Over the Counter Items - GP Guide to Self Care 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 routinely be prescribed in primary care. 1 It listed 35 conditions plus probiotics and vit...

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 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 4 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 15. Earwax 10 16. Excessive sweating (hyperhidrosis) 17. Head lice 10 18. Indigestion and heartburn 11 19. Infrequent constipation 12 20. Infrequent migraine 13 21. Insect bites and stings 22. Mild acne 14 23. Mild dry skin 14 24. Sunburn due to excessive sun exposure 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) 33. Ringworm/Athletes foot 21 34. Teething/mild toothache 22 35. Threadworms 23 36. Travel sickness 23 37. Warts and verrucae 24 9 10 14 15 21 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 1. Probiotics Exceptions 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. 2. Vitamins and minerals Any prescribing not in-line with listed exceptions should be discontinued. 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 Condition P = pharmacy only Exceptions GSL = general sales list Medication Benzydamine 0.15% mouthwash 5 and oromucosal spray 6 Common brands OTC restrictions Difflam®Spray 7 Difflam® Oral rinse Children under 12 years (oral rinse) 8 Pregnancy, breastfeeding Classification P Diabetes Children under 6 years (Strepsils®) Strepsils® 9 3. Acute sore throat Red flag symptoms Throat lozenges Throaties® 10 Tyrozets® 11 Children under 3 years (Throaties® Tyrozets®) Fructose intolerance, glucose- galactose malabsorption or sucrose- isomaltose insufficiency GSL P Pregnancy, breastfeeding Children under 6 years Throat sprays Ultra Chloraseptic® 12 Epiglottitis Methaemoglobinaemia GSL Pregnancy, breastfeeding 4. Infrequent cold sores of the lip Immunocompromised patients Red flag symptoms Virasorb® 14 Aciclovir cream 5% 13 Zovirax® 15 Lypsyl® 16 Immunocompromised and terminally ill Only for face and lips This document is for use within the NHS and is not for commercial or marketing purposes GSL 4 of 38 227. Over the counter items - GP guide to self care 2.1 Condition 5. Conjunctivitis Exceptions Medication Red flag symptoms Chloramphenicol 0.5% Brochlor® 19 eye drops 17 Golden eye® 20 Chloramphenicol 1% Optrex® 21 eye ointment 18 Paracetamol 500mg tablets 22 and capsules 23 Paracetamol 120mg/5ml suspension (from 3 months) sugar free 24 6. Coughs and colds and nasal congestion Paracetamol 250mg/5ml suspension (from 6 years old) 25 Common brands OTC restrictions Children under 2 years Pregnancy, breastfeeding Anadin paracetamol® 26 Mandanol® 27 Panadol® Children under 2 months Hedex® 29 P Severe renal or severe hepatic impairment Long term conditions requiring regular pain relief 28 Classification GSL/P depending on pack size Babies born before 37 weeks Calpol® 30 Babies weighing less than 4kg Long term conditions requiring regular pain relief Red flag symptoms Asthma Unstable high blood pressure Ibuprofen 200mg, 400mg capsules/ tablets 31-34 Anadin Ibuprofen® Nurofen® 36 37 Calprofen® 38 Ibuprofen 100mg/5ml Cuprofen® 39 oral suspension 35 Anadin Joint pain® 40 Taking anticoagulants Stomach ulcer, perforation or bleeding (active or history of) Children under 3 months GSL/P depending on pack size 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 Pseudoephedrine or pseudoephedrinecontaining preparations 6. Coughs and colds and nasal congestion continued 8. Cradle cap (seborrhoeic dermatitis – infants) Haemorrhoids Severe renal impairment Red flag symptoms If causing distress to the infant and not improving Red flag symptoms P Phaeochromocytoma Diabetes Galpseud® 43 Hyperthyroidism Closed angle glaucoma Paracetamol 1000mg/ Pholcodine 10mg/ Pseudoephedrine HCL 60mg in 30ml oral Day Nurse® Oral solution 44 Solution 44 Day Nurse® Capsules Paracetamol 500mg/ Pholcodine 5mg/ Pseudoephedrine HCL 30mg capsules 45 7. Severe hypertension or severe coronary artery disease Benadryl® Allergy Relief Plus Decongestant Capsules 42 Children under 16 years Severe hypertension or severe coronary artery disease 45 Capasal TM Therapeutic Shampoo 46 Emulsifying ointment and shampoo Dentinox® Shampoo Cradle Cap 47 Boots Cradle Cap Cream® 48 Zinc oxide preparations Anusol® cream 49 ointment 50 and suppositories 51 Germoloids® cream 52 ointment 53 and suppositories 54 Severe renal