SELFCARE FOCUS

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.

ORAL ANTIHISTAMINE-DECONGESTANT-ANALGESIC COMBINATIONS FOR THE COMMON COLD.

By: AJM De Sutter, ML van Driel, AA Kumar, et al.

Cochrane database of systematic reviews (Online) 2012 Feb 15;2

Summary: To assess the effectiveness of antihistamine-decongestant-analgesic combinations in reducing the duration and alleviating the symptoms of the common cold in adults and children. Current evidence suggests that antihistamine-analgesic-decongestant combinations have some general benefit in adults and older children. These benefits must be weighed against the risk of adverse effects. There is no evidence of effectiveness in young children.
Abstract.

DICLOFENAC WITH OR WITHOUT AN ANTIEMETIC FOR ACUTE MIGRAINE HEADACHES IN ADULTS.

By: S Derry, R Rabbie , RA Moore.

Cochrane database of systematic reviews (Online) 2012 Feb 15;2

Summary: Many migraine sufferers rely on over-the-counter (OTC) analgesics. Diclofenac is an established analgesic, and new formulations using the potassium or epolamine salts, which can be dissolved in water, have been developed for rapid absorption, which may be beneficial in acute migraine. Co-therapy with an antiemetic should help to reduce the nausea and vomiting commonly associated with migraine. Oral diclofenac potassium 50mg is an effective treatment for acute migraine, providing relief from pain and associated symptoms, although only a minority of patients experience pain-free responses. Adverse events are mostly mild and transient and occur at the same rate as with placebo.
Abstract.

A NEW MODEL OF PRESCRIPTION TO NONPRESCRIPTION RECLASSIFICATION: THE CALCIPOTRIOL CASE STUDY.

By: N Gauld, L Emmerton, et al.

Clinical Therapeutics. Volume 34, Number 6, 2012

Summary: This commentary describes the recent reclassification of calcipotriol, a topical drug treatment for psoriasis, to non-prescription status in New Zealand.  This switch was highly unusual in that it was initiated by a pharmacy retailer rather than the manufacturer. The paper reviews the particular challenges that the application had to overcome and the pharmacy supply model which resulted. The authors comment that such ‘third party’ reclassifications may be possible in some other countries and may provide an additional impetus to reclassifications when there are multiple potential beneficiaries.
Abstract.

TRENDS IN THE USE OF TOPICAL OVER THE COUNTER PRODUCTS IN THE MANAGEMENT OF DERMATOLOGIC DISEASE IN THE UNITED STATES.

By: BV Nolan, MM Levender, SA Davis, et al.

Dermatology Online Journal 2012 Feb 18(2)

Summary: In the U.S. topical OTCs are widely used, but use in dermatology is not well defined. To characterize topical OTC use in the U.S., the National Ambulatory Medical Care Survey was queried for physician visits in which topical OTCs were recorded. From 1989 to 2008, there were an estimated 320 million visits documenting topical OTC recommendations; the majority of which were visits to a dermatologist (33.5%). Dermatologists most commonly recommended hydrocortisone (16.9%), benzoyl peroxide (13.3%), and sunscreen (7.4%). Dermatologists were more likely than other providers to use moisturizers in the treatment of dermatologic disease. Overall, topical OTC recommendations by all physicians has decreased over time (p<0.0001). However, dermatologists’ recommendations for moisturizers and sunscreens has increased significantly. Conclusion: Topical OTC products have an important role in the prevention and treatment of dermatologic disease. Topical OTC recommendations are decreasing over time whereas their use as complementary components (sunscreen/moisturizers) appears to be increasing.
Abstract.

ROLE OF GLUCOSAMINE IN THE TREATMENT FOR OSTEOARTHRITIS.

By: JY  Reginster, A Neuprez, MP Lecart et al.

Rheumatol Int. 2012 Mar 30

Summary: There is now a large, convergent body of evidence that glucosamine sulfate, given at a daily oral dose of 1,500 mg, is able to significantly reduce the symptoms of osteoarthritis in the lower limbs. This dose of glucosamine sulfate has also been shown, in two independent studies, to prevent the joint space narrowing observed at the femorotibial compartment in patients with mild-to-moderate knee osteoarthritis. This effect also translated into a 50 % reduction in the incidence of osteoarthritis-related surgery of the lower limbs during a 5-year period following the withdrawal of the treatment. Some discrepancies have been described between the results of studies performed with a patent-protected formulation of glucosamine sulfate distributed as a drug and those having used glucosamine preparations purchased from global suppliers, packaged, and sold over-the-counter as nutritional supplements.
Abstract.

MEDICATION AND SUPPLEMENT USE FOR MANAGING JOINT SYMPTOMS AMONG PATIENTS WITH KNEE AND HIP OSTEOARTHRITIS: A CROSS-SECTIONAL STUDY.

By: JB Driban, SA Boehret, E Balasubramanian et al.

