or marketing purposes 23 of 38  227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Common brands OTC restrictions Classification Bazuka® Extra strength gel 176 Diabetes patients Verruca gel such as Bazuka® Gel 177 Face, neck, ano-genital area P those containing Bazuka® Treatment Moles, birthmarks, hairy warts or skin salicylic acid and lesions GSL (Bazuka Gel 178 lactic acid treatment gel) Bazuka Extra Broken skin Strength® Treatment Impaired peripheral blood circulation Gel 179 Diabetes patients No routine Wart paint/ointment Salactol Collodion® 180 Face, neck, ano-genital area 37. Warts and exceptions have such as those Occlusal® 181 Moles, birthmarks, hairy warts or skin verrucae been identified See earlier containing salicyclic Salatac® 182 lesions acid and lactic acid P for general Verrugon® ointment 183 Broken skin exceptions Impaired peripheral blood circulation Children under 4 years Wart freeze Diabetes patients treatments containing Face, armpits, breasts , ano-genital area liquid freezing agents Scholl® Freeze 184 Moles, birthmarks, hairy warts or skin GSL such as dimethyl Bazuka® Sub Zero 185 lesions ether, propane and isobutane Broken skin Impaired peripheral blood circulation This document is for use within the NHS and is not for commercial or marketing purposes 24 of 38  227. Over the counter items - GP guide to self care 2.1 References 1. NHS England and NHS Clinical Commissioners. Conditions for which over the counter items should not routinely be prescribed in primary care. Guidance for CCGs. March 2018. 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