SelfCare Focus 7.4

A selection of newly published papers on self-care from the worldwide literature

Every week, we will provide a brief summary and a link to the published abstract of newly published papers selected from the worldwide literature as being of particular interest to the SelfCare community.

Poor Man’s Methadone: A Case Report of Loperamide Toxicity.

By: Dierksen J, Gonsoulin M, Walterscheid JP.

American Journal of Forensic Medicine & Pathology 2015; 36: 268-70.

Summary: Loperamide at high doses crosses the blood-brain barrier and reaches central opioid receptors in the brain, leading to central opiate effects including euphoria and respiratory depression. This is a report of a young man found dead in his residence with a known history of drug abuse. Drug screening found non-toxic levels of alprazolam, fluoxetine, and marijuana metabolites. Then, loperamide toxicity was suspected because of its opioid properties and chlorine found in a screening panel. Quantitative testing detected 63 ng/mL of loperamide (more than 6 times of therapeutic peak concentration). Because of its opioid effects and easy accessibility, loperamide is known as “poor man’s methadone”.


Mandatory labeling requirements and over-the-counter cough and cold medication use in early childhood.

By: DeGroot J, Anderson LN, Chen Y, Birken CS, Parkin PC, Carsley S, Khovratovich M, Mamdani M, Maguire JL; TARGet Kids! collaboration..

Canadian Journal of Public Health 2015; 106: e477-82.

Summary: In October 2009, Health Canada required manufacturers to state products should not be used in children under six years of age. This labeling legislation resulted in a small decrease in OTC product use. The authors felt that stronger measures may be needed to curtail use.


Women’s questions about medicines in pregnancy – An analysis of calls to an Australian national medicines call centre.

By: Pijpers EL, Kreijkamp-Kaspers S, McGuire TM, Deckx L, Brodribb W, van Driel ML.

Australian and New Zealand Journal of Obstetrics and Gynaecology 2016; DOI: 10.1111/ajo.12531.

Summary: Of calls from pregnant women to a drug information service, after anti-depressants most calls were made about OTC medicines.


Nonprescription Antimicrobial Use in a Primary Care Population in the United States

By: Zoorob R, Grigoryan L, Nash S, Trautner BW.

Antimicrobial Agents and Chemotherapy 2016; 60: 5527-32.

Summary: Of 400 respondents, 5% reported nonprescription use of a systemic agent within the last year. Respiratory symptoms were common reasons for such use.


Non-prescription treatment of NSAID induced GORD by Australian pharmacies: a national simulated patient study.

By: MacFarlane B, Matthews A, Bergin J.

International Journal of Clinical Pharmacy 2015; 37: 851-6.

Summary: An observational study took place to assess interactions for reflux symptoms. Pharmacists consulted with the simulated patient in 77% of the cases. Symptoms were asked about in 95% of cases, and a medication history taken in 69%. H2RAs were recommended in 57% of cases, PPIs in 18%, and antacids in 19%. Patients were asked to consider seeing a doctor to discuss reflux symptoms in 63% of cases.


The burden of allergic rhinitis (AR) in Canada: perspectives of physicians and patients.

By: Keith PK, Desrosiers M, Laister T, Schellenberg RR, Waserman S.

Allergy, Asthma & Clinical Immunology 2012;8:7.

Summary: Patients and doctors were surveyed to determine the impact of allergic rhinitis. Slightly less than half of patients had experienced nasal symptoms unrelated to a cold and 20% had been diagnosed with AR by a doctor. Most, however, had not seen a physician in the past year. Physicians estimated they prescribed intranasal steroids to most AR patients, but only 19% of AR patients had used one in the past month. Perceived loss of efficacy and side effects were commonly implicated as reasons for discontinuation.


The Effects of Dextromethorphan on Driving Performance and the Standardized Field Sobriety Test

By: Perry PJ, Fredriksen K, Chew S, Ip EJ, Lopes I, Doroudgar S, Thomas K.

Journal of Forensic Sciences 2015; 60: 1258-62.

Summary: A one-time dose of DM 120 mg did not demonstrate driving impairment with a simulator. The authors felt that doses greater than the current maximum dose of 120 mg are necessary to impact driving behavior.



The heterogeneity of headache patients who self-medicate: a cluster analysis approach.

By: Mehuys E, Paemeleire K, Crombez G, Adriaens E, Van Hees T, Demarche S, Christiaens T, Van Bortel L, Van Tongelen I, Remon JP, Boussery K.

Pain 2016; 157: 1464-71.

Summary: The study aimed to identify sub-groups with headache who self-medicate. Approximately 1000 patients were recruited in 202 community pharmacies. Cluster 3 (of 3 clusters) were mainly migraine sufferers who also reported other bouts of pain and showed the highest rate of medication overuse at 73%.




By: Gardiner SJ, Chang AB, Marchant JM, Petsky HL.

Cochrane Database of Systematic Reviews  2016; 7: Article Number: CD011914.

Summary: A review was undertaken to evaluate the safety and efficacy of codeine (and derivatives) in the treatment of chronic cough in children. While hundreds of articles were found, no studies fulfilled the inclusion criteria of this review, and thus they found no evidence to support or oppose the use of codeine or derivatives as antitussive agents for chronic cough in children. While chronic cough is not the same as acute cough, systematic reviews on the use of codeine efficacy for acute cough in children conclude an overall lack of evidence to support or oppose the use of over-the-counter cough and cold medications containing codeine (or derivatives) for treatment of acute cough in children. The lack of sufficient evidence to support the use of these medications has been consistently re-affirmed by medical experts in international chronic cough guidelines and by governing medical and pharmaceutical authorities in the USA, Europe, Canada, New Zealand, and Australia. Due to the lack of sufficient evidence to support efficacy, and the known risks associated with use, these medications are now not recommended for children under 12 years of age and children between 12 to 18 years with respiratory conditions.




By: Alemanni M, Gatoulis SC, Voelker M.

Minerva Medica 2016;  107: 125-130.

Summary: The researchers considered 5 formulations currently marketed in Italy: aspirin tablets (Aspirina Dolore e Infiammazione), ibuprofen tablets and liquid capsules (Moment), ibuprofen lysine tablets (Nurofenimmedia) and dexketoprofen trometamol tablets (Enantyum). Dissolution tests were performed according to the current USP/NF monograph dissolution procedure. Drug dissolution was evaluated at 1, 3, 6, 15, and 30 minutes. Dissolution was evaluated at three different pH. The aspirin formulation was by far the most rapid dissolving formulation, with more than 80% of the tablet dissolved at 6 minutes for every pH considered. At pH 1.2 and 4.5, only the dexketoprofen formulation was able to reach the dissolution level of aspirin at 30 minutes, but had lower levels of dissolution at the previous time points. The authors concluded that different formulation strategies can lead to great differences in the dissolution rates even among drugs of the same class.




By: Porteous T, Ryan M, Bond C, Watson M, Watson V.

PLoS ONE 2016; 11 (3): Article Number: e0152257

Summary: Community pharmacies are sources of treatment and advice for people wishing to manage minor ailments. However, increasing the public’s use of pharmacy services may depend on attributes of pharmacies and their staff. This study aimed to determine the general public’s relative preferences for community pharmacy attributes. A UK-wide survey of the general public was conducted using face-to-face computer-assisted personal interviews. The context for the experiment was a minor ailment scenario describing flu-like symptoms. When seeking help or treatment for flu-like symptoms, respondents most valued a pharmacy service that would improve their understanding and management of symptoms, provided by staff who are trained, friendly and approachable. Waiting time, pharmacy location and availability of parking also contributed to respondents’ preferences.