Self Care and Over the Counter Items: a Quick Reference Guide

Self care and over the counter items: A quick reference guide

This is a quick reference guide for GPs. • If you print this document you can use the contents page and headings on the bottom of the pages to quickly find the information you require. • If you use this document on screen you can click on the condition you need information on and the link will take you directly to the page. Contents

Background General exceptions

Items of low clinical effectiveness Minor illnesses suitable for self care Sunburn 24 Probiotics 1 Mild irritant dermatitis 11 Sun protection 25 Vitamins and minerals 2 Dandruff 12 Hay fever/allergic rhinitis 26 Diarrhoea (adults only) 13 Minor burns and scalds 27 Dry eyes/sore tired eyes 14 Minor conditions - pain 28 Self limiting conditions Earwax 15 Mouth ulcers 29 Acute sore throats 3 Excessive sweating 16 Nappy rash 30 Infrequent cold sores of the lip 4 Headlice 17 Oral thrush 31 Conjunctivitis 5 Indigestion and heartburn 18 Prevention of dental caries 32 Coughs, colds, nasal congestion 6 Infrequent constipation 19 Ringworm/athletes foot 33 Cradle cap 7 Infrequent migraine 20 Teething/mild toothache 34 Haemorrhoids 8 Insect bites and stings 21 Threadworms 35 Infant colic 9 Mild acne 22 Travel sickness 36 Mild cystitis 10 Mild dry skin 23 Warts and verrucae 37 Background In March 2018, NHS England published guidance for conditions for which over the counter (OTC) items should not routinely be prescribed in primary care. It listed 35 conditions, plus probiotics and vitamins and minerals, as areas where self care may be more appropriate.1 This guidance is intended to encourage people to self care for minor illnesses as the first stage of treatment. It is envisaged that in most cases (unless specified) these minor conditions will clear up with appropriate self care. If symptoms are not improving or responding to treatment, then patients should be encouraged to seek further advice. It also covers the licenced indications of products available OTC and highlights where the licensing exceptions would prohibit self care. General exceptions to the guidance There are certain scenarios where patients should continue to have their treatments prescribed and these are outlined below:

1. Patients prescribed an OTC treatment for a long term condition (e.g. regular pain relief for chronic arthritis or treatments for inflammatory bowel disease).

2. For the treatment of more complex forms of minor illnesses (e.g. severe migraines that are unresponsive to OTC medicines). 3. 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).

4. Treatment for complex patients (e.g. immunosuppressed patients).

5. Patients on prescription only treatments.

6. Patients prescribed OTC products to treat an adverse effect or symptom of a more complex illness and/or prescription only medications should continue to have these products prescribed on the NHS.

7. Circumstances where the product licence does not allow the product to be sold OTC to certain groups of patients. This may vary by medicine, but could include babies, children and/or women who are pregnant for example or breast-feeding. Community Pharmacists will be aware of what these are and can advise accordingly.

8. Patients with a minor condition suitable for self care that has not responded sufficiently to treatment with an OTC product.

This document is for use within the NHS and is not for commercial or marketing purposes Items of low clinical effectiveness Page 1 Probiotics 1. recommend that probiotics cannot be recommended be recommended cannot probiotics that recommend 3 and NICE CG 84 and NICE CG 2 No exceptions. Exceptions currently and that “Good quality randomised controlled trials should be conducted in the UK to evaluate the effectiveness the effectiveness evaluate in the UK to should be conducted trials controlled randomised quality “Good and that currently routinely are they before measures outcome and regimens treatment defined clearly using probiotic a specific of and safety prescribed”. There is currently insufficient clinical evidence to support prescribing of probiotics within the NHS for the treatment or or treatment the the NHS for within probiotics of prescribing support to evidence clinical insufficient is currently There cause. any of diarrhoea of prevention C.difficile guidance England Health the Public Both Probiotics • Items of low clinical effectiveness Page 2 4 Vitamins and minerals 2. Calcium and vitamin D for osteoporosis. vitamin D for Calcium and including alcoholism. Malnutrition their to six months of the ages between children or pregancy example vitamins for start Healthy receive suitable to Patients separately). but commissioned on prescription is not (This birthday. fourth Medically diagnosed deficiency, including for those patients who may have a lifelong or chronic condition or have undergone have or condition chronic or a lifelong have who may those patients including for diagnosed deficiency, Medically or basis and maintenance on a regular be reviewed need should however Continuing in malabsorption. results that surgery an exception. is not treatment preventative There is insufficient high quality evidence to demonstrate the clinical effectiveness of vitamins and minerals. vitamins of effectiveness the clinical demonstrate to evidence quality high is insufficient There Vitamins and minerals and Vitamins • • • • Exceptions Vitamins and minerals are essential nutrients which most people can and should get from eating a healthy, varied and balanced and balanced varied a healthy, eating from should get which most people can and nutrients essential are Vitamins and minerals is unnecessary. supplementation dietary most cases, In diet. the through go to have do not therefore They medicines. and not classified as foods are supplements vitamin and mineral Many safety quality, their confirm (MHRA) to Agency Regulatory products Healthcare and the Medicines by down laid strict criteria on funded be routinely to such preparations for deemed appropriate not is therefore It the market. reaching before and efficacy the NHS. should be discontinued. exceptions with listed in-line not prescribing Any but are prescription on an NHS prescribed currently not but these are Vitamins Start Healthy to apply does not guidance This separately. commissioned Self limiting conditions Page 3 Acute sore throat sore Acute 3. All preparations - pregnancy or breastfeeding or - pregnancy preparations All be used rinse should not - oral years 12 under - children Benzydamine malabsorption glucose-galactose