BNF for Children 2011-2012

790 Appendix 3: Cautionary and advisory labels BNFC 2011–2012Appendix 3: Cautionary and advisory labels13 Dissolve or mix with water before takingTo be used on preparations that are intended to bedissolved in water (e.g. soluble tablets) or mixed withwater (e.g. powders, granules) before use. In a fewcases other liquids such as fruit juice or milk may beused.14 This medicine may colour your urine. This is harmlessTo be used on preparations that may cause thepatient’s urine to turn an unusual colour. Theseinclude triamterene (blue under some lights), levodopa(dark reddish), and rifampicin (red).15 Caution: flammable. Keep your body away from fire orflames after you have put on the medicineTo be used on preparations containing sufficientflammable solvent to render them flammable ifexposed to a naked flame.16 Dissolve the tablet under your tongue—do not swallow.Store the tablets in this bottle with the captightly closed. Get a new supply 8 weeks afteropeningTo be used on glyceryl trinitrate tablets to remind thepatient not to transfer the tablets to plastic or lesssuitable containers.17 Do not take more than . . . in 24 hoursTo be used on preparations for the treatment of acutemigraine except those containing ergotamine, forwhich label 18 is used. The dose form should bespecified, e.g. tablets or capsules.It may also be used on preparations for which no dosehas been specified by the prescriber.18 Do not take more than . . . in 24 hours. Also, do nottake more than . . . in any one weekTo be used on preparations containing ergotamine.The dose form should be specified, e.g. tablets orsuppositories.19 Warning: This medicine makes you sleepy. If you stillfeel sleepy the next day, do not drive or use tools ormachines. Do not drink alcoholTo be used on preparations containing hypnotics (orsome other drugs with sedative effects) prescribed tobe taken at night. On the rare occasions (e.g. nitrazepamin epilepsy) when hypnotics are prescribed fordaytime administration this label would clearly not beappropriate. Also to be used as an alternative to thelabel 2 wording (the choice being at the discretion ofthe pharmacist) for anxiolytics prescribed to be takenat night.It is hoped that this wording will convey adequatelythe problem of residual morning sedation after taking‘sleeping tablets’.21 Take with or just after food, or a mealTo be used on preparations that are liable to causegastric irritation, or those that are better absorbedwith food.Patients should be advised that a small amount offood is sufficient.22 Take 30 to 60 minutes before foodTo be used on some preparations whose absorption isthereby improved.Most oral antibacterials require label 23 instead (seebelow).23 Take this medicine when your stomach is empty. Thismeans an hour before food or 2 hours after foodTo be used on oral preparations whose absorptionmay be reduced by the presence of food and acid inthe stomach.24 Suck or chew this medicineTo be used on preparations that should be sucked orchewed.The pharmacist should use discretion as to which ofthese words is appropriate.25 Swallow this medicine whole. Do not chew or crushTo be used on preparations that are enteric-coated ordesigned for modified-release.Also to be used on preparations that taste veryunpleasant or may damage the mouth if not swallowedwhole.Patients should be advised (where relevant) that somemodified-release preparations can be broken in half,but that the halved tablet should still be swallowedwhole, and not chewed or crushed.26 Dissolve this medicine under your tongueTo be used on preparations designed for sublingualuse. Patients should be advised to hold under thetongue and avoid swallowing until dissolved. Thebuccal mucosa between the gum and cheek is occasionallyspecified by the prescriber.27 Take with a full glass of waterTo be used on preparations that should be well diluted(e.g. chloral hydrate), where a high fluid intake isrequired (e.g. sulfonamides), or where water isrequired to aid the action (e.g. methylcellulose). Thepatient should be advised that ‘a full glass’ means atleast 150 mL. In most cases fruit juice, tea, or coffeemay be used.28 Spread thinly on the affected skin onlyTo be used on external preparations that should beapplied sparingly (e.g. corticosteroids, dithranol).29 Do not take more than 2 at any one time. Do not takemore than 8 in 24 hoursTo be used on containers of dispensed solid dosepreparations containing paracetamol for adults whenthe instruction on the label indicates that the dose canbe taken on an ‘as required’ basis. The dose formshould be specified, e.g. tablets or capsules.This label has been introduced because of the seriousconsequences of overdosage with paracetamol.30 Contains paracetamol. Do not take anything elsecontaining paracetamol while taking this medicineTo be used on all containers of dispensed preparationscontaining paracetamol.32 Contains aspirin. Do not take anything else containingaspirin while taking this medicineTo be used on containers of dispensed preparationscontaining aspirin when the name on the label doesnot include the word ’aspirin’.