2017 HCHB_digital

HEALTHCARE
HANDBOOK
incorporating the OTC products guide
July 2017 - June 2018
Healthcare Handbook launches
its new OTC Learning Pathway through
ELearning and Pharmacy Today
$105.40 (incl. GST)
Includes Pharmacy Today subscription
VOLUME 19

NEW
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For the temporary relief of mild osteoarthritis of the knees and fingers.
Voltaren ® Osteo Gel 12 Hourly contains diclofenac diethylammonium 23.2 mg/g. Indications and dosage: For short-term (up to 3 weeks) pain relief of mild and localised forms of osteoarthritis of the
knees and fingers. Adults and children ≥ 12 years: Apply to affected area up to 2 times a day. Contraindications: Hypersensitivity to any ingredient; in asthma attacks, urticaria or rhinitis precipitated by
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2017-2018
HEALTHCARE
HANDBOOK
PUBLISHER
The Health Media
GENERAL MANAGER
Anna Mickell
TECHNICAL EDITOR
Carmen Fookes BPharm, PG.Dip.Clin.Pharm, PG.Cert.Psych.Pharm, RegPharmNZ, MPS
EDITOR – PHARMACY TODAY
Mark Longley
ADVISORY PANEL
Carmen Fookes BPharm, PG.Dip.Clin.Pharm, PG.Cert.Psych.Pharm, RegPharmNZ, MPS
Phil Rasmussen MPharm, MPS, Dip.Herb.Med, MNIMH, MNHAA, MNZAMH
BUSINESS MANAGER
Grayson Cobb
DESIGN / PRODUCTION
Tao Jiang
ADVERTISING PRODUCTION
Ali Jacobs
SUBSCRIPTIONS
Sandie Morice
2017-2018 Healthcare Handbook is published in association with
Pharmacy Today.
One copy is distributed free to retail pharmacy subscribers to
Pharmacy Today. Additional copies are available on request,
for $67 (includes GST).
For advertising queries contact Grayson Cobb:
Phone: (09) 488 4295
Email: gcobb@pharmacytoday.co.nz
For additional copies contact Sandie Morice:
Phone: (09) 488 4286
Email: smorice@thehealthmedia.co.nz
The Health Media Ltd
11 Omana Rd, Milford, Auckland 0620
PO Box 31905, Milford, Auckland 0741
Phone: (09) 488 4286
Fax: (09) 912 9257
Email: enquiries@thehealthmedia.co.nz
Website: www.pharmacytoday.co.nz
ISSN 1176-2241
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Index
Common Disorders
Acne------------------------------------------------------------------------- 12
Allergies--------------------------------------------------------------------- 14
Asthma and COPD--------------------------------------------------------- 16
Baby Feeding--------------------------------------------------------------- 18
Bites and Stings------------------------------------------------------------ 20
Bruises, Scars, Spider Veins----------------------------------------------- 22
Childhood Diseases and Immunisations------------------------------- 24
Childhood Pain and Baby Teething-------------------------------------- 32
Colds------------------------------------------------------------------------- 34
Cold Sores------------------------------------------------------------------ 36
Constipation---------------------------------------------------------------- 38
Contraception & Sexual Wellbeing-------------------------------------- 40
Contraception: Emergency----------------------------------------------- 42
Coughs: Dry----------------------------------------------------------------- 44
Coughs: Productive-------------------------------------------------------- 46
Cuts, Abrasions and Blisters---------------------------------------------- 48
Cystitis [Bladder Infection]----------------------------------------------- 50
Dandruff--------------------------------------------------------------------- 52
Dermatitis/Eczema--------------------------------------------------------- 54
Diabetes--------------------------------------------------------------------- 56
Diarrhoea and Vomiting-------------------------------------------------- 58
Dry Skin--------------------------------------------------------------------- 60
Ear Conditions-------------------------------------------------------------- 62
Eye Conditions------------------------------------------------------------- 64
Eyes: Contact Lenses------------------------------------------------------ 68
Fever------------------------------------------------------------------------- 70
Foot Care-------------------------------------------------------------------- 72
Fungal Infections: Superficial-------------------------------------------- 74
Fungal Nail Infections (Onychomycosis)-------------------------------- 76
Gout------------------------------------------------------------------------- 78
Haemorrhoids-------------------------------------------------------------- 80
Hair Loss-------------------------------------------------------------------- 82
Hay Fever-------------------------------------------------------------------- 84
Headache------------------------------------------------------------------- 88
Head Lice-------------------------------------------------------------------- 90
Heart Health---------------------------------------------------------------- 92
Indigestion, Heartburn and Gastritis------------------------------------ 94
Influenza-------------------------------------------------------------------- 96
Iron Deficiency-------------------------------------------------------------100
Irritable Bowel Syndrome------------------------------------------------102
Menopause----------------------------------------------------------------104
Migraine--------------------------------------------------------------------106
Muscular Aches, Pains and Tightness----------------------------------108
Nappy Rash----------------------------------------------------------------110
Oral Health-----------------------------------------------------------------112
Osteoarthritis--------------------------------------------------------------114
Osteoporosis---------------------------------------------------------------116
Period Pain and Endometriosis-----------------------------------------118
Poisonings-----------------------------------------------------------------120
Pregnancy Tests and Supplements-------------------------------------122
Preventive Health---------------------------------------------------------124
Probiotics and Prebiotics------------------------------------------------126
Psoriasis--------------------------------------------------------------------128
Scabies---------------------------------------------------------------------130
Shingles--------------------------------------------------------------------132
Sinus and Nasal Problems-----------------------------------------------134
Sleep Problems and Snoring--------------------------------------------136
Smoking Cessation-------------------------------------------------------138
Sore Throat-----------------------------------------------------------------140
Strains and Sprains-------------------------------------------------------142
Sun Care-------------------------------------------------------------------144
Sun Care: Eye Protection------------------------------------------------146
Sweating: Excessive (Hyperhidrosis)-----------------------------------148
Toothache------------------------------------------------------------------150
Travel Health (including Vaccinations)---------------------------------152
Travel Sickness------------------------------------------------------------154
Urinary Incontinence-----------------------------------------------------156
Urticaria (Hives)-----------------------------------------------------------158
Vaginal Health-------------------------------------------------------------160
Varicose Veins and Support Stockings---------------------------------162
Vitamins and Dietary Supplements-------------------------------------164
Warts-----------------------------------------------------------------------166
Weight Loss----------------------------------------------------------------168
Worms----------------------------------------------------------------------170
Wound Care---------------------------------------------------------------172
Glossary--------------------------------------------------------------------176
Chapter References-------------------------------------------------------177
Reference Charts
Medicines Safety----------------------------------------------------------183
OTC Medicines: Interactions--------------------------------------------184
OTC Medicines: Precautions---------------------------------------------191
OTC Medicines: Adverse Effects----------------------------------------195
Herbal Supplements: Interactions--------------------------------------197
Drugs in Sport-------------------------------------------------------------206
Drugs in Aviation----------------------------------------------------------208
Drugs in Diving------------------------------------------------------------209
Drugs in Pregnancy-------------------------------------------------------210
Drugs in Driving ----------------------------------------------------------211
NZ Support Groups-------------------------------------------------------212
OTC Products
OTC Products Index (by condition)-------------------------------------217
Product Listings-----------------------------------------------------------220
Index
OTC Products Index (by alphabetical order)--------------------------270
Manufacturers’ Index----------------------------------------------------272
Page 3

its new OTC Learning Pathway through
ELearning and Pharmacy Today
$67 (incl.GST)
VOLUME 19
Introduction
HEALTHCARE
HANDBOOK
incorporating the OTC products guide
July 2017 - June 2018
Healthcare Handbook launches
W
elcome to the 2017 Healthcare Handbook, which this year
has the addition of an OTC ELearning, continuing education
component. Aimed at pharmacy technicians, assistants and
retail assistants, the OTC ELearning programme is a 12-month
course that runs in conjunction with Pharmacy Today.
The idea behind the OTC ELearning continuing education is to enable
pharmacy staff to upskill their knowledge and start to build a record of their
education in pharmacy. This can be transferred if someone moves jobs or used to
gain promotion within an existing pharmacy. Pharmacists can also easily ensure
their staff are getting first-class training in a range of relevant subjects.
How to complete the course
Each month in Pharmacy Today there is a continuing education column at the
back of the Retail Therapy section, aimed for pharmacy staff working on the
shop floor. This provides information on treating some of the more common
conditions presenting in pharmacy. This column will correlate to a condition in the
Healthcare Handbook and, once you have read both, you can complete an online
ELearning module at www.elearning.pharmacytoday.co.nz. Each successfully
completed module will earn points and the opportunity to win a prize at the end
of the 12-month course.
After 12 modules have been successfully completed you will be issued a
certificate from Pharmacy Today showing you have completed the course.
Enjoy this year’s Healthcare Handbook and see each issue of Pharmacy Today
for the corresponding continuing education column. The ELearning course is
straightforward so your continuing education is hassle free.
Page 4 HEALTHCARE HANDBOOK 2017-2018 Introduction

Asthma and COPD
CONTINUING OTC EDUCATION
Asthma
present most of the time. During an “attack”, breathing becomes very difficult
New Zealand has one of the highest prevalences of asthma in the world and over due to inflammation and contraction of the smooth muscle within the airway,
460,000 people regularly take medication for asthma. An estimated one in seven excessive mucous secretion, and swelling of the smaller airways. Permanent
children and one in nine adults are affected, and only a small number of children damage of the airways can result from untreated asthma.
appear to grow out of the condition.
It is common for asthmatics to also suffer from hay fever or eczema, and/or to
Common symptoms include wheezing (a whistling sound most obvious when have a family history of these conditions.
breathing out), shortness of breath, tightness in the chest, difficulty speaking, and The cause of asthma is unknown; however, many common triggers have been
a persistent dry cough (usually at night or after exercise). Over time this cough may identified, including animal dander (especially cats), cigarette smoke, cold air,
become more productive. A cough may be the only symptom in young children. exercise, house dust mites, pollen, stress, strong perfume, viral infections (eg, a
These symptoms may occur suddenly as an asthma “attack”, or they can be cold) and some medicines (eg, aspirin and NSAIDs). Asthma cannot be cured but
TREATMENT OPTIONS
Category Examples Comments
Relievers
Beta2-agonists
(short-acting
[PRESCRIPTION MEDICINE]
bronchodilators) eg, salbutamol inhaler (Asthalin, SalAir,
Salamol, Respigen, Ventolin)
eg, terbutaline (Bricanyl)
eg, salbutamol liquid (Ventolin)
Preventers
Corticosteroids
[PRESCRIPTION MEDICINE]
eg, beclomethasone (Beclazone, Qvar),
budesonide (Pulmicort), fluticasone (Floair,
Flixotide)
Mast cell stabilisers and others
[PRESCRIPTION MEDICINE]
eg, nedocromil (Tilade), sodium
cromoglycate (Intal Spincaps/Forte),
montelukast (Singulair)
Anticholinergic [PRESCRIPTION MEDICINE]
bronchodilators or eg, ipratropium (Atrovent, Univent)
long-acting muscarinic tiotropium (Spiriva), glycopyrronium
antagonists
(Seebri), umeclidinium (Incruse Ellipta),
aclidinium (Bretaris)
Symptom controllers [PRESCRIPTION MEDICINE]
(long-acting beta2 eg, eformoterol (Foradil, Oxis), indacaterol
agonists)
(Onbrez), salmeterol (Meterol, Serevent)
Combination therapy [PRESCRIPTION MEDICINE]
eg, eformoterol + budesonide (Symbicort
Smart, Vannair), glycopyrronium
+ indacaterol (Ultibro Breezhaler),
ipratropium + salbutamol (Duolin
HFA), salmeterol + fluticasone (RexAir,
Seretide), tiatropium + olodaterol (Spiolto
Respimat), umeclidinium + vilanterol
(Anoro), vilanterol + fluticasone (Breo)
Spacers
eg, e-chamber, Volumatic
Children aged six or less
eg, e-chamber mask
Reliever inhalers are used to treat the acute symptoms of asthma (ie, the difficulty in breathing). They provide
relief within a couple of minutes. Most reliever inhalers are blue.
Anyone using a reliever more than three times a week or waking at night with symptoms should go to the
doctor. If a person finds his bronchodilator has become less effective, it may indicate worsening asthma and
the need to initiate an action plan or to visit the doctor to review therapy.
Preventer inhalers contain corticosteroids. They do not have an immediate effect, so nothing is felt after
inhalation; however, when used regularly they reduce the underlying inflammation of the airways and help
reduce the incidence and severity of asthma attacks and hospitalisations. Most preventer inhalers are either
brown, orange or dark red.
Reduce risk of oral thrush by using a spacer and rinsing the mouth with water after using inhaled
corticosteroids (ICS).
Mast cell stabilisers (ie, nedocromil, sodium cromoglycate) are not commonly used since they are less effective
than ICSs. May be useful for preventing exercise-induced asthma. Sodium cromoglycate needs to be taken
anywhere from four to eight times daily. They may take up to six weeks to take effect.
Montelukast is a leukotriene receptor antagonist that may be used in addition to ICSs for an additive effect.
Can be of benefit in exercise-induced asthma and in people who also have rhinitis. Special Authority needed.
Ipratropium reduces mucous secretions and relaxes airway muscle. It is short-acting and has a slower onset of
action than beta2-agonists so is used more in COPD, although certain asthma patients may benefit. Longer
acting antimuscarinic bronchodilators include tiotropium, glycopyrronium, umeclidinium, and aclidinium.
Long-acting bronchodilators. Do not treat the underlying inflammation but may be beneficial in mild to
moderate asthma instead of using higher doses of ICS. Used in conjunction with an ICS. Not useful for acute
asthma attacks since they do not open airways immediately. Do not exceed recommended dose.
Combination agents may aid adherence to recommended preventative regimens.
Dispense
Ventolin ®
The original blue inhaler
that Kiwis know and trust 2
Help to improve delivery of MDIs to the lungs, reduce adverse effects of ICSs. Wash once a week with warm
water and a squirt of detergent and allow to completely drip dry. This leaves a slight residue of detergent
on the inside of the spacer which reduces static and stops the medicine in the inhaler sticking to the sides.
Replace every six to 12 months (tiny scratches or abrasions can prevent the spacer working as effectively).
Te Hã Ora: The Breath Of Life
Te Hã Ora is New Zealand's National Respiratory Strategy launched in November 2015. Respiratory
disease (including asthma, bronchiectasis, COPD, lung cancer, obstructive sleep apnoea, and
pneumonia) affects almost 700,000 people in New Zealand but despite improvements in medical
treatments and health care, respiratory illness rates here continue to worsen. Te Hã Ora aims to:
• reduce the incidence and impact of respiratory disease in New Zealand
• eliminate inequalities in respiratory health, particularly among Maori, Pacific peoples and low
income families.
The full National Respiratory Strategy document can be found at asthmafoundation.org.nz
most people are able to manage it with medicine so that it does not interfere with
their day-to-day life. Education is vital to help sufferers recognise symptoms of
worsening asthma and to avoid severe attacks by taking early action. Symptoms
that indicate worsening asthma include a dry, persistent cough, usually at night
and after exercise, and increasing use of “reliever” medicine. Home-use of a peak flow
meter (a device that measures maximum flow of air from the lungs) may help identify
deteriorating lung function. Common treatment options include beta-2 agonists,
corticosteroids, mast cell stabilisers, and leukotriene receptor antagonists.
COPD (Chronic Obstructive Pulmonary Disease)
COPD is an umbrella term used to describe several different progressive lung
diseases, such as emphysema and chronic bronchitis. COPD is more likely to
develop in people over the age of 40 and symptoms include breathlessness,
coughing, and increased phelgm. The major difference between COPD and
asthma is that COPD is generally irreversible, although most symptoms can
be controlled and further deterioration in lung function prevented with early
treatment. Some people have both COPD and asthma.
Ninety per cent of people who develop COPD have previously smoked; other
causes include environmental pollutants and genetic deficiencies (eg, Alpha-1
Antitrypsin Deficiency). Treatments include oxygen, antimuscarinics, beta-2
agonists, corticosteroids, theophylline, antibiotics, and pulmonary rehabilitation
programmes.
Initial assessment
The majority of customers with asthma or COPD require life-long medications so
will regularly come into your pharmacy to collect these.
Pay attention to the way they usually look, and if you notice any deterioration in
their health, breathing, or if talking or walking appears difficult, ask if they would
like to talk to a pharmacist. Always involve a pharmacist in cold or flu medicine
requests, as lung function can quickly become compromised with illness.
Types of delivery devices and spacers
Metered dose inhalers (MDIs) – also called “puffers” are the most common devices
available for delivery of medications used to treat asthma or COPD. However, many
Refer to
PHARMACIST
If someone collapses and appears to have difficulty breathing, CALL
AN AMBULANCE IMMEDIATELY, whether or not the person is
known to have asthma or COPD.
All other people presenting with asthma symptoms should be
referred to the pharmacist, who should:
• ASSESS the severity of the episode and call 111 if severe
• SIT the person down and get them to lean forward
• TREAT with six puffs of a blue “reliever” inhaler, preferably
through a spacer (use patient’s own if available)
• HELP by calling an ambulance if the person does not improve
• MONITOR for improvement and repeat doses if needed
• ALL OK. Stay with them until they are free from wheeze, cough
and breathlessness then refer them to their doctor.
older and younger patients find them difficult to use since good coordination is
required between activation of the MDI and inhalation. Most MDIs require regular
cleaning, preferably weekly, and should be shaken before use.
Dry powder inhalers are breath-activated inhalers. They require less
coordination and there is no need to use a spacer. However, they may be
unsuitable if the person’s ability to inhale is too weak.
Nebulisers are machines that convert liquid into a mist that can be inhaled
into the lungs.
Spacers are specially designed plastic tubes that are designed to be used with
MDI (puffer) inhalers. They bypass the need for patients to coordinate activation
of the inhaler with inhalation, and also help prevent the occurrence of oral thrush.
Spacers can be very helpful during an acute asthma episode and some are available
fully funded (see Treatment options).
Advice for customers
• Ensure customers know what each inhaler is for and how to use them.
• Advise people with asthma to use paracetamol instead of NSAIDs because
NSAIDs may precipitate an asthma attack in some people.
• Ensure they have talked with their doctor about what to do if their asthma
worsens and they have an Asthma Self-management plan.
• Treat allergies and avoid known asthma triggers wherever possible, including
cigarette smoke.
• Warm up and use a reliever before exercise if they get exercise-induced asthma.
VENTOLIN
Asthma
Symptom Relief
doesn’t need to involve an
unpleasant aftertaste. 1
DISPENSE
ALCOHOL
FREE
VENTOLIN 2
References: 1. Gillies J et al. NZ Med J. 2005:118(1220):79-83. 2. Ventolin Data Sheet, GSK New Zealand.
Ventolin ® (salbutamol; available as an alcohol-free and CFC-free Inhaler,100mcg per actuation) is a Prescription Medicine. Ventolin is a short acting bronchodilator
(selective beta-2 adrenoreceptor agonist) for relieving symptoms in patients with asthma and for bronchodilation in patients with reversible airways obstruction due
to asthma, chronic bronchitis and emphysema. Ventolin is a partially funded medicine. Dosage: Acute bronchospasm – 1 or 2 puffs, Chronic therapy – may take
up to 2 puffs four times daily. This medicine has risks and benefits. Contraindications: Hypersensitivity to this medicine or to any of its components. Warnings and
Precautions: Increasing use to control symptoms indicates deterioration of asthma control. Under these conditions, the patient’s therapy plan should be reassessed.
Hypokalaemia may occur, particularly in acute severe asthma, potentiated by xanthine derivatives, steroids, diuretics and hypoxia. Caution in hyperthyroidism,
hypertension, cardiovascular diseases and diabetes. Avoid beta-blockers, tricyclic antidepressants, MAOIs, digitalis. Common Side Effects: Headache, mild tremor,
mouth and throat irritation, tachycardia and peripheral vasodilation, paradoxical bronchospasm. Before prescribing Ventolin, please review the Data Sheet at www.
medsafe.govt.nz. Ventolin is a registered trade mark of the GlaxoSmithKline group of companies. Marketed by GlaxoSmithKline NZ Limited, Auckland. Adverse events
involving GlaxoSmithKline products should be reported to GSK Medical Information on 0800 808 500. TAPS DA1728IG/17MA/SLB/0001/17
Page VEN_XXXX_Ventoline 18 HEALTHCARE Strip Ad Marc HANDBOOK 17 V3.indd 1 2017 Common Disorders 17/03/17 Page 12:10 PM 19
» Colds - Treatment
BONNINGTON’S IRISH MOSS
ASPEN PHARMACARE
Presentation: Cough Syrup, 200mL bottle
Active Ingredients: Each 10mL contains: 1.7 mg menthol, 9 mg camphor, 240 mg liquorice extract, 13 mg carrageenan,
3.8 uL ipecacuanha
Approved Indications: Soothes and relieves coughs and sore throats.
Contraindications: None known
Precautions: Use only as directed. If symptoms persist, see your doctor. Store below 30 degrees celsius.
Adverse Effects: None known
Directions: For adults and children over 12 years, take 10mls and repeat every 2 hours as needed.
Price Band: $14-16 per 200mL bottle
Medicine Classification: General Sale
Each common condition includes:
• General information
• Initial assessment
• Treatment options
• Customer advice
• When to refer to the pharmacist.
CODRAL ALL IN ONE
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Capsules, 24s
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg.
Night: Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy, do not drive or operate machinery. Avoid alcohol. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red and white night capsules at
bedtime. Allow 4-6 hours as necessary between doses. Maximum 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches, fever, body aches and pains, blocked and runny
nose, and sore throat.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems or are
pregnant or breastfeeding, are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected do not drive
a vehicle or operate machinery. Keep to the recommended dose.
Directions: For adults and children 12 years and over: take 2 day tablets every 4-6 hours as necessary. Maximum 8 tablets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL COLD & FLU + COUGH
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg.
Night: Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs, and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy do not drive or operate machinery. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red night capsules at bedtime.
Allow 4-6 hours as necessary between doses. Maximum: 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
Page 224 HEALTHCARE HANDBOOK 2017-2018 OTC Products
Using this handbook
The front section of this handbook gives an overview of 75 of the most common
conditions customers seek advice about from a pharmacy. These conditions are
presented in alphabetical order and are usually in a two-page format (see above).
Initial assessment
When talking to a customer about a condition, it is important to be observant
and not to bombard them with too many questions, especially if the answers
are obvious. The initial assessment paragraph for each condition offers guidance
about how to approach a customer or what specific symptoms to look for. Further
details about the initial assessment are given over the page.
When to refer to the pharmacist
These are prompts for questions to ask your customer. If the answer is obvious
or the answer already clarified during your initial assessment you do not need to
ask the question again. Listen for responses that indicate that it would be more
appropriate to refer the customer to the pharmacist.
Treatment options: OTC products
The Treatment Options Table in each chapter lists most currently available
products for that condition. Products with an asterisk have abridged, but more
detailed, product information in the OTC Products section (see left, for an example).
Page 5