impairment P Hyperexcitability Pregnancy, breastfeeding If the cradle cap has spread to the face Do not use on broken skin or infected skin GSL Not recommended for children (Anusol®) Children under 12 years (Germoloids®) GSL Pregnancy, breastfeeding 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 9. Infant colic Exceptions Red flag symptoms Medication Common brands OTC restrictions Classification Simeticone 40mg/ml 55 Infacol® 55 No restrictions GSL Dimeticone 42mg/5ml 56 Fructose, glucose-galactose, or sucrose intolerant patients (contains sucrose) GSL Dentinox® 56 Men Sodium citrate 4g sachet 57 10. Mild cystitis Red flag symptoms Children under 16 years Caneoasis cystitis relief granules® 58 Boots cystitis relief® Diabetes 59 Heart disease, hypertension, renal disease GSL Pregnancy, breastfeeding Potassium citrate 1.5g liquid 60 Cymaclear® 60 Children under 6 years 3g sachet Renal disease/impairment 61 1.5g tablet (effervescent) 62 Cystopurin® 61 Effercitrate® 62 GSL Pregnancy, breastfeeding 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: 11. Mild irritant dermatitis No routine exceptions have been identified Emollients See earlier for general exceptions Steroid-containing preparations such as hydrocortisone Crotamiton »» Eurax® 63 Eurax-Hc® Cream 64 Hc45 Hydrocortisone Cream® 65 Eurax® licenced for children over 3 years » » Hc45® Hydrocortisone Cream licenced for children over 10 years P Pregnancy, breastfeeding Broken or inflamed skin Use on the eyes and face Ano-genital region Ketoconazolecontaining shampoo 12. Dandruff No routine exceptions have been identified See earlier for general exceptions Nizoral® Anti-dandruff Pregnancy, breastfeeding shampoo 66 Children under 12 years Polytar® scalp shampoo 67 Coal tar shampoo Selenium sulfide shampoo Pregnancy, breastfeeding Capasal TM Therapeutic Shampoo 68 Children under 12 years Alphosyl® ‘2in1’ shampoo 69 Sore or acute pustular psoriasis Selsun® Shampoo 70 GSL Infected open skin lesions Pregnancy, breastfeeding Children under 5 years This document is for use within the NHS and is not for commercial or marketing purposes GSL/P P 8 of 38 227. Over the counter items - GP guide to self care 2.1 Condition Exceptions No routine exceptions have been identified 13. Diarrhoea (Adults only) Medication Oral rehydration solutions/sachets OTC restrictions Dioralyte® Relief Sachets 71 Children under 5 years Loperamide 2mg capsules 73 Imodium® 74 Inflammatory bowel disease Dioraleze® 75 Post bowel surgery Entrocalm® Post pelvic radiation 75 Diafix® 75 Hypromellose 0.3% 76 Classification Liver or renal disease Imodium® Rehydration Low potassium/sodium diets Salts 72 Diabetes See earlier for general exceptions THIS RECOMMENDATION DOES NOT APPLY TO CHILDREN Common brands Colorectal cancer GSL GSL/P depending on pack size Tears Naturale® Eye Drops 77 Isopto® Plain 78 14. Dry eyes/ sore (tired) eyes No routine exceptions have been identified See earlier for general exceptions Pre-existing eye conditions Carbomer Viscotears® Liquid Gel 79 Gel Tears® 80 Liquivisc® 81 Children under 18 years (Carbomer) Pregnancy, breastfeeding (check individual brands) Yellow Soft Paraffin BP/ PhEur Anhydrous Lanolin (Wool Fat) BP/PhEur Liquid Paraffin BP/ PhEur Simple® Eye Ointment 82 Distilled witchhazel Optrex® Sore Eyes Drops 83 This document is for use within the NHS and is not for commercial or marketing purposes P 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 exceptions have been identified 15. Earwax 16. Excessive sweating (hyperhidrosis) Acetic acid 2% (not See earlier for licensed for wax general exceptions removal, may help if ears itch after wax Perforated ear removal, however drum significant itching may indicate infection and this should be confirmed and treated by the GP) No routine exceptions have been identified Aluminium chloride See earlier for general exceptions No routine exceptions have been identified 17. Head lice Docusate sodium 0.5% drops Dimeticone gel, lotion or spray 4% Malathion Aqueous See earlier for general exceptions lotion 0.5% Current skin conditions of the scalp Side effects of a severe infestation Conditioner Headlice combs Cerumol® 84 GSL (Olive oil) Waxsol® 85 EarCalm® No restrictions 86 Driclor® 87 Anhydrol Forte® P (all other ear drops/sprays) Broken or infected skin 88 External use only P Pregnancy, breastfeeding GSL/P depending on pack size Derbac-M® 91 Avoid