intolerance, fructose years, six under children - diabetes, Lozenges insufficiency sucrose-isomaltose or methaemoglobinaemia or epiglottitis years, six under - children sprays Throat Benzydamine, for example as Difflam® Spray and Difflam® Oral rinse (Pharmacy only P) only rinse (Pharmacy Oral and Difflam® Spray as Difflam® example for Benzydamine, only (Pharmacy Tyrozets® GSL) and List Sales (General Throaties® Strepsils®, example for Lozenges, P) List GSL) Sales (General Chloraseptic® Ultra example for sprays, Throat • • • • Red flag symptoms Red • • • Acute sore throat sore Acute the treat help to sprays throat or such as lozenges treatments that suggest to is little evidence There throat. sore cause of such as measures care some self and implement simple painkillers take to should be advised Patients instead. water warm with gargling salty 5 OTC restrictions OTC to purchase OTC purchase to Examples of Examples of medicines available Advice to patients to Advice Exceptions Illness Self limiting conditions Page 4 Infrequent cold sores of the lip of sores cold Infrequent 4. Aciclovir cream 5% (General Sales List GSL) Sales 5% (General cream Aciclovir ill and terminally Immunocompromised and lips face for Only • • • help ease symptoms and speed up the healing time. speed up the healing time. and help ease symptoms appear. sore a cold of signs as soon as the first apply be effective, To an effect. much of have to is unlikely this initial period after cream an antiviral Using patients Immunocompromised flag symptoms Red Infrequent cold sores of the lip the of sores cold Infrequent ten to seven within without treatment up clear virus usually the herpes simplex caused by sores Cold days. can they used correctly, If a prescription. without pharmacies from OTC available are creams Antiviral 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Self limiting conditions Page 5 Conjunctivitis 5. Chloramphenicol 0.5% eye drops (Pharmacy only P) only (Pharmacy drops 0.5% eye Chloramphenicol P) only (Pharmacy ointment 1% eye Chloramphenicol years 2 under Children Pregnancy Breastfeeding Irritant conjunctivitis will clear up as soon as whatever is causing it is removed. is causing it is removed. whatever up as soon as will clear conjunctivitis Irritant such as antihistamines. medications antiallergy with be treated can usually conjunctivitis Allergic should be avoided. the allergy caused that substance The In severe bacterial cases, antibiotic eye drops and eye ointments can be used to clear the infection. the infection. clear can be used to ointments and eye drops eye cases, antibiotic bacterial severe In • • • • • • • all simple of half almost however the counter over can be purchased conjunctivitis for Treatments treatment. without any days within ten up clear conjunctivitis cases of flag symptoms Red Conjunctivitis There week. within a clear usually as the symptoms conjunctivitis needed for usually is not Treatment is treatment is needed, then treatment If with symptoms. help may that measures care self several are on the cause: dependent • 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Self limiting conditions Page 6 Coughs and colds and nasal congestion and colds Coughs 6. coronary artery disease, severe renal impairment, phaeochromocytoma, diabetes, hyperthyroidism hyperthyroidism diabetes, phaeochromocytoma, impairment, renal disease, severe artery coronary and closed angle glaucoma Sodium chloride 0.9% nasal drops and spray, for example Snufflebabe® nasal drops, Calpol® Soothe Calpol® Soothe nasal drops, Snufflebabe® example for spray, and chloride 0.9% nasal drops Sodium List GSL) Sales (General drops nasal and Mandanol® and spray drops and Care asthma, unstable high blood pressure, pain relief, regular requiring conditions - long term Ibuprofen or hepatic renal, of), history or bleeding (active or perforation ulcer, stomach taking anticoagulants, use in chicken for and not 3 months under children breastfeeding, pregnancy, impairment, cardiac pox hepatic severe or renal severe pain relief, regular requiring conditions term - long Paracetamol less than weighing and babies weeks 37 babies born before 2 months, under children impairment, 4kg severe hypertension, severe breastfeeding, pregnancy, years, 12 under - children Pseudoephedrine Ibuprofen tablets/capsules and suspension (General Sales List GSLx16, Pharmacy only Px32 pack pack Px32 only Pharmacy List GSLx16, Sales (General and suspension tablets/capsules Ibuprofen size) pack Px32 only List GSLx16, Pharmacy Sales and suspension (General tablets/capsules Paracetamol size) List GSL) Sales rub (General vapour Vicks® oil and Olbas® example for inhalations, Aromatic Plus Relief Allergy Benadryl® Sudafed®, example for preparations, containing Pseudoephedrine P) only (Pharmacy Capsules and Galpseud® Decongestant • • • • Red flag symptoms Red • • • • Coughs and colds and nasal congestion and nasal colds and Coughs weeks. three to two within up clear coughs Most days. ten to in seven improve start to colds Most some However, treatment. any requires condition Neither nasal congestion. can cause conditions Both congestion. and nasal fevers term short relieve help to medicines counter the over help to medicines the counter some over However, treatment. any require do not conditions These nasal congestion. and fevers short term relieve 5 OTC restrictions OTC to purchase OTC purchase to Examples of Examples of medicines available Advice to patients to Advice Exceptions Illness Self limiting conditions Page 7 Cradle cap cap Cradle 7. Metanium® Cradle Cap Cream Cap Cream Cradle Metanium® Cap Cream Cradle Snufflebabe® Pickles Shampoo Babycare Savlon® the face to it has spread If skin infected skin or use on broken not Do Capasal® therapeutic shampoo Capasal® therapeutic Shampoo Treatment Cap Cradle Dentinox® Shampoo Infaderm® Oil Baby Johnson’s® • • • • • If causing distress to the infant and not improving and not the infant to causing distress If include: List GSL). Examples Sales and shampoos (General ointments Emulsifying • • • • Cradle cap (seborrhoeic dermatitis – infants) – dermatitis Cradle cap (seborrhoeic in babies in the appears usually It cause discomfort. or itch usually and does not cap is harmless Cradle months. a few to weeks within without treatment up and clears lives, their of months two first is self-limiting as the condition care in primary be offered routinely should not cap treatment Cradle treatment. without the need for up on its own will clear and 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Advice to patients to Advice Exceptions Illness Self limiting conditions Page 