Initial Assessment
Every day, complete strangers walk into a pharmacy to purchase products off the
shelf. While many happily self-select what they need, pay for it, and then leave,
often without discussing their purchase with anybody, as a staff member working
on the shop floor there are times when it may be in your customer’s best interest
that you intervene, or at least offer some advice about their purchase.
But deciding who does and who doesn’t need extra assistance and advice
can be a challenge. In addition, some customers quickly brush aside all offers
of help, although the time of purchase always allows another opportunity to try
to engage with them. Try to always remain friendly and open, instead of “Can
I help you?”, tailor your approach to what they are looking for, for example “I
can let you know the pros and cons of each cough medicine”, or “We have an
informative fact sheet about head lice treatment that you may be interested in”.
An initial visual assessment can tell you a lot about a person and provide
a good basis for asking a few questions, but always be mindful that it is
your own subjective opinion and you need to be careful not to come across
as judgemental or offensive in your questioning. When somebody approaches
you in the pharmacy, or if you see somebody looking at medicines on the shelf,
take note of their age, body shape and overall look, mood, posture, and general
mobility and involve yourself in their purchase if you have any concerns. The
heading Initial assessment within each chapter offers some pointers about
approaching customers or key symptoms to look for, for that particular topic.
Frame your questions tactfully. Instead of jumping in with “You look pregnant.
Are you?”, ask instead “Is there a possibility you could be pregnant?”.
Age
As a rule, any purchases for infants under the age of two should be referred to
a pharmacist. Many products are not recommended for babies, and babies are
often more susceptible to the side effects of medicines, so even if the parent has
self-selected a product for their child, ask if they are happy for you to check with
the pharmacist for suitability.
Older people are more likely to have reduced kidney function, other health
conditions and be on other medications. Side effects are therefore more likely
with medicines such as non-steroidal anti-inflammatory drugs (eg, ibuprofen,
aspirin) and sedating antihistamines, and a pharmacist’s involvement is necessary.
Body shape
People who carry excess weight are at higher risk of cancer, heart disease, high
blood pressure, high cholesterol, gout, reproductive problems, sleep apnoea,
type 2 diabetes, and osteoarthritis. Overeating is best viewed as an addiction,
and it can be very difficult for some people to lose weight, so ensure you are
empathetic in your approach without being condescending. Some pain-relieving
medications, cough and cold remedies, and motion sickness treatments may not
be suitable with some of the conditions listed above.
Overall look
Most people who look unwell, are unwell, and this can provide a lead-in to ask
about their health, particularly if your customer is a regular who usually appears
healthy.
Take note of the colour and condition of somebody’s skin. A grey or a blue
tinge suggests a lack of oxygenated blood that could be caused by a breathing
problem, cancer or late-stage disease such as heart failure or kidney failure. A
yellowish discolouration (jaundice) may indicate a problem with the liver or with
bile flow. In newborns, jaundice is relatively common and usually improves with
light treatment. Very pale skin or mucous membranes could signal anaemia. Be
careful not to assume your customer has a specific underlying condition; that
may just be their natural colouring. However, you could ask if they have any
This infographic summarises key
features to note during an initial
assessment
Always invite
your customer
to talk in
a private area of
the pharmacy
underlying health issues that may impact on what products they buy.
Be observant for any skin rashes or significant blemishes. Seniors and
people with fair skin are prone to skin cancers, such as basal or squamous cell
carcinomas, and melanoma. Most skin cancers can be successfully treated if
found early, and with regular customers you may like to point out any blemishes
of concern and ask if they have seen a doctor about them. Many creams
and topical products sold over the counter may irritate some people’s skin,
particularly those with eczema, allergies, or psoriasis so refer people with
sensitive skin to a pharmacist.
Mood
We all feel anxious or a bit down at times, but, while we readily
admit to having a cold or the flu, most of us tend to hide our
times of emotional fragility. Recognising a low mood in a customer
and sensitively asking “Are you under any stress at the moment?”,
or “You don’t seem your normal self today”, shows compassion, and
you may well be the only person who has reached out to them that day.
Listen to what they have to say, and talk with a pharmacist if you have any
serious concerns about their mental health.
Posture and mobility
A person’s posture may give some clues as to what other underlying medical
conditions they may have. For example, osteoporosis is the most likely cause of a
stooped posture in elderly people, pain may be a reason younger people appear
doubled over. A shuffling or slowness of movement can be associated with
conditions such as Parkinson’s disease; involuntary movements of the tongue or
jaw may reflect a side-effect of antipsychotics.
When to refer to the pharmacist
Once you have conducted your initial assessment, you need to make a decision
about whether to refer the customer to a pharmacist or sell them a product
yourself. ALWAYS refer customers to the pharmacist in the following situations:
• the customer requires a pharmacist only product (eg, for vaginal thrush)
• the customer has had no success with other treatment products
• the customer has other medical conditions or takes other medicines
• the customer is particularly unwell
• the customer is pregnant or breastfeeding
• the customer indicates that they would prefer to talk to the pharmacist
• the medicine sought is for an infant or an elderly person
• there are symptoms of concern (eg, listed under the different chapters)
• you have concerns about the customer’s behaviour or intentions.
Page 6 HEALTHCARE HANDBOOK 2017-2018 Introduction

Head and scalp
• Condition of hair and scalp: dandruff, dermatitis, hair loss, itching, oiliness.
• Ears: discharge, hearing loss, pain
• Eyes: discharge, itchiness, pain, presence of contact lenses, reactivity to light, redness
• Face: acne, cold sores, dermatitis, facial droop, shingles-like rash (typically occurs around
one eye)
• Mouth and Throat: difficulty swallowing, enlargement around thyroid gland, lesions,
odour, pain, presence of dentures, sore neck, swelling, thrush on tongue
• Nose: congestion, difficulty breathing, discharge, sneezing
• General: confusion, dizziness, headache, sedation
Skin
• Colour: blue-grey, flushed, jaundiced (yellow), pale
• Quality: calloused, numerous veins, paper-thin, rough, sun-damaged
• Temperature: clammy, cold, hot, sweaty
• Wounds and lesions: discharge, infection, state of healing, swelling,
tenderness
• General: bruising, irritated, itchy, moisture content, rash
Whole body
• Breathing: heavy, noisy, shallow, wheezing
• Mood: anxious, depressed, friendly, reserved, stand-offish, suspicious, tired
• Movement: difficult, limping, painful, shaking, shuffling, uncoordinated
• Posture: clutching abdomen, curvature of spine, deformities, stooped
• Size: frail, overweight, pregnant, underweight
• General: smells of cigarette smoke or alcohol
Page 7

Selling OTC Products
Building a rapport with your customers is one of the most important things you
can do for the pharmacy you work for. Customers are more likely to come back if
they feel listened to, valued, and if you give good advice. In some circumstances,
foregoing a sale in favour of refering somebody to a doctor or other health
professional is more likely to result in repeat business from that customer than
just selling them something for the sake of it.
Selling points
Make sure you are well presented before you even walk on the shop floor.
Pharmacies are viewed by the public as professional businesses, so it is important
that your own personal grooming reflects this. Hair, nails and make-up should be
neat; and uniforms, clean and ironed. Keep your body language open and friendly
and have a smile on your face.
Pharmacy staff are expected to have good product knowledge and be able to
explain key differences between a wide range of products that look and sound
the same, and are used for a similar purpose. Consider enrolling in a pharmacy
assistant or technician training programme to gain this knowledge in a structured
way, or use this handbook and online resources to educate yourself about the
most common ingredients used in over-the-counter products. Determine which
ingredients are used for particular symptoms; for example, phenylephrine and
oxymetazoline relieve nasal congestion, pholcodine and dextromethorphan
relieve a dry cough. This saves you from having to remember confusing brand
names, and allows you to pick up any product box and read and explain the
ingredients off the label.
Once you have conducted your initial visual assessment (see previous page)
use the information you have gained and your product knowledge to select the
best product for that particular customer. Be mindful that some elderly customers
may have already spent a significant amount of time and effort at a doctor’s
rooms before presenting a script at your pharmacy, so offer them a seat or a
glass of water if they look tired. If at any time you feel unsure about your advice
or out of your depth, refer the customer to a pharmacist or senior staff member,
whoever is the most appropriate.
Once you have chosen a product for your customer, or if a customer has selfselected
an appropriate product, cover the following points:
• discuss the DOSE, FREQUENCY OF ADMINISTRATION, and HOW LONG
each product should be used
• reiterate the NAME of the product and mention OTHER NAMES that the
product may be called to avoid therapy duplication
• offer ADVICE (refer to the “Advice for customers” section for each common
disorder)
• encourage FOLLOW-UP, and advise customers to return, or seek medical
advice if the problem persists for more than a few days, despite treatment
• suggest customers TELL THEIR DOCTOR, or any other pharmacy they
visit, that they are using this product so as to avoid possible interactions or
duplications
• THANK the customer for their purchase and finish off the sale with a smile!
Lastly, confidentiality is another key aspect of pharmacy, and one that
customers expect you to uphold. Never discuss specific sales, conversations, or
medication histories with other people outside of your pharmacy. Act respectfully
when told sensitive information and do not judge.
This publication is not intended to provide definitive product advice.
For further product details of prescription and most OTC products refer to www.mims.co.nz or www.medsafe.co.nz or contact the company that manufactures the product.
Page 8 HEALTHCARE HANDBOOK 2017-2018 Introduction