use on broken or inflamed skin GSL Various No restrictions GSL Hedrin® 89 Nyda® 90 Children under 6 months 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 Gaviscon® tablets 92 Sodium alginate Calcium carbonate Gaviscon Double action® 93 Acidex® 94 Gaviscon Infant® 95 18. Indigestion and heartburn See earlier for general exceptions Classification Children under 12 years Renal failure Hypercalcaemia GSL Nephrocalcinosis Kidney stones Children under 12 months Sodium bicarbonate No routine exceptions have been identified OTC restrictions Babies born before 37 weeks Children over 2 years P Renal impairment Children under 18 years Esomeprazole 20mg tablets Nexium Control® 96 Adults over 55 years Pregnancy, breastfeeding GSL Jaundice or liver disease Children under 18 years Pantoprazole 20mg tablets Pantoloc Control® 97 Adults over 55 years Pregnancy, breastfeeding P Jaundice or liver disease Ranitidine 75mg tablets 98 Zantac® 99 Gavilast® 100 Ranicalm® 101 Children under 16 years Peptic ulceration Elderly taking NSAIDs GSL (pack size 12 tablets) 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 Lactulose 102 Common brands Duphalac® 103 Lactugal® 104 OTC restrictions Classification Galactosaemia Gastro-intestinal obstruction, digestive perforation or risk of digestive perforation P Acute inflammatory bowel diseases 19. Infrequent constipation No routine exceptions have been identified See earlier for general exceptions Bisacodyl tablets 5mg 105 Dulcolax® 106 Severe dehydration Pregnancy and breastfeeding Children under 4 years Senna 107 Ispaghula Husk Granules Senokot® Dual Relief Tablets 108 Fybogel® 109 Ispagel® 110 Manevac® 111 GSL/P depending on pack size Severe dehydration Children under 18 years Pregnancy, breastfeeding GSL Children under 6 years Diabetes This document is for use within the NHS and is not for commercial or marketing purposes GSL 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 maleate Buccastem® M Tab 3mg 112 Parkinson’s Disease Protastic hypertrophy P Narrow angle glaucoma Pregnancy, breastfeeding Children under 18 years Paracetamol 500mg tablets 22 and capsules 23 20. Infrequent migraine No routine exceptions have been identified Paracetamol 500mg/5ml oral solution 113 See earlier for general exceptions Paracetamol 500mg soluble tablets 114 Anadin paracetamol® 26 Long term conditions requiring regular pain relief Mandanol® 27 Children under 12 years Panadol® 28 Severe renal or severe hepatic Hedex® 29 impairment GSL/P depending on pack size Long term conditions requiring regular pain relief Asthma Ibuprofen 200mg, 400mg capsules and tablets 31-34 Unstable high blood pressure Anadin® Ibuprofen Nurofen® 37 Ibuprofen 100mg/5ml Calprofen® 38 liquid/suspension Cuprofen® 39 sugar free 35 36 Taking anticoagulants Stomach ulcer, perforation or bleeding (active or history of) Renal impairment GSL/P depending on pack size 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 Infrequent migraine continued 21. Insect bites and stings 22. Mild acne Exceptions No routine exceptions have been identified See earlier for general exceptions Medication Common brands Co-codamol 8/500mg Migraleve® Yellow tablets 115 tablets, capsules, effervescent tablets Paracodol® 116 OTC restrictions Children under 12 years Severe liver disease Pregnancy, breastfeeding Mepyramine maleate 2% Anthisan® Bite & Sting Broken or infected skin cream 2% 117 Children under 2 years No routine exceptions have been identified Lidocaine hydrochloride/zinc sulphate/cetrimide Savlon® Bites & Stings Pain Relief Gel 118 See earlier for general exceptions Calamine/zinc oxide 119 Calamine lotion 119 Broken or infected skin Chloroxylenol/ triclosan/edetic acid Dettol® Antiseptic Cream 120 Dermatitis, eczema or other skin complaints Benzoyl peroxidecontaining preparations Acnecide® 121 No routine exceptions have been identified See earlier for general exceptions Duac® Once Daily 122 Quinoderm® 123 Balneum Plus® 124 See earlier 23. Mild dry skin for general exceptions Emollients, creams and ointments Cetraben® 125 Dermol® 126 E45® 127 Oilatum® 128 Classification P (up to 32 tablets) GSL Children under 12 years Animal bites GSL Broken or infected skin GSL GSL Pregnancy, breastfeeding Damaged skin Elderly P Children under 12 years Broken or inflamed skin E45 for children over 1 month old Cetraben® Cream and lotion over 1 year olds This document is for use within