BMC musculoskeletal disorders 2012 Mar ;13:47-47

Summary: The study was to determine the professionally-guided and self-guided medication and supplement use for joint symptom management among patients with knee and/or hip osteoarthritis (OA) in an urban hospital-based outpatient orthopedic practice. Both professional and self-guided medications and supplements are used by inner city OA patients to manage their joint symptoms. It is important for clinicians to discuss with these patients how to effectively manage multiple joint symptoms, the importance of taking medications as prescribed, and what they should if they believe a treatment is ineffective or their medication runs out.
Abstract.

NATURE AND FREQUENCY OF DRUG-RELATED PROBLEMS IN SELF-MEDICATION (OVER-THE-COUNTER DRUGS) IN DAILY COMMUNITY PHARMACY PRACTICE IN GERMANY.

By: C Eickhoff, A Hämmerlein, N Griese et al.

Pharmacoepidemiology and Drug Safety 2012 21(3): 254-260

Summary: This study was to quantify drug-related problems (DRPs) in self-medication (over-the-counter [OTC] drug use) identified by community pharmacists (CPs) in Germany at the time the drug is dispensed. In total, 109 CPs documented 12567 encounters identifying DRPs in 17.6% of all cases. Four indications comprised more than 70% of all DRPs: pain, respiratory, gastrointestinal, and skin disorders. Four DRPs were responsible for almost 75% of all DRPs identified: self-medication inappropriate (29.7%), requested product inappropriate (20.5%), intended duration of drug use too high including abuse (17.1%), and wrong dosage (6.8%). If a drug history was available, significantly more cases with wrong dosage (p<0.05) and drug-drug interactions (p<0.001) were detected. All patients with identified DRPs were counseled accordingly. Furthermore, the most frequent interventions were referral to a physician (39.5%) and switching to a more appropriate drug (28.1%). Conclusions: In nearly one of five encounters, a direct pharmacist-patient interaction about self-medication revealed relevant DRPs. Having access to patient files including data on prescription and OTC drugs may increase patient safety.
Abstract.

AN OVER-THE-COUNTER SIMULATION STUDY OF A SINGLE-TABLET EMERGENCY CONTRACEPTIVE IN YOUNG FEMALES.

By: TR Raine, N Ricciotti, A Sokoloff et al.

Obstetrics and Gynecology 2012 Apr 119(4): 772-779

Summary: This study evaluated use of a single-tablet (levonorgestrel 1.5 mg) emergency contraceptive administered to young females (11-17 years) under simulated over-the-counter conditions. 311 (91.5%) participants appropriately selected to use or not use product. Among the 298 participants who used product, 274 (92.9%) correctly used it as labeled. Selection and correct use were not associated with age. The study concluded that restricting young females’ use of a single-tablet emergency contraceptive by prescription only is not warranted, because females younger than 17 years can use it in a manner consistent with over-the-counter access.
Abstract.

 

RESULTS OF A NATIONAL SURVEY ON OVER-THE-COUNTER MEDICINES, PART 1: PHARMACIST OPINION ON CURRENT SCHEDULING STATUS.

By: J Taylor, E Landry, L Lalonde, RT Tsuyuki.

Canadian Pharmacists Journal 2012 Jan; 145(1): 40-44

Summary: To gauge pharmacist agreement on the scheduling status of various OTC medicines,  community pharmacists across Canada were surveyed by mail. Across 25 agents, pharmacists tended to support existing control for pharmacies (such as Nix creme rinse and minoxidil topical solution) and returning control to pharmacies for unscheduled agents (such as ranitidine 75mg tablets and nicotine patches). Conclusions: Pharmacists generally favour tighter control of OTC agents, especially those that are unscheduled.
Link.

 

RESULTS OF A NATIONAL SURVEY ON OVER-THE-COUNTER MEDICINES PART 2: DO PHARMACISTS SUPPORT SWITCHING PRESCRIPTION AGENTS TO OVER-THE-COUNTER STATUS?

By: L Lalonde, RT Tsuyuki, E Landry, J Taylor.

Canadian Pharmacists Journal 2012 Mar; 145 (2): 73-76

Summary: Switching prescribed medications to over- or behind-the-counter status is considered an option to improve accessibility to treatment while insuring appropriate and safe use. This paper explores pharmacists’ readiness for switching simvastatin, omeprazole and fluticasone to Schedule II status and also identifies the barriers and facilitators for such a switch. The majority of pharmacists would not support an OTC switch for simvastatin (88%) and omeprazole (61%).  In contrast, more pharmacists (54%) would support such a change for fluticasone. This large national survey shows that Canadian pharmacists do not support the deregulation of simvastatin or omeprazole and only moderately support an OTC switch for fluticasone.  The complexity of disease and drug management was listed as the main barrier by those who were against such a switch, while additional training on the initial assessment and monitoring of these conditions was deemed necessary by pharmacists who would agree with such legislative change.  Access to laboratory test results, liability issues and loss of drug plan coverage were also listed as important issues.  Lack of remuneration and the need for a reorganised dispensary floorplan were not perceived by most pharmacists as an important barrier and facilitator, respectively.  The authors note that these findings differ from the reported results of surveys of pharmacists in the UK.
Link.

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