8 Haemorrhoids 8. Children under 18 years 18 under Children Pregnancy Breastfeeding blood in the stool bleeding or Rectal Anusol® creams/ointments creams/ointments Anusol® creams/ointments Germoloids® relief Haemorrhoid • • • • Red flag symptoms Red include: List GSL). Examples Sales (General products oxide Zinc • • • Haemorrhoids have they realise even do not some people and cause symptoms do not haemorrhoids cases, many In days. few a after themselves up by clear often them. Haemorrhoids first. recommended often are on the toilet straining and not changes simple dietary Making and these are and discomfort itching can reduce and suppositories) ointments (creams, Treatments purchase. for counter the over available 5 OTC restrictions OTC medicines available medicines available OTC purchase to Examples of Examples of Advice to patients to Advice Exceptions Illness Minor illnesses suitable for self care Page 9 Infant colic Infant 9. Dimeticone 42mg/5ml - should be avoided in frutose, glucose-galactose or sucrose intolerant intolerant sucrose or glucose-galactose in frutose, be avoided 42mg/5ml - should Dimeticone sucrose as it contains patients Simeticone 40mg/ml, for example Infacol® (General Sales List GSL) Sales (General Infacol® example for 40mg/ml, Simeticone List GSL) Sales (General Dentinox® example 42mg/5ml, for Dimeticone • The most useful intervention is support for parents and reassurance that colic will resolve. will resolve. colic that and reassurance parents is support for intervention most useful The flag symptoms Red • • Infant colic Infant recommended. usually is not treatment medical on its own, improves eventually As colic is limited there be tried. However, could that available treatments the counter some over are There these treatments. of the effectiveness for evidence 5 to purchase OTC purchase to restrictions OTC Exceptions Examples of medicines available Advice to patients to Advice Illness Self limiting conditions Page 10 Mild cystitis Mild 10. Sodium citrate 4g sachet products – men, children under 16 years, diabetes, heart disease, disease, heart diabetes, years, 16 under – men, children products 4g sachet citrate Sodium and breastfeeding , pregnancy disease renal hypertension, and disease, pregnancy renal of history years, 6 under - children products citrate Potassium breastfeeding Sodium citrate 4g sachets products, for example Cystoclam® and Cymalon® (General Sales List GSL) Sales (General and Cymalon® Cystoclam® example for products, 4g sachets citrate Sodium Cymaclear®, example for products tabs effervescent 1.5g or sachets 3g liquid, 1.5g citrate Potassium List GSL) Sale (General and Effercitrate® Cystopurin® • • Symptomatic treatment using products that reduce the acidity of the urine to reduce symptoms are are symptoms reduce the urine to of the acidity reduce that using products treatment Symptomatic effective. are they suggest to evidence is a lack of but there available, flag symptoms Red • • Mild cystitis Mild however an infection; caused by normally inflammation, tract urinary type of is a common cystitis Mild as those cases can be defined Mild serious concern. than a cause for a nuisance of more it is usually do not symptoms If own. up on their will also clear but treatment symptomatic to responsive are that GP. see their be advised to should then the patient measures, care self despite days, in three improve 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 11 Mild irritant dermatitis irritant Mild 11. Eurax® licenced for children over 3 years 3 over children for licenced Eurax® years 10 over children for licenced Cream Hydrocortisone® Hc45 Use on the eyes, face or ano-genital region ano-genital or face on the eyes, Use Eurax® licenced for children over 3 years 3 over children for licenced Eurax® years 10 over children for licenced Cream Hydrocortisone® Hc45 be used: may the following However, some brands. 12 for under Children breastfeeding Pregnancy, skin inflamed or Broken Emollients, for example Exocream®, Dermacool® Cream Dermacool® Exocream®, example for Emollients, Eurax® example for Crotamiton, Cream, include Eurax-Hc® P). Brands only (Pharmacy hydrocortisone example for creams, Steroid Cream Hydrocortisone® and Hc45 » » » » • • • • • • Treatment normally involves avoiding the allergen or irritant and treating symptoms with over the the over with symptoms and treating irritant or the allergen avoiding involves normally Treatment corticosteroids. and topical emollients counter exceptions. general for earlier See been identified. have exceptions routine No • • • Mild irritant dermatitis irritant Mild treated Once substance. a particular with contact by triggered eczema of is a type dermatitis Irritant allergen or the irritant if up completely clear and/or improve to symptoms their expect most people can such as soaps, irritants by caused commonly is most It avoided. or and removed can be identified water. with contact regular or solvents detergents, powders, washing 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 12 Dandruff 12. All products - pregnancy, breastfeeding - pregnancy, products All years 12 under - children Ketoconazole psoriasis pustular acute or and sore open skin lesions infected years, 12 under - children tar Coal years 5 under sulfide - children Selenium Ketoconazole, for example Nizoral® anti-dandruff® Shampoo (General Sales List GSL) Sales (General Shampoo anti-dandruff® Nizoral® example for Ketoconazole, List GSL) Sales (General Shampoo Scalp Polytar® example shampoo, for tar Coal P) only (Pharmacy Shampoo Selsun® example sulfide shampoo, for Selenium • • • • Dandruff can be easily treated with over the counter antifungal shampoos. antifungal the counter with over treated can be easily Dandruff exceptions. general for earlier See been identified. have exceptions routine No • • • Dandruff without itching. the scalp as mild scaling of be defined can It skin condition. is a common Dandruff harmful. or contagious is not Dandruff 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 13 Diarrhoea (adults) Diarrhoea 13. Oral rehydration sachets, for example Dioralyte® Relief sachets and Electrolade® sachets (General (General sachets and Electrolade® sachets Relief Dioralyte® example for sachets, rehydration Oral List GSL) Sales colorectal and post pelvic radiation surgery, bowel disease, post bowel – inflammatory Loperamide cancer potassium/sodium on low disease, patients renal or with liver patients - sachets rehydration Oral with diabetes and patients diets Loperamide 2mg capsule products for example Imodium®, Diocalm®, Entrocalm®, Diah-limit® Diah-limit® Entrocalm®, Diocalm®, Imodium®, example