the NHS and is not for commercial or marketing purposes GSL 14 of 38 227. Over the counter items - GP guide to self care 2.1 Condition Exceptions 24. Sunburn due See earlier to excessive for general sun exposure exceptions 25. Sun protection ACBS approved indication of photodermatoses (i.e. where skin protection should be prescribed) Medication Common brands OTC restrictions Classification After sun products Various including calamine lotion 119 No restrictions GSL Sun protection cream/ sprays/gels Various No restrictions GSL 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 Chlorphenamine 4mg tablets 129 Chlorphenamine 2mg/5ml solution 130 26. Mild to moderate hay fever/ allergic rhinitis Adult or children taking monoamine oxidase inhibitors within the last 14 days Caution in epilepsy; raised intra- ocular pressure including glaucoma; prostatic hypertrophy; severe hypertension or cardiovascular disease; bronchitis, bronchiectasis or asthma; hepatic impairment; renal impairment Piriton® 131 No routine exceptions have been identified See earlier for general exceptions P Rare hereditary problems of galactose intolerance, Lapp lactase deficiency or glucose-galactose malabsorption Loratadine 10mg tablets 132 Loratadine 5mg/5ml syrup 133 Children under 6 years - tablets, children under 2 years – syrup Pregnancy, breastfeeding Clarityn Allergy® 134 Liver impairment Rare hereditary problems of galactose intolerance, the Lapp lactase deficiency or glucose- galactose malabsorption GSL/P depending on pack sizes Children under 12 years Adults over 65 years Acrivastine 8mg capsules 135 Benadryl Allergy Relief® 135 Pregnancy, breastfeeding Renal impairment Rare hereditary problems of galactose 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 GSL/P depending on pack sizes 16 of 38 227. Over the counter items - GP guide to self care 2.1 Condition Exceptions Medication Cetirizine 10mg tablets 136 Cetirizine 1mg/ml solution 137 No routine exceptions have Mild to moderate been identified hay fever/allergic rhinitis continued See earlier for general exceptions Common brands OTC restrictions Children under 6 years - tablets, children under 2 years - solution (depending on the brand) Zirtek Allergy Relief® 138 Renal impairment Piriteze Allergy® 139 Benadryl Allergy® 140 Rare hereditary problems of fructose intolerance Classification GSL/P depending on pack sizes Pregnancy, breastfeeding Epilepsy Beclomethasone 0.05% nasal spray Beconase Hayfever® 141 Allercrom® 142 Sodium cromoglycate 2% eye drops Optrex Hayfever Relief® 143 Children under 18 years Pregnancy, breastfeeding Children under 6 years Pregnancy, breastfeeding This document is for use within the NHS and is not for commercial or marketing purposes GSL/P depending on pack sizes GSL 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 27. Minor burns and scalds However more serious burns always require professional medical attention. Burns requiring hospital A&E treatment include but are not limited to: all chemical and electrical burns; large or deep burns; burns that cause white or charred skin; burns on the face, hands, arms, feet, legs, or genitals that cause blisters. Pregnancy, breastfeeding Betadine® Dry Powder Children under 2 years Spray 144 Lithium therapy GSL Antiseptic burn cream Cooling burn gel Germolene® Antiseptic Cream 145 Germolene® Antiseptic Ointment 146 Savlon® Antiseptic Cream 147 Broken or infected skin GSL Sudocrem® Antiseptic Healing Cream 148 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 Anadin paracetamol® 26 Long term conditions requiring regular pain relief Paracetamol 500mg tablets 22 and capsules 23 Paracetamol 120mg/5ml suspension (from 3 months)/sugarfree 24 28. Minor conditions associated with pain, discomfort and fever, e.g. aches and sprains, headache, period pain, back pain Paracetamol 250mg/5ml suspension (from 6 years old)/sugar free 25 Mandanol® 27 Panadol® Children under 2 months Babies born before 37 weeks Babies weighing less than 4kg 28 Hedex® 29 GSL/P depending on pack size Severe renal or severe hepatic impairment Calpol® 30 No routine exceptions have been identified See earlier for general exceptions Classification Long term conditions requiring regular pain relief Asthma Ibuprofen 200mg, 400mg tablets, capsules, liquid capsules Unstable high blood pressure Anadin Ibuprofen® Nurofen® 36 37 Calprofen® 38 Ibuprofen 100mg/5ml Cuprofen® 39 