HELP KIDS BE
THEMSELVES AGAIN
NEW
LOOK
Fast Acting - 1 hour
Non-drowsy
Great Tasting Raspberry Flavour
Hayfever can affect sleep and make children drowsy 1 , so recommend a treatment that doesn’t.
Telfast Oral Liquid is suitable for hives in children over 6 months & hayfever in children 2-11 years
old. It is non-drowsy, fast-acting and helps relieve hayfever symptoms such as sneezing, runny
nose, itchy eyes & throat as well as itchy skin, rash & hives.
Help your customer’s children breakthrough hayfever allergies with Telfast.
Pharmacy Medicine. Contains fexofenadine hydrochloride 30mg/5ml. For itchy skin rash/hives (6-23 months): take 2.5ml twice daily as required. For itchy
skin rash/hives & hayfever allergies (2-11 years): take 5ml twice daily as required. Telfast is generally well tolerated, headaches may occur. Caution when
driving. Always read the label and recommend only as directed. Full product information is available on request from Sanofi, Auckland
0800 283 684 or at www.medsafe.govt.nz. TAPS PP8624. CHCANZ.CFEX.16.09.0913b
1. http://www.bpac.org.nz/BPJ/2009/November/hayfever.aspx
www.telfast.co.nz
Page 9

Selling OTC Products (continued)
Medicine classifications
New Zealand is unique in the way that it classifies medicines. Overseas, medicines
tend to be either available through a doctor on a prescription and dispensed in a
pharmacy or available unrestricted, through a general retail outlet, supermarket,
or gas station. New Zealand has four broad categories of medicine classifications:
• [GENERAL SALE] can be sold through other retail outlets not just pharmacies
• [PHARMACY ONLY MEDICINE] only available in pharmacies
• [PHARMACIST ONLY MEDICINE] can only be sold by a pharmacist
• [PRESCRIPTION MEDICINE] only available on a doctor’s prescription but
dispensed by a pharmacist.
Medicine classifications can change after the Healthcare Handbook goes to
print, so it is important you are alert to updates circulated by the Medicines
Classification Committee regarding classification changes. The current
classification of any medicine can be found on the Medsafe website at www.
medsafe.govt.nz/profs/class/classintro.asp Alternatively go to www.
medsafe.govt.nz and click on the medicines tab and choose classification. Click
on classification database and enter the generic name of the medicine whose
classification you wish to check in the search box provided.
Pitfalls of some pharmacy products
Be mindful of certain products that may be a challenge to administer to specific
populations; for example, eye drops in the very old; liquid medicines for an
uncooperative toddler; nit combs on very curly, thick hair. People with limited
mobility or arthritis may have difficulty opening foil packaging or correctly
applying fungal nail products. Seek advice from your pharmacist or more
experienced staff members about ways people can overcome these difficulties.
Complementary therapies
Complementary therapies have been included in many treatment options tables,
in the row headed “Natural/ herbal products/ supplements”.
In most instances, only those with evidence for an effect as cited by a reputable
natural medicines database have been included.
More complex health problems
The Healthcare Handbook also includes general information on a few common
medical conditions, such as Asthma, Diabetes, and Gout. Although most of the
medicines prescribed for these conditions are only available on a prescription,
customers with these conditions may request OTC products for other conditions from
time to time. Always involve a pharmacist in any discussion about OTC product use
in people with chronic conditions, such as arthritis, asthma, blood pressure, cancer,
depression, glaucoma, gout, heart disease, osteoporosis and pain.
Additional reference material
The Ministry of Health also provides free pamphlets, stickers, and posters covering
a wide range of topics (for example, head lice, HPV vaccination) for consumers.
These are available online from www.healthed.govt.nz
Page 10 HEALTHCARE HANDBOOK 2017-2018 Introduction

NUROFEN ZAVANCE*
IS ABSORBED UP TO
THAN STANDARD NUROFEN
*Applies to Nurofen Zavance tablets and caplets only.
Always read the label. Use only as directed. Incorrect use could be harmful. Do not use if you have a stomach ulcer.
If symptoms persist see your healthcare professional. Reckitt Benckiser, Auckland. 0800 40 30 30. TAPS DA1704JD.

2017-2018 Healthcare Handbook
Common
Disorders
Page 11

Acne
Acne is a common skin problem affecting more than 85% of adolescents and is
most prevalent in those aged 16 to 18 years. It usually starts between the ages
of 12 and 14 due to hormone changes which activate glands in the hair follicles
of the skin, causing them to enlarge and produce more sebum (oil) as well as
other substances that induce inflammation. Skin pores can become blocked and
inflamed resulting in the development of comedones.
Comedones are dark or skin-coloured small bumps, better known as blackheads
or whiteheads. If the walls of the hair follicle inside the skin pore rupture, a
more intense inflammatory response is seen and pustules (also known as spots,
pimples or zits) develop. Bacteria within the hair follicle (Propionibacterium
acnes) enhance inflammatory lesions.
Acne is more common on the face and neck, but can occur on the back, buttocks
and chest. It can lead to secondary skin colour changes (red, white and brown
patches) and scarring.
Acne is due to a combination of factors including a familial tendency (other
family members have bad acne), androgenic hormones, acne bacteria, a person's
immune response and vulnerability of their hair follicles. Flares of acne can
be provoked by high environmental humidity, application of occlusive skin
products (especially moisturisers or foundations containing lanolin, petrolatum,
vegetable oils, butyl stearate, lauryl alcohol or oleic acid), greasy or waxy hair
styling products, pressure from head bands or chin straps, polycystic ovarian
disease and diets high in dairy products and high-glycaemic foods. Acne can
also be caused by some medicines (eg, oral corticosteroids, contraceptive agents,
anticonvulsants) or as a result of occupational exposure to oils, tars or other
petrochemical products.
In most people, acne will clear up by the age of 25 years, although acne that
persists into adulthood is still common, particularly in women. Persistent acne is
more likely to cause deep-seated, inflamed pimples and nodules, and may be less
responsive to normal treatment. Combination treatment may be needed.
Initial assessment
Looking at a person's face may give you some idea of the severity of their acne
but it is important to ask them if they also have it elsewhere, such as their back
or shoulders, and how it impacts on their day-to-day life. Mild acne can be easily
treated with topical anti-acne products but refer people with moderate-to-severe
acne, acne that affects their self-esteem, or acne unresponsive to over-thecounter
treatments to a pharmacist who may suggest further referral to a doctor
or skin specialist.
Treatment
Active ingredients in over-the-counter products available for mild acne may
reduce counts of Propionibacterium acnes bacteria, calm red or inflamed skin,
contain antioxidants that protect cells from damage, unplug blocked follicles,
increase the shedding of dead cells from the surface of the skin, or normalise
TREATMENT OPTIONS
Category Examples Comments
Soap-free face washes
Keratolytic +
antibacterial action
Antibacterial, antiinflammatory
or
keratolytic action
Other
[GENERAL SALE] eg, AZClear Action,
Benzac range, DermaLab range, Clearasil
range, GramaDerm cleanser, OXY Daily
Face Wash, No 'Zit' Sherlock
[GENERAL SALE]
Contains benzoyl or hydrogen peroxide
eg, Benzac AC 10%, Crystaderm cream*
Contains salicylic acid
eg, Clean & Clear, No 'Zit' Sherlock
[GENERAL SALE] eg, Epiology
Contains phycosaccharide ACP and
keratolytics eg, OXY range for men
Superoxidised solutions eg, Gramaderm
Antiacne Hydrogel
[PHARMACY ONLY]
Contains azaleic acid
eg, AZClear Action, Skinoren
[GENERAL SALE]
eg, Mebo Acne Clear, Tea Tree, zinc
Products with an asterisk have a detailed listing in the Acne section of OTC Products, on page 220.
Face washes degrease the skin and help to reduce skin bacteria. Use at least twice daily before applying
treatment products for best effect. Some products contain cetrimide or chlorhexidine for their antibacterial
action. Others include benzoyl peroxide or salicyclic acid for their keratolytic effect.
Phycosaccharide ACP is a naturally sourced ingredient derived from brown seaweed that regulates sebum
production, reduces bacterial counts, and has an anti-inflammatory action.
Consider as first-line treatment for mild to moderate acne. Some reddening, soreness and worsening of acne
may occur initially and a light, non-oily moisturiser may be applied. Discontinue use if skin becomes too
reddened, inflamed and sore. Some improvement may be seen in as little as five days but may take several
weeks or months to have the maximum effect.
Benzoyl peroxide can bleach clothing, bedding and, rarely, hair and eyebrows. Apply to the entire affected
area at night and avoid exposure to direct sunlight during treatment. Start with the lowest strength
formulation but consider a higher strength if three or four weeks of treatment produces no improvement.
Epiology contains an antibacterial agent, IPD, that also calms and soothes skin.
Phycosaccharide ACP regulates sebum production, reduces bacterial counts, and has an anti-inflammatory
action. Keratolytics remove dead skin and clear clogged pores.
Superoxidised solutions are electrochemically processed aqueous solutions made from water and sodium
chloride that represent a safe, effective alternative to antibiotics and hydrogen peroxide.
Azaleic acid products should be applied to the entire affected area twice daily and rub in well. Avoid contact
with the eyes as products will sting. Make-up can be applied over the application. If irritation occurs reduce
frequency of application until the skin settles. Can take several weeks for effects to be noticeable.
Mebo contains cactus extracts and other ingredients to help fight bacteria and stimulate the natural regrowth
of skin tissue. Tea tree and zinc may help support acne-prone skin.
End the embarrassment
of Adult Acne
Page 12 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
skin cell maturation. Treatment is usually effective, although it may take several
weeks or months to see a noticeable improvement. Good, consistent, twicedaily
skincare underlies treatment success. The face should be cleansed with a
mild soap-free cleansing wash prior to applying the treatment product. Some
people may be sensitive to treatment products so recommend a customer test the
treatment product on a small area of skin when using for the first time.
Stronger treatments (eg, antibiotics, hormonal contraceptives, retinoids) are
available on prescription. There are also various laser and light therapy treatments
for acne. Acne can have a long-lasting effect on a person's self-esteem in addition
to causing permanent skin changes such as scarring and discolouration, so finding
a treatment that works is very important.
Advice for customers
• Avoid regular soap as this can be too drying. Instead, use a mild cleansing
lotion twice a day and after exercise to gently cleanse the skin.
• Apply a thin smear of treatment product to the whole area of affected skin,
not just to individual spots or pimples. This is because it can take two to three
weeks for the blocked follicle to show on the surface of the skin, so it is
important to treat those areas which are still in the process of developing.
• Most treatment products cause dryness, particularly in the first month of use.
Reassure the customer that this shows the product is working, and the skin
usually adjusts to this effect. An oil-free moisturiser may be applied between
treatments if the skin is obviously peeling.
• Minimise the use of oily substances on the face. Use sunscreens that are noncomedogenic
or non-acnegenic and if using foundation, choose an oil-free
one specific for acne-prone skin and apply it lightly.
• Avoid picking or squeezing acne spots – it can aggravate the inflammation
and cause scarring.
• Exposure to sunlight filtered through window glass can help, but avoid
sunburn.
»»
Use a sunscreen before going outside.
• There is a link between what you eat and acne with research showing high
glycaemic diets and dairy can exacerbate acne. Low-glycaemic and low-dairy
diets that contain plenty of wholefoods and vegetables may help improve
acne. Avoid protein or amino acid supplements, particularly if they contain
leucine.
• Avoid cigarette smoke – nicotine increases comedone formation.
• Don’t be discouraged if one treatment product does not work – there are
many different types available and more than one may need to be tried.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, immunosuppression,
diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications) that may be affecting the acne?
• Is the customer younger than 12 years or older than 30?
• Are there any atypical features? (Some other skin conditions may
appear similar to acne but need different treatment.)
• Is the acne moderately severe or severe (ie, are there many
inflammatory lesions or cysts), or extensive?
• If the customer is a woman ask if she also has problems with
excessive facial hair, irregular periods and weight gain.
• Has previous treatment been unsuccessful despite use for longer
than three months?
• Could the customer’s acne be the result of their occupation
(eg, work involving long-term contact with oils) or does the acne
occur after exposure to certain topical products?
• Does the customer have sensitive skin or any allergies to topical
products?
Grown up acne needs a grown up solution
Azclear Action Medicated Lotion is an antibacterial
lotion for the treatment of blackheads, pimples, acne and
papulopustular rosacea.
Dual action: Works by fighting bacteria and unblocking the
oil ducts, which acts to reduce redness and dry up pimples.
Active: Azaleic Acid 20%w/w. Pharmacy Medicine. Dosage and Administration: Apply a small amount to cleansed skin onto the affected
skin. Precautions: Avoid eye contact. If no improvement in 8 weeks, consult a healthcare professional. Side Effects: Discontinue use if
severe irritation occurs. Douglas Pharmaceuticals, Auckland. TAPSMR5158
Page 13