for 2mg capsule products Loperamide P) only Pharmacy pack sizes 6 Capsules, larger List GSL Sales (General • • • Over the counter treatments can help replace lost fluids or reduce bowel motions. bowel reduce fluids or lost replace can help treatments the counter Over children. to apply does not this recommendation note: Please exceptions. general for earlier See been identified. have exceptions routine No • Diarrhoea (adults only) (adults Diarrhoea about. worry to nothing and is usually time time to people from most affects normally Diarrhoea up. clear to week a to days a few it can take However, causes include drugs, and other infection viral or a bacterial by caused diarrhoea is usually Acute allergy. a food or anxiety 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 14 Dry eyes/sore tired eyes tired eyes/sore Dry 14. Optrex® Sore Eyes Drops Eyes Sore Optrex® Ointment Eye Simple® Drops Eye Naturale® Tears Gel Eye Viscotears® and breastfeeding Pregnancy Lubricant eye treatments include hypromellose 0.3% (Pharmacy only P) and carbomer (Pharmacy (Pharmacy P) and carbomer only 0.3% (Pharmacy include hypromellose treatments eye Lubricant P) only GelTears® • • • • • eye treatments that consist of a range of drops, gels and ointments that can be easily be purchased be purchased easily can be that and ointments gels drops, of a range of consist that treatments eye counter. the over the eyes. affecting conditions long term Pre-existing • include: Brands • Dry eyes/sore tired eyes tired eyes/sore Dry make not do the eyes when occurs that condition is a common disease, eye dry or syndrome, eye Dry themselves. resolve eyes tired sore cases of Most quickly. too evaporate the tears or enough tears, care some self implementing by eyes and sore eyes dry both manage to should be encouraged Patients treatment. alongside factors environmental of and avoidance hygiene eyelid such as good measures using lubricant be treated can usually eyes tired sore or syndrome eye dry cases of moderate to Mild 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 15 Earwax 15. Docusate sodium 0.5% drops, for example Waxsol® (Pharmacy only P) only (Pharmacy Waxsol® example for sodium 0.5% drops, Docusate itch ears help if may removal, wax for licensed (not Calm® Spray Ear example 2%, for acid Acetic and this should be confirmed infection indicate may itching significant however removal, wax after the GP) by and treated restrictions No Olive oil drops (General Sales List GSL) Sales (General oil drops Olive P) only (Pharmacy Cerumol® example for drops, hemihydrate oil/chlorobutanol Arachis • • • A build-up of earwax is a common problem that can often be treated using eardrops bought over the the over bought using eardrops be treated can often that problem is a common earwax build-up of A out naturally. it falls so that the earwax can help soften These counter. drum ear Perforated • • Earwax ears the out of passes usually It germs. of and free them clean keep to inside ears is produced Earwax ears. can build up and block the much too but sometimes harmlessly, 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 16 Excessive sweating Excessive 16. No restrictions No Wear loose-fitting clothes to minimise signs of sweating minimise signs of to loose-fitting clothes Wear possible if a day twice least socks at your and change absorb moisture socks that Wear day to shoes day different wear to shoes and try leather Wear nylon example, – for fabrics man-made or clothes tight Wear more sweat to feet your cause may sports shoes that or boots enclosed Wear food spicy eating or drinking alcohol example, – for worse sweating your make might things that Do No routine exceptions have been identified. See earlier for general exceptions. general for earlier See been identified. have exceptions routine No Forte® Anhydrol and Driclor® example chloride, for Aluminium • • • • Don’t • • • Excessive sweating (hyperhidrosis) sweating Excessive line treatment First excessively. sweats which a person in condition is a common Hyperhidrosis changes. lifestyle simple involves in most and is sold treatment line of the first chloride is usually aluminium containing antiperspirant An are: sweating with excessive help can do to you Things pharmacies. Do 5 Examples of Examples of medicines available OTC purchase to restrictions OTC Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 17 Head lice Head 17. Children under 6 months under Children Dimeticone gel, lotion or spray 4%, for example Hedrin®, Lyclear® and Nitrid® (General Sales List List Sales (General and Nitrid® Lyclear® Hedrin®, example 4%, for spray or lotion gel, Dimeticone P) only Pharmacy pack sizes other 100ml or for GSL ) List GSL Sales M® (General Derbac- example 0.5%, for aqueous lotion Malathion sprays solutions or lotions, with conditioner, treatment after hair combing wet – for comb Headlice • Current skin conditions of the scalp of skin conditions Current infestation a severe of effects Side • • • Frequent checking - carefully looking at your child’s scalp and hair for head lice, especially at the start the start at especially head lice, for and hair scalp child’s your looking at - carefully checking Frequent weekly. do this Ideally year. the school of to comb a normal Use this off. wash do not as usual then use conditioner, hair Wash combing’- ‘Wet head lice. live remove to comb detection head lice then a fine-toothed hair, untangle pillows. towels, hairbrushes, combs, sharing - Hats, Avoid for because it is easier simply head lice, catch to likely more are hair with longer length - People Hair hair. longer and from to transfer to the head lice is hair treated serious burns if is a risk of there alcohol: containing products eradication lice Head ignition, e.g. cigarettes. of sources other open flames or to exposed Headlice harmless, largely are They 4-11. aged children in school particularly problem, a common are Headlice with. deal to and frustrating irritating and can be treated not a long time if for in the hair but can live head close head to by spread are as they infestation, head lice prevent possible to always is not It detection with help will tips care these self However, playing. are when children especially contact, and prevention. 