liquid/suspension Anadin Joint Pain® 40 sugar free Taking anticoagulants Stomach ulcer, perforation or bleeding (active or history of) Children under 3 month GSL/P depending on pack size Renal impairment Hepatic impairment Cardiac impairment Pregnancy, breastfeeding Not for use in chicken pox Co-codamol 8/500mg Migraleve® Yellow tablets, 149 capsules, 150 tablets 115 effervescent Paracodol® 116 tablets 151 Children under 12 years Severe liver disease Pregnancy, breastfeeding This document is for use within the NHS and is not for commercial or marketing purposes P (up to 32 tablets) 19 of 38 227. Over the counter items - GP guide to self care 2.1 Condition 28. Minor conditions associated with pain, discomfort and fever, e.g. aches and sprains, headache, period pain, back pain Exceptions No routine exceptions have been identified See earlier for general exceptions No routine exceptions have 29. Mouth ulcers been identified See earlier for general exceptions 30. Nappy rash No routine exceptions have been identified See earlier for general exceptions Medication Ibuprofen 5% gel 152 Lidocaine hydrochloride/ chlorocresol/ cetylpyridinium chloride Choline salicylate/ cetalkonium chloride Common brands OTC restrictions Fenbid® 153 Children under 14 years Ibuleve® 154 Pregnancy, breastfeeding Nurofen® 155 Broken/infected skin Bonjela® 156 Children under 16 years Anbesol® 157 Active peptic ulceration Orajel® Pregnancy, breastfeeding 158 Classification GSL GSL Benzocaine Titanium dioxide/ titanium peroxide/ titanium salicylate Metanium® Nappy Rash ointment 159 No restrictions Zinc oxide/ benzyl alcohol/ benzylbenzoate/ lanolin Sudocrem® Antiseptic Healing Cream 149 No restrictions This document is for use within the NHS and is not for commercial or marketing purposes GSL GSL 20 of 38 227. Over the counter items - GP guide to self care 2.1 Condition 31. Oral thrush Exceptions No routine exceptions have been identified See earlier for general exceptions Medication Common brands OTC restrictions Classification Children under 4 months Miconazole 2% oral gel 15g 160 Daktarin® Oral Gel 160 Pregnancy, breastfeeding Patients taking warfarin P Liver dysfunction No routine exceptions have been identified Prescription only 32. Prevention medicines need of dental to be re-directed caries (dental to the dentist to decay) prescribe Mouthwashes such as chlorhexidine gluconate Corsodyl® 161 Children under 12 years GSL Diabetes P (cream) Pregnancy, breastfeeding GSL (powder) Fluoride toothpaste See earlier for general exceptions Miconazole 2% cream 162 Daktarin® 162 163 Daktarin Powder 163 Lymphoedema or Miconazole powder history of lower Daktarinaktiv® 164 Miconazole 0.16% limb cellulitis spray powder 164 33. Ringworm/ Athletes foot See earlier for general exceptions Terbinafine hydrochloride 1% Lamisil® AT cream, 165 gel, 166 spray 167 Scholl® Athlete’s Foot powder, 168 spray liquid 169 Children under 16 years Diabetes GSL Pregnancy, breastfeeding 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 Paracetamol 500mg tablets, capsules, effervescent tablets Paracetamol 120mg/5ml suspension (from 3 months) sugar free Paracetamol 250mg/5ml suspension (from 6 years old) sugar free 34. Teething/ mild toothache No routine exceptions have been identified See earlier for general exceptions Common brands OTC restrictions Anadin Paracetamol® 26 Long term conditions requiring regular pain relief Mandanol® 27 Children under 2 months Panadol® Babies born before 37 weeks 28 Hedex® 29 Babies weighing less than 4 kg Calpol® 30 Severe renal or severe hepatic impairment Classification GSL/P depending on pack size Long term conditions requiring regular pain relief Asthma Unstable high blood pressure Ibuprofen 200mg, 400mg capsules and tablets 31-34 Anadin Ibuprofen® Nurofen® 36 37 Calprofen® 38 Ibuprofen 100mg/5ml Cuprofen® 39 liquid sugar free 35 Anadin Joint Pain® 40 Taking anticoagulants Stomach ulcer, perforation or bleeding (active or history of) Children under 3 months GSL/P depending on pack size Renal impairment Hepatic impairment Cardiac impairment Pregnancy, breastfeeding Avoid the use in chicken pox Teething gel Bonjela® 156 Dentinox® TeethingGel 170 Babies under 2 months Heart disease GSL 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 35. Threadworms Exceptions No routine exceptions have been identified See earlier for general exceptions Medication Common brands