Allergies
An allergy occurs when the body’s immune system overreacts to a normally
harmless substance (called an allergen). Symptoms vary and range from very mild
to potentially life-threatening. Allergies are a contributing factor to conditions such as
hay fever, eczema and asthma.
Allergens may be in the air or on things that are touched or eaten, and
encompass many different things. Environmental allergens can be grouped into
those that are seasonal (for example, pollens and moulds) and those that last
year round (such as house dust mites and pets). Other common allergens in New
Zealand include:
• foods such as cow’s milk, eggs, fish, peanuts and other nuts, soy, and wheat
(account for over 90% of all food allergies)
• insect stings or bites (see also Bites and Stings)
• latex
• medicines (for example, aspirin, penicillin).
While allergies are not directly inherited, people do inherit the tendency to be
allergic. A person prone to allergies is called atopic, and these individuals have
a tendency to develop new allergies, often to things that they have not been
allergic to in the past.
When a person who is allergic to a particular allergen is exposed to that
allergen, their body responds by overproducing immunoglobulin E (IgE)
antibodies. The antibodies attach themselves to immune system cells, called
mast cells, and trigger the release of histamine and other chemicals. Mast cells
are most commonly found in the skin, mucosa of the lungs and digestive tract,
as well as in the mouth, conjunctiva of the eye, and nose, and the release of
histamine causes allergic symptoms such as itching, redness, sneezing, swelling,
and tightness.
Initial assessment
A person’s symptoms depend on how the allergen entered the body, for example,
mosquito bites on the skin cause a characteristic wheal and flare reaction,
whereas allergic rhinitis caused by inhalation of pollens into the nose results in
sneezing, a blocked and runny nose, tickly throat and itchy eyes (see also Hay
Fever). Other symptoms include a swelling of the lips, face and eyes, hives or
welts on the skin (see also Urticaria), a tingling mouth, and with food allergy,
abdominal pain and vomiting. Symptoms may rapidly progress in some people
to anaphylaxis.
Symptoms caused by conditions such as hay fever or insect bites are usually
obvious; however, some allergic reactions are not so obvious, so ensure you ask
your customer for a full description of their symptoms and if they have any idea of
the likely cause. Refer customers with severe or recurring allergies to the pharmacist.
Emergency treatment should be sought for any customer who presents with facial
swelling or with breathing difficulties. Many people just buy treatments in case of
future exposure, so make sure that the product sold will be effective against their
typical symptoms. Always take a person’s history of allergy seriously, and ensure
they know what to do if they ever have a serious allergic reaction.
Diagnosing allergies
Although some people are aware of what is causing their allergy, many people
are not, and actually pinpointing the allergen can be a complicated process. A
medical and family history may be required, in addition to a physical exam, skin
prick testing, and/or blood tests.
Food diaries are often used to narrow down likely allergens in people with
suspected food allergies or intolerances. A food diary is a written record of a
person’s diet and any resultant symptoms over a set period of time. Over a period
of a week or two, a pattern may emerge. It is important to note, if reactions to
TREATMENT OPTIONS
Category Examples Comments
Adrenaline
Oral antihistamines
[PHARMACIST ONLY]
eg, adrenaline auto-injector device (EpiPen
Adult, EpiPen Junior)
[PHARMACY ONLY MEDICINE]
Non-sedating, eg, cetirizine (Razene,
Zetop), desloratadine (Aerius),
fexofenadine (Fexofast, Telfast, Xergic),
levocetirizine (Levrix), loratadine
(Claratyne, Loraclear)
Sedating, eg, promethazine (Phenergan*)
Customers with allergies should be trained on how to use an auto-injector device. EpiPen training pens are
available free on joining EpiClub (www.epiclub.co.nz). Inject into the upper thigh not the buttock. Always
call an ambulance following administration for further follow-up. ACC may reimburse cost of EpiPen used as
treatment for an anaphylactic reaction. Note: At the time of going to print, EpiPen was the only auto-device
available to purchase in New Zealand
Oral antihistamines help control total body itch and inflammation. Generally, non-sedating medicines do not
cause drowsiness; however, some people may be more sensitive than others. Customers need to be warned
about the risks of driving or operating machinery if they do get drowsy (see also Hay Fever).
Oral and topical (nasal and ocular) antihistamines, nasal corticosteroids and decongestants See Hay Fever for a list of products in this category
Emollients and topical corticosteroids See Dermatitis/Eczema for a list of products in this category
Products with an asterisk have a detailed listing in the Allergies section of OTC Products, on page 220.
Dual Action Relief
Non-drowsy
Antihistamine
for hayfever
+
Decongestant
for blocked
or runny nose
Maxiclear Hayfever & Sinus Relief combines a non-sedating antihistamine (Loratadine) with
a nasal decongestant (Phenylephrine) to simultaneously treat hayfever and a blocked or runny nose.
Page 14 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
a particular food are obvious, advise the customer to avoid the food in question
until they have consulted their doctor.
Treatment of allergies
The best management for allergies is to avoid the allergen; however, this is not
always possible. Treatment of an allergic reaction depends on the reaction, but
may include antihistamines, decongestants, skin creams, corticosteroids and
adrenaline, some of which may need to be prescribed by a doctor (see treatment
options below).
Some allergies can be treated with immunotherapy (also called desensitisation
or hyposensitisation). This involves a series of injections over a long period (up
to five years in some cases) that gradually increase the exposure to an allergen
and stimulate the immune system to develop a resistance to the allergen.
Immunotherapy is particularly useful for allergies to insect venom, such as bee
or wasp stings.
People who have life-threatening allergic reactions should always carry
adrenaline and know how to use it correctly. Adrenaline is available in an automatic
device (such as the EpiPen); however, automatic devices are expensive as they are
not currently subsidised and have a limited shelf life.
Encourage people with allergies to wear a medical bracelet or necklace (eg,
Mediband, Medic Alert) that states details of their allergy(ies). People with allergies
should always tell a doctor, pharmacist, or other health professional of their
allergies before starting any new treatment, including complementary medicines.
For children with serious allergies attending school or daycare, caregivers
should consider providing a poster complete with their child’s photograph that
clearly outlines their child’s condition and treatment. Training for staff on how
to use auto-injector devices may also be needed. See www.allergy.org.nz for
more information on keeping children with allergies safe at school and preschool.
Anaphylaxis
Anaphylaxis is the most severe form of allergic reaction and is potentially lifethreatening.
It must be treated as a medical emergency, requiring immediate
treatment and urgent medical attention. Anaphylaxis can occur in anybody, even
people who have never reacted to an allergen before.
Signs and symptoms
Signs and symptoms of anaphylaxis may occur almost immediately after exposure
or within the first 20 minutes of exposure and may include:
• difficulty and/or noisy breathing
• swelling of the tongue, or swelling or tightness in the throat
• difficulty talking or a hoarse voice, wheeze or persistent cough
• loss of consciousness and/or collapse.
Abdominal pain and vomiting is also a sign of anaphylaxis with insect allergy.
Reactions in young children may be more subtle. They may turn pale, become
unresponsive and go floppy. Symptoms can rapidly become life-threatening.
Useful websites
www.allergy.org.nz Charitable organisation that provides information, education and support
(includes anaphylaxis e-training and guidelines for schools, parents and others).
www.allergy.org.au The Australasian Society of Clinical Immunology and Allergy (ASCIA)
provides education, information and action plans.
Treatment of anaphylaxis
Administration of adrenaline is the first line of treatment for anaphylaxis. Once
medical attention is available, other medications may also be administered.
Antihistamines are not a treatment for anaphylaxis.
People who are prescribed reliever-type asthma inhalers (such as salbutamol)
should use their inhaler for breathing problems after using the adrenaline autoinjector,
not before. Co-existing asthma is associated with a higher risk of death
from anaphylaxis so it is important asthma is kept well controlled.
Prevention of anaphylaxis
Accidental exposure to allergens happens and customers and their caregivers
should be educated on recognising the signs and symptoms of anaphylaxis and
in the administration of adrenaline if they are at high risk of anaphylactic shock.
ALLERGY TRIGGER
Animal dander
Dust mites
Food allergies
Insect bites and stings
Pollen
Skin allergies
ADVICE
Keep pets out of your bedroom and off carpet and furniture.
Use allergen-proof bed covers and wash bedding weekly.
Keep humidity low and ensure good house ventilation. Buy
washable stuffed toys and keep stuffed toys off beds.
Remove dust regularly with a damp rag.
Vacuum regularly with a double-layered microfilter bag or
HEPA filter.
Remove carpeting and replace with wood or vinyl flooring.
Remove any clutter that is likely to collect dust.
Consider the introduction of allergenic-type foods in babies
aged four to six months once less-allergenic foods have been
tolerated.
Wear footwear outdoors and cover body with clothes.
Be alert for the presence of wasps around camp-sites or bins.
Wear gloves and insect repellent when gardening.
Keep the garden free of highly allergenic plants.
Stay indoors when pollen count is high (eg, hot or windy
days), shut windows and turn on air conditioner.
Get someone else to mow your lawn, or wear a good mask
and wraparound sunglasses.
Shower and wash hair at night to wash away any pollen.
Avoid strong soaps, perfumes and products that may irritate.
Hayfever
Itchy eyes
Sneezing
Runny nose
Nasal congestion
Maxiclear® Hayfever & Sinus Relief (Phenylephrine HCl 10mg and Loratadine 2.5mg, 30s) is a Pharmacy
Medicine for the temporary relief of nasal and sinus congestion, hayfever, runny nose, watery and itchy
eyes and sneezing. AFT Pharmaceuticals Ltd, Auckland. TAPS 1733HA. NZ Patent No. 588134.
Page 15

Asthma and COPD
Asthma
New Zealand has one of the highest prevalences of asthma in the world and over
460,000 people regularly take medication for asthma. An estimated one in seven
children and one in nine adults are affected, and only a small number of children
appear to grow out of the condition.
Common symptoms include wheezing (a whistling sound most obvious when
breathing out), shortness of breath, tightness in the chest, difficulty speaking, and
a persistent dry cough (usually at night or after exercise). Over time this cough may
become more productive. A cough may be the only symptom in young children.
These symptoms may occur suddenly as an asthma “attack”, or they can be
present most of the time. During an “attack”, breathing becomes very difficult
due to inflammation and contraction of the smooth muscle within the airway,
excessive mucous secretion, and swelling of the smaller airways. Permanent
damage of the airways can result from untreated asthma.
It is common for asthmatics to also suffer from hay fever or eczema, and/or to
have a family history of these conditions.
The cause of asthma is unknown; however, many common triggers have been
identified, including animal dander (especially cats), cigarette smoke, cold air,
exercise, house dust mites, pollen, stress, strong perfume, viral infections (eg, a
cold) and some medicines (eg, aspirin and NSAIDs). Asthma cannot be cured but
TREATMENT OPTIONS
Category Examples Comments
Relievers
(short-acting
bronchodilators)
Preventers
Short-acting muscarinic
antagonists (SAMA) or
long-acting muscarinic
antagonists (LAMA)
Symptom controllers:
long-acting beta2
agonists (LABA)
Combination therapy
Spacers
Beta2-agonists
[PRESCRIPTION MEDICINE]
eg, salbutamol inhaler (Asthalin, SalAir,
Salamol, Respigen, Ventolin)
eg, terbutaline (Bricanyl)
eg, salbutamol liquid (Ventolin)
Inhaled corticosteroids (ICS)
[PRESCRIPTION MEDICINE]
eg, beclomethasone (Beclazone, Qvar),
budesonide (Pulmicort), fluticasone
propionate (Floair, Flixotide)
Mast cell stabilisers and others
[PRESCRIPTION MEDICINE]
eg, nedocromil (Tilade), sodium
cromoglycate (Intal Spincaps/Forte),
montelukast (Singulair)
[PRESCRIPTION MEDICINE]
eg, ipratropium (Atrovent, Univent)
tiotropium (Spiriva), glycopyrronium
(Seebri), umeclidinium (Incruse Ellipta),
aclidinium (Bretaris)
[PRESCRIPTION MEDICINE]
eg, eformoterol (Foradil, Oxis), indacaterol
(Onbrez), salmeterol (Meterol, Serevent)
[PRESCRIPTION MEDICINE]
eg, eformoterol + budesonide (Symbicort
Smart, Vannair), glycopyrronium
+ indacaterol (Ultibro Breezhaler),
ipratropium + salbutamol (Duolin HFA),
salmeterol + fluticasone propionate
(RexAir, Seretide), tiotropium + olodaterol
(Spiolto Respimat), umeclidinium +
vilanterol (Anoro), vilanterol + fluticasone
furoate (Breo)
eg, e-chamber, Volumatic
Children aged six or less
eg, e-chamber mask
Reliever inhalers are used to treat the acute symptoms of asthma (ie, the difficulty in breathing). They provide
relief within a couple of minutes. Most reliever inhalers are blue.
Anyone using a reliever more than three times a week or waking at night with symptoms should go to the
doctor. If a person finds his bronchodilator has become less effective, it may indicate worsening asthma and
the need to initiate an action plan or to visit the doctor to review therapy.
Preventer inhalers contain ICS. They do not have an immediate effect, so nothing is felt after inhalation;
however, when used regularly they reduce the underlying inflammation of the airways and help reduce the
incidence and severity of asthma attacks and hospitalisations. Most preventer inhalers are either brown,
orange or dark red. Reduce risk of oral thrush by using a spacer and rinsing the mouth with water after using
ICS.
Mast cell stabilisers (ie, nedocromil, sodium cromoglycate) are not commonly used since they are less effective
than ICSs. May be useful for preventing exercise-induced asthma. Sodium cromoglycate needs to be taken
anywhere from four to eight times daily. They may take up to six weeks to take effect.
Montelukast is a leukotriene receptor antagonist that may be used in addition to ICSs for an additive effect.
Can be of benefit in exercise-induced asthma and in people who also have rhinitis. Special Authority needed.
Ipratropium reduces mucous secretions and relaxes airway muscle. It is short-acting and has a slower onset of
action than beta2-agonists so is used more in COPD, although certain asthma patients may benefit. Longer
acting antimuscarinic bronchodilators include tiotropium, glycopyrronium, umeclidinium, and aclidinium.
Long-acting bronchodilators. Do not treat the underlying inflammation but may be beneficial in mild to
moderate asthma instead of using higher doses of ICS. Used in conjunction with an ICS. Not useful for acute
asthma attacks since they do not open airways immediately. Do not exceed recommended dose.
Combination agents may aid adherence to recommended preventative regimens.
Please refer to detailed product information as well as asthma guidelines to distinguish when combination
inhalers should be used, and which combinations are recommended depending on the severity of the asthma
or COPD.
Dispense
Ventolin ®
The original blue inhaler
that Kiwis know and trust 2
Help to improve delivery of MDIs to the lungs, reduce adverse effects of ICSs. Wash once a week with warm
water and a squirt of detergent and allow to completely drip dry. This leaves a slight residue of detergent
on the inside of the spacer which reduces static and stops the medicine in the inhaler sticking to the sides.
Replace every six to 12 months (tiny scratches or abrasions can prevent the spacer working as effectively).
VENTOLIN
Asthma
Symptom Relief
doesn’t need to involve an
unpleasant aftertaste. 1
DISPENSE
ALCOHOL
FREE
VENTOLIN 2
Page VEN_XXXX_Ventoline 16 HEALTHCARE Strip Ad Marc HANDBOOK 17 V3.indd 1 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Te Hã Ora: The Breath Of Life
Te Hã Ora is New Zealand's National Respiratory Strategy launched in November 2015. Respiratory
disease (including asthma, bronchiectasis, COPD, lung cancer, obstructive sleep apnoea, and
pneumonia) affects almost 700,000 people in New Zealand but despite improvements in medical
treatments and health care, respiratory illness rates here continue to worsen. Te Hã Ora aims to:
••
reduce the incidence and impact of respiratory disease in New Zealand
••
eliminate inequalities in respiratory health, particularly among Maori, Pacific peoples and low
income families.
The full National Respiratory Strategy document can be found at asthmafoundation.org.nz
most people are able to manage it with medicine so that it does not interfere with
their day-to-day life. Education is vital to help sufferers recognise symptoms of
worsening asthma and to avoid severe attacks by taking early action. Symptoms
that indicate worsening asthma include a dry, persistent cough, usually at night
and after exercise, and increasing use of “reliever” medicine. Home-use of a peak flow
meter (a device that measures maximum flow of air from the lungs) may help identify
deteriorating lung function. Common treatment options include beta-2 agonists,
corticosteroids, mast cell stabilisers, and leukotriene receptor antagonists.
COPD (Chronic Obstructive Pulmonary Disease)
COPD is an umbrella term used to describe several different progressive lung
diseases, such as emphysema and chronic bronchitis. COPD is more likely to
develop in people over the age of 40 and symptoms include breathlessness,
coughing, and increased phelgm. The major difference between COPD and
asthma is that COPD is generally irreversible, although most symptoms can
be controlled and further deterioration in lung function prevented with early
treatment. Some people have both COPD and asthma.
Ninety per cent of people who develop COPD have previously smoked; other
causes include environmental pollutants and genetic deficiencies (eg, Alpha-1
Antitrypsin Deficiency). Treatments include oxygen, antimuscarinics, beta-2
agonists, corticosteroids, theophylline, antibiotics, and pulmonary rehabilitation
programmes.
Initial assessment
The majority of customers with asthma or COPD require life-long medications so
will regularly come into your pharmacy to collect these.
Pay attention to the way they usually look, and if you notice any deterioration in
their health, breathing, or if talking or walking appears difficult, ask if they would
like to talk to a pharmacist. Always involve a pharmacist in cold or flu medicine
requests, as lung function can quickly become compromised with illness.
Types of delivery devices and spacers
Metered dose inhalers (MDIs) – also called “puffers” are the most common devices
available for delivery of medications used to treat asthma or COPD. However, many
Refer to
PHARMACIST
If someone collapses and appears to have difficulty breathing, CALL
AN AMBULANCE IMMEDIATELY, whether or not the person is
known to have asthma or COPD.
All other people presenting with asthma symptoms should be
referred to the pharmacist, who should:
• ASSESS the severity of the episode and call 111 if severe
• SIT the person down and get them to lean forward
• TREAT with six puffs of a blue “reliever” inhaler, preferably
through a spacer (use patient’s own if available)
• HELP by calling an ambulance if the person does not improve
• MONITOR for improvement and repeat doses if needed
• ALL OK. Stay with them until they are free from wheeze, cough
and breathlessness then refer them to their doctor.
older and younger patients find them difficult to use since good coordination is
required between activation of the MDI and inhalation. Most MDIs require regular
cleaning, preferably weekly, and should be shaken before use.
Dry powder inhalers are breath-activated inhalers. They require less
coordination and there is no need to use a spacer. However, they may be
unsuitable if the person’s ability to inhale is too weak.
Nebulisers are machines that convert liquid into a mist that can be inhaled
into the lungs.
Spacers are specially designed plastic tubes that are designed to be used with
MDI (puffer) inhalers. They bypass the need for patients to coordinate activation
of the inhaler with inhalation, and also help prevent the occurrence of oral thrush.
Spacers can be very helpful during an acute asthma episode and some are available
fully funded (see Treatment options).
Advice for customers
• Ensure customers know what each inhaler is for and how to use them.
• Advise people with asthma to use paracetamol instead of NSAIDs because
NSAIDs may precipitate an asthma attack in some people.
• Ensure they have talked with their doctor about what to do if their asthma
worsens and they have an Asthma Self-management plan.
• Treat allergies and avoid known asthma triggers wherever possible, including
cigarette smoke.
• Warm up and use a reliever before exercise if they get exercise-induced asthma.
References: 1. Gillies J et al. NZ Med J. 2005:118(1220):79-83. 2. Ventolin Data Sheet, GSK New Zealand.
Ventolin ® (salbutamol; available as an alcohol-free and CFC-free Inhaler,100mcg per actuation) is a Prescription Medicine. Ventolin is a short acting bronchodilator
(selective beta-2 adrenoreceptor agonist) for relieving symptoms in patients with asthma and for bronchodilation in patients with reversible airways obstruction due
to asthma, chronic bronchitis and emphysema. Ventolin is a partially funded medicine. Dosage: Acute bronchospasm – 1 or 2 puffs, Chronic therapy – may take
up to 2 puffs four times daily. This medicine has risks and benefits. Contraindications: Hypersensitivity to this medicine or to any of its components. Warnings and
Precautions: Increasing use to control symptoms indicates deterioration of asthma control. Under these conditions, the patient’s therapy plan should be reassessed.
Hypokalaemia may occur, particularly in acute severe asthma, potentiated by xanthine derivatives, steroids, diuretics and hypoxia. Caution in hyperthyroidism,
hypertension, cardiovascular diseases and diabetes. Avoid beta-blockers, tricyclic antidepressants, MAOIs, digitalis. Common Side Effects: Headache, mild tremor,
mouth and throat irritation, tachycardia and peripheral vasodilation, paradoxical bronchospasm. Before prescribing Ventolin, please review the Data Sheet at www.
medsafe.govt.nz. Ventolin is a registered trade mark of the GlaxoSmithKline group of companies. Marketed by GlaxoSmithKline NZ Limited, Auckland. Adverse events
involving GlaxoSmithKline products should be reported to GSK Medical Information on 0800 808 500. TAPS DA1728IG/17MA/SLB/0001/17
Page 17
17/03/17 12:10 PM