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 18 Indigestion and heartburn Indigestion 18. Ranitidine - children under 12 years, peptic ulceration or elderly taking NSAIDS elderly or ulceration peptic years, 12 under - children Ranitidine Rantidine 75mg tablets, for example Zantac®, Gavilast ®, Ranicalm® (General Sales List GSL for for List GSL Sales (General Ranicalm® ®, Gavilast Zantac®, example for 75mg tablets, Rantidine 12) of pack size disease liver or jaundice breastfeeding, - Pregnancy, products All stones kidney nephrocalcinosis, hypercalcaemia, failure, renal years, 12 under - Children Gaviscon® years 2 over children weeks, 37 babies born before 12 months, under - Children Infant Gaviscon® impairment and renal or with new years 55 adults over or years 18 under - children and pantoprazole Esomeprazole symptoms changed recently Sodium alginate, calcium carbonate, sodium bicarbonate, for example Gaviscon® (General Sales List List Sales (General Gaviscon® example for sodium bicarbonate, calcium carbonate, alginate, Sodium P) only (Pharmacy Infant® GSL) and Gaviscon List GSL) Sales (General Control® Nexium example for 20mg tablets, Esomeprazole P) only (Pharmacy Control® Pantoloc example for 20mg tablets, Pantoprazole • • • • • • Most people can ease symptoms by simple changes to diet and lifestyle and avoiding foods that make make that foods and avoiding and lifestyle diet to simple changes by symptoms people can ease Most drinks). caffeinated foods, fatty or rich spicy (e.g. worse indigestion exceptions. general for earlier See been identified. have exceptions routine No • • • Indigestion and heartburn and Indigestion serious and can more anything a sign of it is not Usually, some point. at indigestion people have Most and specialist mild and infrequent as it is often medical advice, the need for without home at be treated required. is not treatment or changes, and lifestyle making simple diet by indigestion their manage able to people are Most such as antacids. taking medication 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 19 Infrequent constipation Infrequent 19. Ispaghula Husk Granules, for example Fybogel® (General Sales List GSL) Sales (General Fybogel® example for Granules, Husk Ispaghula digestive risk of or perforation obstruction, digestive gastro-intestinal Lactulose - galactosaemia, perforation and breastfeeding pregnancy dehydration, severe diseases, bowel inflammatory - acute Bisacodyl years 10 under and children and breastfeeding pregnancy years, 18 under children dehydration, - severe Senna and diabetes years 6 under - children Granules Husk Ispaghula Lactulose, for example Duphalac®, Lactugal® (Pharmacy only P) only Lactugal® (Pharmacy Duphalac®, example Lactulose, for depending on pack P only and Pharmacy List GSL Sales (General Dulcolax® example for Bisacodyl, size) List GSL) Sales (General Tablets® Relief Dual Senokot example for Senna, • • • • • laxatives. exceptions. general for earlier See been identified. have exceptions routine No • • • Infrequent constipation Infrequent time. a short period of be just for and can all ages people of can affect Constipation the counter over use of short term and lifestyle or in diet with a change managed can be effectively It 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 20 Infrequent migraine Infrequent 20. Ibuprofen - long term conditions requiring regular pain relief, asthma, unstable high blood pressure, asthma, unstable high blood pressure, pain relief, regular requiring conditions - long term Ibuprofen or hepatic renal, of), history or bleeding (active or perforation ulcer, stomach taking anticoagulants, years 12 under children , breastfeeding, pregnancy impairment, cardiac babies 2 months, under children pain relief, regular requiring conditions term - long Paracetamol less than 4kg weighing and babies weeks 37 born before and pregnancy breastfeeding disease, liver severe years, 12 under - children Co-codamol parkinson’s epilepsy, blood dyscrasias, existing function, liver - impaired maleate Prochlorperazine and breastfeeding pregnancy angle glaucoma, narrow hypertrophy, disease, prostatic Ibuprofen tablets, capsules and suspension (General Sales List GSLx16, Pharmacy only Px32) only List GSLx16, Pharmacy Sales and suspension (General capsules tablets, Ibuprofen Px32) only GSLx16, Pharmacy List Sales (General capsules and suspension tablets, Paracetamol P) only (Pharmacy and Paracodol® tablets Yellow® Migraleve example 8/500mg, for Co-codamol P) only 3mg (Pharmacy Tab M® Buccastem example for maleate, - prochlorperazine Anti-sickness • • • • medicines. exceptions. general for earlier See identified. been have exceptions routine No • • • • Infrequent migraine Infrequent in one around and women five one in every around affecting condition, health is a common Migraine men. 15 every a number and painkillers the counter with over treated can be adequately migraines infrequent Mild and anti-sickness painkillers both contain that available are migraine medicines for combination of 5 OTC restrictions OTC to purchase OTC purchase to Exceptions Examples of medicines available Advice to patients to Advice Illness Minor illnesses suitable for self care Page 21 Insect bites and stings bites Insect 21. Dettol® Antiseptic Cream® (General Sales List GSL) Sales (General Cream® Antiseptic Dettol® 6 months under Children Calamine lotion 2%® Cream and Sting Bite Anthisan® example 2%, for maleate Mepyramine Gel Relief Pain and Stings Bites Savlon® • • antihistamines. exceptions. general for earlier See been identified. have exceptions routine No • • • Insect bites and stings and bites Insect days. or hours a few within better will get serious and not stings are and insect bites Most and itching for creams painkillers, such as can help ease symptoms, treatments Over-the-counter 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 22 Mild acne Mild 22. Duac once daily® once Duac Quinoderm® Brevoxyl® PanOxyl Aquagel® PanOxyl Acnecide® Pregnancy, breastfeeding Pregnancy, skin Damaged Elderly years 12 under Children Benzoyl peroxide-containing preparations (Pharmacy only P), for example: P), for only (Pharmacy preparations peroxide-containing Benzoyl » » » » » » » » » » • • • • to three months to work. to months three to exceptions. general for earlier See been identified. have exceptions routine No • Mild acne Mild be acne cannot Although some point. most people at affects that skin condition is a common Acne with treatment. it can be controlled cured, up can take Treatments pharmacies. at available acne are treating for and gels lotions creams, Several 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 23 Mild dry skin dry Mild 23. Cetraban® Cream and lotion over 1 year olds year 1 over lotion and Cream Cetraban® Dermol® E45® Oilatum® Zerobase® skin infected or Broken olds 3 month over for and lotion Cream Aveeno® old 1 month over children E45 for Aveeno® Balneum® Cetraben® • • • • • • • • Emollients are often used to help manage dry, itchy or scaly skin conditions. scaly or itchy dry, help manage used to often are Emollients exceptions. general for earlier See been identified. have exceptions routine No List GSL): Sales include (General brands Emollient • • • Mild dry skin dry Mild on a long term products the counter using over managed skin can be successfully with mild dry Patients basis. 