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 GP will be required to write a prescription:

OTC condition Product Restrictions on OTC (therefore must License* be prescribed) Benzoyl peroxide 5% gel None Acne P (Acnecide®) Patient < 18 years old GSL (100 Beclomethasone 0.05% Cases of chronic rhinitis (OTC product doses) nasal spray advises patients to consult doctor if using P (180 (Beconase®) for than 3 consecutive months) doses) Fluticasone 0.05% nasal GSL (60 spray doses) (Pirinase Allergy®) Patients < 12 years old Clobetasone butyrate For chronic diagnosed skin conditions. 0.05% cream P For facial use (Eumovate®) Allergies Patient has used OTC product > 7 days Patients < 10 years old Hydrocortisone 1% For chronic diagnosed skin conditions P cream For use on genital areas or face Patient has used OTC product > 7 days Chlorphenamine maleate Patient < 1 years old P 2mg/5ml oral solution Cetirizine GSL(pack 10mg tablets Pregnancy sizes 7 or 14 Breastfeeding tablets) Loratadine 10mg P (other tablets pack sizes) Patients <10 years old OTC license only covers sweat rash & Hydrocortisone 1% & athletes foot miconazole 2% cream P For use on genital areas or face (Daktacort®) Patient has used OTC product for > 7 days Patient is diabetic (and is using on the Athlete’s foot Miconazole 2% cream foot) P (Daktarin®) OTC license covers single dose Terbinafine 1% treatment of athlete’s foot cutaneous solution Patient is < 18 years old GSL (Lamisil Once®) No improvement in 7 days.

* GSL (General Sales List) P (Pharmacy only)

OTC condition Product Restrictions on OTC (therefore must License be prescribed) Chloramphenicol 0.5% Patient < 2 years old eye drops Pregnancy Bacterial Chloramphenicol 1% Breastfeeding conjunctivitis P eye ointment OTC license only covers treatment of (Optrex®) bacterial conjunctivitis only

Patient falls within ACBS criteria. Colic Lactase (Colief® drops) GSL

Bisacodyl 5mg GR Patient < 10 years old GSL tablets Chronic use (as part of a treatment plan P (pack (Duloclax®) size 100 Constipation tablets)

Patient <12 years old GSL Senna 7.5mg tablets Chronic use (as part of a treatment plan) Long term cough or asthma Pholcodine 5mg/5ml OTC product should only be used for 5 P linctus days for treatment of acute non- productive cough Patient < 12 years old Coughs & Patient has hypertension colds Patient requires a product or a Pseudoephedrine combination of products which contain P tablets more than 720mg of pseudoephedrine (or 180mg of ephedrine) or they require both pseudoephedrine and ephedrine containing products OTC license covers treatment of dandruff Ketoconazole 2% Dandruff and seborrheic dermatitis (scalp) only P shampoo (Nizoral®)

For chronic use in the management of Chlorhexidine Dental hygiene long term condition (e.g. prevention of gluconate 0.2% GSL oral candidiasis in immunocompromised mouthwash patients) Dioralyte® relief Patient < 1 years old GSL sachets Patients <12 years old (for diarrhoea) or GSL (pack Diarrhoea patients < 18years (for relief of acute Loperamide 2mg size 6) episodes of diarrhoea associated with capsules P (other diagnosed IBS) pack sizes) Chronic use (as part of treatment plan) Dry skin Should only prescribe an emollient for a diagnosed skin condition and conditions product choice should be in line with E N Herts CCG’s ‘Emollient Guidelines’: 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 Food items safeguarding concerns in at-risk adults or children. Prescribing of milk products in children < 2 years old with Cow’s Milk Protein Allergy should be in line with CCG decision document.

* GSL (General Sales List) P (Pharmacy only)

Restrictions on OTC (therefore must License OTC condition Product be prescribed) E N Herts CCG does not recommend the prescribing of topical Fungal Nail antifungal nail preparations. Treatment

Patient requires high doses of vitamin D Vitamin D for deficiency purposes (only if levels GSL General supplements <30nmol/L) as per local guidance wellbeing

Anusol® Chronic use (as part of a treatment Haemorrhoids cream/ointment GSL plan) /suppositories GSL (50ml Dimeticone 4% lotion pack) Headlice Patient < 6 months old (Hedrin®) P (other pack size) GSL (pack Gaviscon Advance® size 150ml Double Action® liquid Patient < 12 years old & 300ml) Symptoms are persistent after 7 days Gaviscon Double Action® liquid GSL Patient <6 years old Gaviscon Original® Symptoms are persistent after 7 days GSL liquid Heartburn/ Esomeprazole 20mg g/r tablets Patient < 18 years old ingestion GSL (Nexium control®) Patient requires a daily dose >20mg Omeprazole 10mg Pregnancy P GR tablets Breastfeeding Pantoprazole 20mg g/r For chronic use (over 14 days) tablets P (Pantoloc control®) Ranitidine 75mg Patient < 16 years old GSL (pack tablets Patient requires a daily dose >150mg size of 6, (Zantac relief®) For chronic use (over 14 days) 12)

* GSL (General Sales List) P (Pharmacy only)

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

* GSL (General Sales List) P (Pharmacy only)

OTC license covers treatment of threadworms only Mebendazole Patient requires a daily dose >100mg Threadworms 100mg tablets P Patient < 2 years old (Ovex®) Pregnancy Breastfeeding

* GSL (General Sales List) P (Pharmacy only)

OTC condition Product Restrictions on OTC (therefore must be License prescribed) Clotrimazole 10% Patients < 16 years old or >60 years old internal & 2% More than 2 episodes of thrush within 6 external cream months P combi Underlying conditions which predisposes (Canestan®) patient to develop thrush Pregnancy Clotrimazole 2%

cream P (Canestan Thrush® Cream) Thrush Clotrimazole Patients < 16 years old or >60 years old 500mg pessary & More than 2 episodes of thrush within 6 2% external months GSL cream No improvement in symptoms within 7 days (Canestan®) Underlying conditions which predisposes Fluconazole patient to develop thrush 150mg oral Pregnancy P capsule (Canestan®) Patient children < 5 years old Travel Cinnarizine OTC license covers treatment of symptoms P protection 15mg tablets associated with motion sickness only

OTC license does not cover use near the GSL face, neck, armpits, breasts, bottom or genital (Bazuka regions, or by diabetics or individuals who gel) Verrucas and Bazuka® gel suffer from poor blood circulation to the hands P Warts or feet (Bazuka extra strength)

* GSL (General Sales List) P (Pharmacy only)