Baby Feeding
Breastfeeding is best for babies and recommended by the World Health
Organization, the New Zealand Ministry of Health, health professionals and
maternity services in New Zealand and globally. Breast milk is nutritionally wellbalanced,
easily absorbed, economical, safe and always at the right temperature.
For the mother it is a time saver compared with cleaning, sterilising and making
bottles of formula.
It is also protective against breast and ovarian cancer and may help a
woman return to her pre-pregnancy weight sooner. Breastfeeding allows close
body contact with the baby which encourages bonding and gives a baby vital
antibodies (especially in colostrum – produced in the first few days) that helps
protect against infections. Babies who are breastfed are less likely to develop
allergies, eczema, childhood diabetes, and to die suddenly in their sleep.
Beginning breastfeeding
Breastfeeding is easy for some women but can be tricky for others to begin with.
Some women may need a lot of support and help.
Each feed should start on the opposite breast to the one used at the beginning
of the last feed. The baby should not suck on the nipple alone, but take in part or
all of the areola (the pigmented area around the nipple) as well. This allows the
nipple and areola to be drawn right to the top of the baby’s mouth for effective
feeding. If the nipple alone is suckled the baby’s tongue flattens and pinches the
tip of the nipple against his hard palate, causing damage (cracked nipples) and
making feeding less effective for the baby.
Babies may make audible swallowing sounds when breast milk flows fast at
the start of the feed. Allow the baby to completely empty one breast before
swapping to the other. To release the baby’s latch (eg, to change sides) the
mother can gently slide her little finger (clean) into the corner of baby’s mouth.
Exclusive breastfeeding is recommended for the first four to six months.
Around this time, a baby should be started on plain, smooth, and soft solid foods
in addition to breastfeeding. Encourage mothers to continue breastfeeding until
their baby is at least one year old.
Weaning
Advise mothers wishing to wean (finish breastfeeding) to reduce feeding gradually,
eg, drop one feed a day, then, after a while, drop another feed. If breasts become
engorged, expressing a little milk will make them more comfortable. Tablets are
rarely recommended to stop breastfeeding due to side effects.
Initial assessment
Be mindful that new mums may be exhausted and fragile. Becoming a parent
TREATMENT OPTIONS
Category Examples Comments
Products for cracked
nipples and breastcare
while breastfeeding
Products for thrush on
the nipples
Products for reflux
Sterilising products
Products for expressing
milk
Other products
[GENERAL SALE] eg, creams (Lansinoh*,
Lucas Papaw ointment, Medela Purelan,
Mustela 9 Months Nursing Comfort)
eg, breast-care (Manuka Health Breast
Pads [contain manuka honey]), NUK
Breast Gel Cushions*, NUK Nursing
Pads*, Rite Aid Hydrogel Breast Discs)
[PHARMACY ONLY MEDICINE]
eg, clotrimazole (Canesten cream),
miconazole
[GENERAL SALE]
eg, Gaviscon infant sachets
eg, Avent 3 in 1 Electric Steam Steriliser,
Milton tablets, NUK microwave/electric
sterilising equipment*
eg, NUK manual pump*, NUK electric
pump,* NUK Breast Milk Containers*,
Closer to Nature electric pump
eg, Lansinoh range* (gel packs, nursing
pads, pour spouts, storage bages) NUK
Orthodontic Shaped Teats/Soothers*,
NUK Glass and BPA-free bottles*, MAM
Anticolic bottles
eg, Neil Med Naspira Nasal-Oral Aspirator
Cracked nipples are usually caused by poor latching or from comfort sucking (slipping back onto the nipple
for long periods after nutritional feeding has slowed). Do not stop feeding but try to get a better latch –
contact a midwife, Plunket nurse, La Leche League or a lactation consultant for help.
Nipple shields are not generally recommended except for women with inverted nipples or on the advice of
a lactation consultant. Breast pads containing manuka honey relieve nipple discomfort as well as absorbing
excess milk. Breast gel cushions can be used warm to stimulate milk flow or cold to relieve discomfort.
Nursing pads absorb any leakage between feeds.
Treat mother and baby simultaneously. Use a regular topical antifungal cream, such as clotrimazole or
miconazole, on the mother’s nipples and wipe off before breastfeeding. Apply nystatin oral drops to the inside
of the baby’s mouth (see Oral Health) and an antifungal cream to their bottom.
Mixes with and stabilises stomach contents preventing reflux and regurgitation. Not to be used in babies
under one year except under medical supervision.
Clean all equipment put in a baby’s mouth, such as feeding bottles, nipple shields and pacifiers using
detergent, hot water and a brush. Sterilise all equipment used for babies under three months in addition to
washing.
Expressing can be done by hand, manual pump, battery pump or electric pump. Expressed milk can be
refrigerated or frozen. Inverted nipples can be helped by using a breast pump briefly before feeding to bring
the nipple outwards.
Specialised teats (eg, for babies with cleft palates) are also available. Pacifiers may reduce the risk of sudden
unexpected death in infancy but are best used after breastfeeding has been established. Keep clean, sterilise
frequently and check for loose parts or cracks regularly.
Nasal-oral aspirators allow nasal mucus to be removed efficiently.
Products with an asterisk have a detailed listing in the Baby Feedingsection of OTC Products, on page 220.
Page 18 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
for the first time can be both joyous and stressful, so make life easier for them
by keeping your aisles free of clutter and wide enough to fit a buggy or pram
through. Keep baby products in an easy to reach location and provide a small box
of toys for any accompanying toddlers to play with.
Greet them with a smile and ask how you can help. Ensure you can confidently
talk about the baby products you stock but women with "yes" answers to the
Refer to Pharmacist questions will need to talk to a pharmacist.
Breastfeeding problems
Do not offer advice about breastfeeding unless you really know what you are
talking about – incorrect advice in this area may affect milk production, feeding,
or a mother's confidence. Instead, refer the woman to her midwife, Plunket, La
Leche League or a local lactation consultant.
Engorged breasts
Sometimes breasts can become engorged, causing pain and difficulty in
“latching” the baby. The mother can try expressing just a little milk before
latching, and to make herself feel more comfortable, if this is a problem.
Mastitis
Mastitis (infected, blocked milk ducts) may follow engorgement. Symptoms
usually include breast pain, warmth, redness and swelling in one area of the
breast with fever and flu-like symptoms. Antibiotics prescribed by a doctor
or midwife are often needed if symptoms persist for longer than 24 hours.
Encourage frequent milk removal during mastitis.
Cracked nipples
For cracked nipples apply a soothing cream (see Treatment options previous
page) and get help with technique – the baby is probably latching incorrectly.
Low milk supply
Some mothers worry that they do not have enough milk, often in response to a
baby feeding more often than normal. Reassure the mother that babies naturally
go through growth periods, and will feed more frequently during this time. Generally,
if a baby appears healthy and active AND is gaining weight AND having six or more
very wet nappies a day, then the milk supply is fine. In most cases, the mother’s supply
adjusts to this increased demand within a couple of days and the baby soon resorts
back to its regular feeding schedule.
Occasionally, a baby may not be getting enough milk due to incorrect latching
or sucking, or rarely due to an underproduction of milk by the mother. Encourage
the mother to get help with her technique, to rest and relax whenever she can,
and to make sure she is eating and drinking well. She should also contact her
midwife, La Leche League, or lactation consultant for further advice.
Reflux in babies
Reflux in babies is common and is thought to be caused by an immature lower
Refer to
PHARMACIST
• Any mother with symptoms of mastitis, such as breast pain,
redness, swelling, fever or flu-like symptoms.
• Any baby who is not gaining weight or appears unwell.
• Anybody planning to take or buy any medicine, supplement or
herbal remedy for a woman who is breastfeeding or for a baby.
• Any mother with possible signs of depression (eg, crying,
feelings of helplessness, inability to cope, difficulty sleeping,
reduced appetite or no enjoyment in things that would usually be
enjoyable).
oesophageal sphincter (the band of tissue that prevents the contents of the
stomach from rising up the oesophagus). Symptoms include distress or arching
of the back when feeding, irritability, coughing and frequent hiccups. Colic may
also coexist with reflux. Parents should take their baby to a doctor for a proper
diagnosis if reflux is suspected.
Bottle-feeding
Health professionals have a responsibility to promote and support breastfeeding
although, if a woman decides to bottle-feed, she will need support and advice.
Infant formula
Cow’s milk must not be used for infants aged less than one because it contains
higher levels of protein and salt and not enough iron and other nutrients
necessary for a growing baby. Infant formula is formulated to contain differing
levels of whey and casein depending on the baby’s age, as well as all the
recommended essential vitamins and minerals.
Dermatitis, vomiting, diarrhoea and colic may be caused by lactose intolerance
or cow’s milk protein intolerance (CMPI). Advice must be sought from Plunket, a
midwife, or a doctor before giving lactose-free or non-dairy formulas long term.
Use good quality bottles and teats that are the right flow for the baby’s age
(slow for young babies through to faster flow for older babies).
Keep powdered formula covered and use within four weeks of opening. Wash
hands and clean all feeding equipment thoroughly before preparing formula.
Sterilise all equipment if a baby is less than three months old.
Formula should be made up with cold, previously boiled, water. Prepared
formula should not be used if it has been out of the refrigerator for more than
two hours. Never reheat any prepared formula that has already been warmed or
partially consumed. For more information on infant formula as well as preparing
baby food see Baby Food and Infant Formula at www.foodsafety.gov
Page 19