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 24 Sunburn 24. No restrictions No Calamine lotion (General Sales List GSL) Sales (General Calamine lotion List GSL) Sales (General sun preparations After • Use lotions containing aloe vera to soothe and moisturise the skin and drink plenty of fluids to avoid avoid fluids to of plenty moisturise the skin and drink and soothe to vera aloe containing lotions Use dehydration. required. pain if the relieve to ibuprofen or such as paracetamol painkillers Take exceptions. general for earlier See been identified. have exceptions routine No • • Sunburn due to excessive sun exposure excessive to due Sunburn sun using by developing symptoms prevent or themselves burn symptoms sun people manage Most supermarket. or in a pharmacy bought be can easily products These protection. it. to holding a flannel or water with cold sponging it shower, or bath a cold having skin by your Cool 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 25 Sun protection Sun 25. No restrictions No Sun protection lotion, gels and creams (General Sales List GSL) Sales (General and creams gels lotion, protection Sun • Sun protection products can readily be bought in a pharmacy or supermarket. or in a pharmacy be bought can readily products protection Sun should be prescribed. skin protection where i.e. photodermatoses, of indication approved ACBS • Sun protection Sun can products These using sun protection. developing sun damage of symptoms people prevent Most supermarket. or in a pharmacy bought be easily 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Minor illnesses suitable for self care Page 26 y Mild to moderate hay fever/allergic rhinitis fever/allergic hay moderate to Mild 26. Loratadine - Tablets not for children under 6 years, 1mg/ml syrup not for children under 2 years. Rare hereditar Rare years. 2 under children for not syrup 1mg/ml years, 6 under children for not Tablets - Loratadine impairment, liver malabsorption, glucose-galactose or the Lapp lactase deficiency intolerance, galactose of problems and breastfeeding. pregnancy of problems hereditary rare impairment, renal years, 65 and adults over years 12 under children for - Not Acrivastine and breastfeeding. pregnancy malabsorption, glucose-galactose or the Lapp lactase deficiency intolerance, galactose renal epilepsy, years, 2 under children for solution not 1mg/ml years, 6 under children for not Tablets - Cetirizine and breastfeeding. , pregnancy intolerance fructose of problems hereditary rare impairment, and breastfeeding pregnancy years, 18 under -children nasal spray 0.05% Beclomethasone and breastfeeding. pregnancy years, 6 under - children drops 2% eye cromoglicate Sodium Acrivastine 8mg capsules, for example Benadryl® (General Sales List GSL/Pharmacy only P)* only GSL/Pharmacy List Sales (General Benadryl® example 8mg capsules, for Acrivastine List GSL/ Sales (General Piriteze® Zirtek®, allergy®, Benadryl example solution, for 5mg/5ml or tablets Cetirizine P)* only Pharmacy P)* only GSL/Pharmacy List Sales (General hayfever® Beconase example for nasal spray, 0.05% Beclometasone GSL) List Sales ® (General relief hayfever Optrex Allercrom®, example for drops, 2% eye cromoglicate Sodium Taken year. 1 under children for 2mg/5ml solution not years, 6 under children for not Tablets Chlorphenamine - including glaucoma, pressure intra-ocular raised epilepsy, within the last 14 days, inhibitors monoamine oxidase asthma, hepatic or bronchiectasis bronchitis, disease, cardiovascular or hypertension severe hypertrophy, prostatic glucose- or Lapp lactase deficiency intolerance, galactose of problems hereditary rare impairment, renal impairment, and breastfeeding. pregnancy malabsorption, galactose Chlorphenamine 4mg tablets or 2mg/5ml solution, for example Piriton® (Pharmacy only P) only (Pharmacy Piriton® example solution, for 2mg/5ml or 4mg tablets Chlorphenamine P)* only List GSL/Pharmacy Sales (General Clarityn allergy® example for syrup, 1mg/1ml or 10mg tablets Loratadine • • • • • • • • • • Mild to moderate hay fever/allergic rhinitis fever/allergic hay moderate to Mild people. in five one to up affects that condition allergic is a common fever Hay with symptoms relieve able to are symptoms moderate with mild to but most people fever, hay for no cure is currently There a pharmacist. by recommended treatments OTC exceptions. general for earlier See been identified. have exceptions routine No • • 5 OTC restrictions OTC Examples of Examples of medicines to available purchase Advice to to Advice patients Exceptions Illness Minor illnesses suitable for self care Page 27 Minor burns and scalds Minor 27. owder - Pregnancy, breastfeeding, children under 2 years and taking lithium therapy years 2 under children breastfeeding, - Pregnancy, owder ® p Betadine Betadine® powder Betadine® gel or cream antiseptic Germolene® cream antiseptic Savlon® Savlon® Aid First Wash Cream Aid First Sudocrem® • Creams /gels/sprays (General Sales List GSL) for example: List GSL) for Sales (General /gels/sprays Creams • • • • • Antiseptic creams and treatments for burns should be kept in a medicine cabinet at home. at cabinet in a medicine kept burns should be for treatments and creams Antiseptic and E A hospital requiring Burns medical attention. professional require burns always Serious to: limited not include but are treatment chemical and electrical burns All a) deep burns or Large b) skin charred or white cause that Burns c) blisters. cause that genitals legs or hands, arms, feet, on the face, d) Burns Minor burns and scalds and burns Minor Depending way. in the same treated are Both heat. skin caused by the to damage and scalds are Burns home. at burns treat to a burn is, it is possible serious on how 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 28 Minor conditions associated with pain associated conditions Minor 28. Co-codamol 8/500mg, for example Migraleve® Yellow tablets and Paracodol® (Pharmacy only P) only (Pharmacy and Paracodol® tablets Yellow Migraleve® example 8/500mg, for Co-codamol asthma, unstable high blood pressure, pain relief, regular requiring conditions - long term Ibuprofen children ulcers/problems, stomach taking anticoagulants, impairment, hepatic