Mebendazole 100mg tablets Ovex® 171 OTC restrictions Children under 2 years Pregnancy, breastfeeding Classification P Parkinsons Cinnarizine tablets 15mg 36. Travel sickness Stugeron® Tablets 15mg 172 People with fructose or galactose intolerance, Lapp lactase deficiency, glucose- galactose malabsorption or sucrase- isomaltase insufficiency, should not take this medicine because it P contains lactose and sucrose Porphyria No routine exceptions have been identified Children under 5 years Pregnancy, breastfeeding See earlier for general exceptions Hyoscine hydrobromide tablets 150mcg Joy-Rides® Tablets Chewable 150mcg 173 Children under 3 years (Joyrides®) under 4 years (Kwells®) Epilepsy Kwells 300mcg tablets 174 Glaucoma Kwells Kids® Tablets 150mcg 175 Paralytic ileus, pyloric stenosis, prostatic enlargement Pregnancy, breastfeeding P 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 Verruca gel such as those containing salicylic acid and lactic acid 37. Warts and verrucae No routine exceptions have been identified See earlier for general exceptions Wart paint/ointment such as those containing salicyclic acid and lactic acid Common brands OTC restrictions Bazuka® Extra strength gel 176 Diabetes patients Bazuka® Gel 177 Face, neck, ano-genital area Bazuka® Treatment Gel 178 Moles, birthmarks, hairy warts or skin lesions Bazuka Extra Strength® Treatment Gel 179 Broken skin Salactol Collodion® P GSL (Bazuka treatment gel) Impaired peripheral blood circulation Diabetes patients 180 Occlusal® 181 Salatac® Classification 182 Face, neck, ano-genital area Moles, birthmarks, hairy warts or skin lesions Verrugon® ointment 183 Broken skin Impaired peripheral blood circulation Wart freeze treatments containing liquid freezing agents Scholl® Freeze 184 such as dimethyl Bazuka® Sub Zero 185 ether, propane and isobutane P Children under 4 years Diabetes patients Face, armpits, breasts , ano-genital area Moles, birthmarks, hairy warts or skin lesions GSL 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. 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This document is for use within the NHS and is not for commercial or marketing purposes 37 of 38 227. Over the counter items - GP guide to self care 2.1 Acknowledgements Mid Essex Clinical Commissioning Group. Policy on Prescribing of Medicines that are Available for Purchase (Self care), August 2017. Available at: https://midessexccg.nhs.uk/your-health-services/medicines-optimisation/selfcare-materials Information compiled by Claire Dearden, PrescQIPP CIC, August 2018, edited by Gemma Dowell, September 2018 and reviewed by Katie Smith, Senior Medicines Evidence Reviewer, October 2018. Non-subscriber publication February 2018. Contact [email protected] with any queries or comments related to the content of this document. This document represents the view of PrescQIPP CIC at the time of publication, which was arrived at after careful consideration of the referenced evidence, and in accordance with PrescQIPP’s quality assurance framework. The use and application of this guidance does not override the individual responsibility of health and social care professionals to make decisions appropriate to local need and the circumstances of individual patients (in consultation with the patient and/or guardian or carer). Terms and conditions Additional PrescQIPP resources Quick reference guide Patient information letter Available here: www.prescqipp.info/our-resources/bulletins/bulletin-227-self-care-over-the-counter-items/ Information compiled by Claire Dearden, PrescQIPP CIC and reviewed by Katie Smith, Director of Clinical Quality, PrescQIPP CIC, October 2018. Non-subscriber publication February 2018. Contact [email protected] with any queries or comments related to the content of this document. This document represents the view of PrescQIPP CIC at the time of publication, which was arrived at after careful consideration of the referenced evidence, and in accordance with PrescQIPP’s quality assurance framework. The use and application of this guidance does not override the individual responsibility of health and social care professionals to make decisions appropriate to local need and the circumstances of individual patients (in consultation with the patient and/or guardian or carer). Terms and conditions This document is for use within the NHS and is not for commercial or marketing purposes 38 of 38