Bites and Stings
Bites and stings can be either venomous or non-venomous. Bees, hornets,
wasps, jellyfish, and the katipo and red-back spider are venomous. Fleas, lice,
mosquitoes, sandflies, scabies and ticks are non-venomous.
In general, venomous stingers or biters inject a toxic and often painful venom
into their victim as a defence mechanism to ward off attack. A stinging sensation
or pain is felt in the area which becomes inflamed, swollen and sometimes itchy.
Certain wasp or jellyfish stings are particularly painful and the pain may persist
for several hours even after first aid has been applied. Most jellyfish stings in New
Zealand can be attributed to bluebottles, lion’s mane jellyfish, mauve stingers, or
hydromedusae (microscopic jellyfish larvae).
Non-venomous biters pierce the skin and feed on their victim’s blood,
resulting in a small raised red spot and often intense itching. Infection of the
open sore commonly occurs due to scratching. Outside of New Zealand, many
non-venomous biting insects carry diseases, for example, malaria, zika or dengue
fever carrying mosquitoes (see also Travel Health).
In most people, a bite or sting causes a mild reaction. However, a more
serious allergic reaction known as anaphylaxis can occur in people who are
sensitive to a particular venom, and occasionally in people who have never
had a reaction before (see also Allergies). This results in facial swelling,
difficulty breathing and an itchy rash (see also Urticaria) over most of the
body. Immediate medical attention and treatment must be sought as this
reaction can be life-threatening.
TREATMENT OPTIONS
Category Examples Comments
Oral antihistamines
Topical antihistamines
Anti-pruritic (anti-itch)
preparations
Topical corticosteroids
Local anaesthetics
Anti-sting preparations
PREVENTION
Insect repellents
Natural / herbal /
supplements
Non-sedating
[PHARMACY ONLY MEDICINE]
eg, cetirizine (Razene, Zetop, Zyrtec),
desloratadine (Aerius), fexofenadine
(Fexofast, Xergic), levocetirizine (Levrix),
loratadine (Claratyne)
Sedating
[PHARMACIST ONLY MEDICINE]
eg, dexchlorpheniramine (Polaramine),
promethazine (Phenergan, Allersoothe)
[PHARMACY ONLY MEDICINE]
eg, mepyramine (Anthisan cream*)
[GENERAL SALE]
eg, Calamine, Itch-Soothe, Pinetarsol, Eurax
[PHARMACY ONLY MEDICINE]
eg, hydrocortisone 0.5% (DermAid Soft)
[PHARMACIST ONLY MEDICINE]
eg, hydrocortisone 1% (DermAid Soft)
[PHARMACY ONLY MEDICINE]
eg, lignocaine (Ethics 4 Way Antiseptic Soothing
Cream [+ bufexamac], Medicreme Antiseptic
cream, Soov Cream/Gel Bite [with cetrimide])
[GENERAL SALE]
eg, Combudoron Spray, Click That Itch,
Ozone Anti-itch, Stingose Spray/Gel*
Anti-insect bands
eg, Para'Kito Mosquito-band
Topical insect repellents
eg, picardin (eg, Repel New Era)
eg, DEET (eg, Aerogard, Bushman, Repel)
eg, essential oils (eg, Badger Anti-Bug Balm)
Citronella, clove, eucalyptus, neem oil or
cream
Helps control total body itch and inflammation relating to bite or sting.
More convenient for multiple bites/stings than topical antihistamines.
Generally, non-sedating medicines do not cause drowsiness; however, some people may be more sensitive
than others. Customers need to be warned about the risks of driving or operating machinery if they do get
drowsy.
Purpose is similar to non-sedating antihistamines (above) but can cause drowsiness which may be useful
to improve sleep quality at night but not if alertness (ie, for driving or operating machinery) is required.
Warn about sedating effects and advise customers to avoid alcohol. Not suitable for everybody (see Reference
Section, OTC Medicine Precautions. Prescription medicine for children under two.
Relieves local itch and inflammation.
Use for only two to three days to help relieve itchy bites.
Tar products (eg, Pinetarsol) help relieve generalised skin itching. Calamine lotion has a soothing, cooling
effect and contains 0.5% phenol, which also provides a local anaesthetic action, but may dry out skin.
Relieves local itch and inflammation.
Apply a thin layer to skin.
Do not use for more than one week unless under medical supervision.
Avoid the face and genital area unless directed by a doctor.
Early use may help relieve the initial sharp pain caused by stings.
Bufexamac has anti-inflammatory properties and is thought to act by inhibiting the enzyme cyclooxygenase.
Not suitable for those with eczema. May cause contact dermatitis.
Combudoron spray contains arnica and herbs to relieve itch. Click That Itch generates a current using
quartz crystals to relieve pain. Ozone Anti-itch contains ammonia, zinc and other ingredients to neutralise
the bite area and soothe skin. Stingose contains aluminium sulphate and inactivates proteins in venom.
Anti-insect bands contain natural oils. Protection against mosquitoes and other insects is provided over
several days (see individual products) with continuous band wearing.
DEET (N,N-diethyl-m-toluamide), picaridin, IR 3535 and synthetic oil of lemon eucalyptus are all effective
at repelling disease-carrying mosquitoes. Recommend to people travelling overseas to at-risk countries.
Plant-based insect repellents (eg, citronella, soybean, eucalyptus) are suitable for use in countries not at
risk of mosquito-borne diseases (eg, New Zealand).
Several essential oils are effective at repelling insects but to date have not shown to be as effective as
DEET. Use only in countries not at risk of mosquito-borne diseases.
Products with an asterisk have a detailed listing in the Bites and Stingssection of OTC Products, starting on page 221.
SOOV BITE
Fast relief from insect bites
Cooling gel to help take away the urge to scratch
after an insect bite or plant sting. Provides welcome
relief from the pain and itchiness.
• 3% w/w lignocaine hydrochloride to anaesthetise the area
• 0.5% w/w cetrimide antiseptic to help prevent infection
• Suitable for children above 2 years and adults
Douglas Pharmaceuticals Ltd, Auckland
Page 20 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Tips to avoid getting bitten
••
Use insect repellents and cover arms and legs if in an area prone to insects.
••
Avoid perfume or wearing bright-coloured clothing around bees; mosquitoes like dark clothing.
••
Cover food and rubbish and try to minimise odours at picnics. Destroy hives or nests.
••
Drain pools of stagnating water or add household bleach to them to eliminate mosquito larvae.
••
Repel mosquitoes with electrical insect-repelling devices or citronella products when outside.
••
De-flea cats, dogs and other household pets regularly.
Initial assessment
Ask your customer to show you the sting or bite mark if they are comfortable
doing so in a private area. If they are unsure of the cause, the appearance,
location and quantity of marks should give you some idea (for example, single
bite: wasp or spider; multiple bites: mosquito or flea; itchy rash under swimsuit:
hydromedusae).
Wasp, bee, or hornet stings
Most people will have successfully removed the stinger by the time they present
to a pharmacy for treatment for a wasp or bee sting. If not, carefully scrape away
the stinger with the side of your fingernail rather than grasping it, as this can
accidentally squeeze more venom into the patient.
Ice should be applied to the affected area and an antihistamine tablet offers
the most effective treatment against inflammation and itch. For very minor stings,
a topical corticosteroid cream may be used. Seek urgent medical help for anybody
with a severe allergic reaction or with signs of anaphylaxis (see also Allergies).
Advise customers with severe allergies to insect stings to carry adrenaline at all
times and wear medical alert jewellery.
Insect bites
Suggest topical and oral antihistamines, anti-pruritic (anti-itch) products, topical
corticosteroids, or topical local anaesthetic agents for itching. If the cause is
thought to be due to scabies or head lice, treatment products should be used.
Refer the customer to a pharmacist if they have recently been overseas and
there is a possibility that they may have been bitten by a disease-carrying insect.
Suggest ways to protect against future bites (see text box above).
Spider bites
New Zealand has many species of spider but only the red-back and katipo
are considered poisonous; an anti-venom effective for both these spiders is
available throughout NZ. No deaths from katipo spiders have been reported
here since the 19th century. Although white-tailed spiders are known to
bite, their venom from rarely causes harm, although some people develop
an allergic reaction. Seek urgent medical help if the person has difficulty
breathing or a severe reaction; otherwise ring the NZ Poisons Centre, 0800
POISON (764 766) for more advice.
SOOV CREAM
Soothing antiseptic cream
Ideal for cuts and grazes, minor burns, scalds and
sunburn. Relieves pain and contains antiseptics to help
prevent infection.
• 1% w/w lignocaine hydrochoride to provide fast, soothing pain relief
• 1% w/w cetrimide antiseptic
• Suitable for children and adults.
Refer to
PHARMACIST
Seek urgent medical advice if the person with the bite or sting
has had severe reactions in the past, or has any of the following
symptoms:
• feeling unwell, dizzy or vomiting
• significant swelling, especially around eyes, lips, tongue or neck
• fever, wheezing, tight chest, difficulty breathing or swallowing.
Refer any customers with other health conditions such as
immunosuppression, diabetes, or who are pregnant or breastfeeding
and wanting advice about bite treatment or prevention to the
pharmacist. Also refer customers seeking treatment for young
children or with:
• extensive swelling or redness around the site of the bite or sting
• a previous bad reaction to a bite or sting
• signs of infection (eg, pain, pus, crusting)
• bites caused by an overseas or unknown source
• allergies to certain medicines.
Jellyfish
Bluebottles
Wash stung area in fresh or salt water and remove any stings or tentacles
attached to the skin (but not with bare hands). Immerse affected area in warm
water for 20 minutes then leave to dry without towelling. DO NOT apply vinegar
(increases toxin release).
Lion’s mane jellyfish/mauve stingers
Apply wet sand or a towel soaked in sea water initially, then flush the area with
warm sea water. Vinegar is effective for these types of jellyfish (but fresh water is
not). Wipe remaining tentacles off with a dry towel after five minutes. Cold packs
may help relieve pain.
Hydromedusae
Remove togs as soon as possible after leaving the water. Shower in preferably
salt water. Wear tight-fitting clothes when swimming.
Treatment after first-aid
Lignocaine, calamine lotion, or a mild hydrocortisone cream may be applied to
the skin and oral antihistamines taken if the skin is itchy. Oral corticosteroid
tablets may be prescribed for extensive jellyfish stings.
Medicines have benefits and some may have risks. Always read the label and use only
as directed. If symptoms persist or you have side effects see your healthcare professional.
TAPS PP 7868
Page 21

Bruises, Scars, Spider Veins
Bruises
Beneath our skin lies a network of tiny blood vessels called capillaries. A bruise
forms when these capillaries break or burst as the result of an injury or blunt
force, and blood leaks out and pools in the area. The area may swell and
feel tender, and the bruise goes through several colour changes from dark
red initially, to purple or black before fading to a yellowish/green as the body
breaks down the pooled blood cells and the capillaries heal.
People who are more likely to bruise include those with thinner skin (women,
elderly) or more fragile blood vessels (elderly, long-term prednisone use). Bruises
are also more likely to occur in areas where there is less fat, such as around the
knees.
Blood clotting is important in fixing the bruise, so clotting problems (eg,
haemophilia, liver disease) or medication that affects clotting (eg, warfarin,
aspirin or anti-inflammatories) can affect bruising.
A haematoma is a hard lump where the blood clots or partly clots in a localised
area (eg, in a muscle) and may need to be drained off. A purplish, flat bruise that
occurs when blood leaks out into the top layers of skin is called an ecchymosis,
and is common in elderly people.
Light bruises are not dangerous but more serious bruises will need to be
referred to a pharmacist or doctor. Spontaneous bruising may be the sign of a
bleeding disorder or bone marrow problem.
Scars
Scars are permanent areas of fibrous tissue that grow over a wound. Part of the
natural healing process, they can occur from surgery, burns, cuts and grazes, acne,
skin infection, chickenpox and scratches. Scars are often thicker, pinker, redder, or
shinier than normal skin. The functional ability of scars is less than that of normal
tissue, and they do not contain sweat glands or hair follicles. Scars are also more
prone to sunburn. How major the scar becomes depends on how big or deep the
wound is, where it is, how long it takes to heal, the age and health of the person,
TREATMENT OPTIONS
Category Examples Comments
Bruises
Scars
eg, arnica (eg, Anti-Flamme range, Natures Kiss
Arnica cream)
eg, mucopolysaccharide (eg, Hirudoid)
Essential oils and vitamins
eg, Derma Oil, Hiruscar Gel, Palmers Skin
Therapy Oil*, Skybright Rosehip Oil, Trilogy
Organic Rosehip Oil
Support stem-cell regeneration
eg, Mebo Skin Restore, Mebo Wound Repair
Anti-Flamme cream contains a mixture of arnica flower and root and several essential oils
to help relieve bruising. Hirudoid contains enzymes that help disperse excess fluid in swollen
areas. Both creams also reduce swelling.
These help reduce the appearance of scars and stretch marks.
Helps return elasticity to damaged skin and fades scars and blemishes. It also protects newly
healed skin.
Veins
Natural / herbal products /
supplements
Topical silicone gel
eg, Bepanthen Scar Treatment, DermaScar,
Dermatix, Epicyn Scar Reducing Silicone Gel
Silicone gel sheets
eg, Cica-Care Adhesive Silicone Gel Sheet
eg, mucopolysaccharide (eg, Hirudoid)
eg, essential oils and vitamins (eg, Bio-Oil)
Spider veins
Horse chestnut
Bilberry extract
Scars
Alphahydroxy acids
Rosehip or Tea Tree oil
Vitamin E
Bruises
Comfrey (eg, Kiwiherb Comfrey)
Arnica
Traumeel gel/cream/drops
Forms a flexible and transparent silicone sheet that acts like a second layer on the skin.
Helps to flatten, soften and smooth hypertrophic and keloid scars. Recommended treatment
duration: two months.
Cica-Care softens, flattens and fades red, dark or raised scars. Use on fresh or old hypertrophic or
keloid scars, or on closed wounds to help prevent hypertrophic scars and keloids.
Cica-Care adheres to the skin. Use only after stitches have been removed.
Spider veins can be treated with laser treatment, Intense Pulsed Light (IPL) therapy and
sclerotherapy, although often other spider veins can develop in the same area.
Hirudoid cream may be used to reduce vein inflammation under medical supervision.
Bio-Oil may help reduce the appearance of spider veins.
Oral horse chestnut seed extracts or bilberry extracts have been used in the treatment of vein
conditions.
Alphahydroxy acids applied as a facial peel appears to improve the appearance of atrophic
acne scars.
Rosehip oil can help to reduce the visible appearance of scars.
Rosehip oil, diluted Tea Tree oil and vitamin E cream or capsules may help reduce scarring.
Topical comfrey improves pain and tenderness of bruises.
Arnica may help reduce bruising.
Traumeel is a homeopathic range that may help with bruising.
Products with an asterisk have a detailed listing in the Bruises, Scars & Spider Veinssection of OTC Products, on page 221.
READY, SET, LEARN!
Page 22 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
and the person's inherited tendency to scar. Scars should be dressed initially as
the wound heals then taped with medical grade paper tape for a least eight to
12 weeks, and perhaps much longer.
Keloid scars are raised, often red and can be bigger than the injury, surgery or
acne causing them. Excess collagen forms as an abnormal response to the injury.
Keloid scars can be treated with surgery, steroid injections, pressure and silicone
gel sheets (eg, Cica-Care, see Treatment options opposite page). Even old scars
can respond to treatment.
Hypertrophic scars are similar to keloid scars but are no bigger than the injury.
They can be treated with silicone gel sheets. Contracture scars may come from a
burn. The skin becomes tight and can also affect mobility.
Scars usually fade over time but never go away completely. Various
treatments – such as surgery, dermabrasion, laser treatments, injections,
chemical peels, creams or oils – can help minimise the appearance of a scar.
Spider and reticular veins
Spider veins (also called starbursts or telangiectasia) are similar to varicose veins
but much smaller. They may be red, blue or purple and are closer to the surface
of the skin than varicose veins (see Varicose Veins & Support Stockings).
They usually occur in a group and look like a tree branch or spider web, and are
commonly found on the legs and face. They can cover a very small or very large
area of skin and can sometimes be painful.
Reticular veins are bigger blue veins and lie deeper in the skin than spider
veins. Spider veins often come from reticular veins, so these may need treating
as well.
Risk factors for developing spider veins include long-term use of strong topical
corticosteroid creams, cirrhosis of the liver, heredity, prolonged standing, obesity,
hormones and sun exposure. Treatment is available at vein clinics.
Initial assessment
Always be tactful when helping customers with obvious scars or spider veins as
some people may be self-conscious about them. Unusual bruising, or bruising
in an older person should always prompt you to ask the customer if they are
taking any other medications or prone to bleeding, particularly if they are buying
NSAIDs or aspirin, as further advice may be needed from a pharmacist.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any allergies to topical medicines?
Bruises
• Is the area particularly painful or difficult to move? There may be
damage, such as a fracture or sprain underneath.
• Has the bruise swollen or become firm?
• Has the bruise persisted for almost two weeks without fading?
• Are there any other symptoms in addition to the bruising (eg,
feeling unwell, headaches)?
• Does the person bruise easily for no apparent reason?
• Does the bruise cover a large area?
Scars
• Is the scar painful, very red, or extremely thick?
• Is there any oozing, pus or blood coming from the scar?
• Is the scarring extensive?
Spider veins
• Is the person using steroid creams? These may be the cause.
• Has the person been unwell or do they have an underlying
condition that might have caused the veins to appear?
Veins
• Wearing support hose, maintaining an ideal body weight, exercise and
avoiding prolonged standing may help prevent spider veins.
Advice for customers
Bruising
• Use RICE treatment (rest, ice, compression and elevation) straight after the
soft tissue injury (see Strains and Sprains). Do not massage a bruise.
Scarring
• Use moist wound dressings and, if necessary, wound closure strips to help
reduce scarring. Continue until the wound heals then tape for at least three
months. Do not pick at wounds. Minimise movement of the area while healing.
• Do not expose new scars to the sun – cover or apply sunblock.
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Page 23