severe or renal severe pox use in chicken for and not breastfeeding pregnancy, 3 months, under hepatic severe or renal severe pain relief, regular requiring conditions term - long Paracetamol less than weighing and babies weeks 37 babies born before 2 months, under children impairment, 4kg and pregnancy disease, breastfeeding liver severe yrs, 12 under - children Co-codamol Ibuprofen tablets, capsules and suspension (General Sales List GSL x16 and Pharmacy only Px32) only Pharmacy x16 and List GSL Sales and suspension (General capsules tablets, Ibuprofen Px32) only x16 and Pharmacy GSL List Sales (General capsules and suspension tablets, Paracetamol • • • • Patients should be encouraged to keep a small supply of OTC analgesics in their medicines cabinets at at cabinets medicines in their analgesics OTC of a small supply keep to should be encouraged Patients appointment. a GP for without the need home at ailments minor manage able to are home so they exceptions. general for earlier See been identified. have exceptions routine No • • Minor conditions associated with pain associated conditions Minor with OTC home at and back pain can be treated period pain, mild fever most cases, headaches, In fluids. and drinking enough rest more such as getting changes, and lifestyle painkillers 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 29 Mouth ulcers Mouth 29. Active peptic ulceration ulceration peptic Active Pregnancy Breastfeeding Lidocaine hydrochloride/chlorocresol cetylpyridinium chloride, for example Bonjela® (General Sales Sales (General Bonjela® example chloride, for cetylpyridinium Lidocaine hydrochloride/chlorocresol List GSL) List GSL) Sales (General Anbesol® example chloride, for Choline salicylate/cetalkonium List GSL) Sales (General Orajel® example for Benzocaine, years 16 under Children • • • No routine exceptions have been identified. See earlier for general exceptions. general for earlier See identified. been have exceptions routine No • • • • Mouth ulcers Mouth themselves up by most clear because be treated need to harmless and do not usually are ulcers Mouth without seeing home, at be managed usually and can common are ulcers Mouth two. or week within a GP. or a dentist discomfort. any and ease swelling reduce can help to treatment OTC 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Advice to patients to Advice Exceptions Illness Minor illnesses suitable for self care Page 30 Nappy rash Nappy 30. No restrictions restrictions No Titanium dioxide, titanium peroxide, titanium salicylate, for example Metanium® (General Sales List List Sales (General Metanium® example for titanium salicylate, titanium peroxide, dioxide, Titanium GSL) List GSL) Sales (General Sudocrem® example lanolin, for benzyl benzoate, benzyl alcohol, oxide, Zinc • about three days if recommended hygiene tips are followed. tips are hygiene recommended if days about three exceptions. general for earlier See been identified. have exceptions routine No • • Nappy rash Nappy one time. any at rash nappy have in nappies babies and toddlers of a third to Up up after clears usually rash Nappy cream. home using a barrier at be treated can usually rash Nappy 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Minor illnesses suitable for self care Page 31 Oral thrush Oral 31. Children under 4 months 4 months under Children breastfeeding Pregnancy, warfarin taking Patients dysfunction Liver Miconazole 2% oral gel (15g) , for example Daktarin® oral gel (Pharmacy only P) only (Pharmacy gel oral Daktarin® example (15g) , for gel 2% oral Miconazole • • • • It can easily be treated with over the counter gel. the counter over with be treated can easily It exceptions. general for earlier See been identified. have exceptions routine No • Oral thrush Oral or consultation a GP for the need without can be treated that condition minor thrush is a Oral instance. in the first prescription inhalers. steroid those using or dentures with people older in babies and is common It 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Minor illnesses suitable for self care Page 32 Prevention of dental caries dental of Prevention 32. Children under 12 years 12 under Children Mouthwashes chlorhexidine digluconate, for example Corsodyl® (General Sales List GSL) Sales (General Corsodyl® example for digluconate, chlorhexidine Mouthwashes List GSL) Sales (General toothpastes Fluoride • preparations can be prescribed by a dentist. by can be prescribed preparations exceptions. general for earlier See been identified. have exceptions routine No • • Prevention of dental caries (dental decay) (dental caries dental of Prevention risk at is particularly patient a if fluoride toothpaste advise on using higher-strength may dentist The decay. tooth of only Prescription the counter. over be purchased can and mouthwashes toothpastes fluoride Higher 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Minor illnesses suitable for self care Page 33 Ringworm/athletes foot Ringworm/athletes 33. All products –diabetic, pregnancy, breastfeeding pregnancy, –diabetic, products All years 16 under – children hydrochloride Terbinafine Miconazole 2% cream 0.16% powder, for example Daktarin® and Daktarin Aktiv® and Daktarin Daktarin® example for 0.16% powder, 2% cream Miconazole advanced Scholl® and spray gel, cream, AT Lamisil® example 1%, for hydrochloride Terbinafine spray powder, cream, • • over the counter treatments. However, they are contagious and easily spread so it is important to to so it is important spread and easily contagious are they However, treatments. counter the over hygiene. foot good practice limb cellulitis. lower of history or Lymphoedema • • Ringworm/athletes foot Ringworm/athletes the skin. on rash ring-like silvery or can cause a red that infection fungal a common is Ringworm worms. with do to anything have doesn’t its name, ringworm Despite the toes. between appears usually fungus that a caused by is a rash foot Athlete’s with treated easily usually serious and are not are “tinea”, as known medically fungal infections, These 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Minor illnesses suitable for self care Page 34 Teething/mild toothache Teething/mild 34. C) then paracetamol or ibuprofen suspension can be given. Mild toothache in in toothache Mild suspension can be given. ibuprofen or C) then paracetamol o Teething gel, for example Bonjela® teething gel, Dentinox® teething gel (General Sales List GSL) Sales (General gel teething Dentinox® gel, teething Bonjela® example for gel, Teething asthma, unstable high blood pressure, pain relief, regular requiring conditions - long term Ibuprofen or hepatic renal, of), history or bleeding (active or perforation ulcer, stomach taking anticoagulants, use in chicken for and not 3 months under children , breastfeeding, pregnancy impairment, cardiac pox hepatic severe or renal severe pain relief, regular requiring conditions term - long Paracetamol less than weighing and babies weeks 37 babies born before 2 months, under children impairment 4kg disease heart disease and liver 2 months, - babies under Bonjela® Ibuprofen tablets and suspension (General Sales List GSL x16) and suspension (Pharmacy only P P only x16) and suspension (Pharmacy List GSL Sales (General and suspension tablets Ibuprofen x32) P only suspension (Pharmacy List GSL)16) and Sales and suspension (General tablets Paracetamol x32) • • • • by teething and these can be purchased from a pharmacy. If the baby is in pain or has a mild raised a mild raised has pain or is in the baby If a pharmacy. from and these can be purchased teething by 38 (less than temperature painkillers. the counter with over be treated adults can also exceptions. general for earlier See been identified. have exceptions routine No • • Teething/mild toothache Teething/mild them. for it easier make to ways are but there some babies, for distressing can be Teething if particularly worse, the pain drinking can make or Eating be constant. or and go, can come Toothache cold. or drink is hot or the food caused discomfort pain or any numb which helps to local anaesthetic, a mild contain often gels Teething 5 OTC restrictions OTC Examples of Examples of medicines available OTC purchase to Exceptions Advice to patients to Advice Illness Minor illnesses suitable for self care Page 35 Threadworm 35. Children under 2 years years 2 under Children Pregnancy Breastfeeding Mebendazole 100mg tablets, for example Ovex® (Pharmacy only P) - available as a family pack or pack or as a family P) - available only (Pharmacy Ovex® example for 100mg tablets, Mebendazole individual pack • • • the likelihood of reinfection. of the likelihood symptoms. have do not they if even treatment, will require in the household Everyone exceptions. general for earlier See been identified. have exceptions routine No • Threadworms and can in children common are They pass in the stools. that worms tiny are (pinworms) Threadworms visit the GP. without the need to treated effectively can be They easily. be spread or tablet a chewable is usually This pharmacies. from be bought can easily threadworms for Treatment and reduce infection up a threadworm clear can also help measures hygiene Strict liquid formulation. 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Minor illnesses suitable for self care Page 36 Travel sickness Travel 36. Cinnarizine tablets 15mg - Parkinsons, people with fructose or galactose intolerance, Lapp lactase Lapp lactase intolerance, galactose or with fructose people 15mg - Parkinsons, Cinnarizine tablets this take should not insufficiency, sucrase-isomaltase or malabsorption glucose-galactose deficiency, and sucrose lactose medicine because it contains breastfeeding pregnancy, years, 5 under children Porphyria, years 4 under (Joyrides®) years 3 under 150mcg - children tablets hydrobromide Hyoscine stenosis/prostatic ileus, pyloric paralytic breastfeeding, pregnancy, glaucoma, epilepsy, (Kwells®), gravis myasthenia enlargement, Cinnarizine tablets 15mg, for example Stugeron® example 15mg, for Cinnarizine tablets and Kwells® Joyrides® example 150mcg, for Tab hydrobromide Hyoscine • • • Severe motion sickness can be treated with over the counter medicines. the counter with over sickness can be treated motion Severe exceptions. general for earlier See been identified. have exceptions routine No • • Travel sickness Travel object, getting a fixed staring at (e.g. measures care self various by can be treated sickness motion Mild music etc). to listening air, some fresh 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness Minor illnesses suitable for self care Page 37 Warts verrucae and Warts 37. Wart freeze treatments, for example Scholl® Freeze and Bazuka® Sub Zero (General Sales List GSL) Sales (General Zero Sub and Bazuka® Freeze Scholl® example for treatments, freeze Wart patients Diabetic area ano-genital neck, Face, skin lesions or warts birthmarks, hairy Moles, skin Broken blood circulation peripheral Impaired years 4 under also including children As above – zero Sub and Bazuka® Freeze Scholl® Verruca gel - Salicyclic acid, lactic acid, for example Bazuka® Extra Strength Gel, Bazuka® Gel Gel Bazuka® Gel, Strength Extra Bazuka® example acid, lactic acid, for - Salicyclic gel Verruca List GSL) Sales (General Gel Treatment P) and Bazuka® only (Pharmacy Salatac®, , Occlusal®, Salactol® example acid, lactic acid, for - Salicyclic paint/ointment Wart P) only (Pharmacy ointment Verrugon® • • • • • • • patients require treatment. require patients exceptions. general for earlier See been identified. have exceptions routine No • • Warts verrucae and Warts life. in their some point at warts will have people Most eventually. own on their away go to harmless and tend generally are They if quickly more verrucae and warts rid of get to a pharmacy from can be purchased treatments Several 5 OTC restrictions OTC medicines available medicines available OTC purchase to Exceptions Examples of Advice to patients to Advice Illness 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. Available at: https://www.england.nhs.uk/wp-content/ uploads/2018/03/otc-guidance-for-ccgs.pdf. Last accessed 06/08/2018. 2. Public Health England. Updated guidance on the management and treatment of Clostridium difficile infection. May 2013. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/321891/Clostridium_ difficile_management_and_treatment.pdf. Last accessed 06/08/2018. 3. National Institute for Health and Care Excellence (NICE). Clinical Guideline 84. Diarrhoea and vomiting caused by gastroenteritis in under 5s: diagnosis and management. April 2009. Available at: https://www.nice.org.uk/guidance/cg84. Last accessed 06/08/2018. 4. NHS PrescQIPP. The Prescribing of Vitamins and Minerals including B Vitamin Preparations (DROP-List). August 2015. Available at: https://www.prescqipp.info/resources/send/212-vitamins-and-minerals-drop-list/2104-bulletin-107-vitamins-and- minerals-drop-list. Last accessed 06/08/2018. 5. Electronic Medicines Compendium (eMC). Directory of prescribing and patient information for licensed medicines. Available at: https://www.medicines.org.uk/emc/. Last accessed 06/08/2018.

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/self-care-materials