Childhood Diseases and Immunisations
Several infectious diseases are more prevalent in children than in adults;
however, non-immune adults are still susceptible to catching these diseases.
Immunisation is the process by which a child or adult is made resistant to an
infectious disease, typically by administration of a vaccine. It is a proven tool for
controlling and eliminating life-threatening infectious diseases and the World
Health Organization estimates it averts between two million and three million
deaths per year.
Benefits of immunisation far outweigh risks but customers seeking
reassurance about the safety and effectiveness of specific vaccines are best
referred to the Immunisation Advisory Centre (www.immune.org.nz or 0800
IMMUNE). This organisation is based at the University of Auckland and provides
independent, factual information based on international and New Zealand
scientific research regarding vaccine-preventable diseases and the benefits and
risks of immunisation.
The National Immunisation Schedule (NIS) is the series of vaccines that are
generally offered free to babies, children, adolescents and adults of certain
ages in New Zealand, although some vaccines have restrictions on their use.
Revaccination of children following significant immunosuppression (eg, as a
result of chemotherapy) is also funded for most vaccines on the NIS, as long
as eligibility rules apply. The current schedule can be found on the Ministry of
Health’s website at www.health.govt.nz. Detailed consumer information
on diseases and vaccines, including diseases not covered by the National
Immunisation Schedule, can be found in the YourHealth section of this website.
Pharmacy staff can help improve immunisation rates by:
• reminding caregivers about the Well Child programme (see text box opposite)
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Non-steroidal antiinflammatory
drugs
(NSAIDs)
[GENERAL SALE]
eg, paracetamol – less than 20 tablets,
(Panadol, Paracare)
[PHARMACY ONLY MEDICINE]
eg, paracetamol – greater than 20 tablets,
suspension (Pamol range, Paracare range)
[PHARMACY ONLY MEDICINE]
eg, ibuprofen (Advil, Fenpaed, Nurofen)
Paracetamol has few side effects and is safe for occasional use at recommended dosages.
Take care to avoid overdose. Advise customers to check strength, formulation and dosage instructions on the
back of the product packet, and to never exceed these.
Given to relieve discomfort rather than to bring down a fever (for more information see Fever).
Paracetamol is not recommended for routine use before or after vaccination as it may decrease the antibody
response to vaccines, and therefore lasting immunity (infection-fighting ability).
Avoid NSAIDs in chickenpox due to the rare possibility of complications. Ibuprofen may not be suitable for
some children (see Childhood Pain and Baby Teething).
Anti-pruritics
Vaccinations: tetanus/
diphtheria/ pertussis
(Tdap), meningococcal
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, Pinetarsol, PoxClin
[PRESCRIPTION] –except when
administered by a registered pharmacist
who has successfully completed an
approved vaccinator training course
Honey, calendula ointment, zinc cream,
vitamin A ointment
Tar-based pine oil products are useful in the bath to help reduce itching.
PoxClin has a natural cooling action and helps enhance the skin's protective barrier. Also relieves itch.
Tdap vaccine (eg, Boostrix) can only be administered by pharmacists to persons aged 18 years or over.
Meningococcal vaccine (Menactra, Neis Vac-C) can only be administered by pharmacists to persons aged 16
years or over. Influenza (see Influenza), varicella (see Shingles) and Dukoral (see Travel Health) vaccines
can also be administered by suitably trained pharmacists. Refer to a doctor or the Immunisation Handbook
available at www.health.govt.nz for more information about cost and availability of all vaccines.
One to two teaspoonfuls of honey taken at night can be effective at relieving cough associated with some
childhood diseases. Calendula or vitamin A ointment or zinc cream may help relieve irritated skin and reduce
scarring (ie, from chickenpox).
Page 24 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Well Child Programme
All New Zealand children, from birth to five years, are entitled to participate in the free Well
Child programme (www.wellchild.org.nz), a package of 12 core health contacts plus a general
practitioner check at six weeks, corresponding to the six-week immunisations.
Pharmacy staff should encourage customers with young children to fully access this programme,
particularly those servicing low socioeconomic areas, as good health in a child's early years sets
the foundation for a life-long good health and well being.
Observation and assessment of the child's health and development is undertaken during each
visit, as well as discussions about breastfeeding, immunisations, and safe sleeping practices. Any
concerns about a child's vision and hearing can also be investigated further.
Well Child also serves to provide support to the baby's mother, and can help with bonding
problems, parenting skills, mental health concerns, income or housing issues, or alcohol or
substance misuse disorders.
• displaying and discussing information on the relative risks and benefits of
immunisation
• informing customers about current epidemics and checking their immunisation status.
Some immunisations can cause pain and fever. While the use of paracetamol
or ibuprofen to relieve pain or discomfort immediately prior to or following
vaccination is not contraindicated, experts do not recommend that pain-relieving
medicines be routinely used as use has been associated with a lower immune
response. However, if a child is distressed by fever, discomfort or pain following
immunisation, they may be given.
Report any suspected adverse reactions to vaccines to the Centre for Adverse
Reactions Monitoring (for details about how to report see Medicines Safety,
page 183).
Initial assessment
The majority of children who are unwell, look unwell, but it can be difficult to tell
whether a child is seriously ill or not. Always encourage caregivers with unwell
children to talk to the pharmacist, unless they have already seen a doctor and are
comfortable with looking after the child.
Any child with difficulty breathing, with a blue tinge around the lips or tongue,
having difficulty feeding or refusing to drink, who is overly sleepy or floppy, feels
cold to the touch, is not urinating, or is under three months old and looks unwell
needs urgent medical attention.
Always be mindful that most childhood diseases are contagious, and
pharmacy staff are at high risk of exposure to some of these conditions that
are still prevalent in the community, particularly during epidemics. Unimmunised
pharmacy staff without natural immunity to common infections need to be
particularly careful, and should be encouraged to bring their immunisation status
up to date.
Refer to a
PHARMACIST/DOCTOR
Refer all children with suspected infectious diseases to a pharmacist
for further advice and evaluation.
For each infectious disease on the following pages, guidance is
offered on when pharmacists should refer customers to their doctor.
General management advice
Children should remain at home until they are no longer infectious (see
individual conditions on the following pages). If possible, infected children
should be kept away from pregnant women, newborn babies or any person who
is immunocompromised (eg, with cancer, HIV, organ transplant recipients) until
they are no longer infectious. Advise parents or caregivers to:
• observe their child frequently and seek urgent medical advice if they are
worried or the child seems in distress
• keep offering their child fluids to avoid dehydration. If their child refuses even
small sips, they should seek medical advice urgently
• wash and dry their hands frequently, especially before and after tending to a
sick child
• dress their child in light, loose-fitting clothing or pyjamas and encourage their
child to rest in a half-darkened room
• only administer pain relief, such as paracetamol, occasionally if needed to
relieve a child’s discomfort (see Fever for more information)
» Aspirin should not be given to children under 18 years (unless under
medical advice) due to the risk of Reye’s syndrome (see Childhood Pain
and Baby Teething for more information).
• trim their child's fingernails short to discourage scratching which may lead to
infection.
Some diseases may require specific medicines prescribed by a doctor (see
individual listings for details).
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Page 25

Childhood Diseases and Immunisation (continued)
Category Description Symptoms Refer to a doctor
CHICKENPOX
Chickenpox is a common, contagious disease caused
by the varicella zoster virus. From 1 July, 2017, varicella
vaccine (Varilrix) is funded on the NIS for all children
at 15 months old, and a catch-up dose for previously
unvaccinated children at 11 years old. The vaccine is also
funded for children and adults with reduced immunity or
at very high risk of contracting the disease (two doses
recommended).
Approximately 50,000 cases of chickenpox occur in New
Zealand each year. People who have had chickenpox
are also at risk of developing shingles later in life (see
Shingles).
Initially, fever, headache, tiredness or sore throat
for up to three days before the rash appears
(adults may develop a flu-like illness). The rash
begins as red itchy spots, usually in crops of three
to five that eventually become blisters. Most
commonly begin on the head and neck before
moving to the trunk and limbs. May also appear
inside the mouth or on the genitals. Blisters crust
over after three to five days and are extremely
itchy. Number of blisters can range from a few to
several hundred. Secondary bacterial infection is
common.
If the blisters become infected.
If there are spots in the eyes, ears, or mouth.
If the child has another illness affecting their
immune system.
If the child seems particularly unwell.
If the diagnosis is uncertain.
DIPHTHERIA
Diphtheria is a serious, often fatal disease caused by
Corynebacterium diphtheriae. Diphtheria is included in
the NIS as part of the Infanrix-hexa (diphtheria, tetanus,
pertussis, polio, hepatitis B, Haemophilus influenzae type
b) vaccine. It is also a component of some other vaccines
(ie, Boostrix, ADT booster, Infanrix-IPV).
Diphtheria is extremely rare in New Zealand but is
endemic in many developing countries.
The bacteria cause mucous membrane
inflammation so the most common symptom is a
sore throat, hoarseness, painful swallowing and
the development of a bluish-greyish membrane
that covers the inside of the throat and tonsils.
Other symptoms include a nasal discharge, fever
and chills. Some people have no symptoms.
Anybody with suspected diphtheria as the
diphtheria toxin can affect the lungs, heart,
peripheral nerves, and kidneys. Fatality rate
is 2%–10%.
HAEMOPHILUS
INFLUENZAE TYPE B
Haemophilus influenzae type b (Hib) is caused by a
bacterium. Humans are the only hosts of these bacteria
and children less than five years are especially at risk. Hib
(Hiberix replaces Act-Hib from 1 July, 2017) is funded on
the NIS for all children aged less than five years.
Before immunisation, most common presentations
were meningitis and epiglottitis.
Meningitis tends to occur in younger children aged
less than three years. Symptoms include fever, loss
of appetite, vomiting, bulging fontanelle (babies),
drowsiness, light sensitivity.
Epiglottitis usually occurs in children aged two to
four years. Symptoms include difficulty breathing
and swallowing and drooling. May extend neck
and stick tongue out. Rapid onset.
Anybody with suspected Hib infection.
Hospitalisation may be required.
HEPATITIS A
Hepatitis A is a virus that is more common in areas with
low living standards, poor hygiene and high population
density. In countries where the disease is endemic,
almost all adults are immune. Several cases of hepatitis
A infection were reported in New Zealand in 2015 linked
to imported frozen berries. Havrix and Havrix Junior
are funded on the NIS for transplant patients, children
with chronic liver disease, and close contacts of known
hepatitis A carriers.
In infants and preschool children most infections
are either asymptomatic or cause mild non-specific
symptoms without jaundice.
Adults typically develop symptomatic disease (eg,
jaundice, weight loss, abdominal discomfort, dark
urine), the severity of which increases with age.
Anybody with suspected hepatitis A
infection.
HEPATITIS B
Hepatitis B is a very infectious viral disease that infects
liver cells. It is the host’s immune response that leads
to the death of the infected liver cell. Two strengths of
HBvaxPRO are funded on the NIS for people meeting
certain criteria.
Symptoms of acute hepatitis B include nausea
and vomiting, jaundice, dark urine, pale faeces,
tiredness, anorexia, stomach and muscle aches and
fever. Some people are infected with the virus but
do not show symptoms for a long time (chronic
hepatitis).
Anybody with suspected hepatitis B.
Significant learning
opportunity: Wound care
Your new Group 3 CPD project
Page 26 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Infectious period and
transmission
Transmitted either by droplet inhalation
(through the infectious person coughing or
sneezing) or by direct contact with the blister
exudate (fluid). Incubation is 10–20 days.
Contagious period is one to two days before
the rash appears and until all the blisters have
formed scabs – may take between five and
10 days. Keep children away from school or
childcare facilities throughout this contagious
period. Immunocompromised people can
develop the disease more than once.
Transmission is by respiratory droplets or by
direct contact with skin lesions or articles
soiled by infected individuals. Diphtheria can
be spread through contaminated food, such
as milk. Untreated people are infectious for
up to a month. Once appropriately treated the
contagious period can be limited to four days.
Incubation period: two to five days.
Spread by infectious droplets through coughing
and sneezing.
Incubation period: unknown, probably two to
four days.
Complications and other management
Scarring as a result of chickenpox infection occurs in approximately 19% of children with an average of three scars per child, often on
the face. Secondary bacterial infection as a result of scratching is common. Antibiotics may be needed. People with asthma may get a
worsening of their asthma symptoms or develop a viral pneumonia. Dehydration can also occur, especially if sores are located inside
the mouth and drinking is painful. Other more severe complications (eg, encephalitis, Guillain-Barré syndrome, Reye’s syndrome) are
rare and more likely in immunocompromised and adult chickenpox cases.
Foetal abnormalities, premature labour and delivery and, rarely, maternal or neonatal death (2%–5% risk) can occur if a pregnant
woman contracts chickenpox at eight to 20 weeks' gestation. Newborns are at risk of serious disease if their mother contracts
chickenpox between the 5th day before delivery and the 2nd day after the baby is born. Other cases of chickenpox acquired in utero
may cause no symptoms in the foetus but may present later as shingles at a young age.
Other management: Avoid NSAIDs in chickenpox due to the rare possibility of complications. Consider aciclovir in
immunocompromised people or people at risk of severe varicella infections. Varicella-zoster immune globulin given within 96 hours of
initial contact can also reduce disease severity.
Treatment is with diphtheria antitoxin and antibiotics.
Booster doses should be considered by adults every 10 years particularly if travelling overseas to developing countries (usually given
as a combined tetanus and diphtheria vaccine). ADT booster is also funded on the NIS for adults aged 45 and 65 years old.
The infection is treated with antibiotics and additional treatments may be required for associated illnesses.
Before the introduction of the Hib vaccine in 1994, Hib disease was the most common cause of life-threatening bacterial infection in
children less than five years. Since 1994 hospitalisations due to Hib have decreased by approximately 90%.
Avoid overcrowded conditions and sharing food and utensils. Practice good hygiene measures.
Can survive outside the body for prolonged
periods in food and water.
Incubation period: 15–50 days.
Transmitted either through person-to-person
contact or through food or drink contaminated
with faeces from an infected person.
Signs and symptoms usually last less than two
months, although can last up to six.
Thoroughly wash hands before and after using the toilet, before preparing and serving food, and after changing nappies.
The number of notified cases has steadily decreased since 1980; however, outbreaks frequently occur, most notably in the Ashburton
district in 2013 with over 28 confirmed cases reported, and more recently nationwide in 2015 linked to frozen berries. Complications
of hepatitis A are rare but can include cholestasis (a build-up of bile inside the liver) and liver failure which is potentially fatal.
Usually transmitted through contact with
infected blood or body fluids during childbirth,
contact with broken skin in childhood, or during
sexual intercourse or intravenous drug use.
Hepatitis B virus in desiccated blood remains
infective for at least one week.
Incubation period: six weeks to six months.
No specific treatment. Chronic hepatitis B infection can be treated with interferon and anti-viral medication.
Contacts and family members of infected persons should be vaccinated against hepatitis B and practise strict hygiene measures.
As there is no cure, preventing infection with the disease through vaccination, not sharing needles and practising safe sex using
condoms is recommended.
People with chronic hepatitis B are at higher risk for liver disease or liver cancer.
Visit ELearning to start your project
www.pharmacytoday.co.nz
Facilitated by Dr Alesha Smith
Page 27

Childhood Diseases and Immunisation (continued)
Category Description Symptoms Refer to a doctor
HUMAN PAPILLOMA
VIRUS (HPV)
HPV viruses are a group of more than 200 related viruses.
At least 40 different types can be spread through sexual
contact and HPV infections are the most commonly
sexually transmitted infections.
As of January 2017, the HPV vaccine Gardasil 9 (protects
against HPV types 6, 11,16,18, 31, 33, 45, 52 and 58)
is funded on the NIS for both males and females from
age nine to 26. A two-dose schedule is recommended for
those aged 14 and under, and a three-dose schedule for
those aged 15 to 26. Any female who started a 3-dose
4-valent Gardasil regimen prior to the change-over is able
to complete their remaining doses in 2017. The vaccine is
licenced but unfunded for females aged 27 to 45 years.
HPV is very common with four out of five people
becoming infected with HPV during their lifetime.
In most people, the infection clears by itself
without causing any symptoms or long-lasting
health problems.
Low-risk HPVs 6 and 11 cause approximately 90%
of genital warts. Genital warts appear as a small
bump or cluster of bumps in the genital area. They
may be raised or flat, small or large, or shaped like
a cauliflower.
High-risk HPVs cause cancer, including cancer of
the cervix and anus and oropharyngeal cancer.
HPVs 16 and 18 are the most commonly implicated
viruses. Cancer often takes years to develop after a
person gets HPV.
If there is any suspicion of genital warts.
For any abnormal bleeding, pain, or
discharge in the genital area.
Women aged 20 to 70 should undergo
cervical screening at least every three years.
MEASLES
Measles is a highly contagious disease caused by a
paramyxovirus of the genus Morbillivirus. A vaccination
against measles is funded on the NIS and is given as a
combined measles, mumps and rubella vaccine (Priorix
replaces MMR-II from 1 July, 2017). Last reported
epidemic in New Zealand was 2011 (595+ cases).
Measles is endemic in many countries overseas and more
than a million children die from the virus each year.
First three days: high temperature, cough, cold,
runny nose, sore throat, swollen neck glands. Red,
sore, watery eyes and an inability to tolerate light.
Day three: Koplik’s spots may appear (small red
spots on inner surfaces of cheeks and soft palate).
These are transient and not seen in every case of
measles.
Days four and five: blotchy, flat red rash, first
appearing on the face then progressing down the
trunk and limbs, with or without itch.
If there is ear pain.
If the child is unwell after the rash subsides.
If the diagnosis is uncertain.
MENINGOCOCCAL
DISEASE
Meningococcal disease is a bacterial infection caused by
the bacterium Neisseria meningitidis, of which several
different groups exist (A, B, C, W-135, Y). Between 40
and 100 cases of meningococcal disease occur in New
Zealand each year, with most cases being caused by
group B bacteria. Group C is the next most common
cause. Humans are the only hosts of these bacteria.
Although there are a number of meningococcal vaccines
available, only Menactra and NeisVac-C are publicly
funded for certain groups of few people at high risk (ie,
those without a spleen, close contacts of meningococcal
cases). Customers may chose to purchase these privately.
NeisVac-C (only protects against Group C bacteria);
Menactra and Nimenrix (both protect against Groups
A, C, Y and W135) are conjugate vaccines and can be
used in children under two years. Conjugate vaccines are
considered superior to polysaccharide vaccines such as
Menomune.
Meningococcal B bacteria vaccines are difficult to develop
and none are currently commercially available in New
Zealand.
Symptoms can develop suddenly and include: a
high fever, headache, sleepiness, joint and muscle
pains. More specific symptoms include: a stiff neck,
photophobia (cannot tolerate light), vomiting,
crying, and a reddish-purple, pin-prick, spotty rash
or bruises that do not blanch (go white) when
pressed.
In babies and very young children, the signs may
be more subtle.
• Infants may refuse to feed.
• The child may be listless or strangely quiet,
irritable, or have a very high-pitched cry.
• The child may have a bulging or tight fontanelle
(top of the head).
• Neck stiffness may be absent in infants.
• Mothers are usually very instinctive about their
children and, if they believe there is “something
not quite right”, the child should be referred to
a doctor.
Be alert for the signs and symptoms of
meningococcal disease and seek urgent
medical treatment if it is suspected or cannot
be ruled out.
For more information go to the YourHealth
topics on the New Zealand Ministry of
Health’s website www.health.govt.nz (or
phone Healthline: 0800 611 116 or 111 if it
is an emergency).
If your customer has already seen a doctor
and been sent home but is still concerned,
advise them to call their doctor again, or
phone a different doctor, and insist on
further tests or observation.
MUMPS
Mumps (epidemic parotitis) is caused by a paramyxovirus
of the genus Paromyxovirus. Most reported cases are in
children aged five to nine years. Mumps is funded on
the NIS and is given as a combined measles, mumps
and rubella vaccine (Priorix replaces MMR-II from 1 July,
2017). Last reported epidemic in New Zealand was 1994
(188 cases); however, mumps cases are still occurring.
Some people do not experience any symptoms.
Both parotid (salivary) glands on the side of the
neck enlarge and become tender although one
usually swells one to two days before the other.
The glands become increasingly sore, especially
when swallowing, talking, chewing and drinking.
Dry mouth, fever, stiff neck, loss of appetite,
nausea, vomiting, tiredness and convulsions may
occur.
If customer is going through puberty.
If the customer has repeated vomiting,
headache and a stiff neck.
If the customer is an adult or adolescent
male with the disease.
If the diagnosis is uncertain.
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Page 28 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Infectious period and
transmission
HPV can be transmitted through skin-to-skin
contact, although it is most commonly spread
during vaginal or oral sex. Transmission can
occur even when condoms are used and
without penetrative intercourse.
Incubation period: typically one to 20 months;
however, in some people, symptoms do not
develop until years after having sex with
somebody who is infected.
Complications and other management
In most infections, a person’s own immune system eradicates cells infected with HPV within five years.
Low-risk HPVs do not cause cancer but can cause skin warts on or around the genitals, anus, mouth and throat. HPV types 6 and 11
can also cause respiratory papillomatosis (a condition where bengin tumors grow within the respiratory system).
More than 10 high-risk HPVs have been identified that cause cancer, including HPV types 16, 18, 31, 33, 45, 52, and 58. HPV types
16 and 18 cause the majority of cancers, including 70% of all cervical cancers. HPV viruses also cause 95% of anal cancers, 70% of
oropharyngeal cancers, 65% of vaginal cancers, 50% of vulvar cancers, and 35% of penile cancers.
Vaccination should ideally be performed before the onset of sexual activity. First dose in girls is recommended to be administered at
age 12, with the course completed within six months. Cervical cancer screening is still recommended in women between the ages of
20 and 70, even if they have received the vaccine.
The vaccine is also licensed but not funded for males between the ages of nine and 26 years.
Transmission of the virus is by inhalation or
ingestion of infected droplets that have become
airborne when a person with measles coughs
or sneezes.
Incubation period: four to 12 days. There are
usually no symptoms until the rash appears.
An infected person is contagious from two
days before any symptoms show to at least five
days after the onset of rash. Children should
stay away from school or childcare facilities
throughout this contagious period.
Transmission is by close or lengthy contact
with an infected person's saliva or respiratory
secretions; the bacteria are transferred during
coughing or kissing. Transmission is more likely
to occur between people living in the same
household or in shared accommodation.
Meningococcal bacteria are not as contagious
as viruses that cause the cold and flu so a
person is unlikely to become infected during
casual contact or by breathing the same air as
an infected person.
Meningococcal disease is more common in
infants, adolescents, and young adults; in
people without a spleen, with HIV, or with
persistent complement component deficiencies;
and in sub-Saharan Africa.
Risk of complications from contracting measles are far greater than risks associated with vaccination with the MMR vaccine. Those
at risk of complications include those who are malnourished (particularly vitamin A deficient), immunocompromised and pregnant
women. Diarrhoea leading to severe dehydration is the most common complication of measles. Other complications include otitis
media which may lead to deafness, pneumonia which may be fatal, bronchitis, croup, conjunctivitis and/or corneal ulceration leading
to blindness (especially if vitamin A deficient), mouth ulceration, acute glomerulonephritis (inflammation of kidneys) and acute renal
failure. Measles infection during pregnancy increases the risk of premature labour and delivery, and foetal loss. There is also a risk
of maternal death. There is no causal link between receiving the MMR vaccine and developing autism or bowel disease. An acute
infection of measles almost always gives lifelong immunity. Vaccination induces probably lifelong immunity in most individuals.
Other management: Severe cases of measles usually require hospitalisation and antibiotic administration for secondary bacterial
infections. Antiviral medication may be prescribed to adults or those with severe infection.
Infection can cause two very serious illnesses: meningitis (an infection in the brain) and septicaemia (blood poisoning). Both are
medical emergencies and can occur suddenly causing a person to deteriorate rapidly. Haemorrhage, shock, coma and death can
occur within several hours despite antibiotic therapy. People who survive may be left with permanent disability or hearing loss.
Parenteral antibiotics should be administered to all cases as soon as meningococcal disease is suspected. Vaccination and/or
prophylactic oral antibiotics should be considered for all people who qualify as close-contacts of a person with meningococcal
disease.
About one in 10 people harbour the bacterium that causes meningococcal disease in the back of their nose and throat without any
signs or symptoms of the disease.
Meningitis may also be caused by viruses and fungi.
General health measures (such as covering the nose and mouth when sneezing or coughing, washing hands before eating, and
not sharing eating or drinking utensils, toothbrushes, or pacifiers) should be practised by everybody to limit the risk of contracting
Meningococcal disease, particularly those living in shared accommodation such as university hostels, flats or army barracks.
Requires close personal contact for transmission
to occur.
Incubation period: 12–25 days.
People with mumps are infectious from about
one week before the onset of mumps to up to
nine days after the swellings appear. Children
should stay away from school or childcare
facilities throughout this contagious period.
Unvaccinated adolescents and adults are most at risk of severe mumps disease. Post-pubertal males are at risk of sterility if the
disease affects the testicles. Mumps in pregnant women in their first trimester is associated with an increased rate of miscarriage.
Complications include viral meningitis (15% of cases), encephalitis (1:6000 cases, of whom 1:100 die) and deafness (1:15,000
cases).
Orchitis (testicle inflammation) affects one in five adult males, may be a risk factor for testicular cancer. Usually affects one testicle,
sterility rare unless both testicles affected. Ovary inflammation affects one in 20 females.
For most people one infection confers lifelong immunity. Vaccination is 95%–96% effective at preventing disease.
Page 29

Childhood Diseases and Immunisation (continued)
Category Description Symptoms Refer to a doctor
PERTUSSIS
PNEUMOCOCCAL
disease
POLIO
ROTAVIRUS
RUBELLA
TETANUS
Pertussis (whooping cough) is a highly contagious
bacterial disease caused by Bordetella pertussis. Pertussis
is one of the leading causes of vaccine-preventable
deaths worldwide, with most deaths occurring in
unvaccinated or incompletely vaccinated young infants.
Pertussis is a component of several combination vaccines
(such as Boostrix, Infanrix IPV, and Infanrix-Hexa) and is
funded on the NIS in children.
Boosters are funded for pregnant women between 28
and 38 weeks’ gestation during epidemics. Parents,
grandparents and adults working in contact with young
children should consider getting a booster vaccination
every 10 years; however, these are not currently funded.
Pneumococcal disease is caused by the Streptococcus
pneumoniae bacterium. More than 90 types of this
bacterium exist and infections can vary from minor to
severe. From 1 July, 2017, the pneumococcal 10-valent
protein conjugate vaccine (Synflorix) is funded on the NIS
for infants up to their fifth birthday or children needing
revaccination. The 13-valent vaccine (Prevenar 13) is
funded for high-risk patients only.
Poliomyelitis is a highly contagious viral disease caused
by three types of polio virus (types 1,2 and 3). Prior
to the development of polio vaccines, nearly every
person became infected, especially infants and young
children. Humans are the only hosts for polioviruses.
Inactivated poliomyelitis vaccine is funded on the NIS for
unvaccinated individuals and for revaccination following
immunosuppression. The first dose is usually given at six
weeks of age as part of Infanrix-hexa.
Rotavirus is the leading cause of severe vomiting and
diarrhoea in babies and young children in New Zealand.
More than 90% of all unvaccinated children will have
been infected by age three. Funded on the NIS (oral
Rotarix replaces RotaTeq from 1 July, 2017). First dose
must be given before 15 weeks of age.
Rubella (German measles or three-day measles) is caused
by a togavirus.
Rubella is funded on the NIS and is given as a combined
measles, mumps and rubella vaccine (Priorix replaces
MMR-II from 1 July, 2017).
Tetanus is a serious infection caused by the bacillus
Clostridium tetani – found worldwide in soil. Tetanus is
funded on the NIS and contained in several combination
vaccines (such as Boostrix, Infanrix IPV, Infanrix-Hexa,
ADT Booster).
Booster doses are given to children aged four and
11, and to adults aged 45 and 65. People in certain
occupations and travellers may benefit from tetanus
booster doses every 10 years.
Disease is more severe in infants and young
children.
Catarrhal stage: Lasts one to two weeks and
includes a runny nose, sneezing, fever, and mild
cough.
Paroxysmal stage: Usually lasts one to six weeks,
but can persist for up to 10. Burst, or paroxysm,
of numerous, rapid coughs occurs followed by a
long inhaling effort characterised by a high-pitched
whoop. Some babies may not “whoop”.
Convalescent stage: The cough may persist for up
to three months although usually disappears after
two to three weeks. Paroxysms may recur with
subsequent respiratory infections.
Major cause of ear infections and sinusitis.
Pneumococcal pneumonia is the most common
form of serious pneumococcal disease (fever,
chills, cough, shortness of breath, rapid breathing).
Pneumococcal meningitis and bacteraemia can
also occur.
Ninety-five per cent of infected people have no
symptoms; 4%–8% have mild symptoms such as
a low-grade fever, headache, fatigue, vomiting,
neck stiffness, sore throat, muscle pain. Some may
develop aseptic meningitis a few days after, but
most recover fully. Two per cent develop acute
irreversible flaccid paralysis with loss of reflexes,
which may also affect the breathing muscles.
Most common symptoms include diarrhoea,
vomiting, and fever. In severe cases, children can
have diarrhoea up to 20 times in one day.
Symptoms can begin suddenly and last up to seven
days.
Symptoms are often mild and may be absent or
missed in 30%–50% of cases. A pink macular
rash occurs on the forehead and face about seven
days following infection. This spreads rapidly to the
body, especially the chest and lasts two to three
days. There may also be a slight fever, a runny nose,
mild conjunctivitis, cervical lymphadenopathy and
aching joints. Small petechial lesions (forchheimer
spots) may be seen on the palate.
Bacteria in the wound produce a toxin which
causes the muscles to stiffen around the jaw, neck,
back, chest, abdomen and limbs; causing painful
muscle spasms and lockjaw. Food may be difficult
to chew or swallow. Some people may develop
fever and sweating and have difficulty breathing.
If the child is less than six months old.
If the disease is in its early stages since
antibiotics prescribed by a doctor can be
effective.
If there is ear pain.
If there is vomiting, convulsions, exhaustion,
dehydration, or the person is not eating.
If the diagnosis is uncertain.
Hospitalisation may be necessary for infants
under six months – about half of older
children may also need hospital care.
Anybody with suspected serious
pneumococcal disease.
Anybody with suspected polio.
Since 1962 only seven cases of polio have
been reported in New Zealand. Six were
vaccine or probably vaccine-associated
before New Zealand changed to the
inactivated polio vaccine in 2002. One case
was acquired in Tonga and imported to New
Zealand.
Seek medical advice immediately if child
becomes dehydrated – symptoms include
drowsiness or floppiness in children, a
sunken fontanelle, sunken eyes or no tears.
All suspected cases of rubella should
be notified so that public health control
programmes can limit spread.
Anybody with suspected tetanus needs to go
to hospital immediately. The disease can be
fatal (one in 10 people die). Children and the
elderly are most at risk.
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Page 30 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Infectious period and
transmission
Spread by inhalation of infected droplets from a
cough or sneeze.
Incubation period: six to 20 days.
Highly infectious and around 90% of nonimmune
household contacts will contract it.
Infectious period: seven days after exposure
until three weeks after the cough begins.
Children should stay away from school or
childcare facilities throughout this contagious
period.
Pneumococcal bacteria are carried in the nose
and throat of healthy adults and children.
Transmitted through infected droplets released
into the air by coughing or sneezing.
Incubation period: varies, may be as short as
one to three days.
Complications and other management
Babies aged less than six months are most at risk (75% require hospitalisation). Almost no maternal protection against pertussis is
passed to the newborn from the mother. Children under 12 months who are ill enough to be admitted to hospital have a one in 200
chance of dying of whooping cough. In one to three per 1000 children whooping cough leads to permanent brain damage, paralysis,
deafness or blindness (mortality rate of approximately 1%). Adolescents and adults may just present with a persistent cough similar
to that found in other upper respiratory infections (but still infectious).
Other management: Antibiotics do not cure pertussis, but may be given to reduce spread of infection to others. Cough medicines
provide little relief and should never be used in children under six. A mist vaporiser may soothe dry, irritated airways. Keep the room
free of irritants such as dust and smoke. Maintain a good fluid intake – keep meals small and more frequent. Ensure sick children get
plenty of bedrest.
Additional notes: Pertussis immunity wanes over time; both following natural disease and vaccination (immunity lasts five to 10
years). Pertussis is estimated to be responsible for up to 20% of severe coughs in adults lasting one to three months. These could be
a significant reservoir of infection. Reinfection may present as a persistent cough, rather than typical pertussis. Currently available
vaccines prevent disease much better than they prevent infection, so outbreaks still occur in countries with widespread vaccination
although mortality and morbidity is greatly reduced.
Pneumococcal disease is more common in autumn and winter and is the leading cause of bacterial pneumonia in young children
and adults older than 65. Maori and Pacific children are affected by pneumococcal disease more than other ethnicities in New
Zealand. Since introduction of a vaccine in 2008, the number of hospitalisations and recorded carriers of the bacteria has reduced.
Combination antibiotic treatment is usually required, although resistance can be a problem. Supportive care may also be needed.
Transmitted by the faecal-oral route or
by ingestion of pharyngeal secretions.
Asymptomatic people will shed the virus in their
stool and through poor hygiene will spread the
infection to others.
Incubation period: three to 21 days.
Virus persists in the pharynx for approximately
one week and in the faeces for three to six
weeks.
Highly contagious. Virus is able to survive a
long time on surfaces such as taps, bench
tops and toys. Main route of infection is
contamination of hands, utensils and other
objects with faeces from an infected person.
Incubation period: 24–72 hours.
Transmission is through direct or droplet
contact with infected nasopharyngeal secretions
(through a cough or sneeze). Infants with
congenital rubella shed virus in their pharyngeal
secretions and urine for months after birth and
should be considered infectious until they are
12 months old.
Incubation period: 14–21 days.
Humans are the only source of rubella infection.
Soil is the most common source of Clostridium
tetani spores and bacilli. Animals also carry the
bacilli and spores in their intestine and release
it in their faeces. Entry can be gained into the
body through a relatively minor cut, graze or
puncture wound.
Incubation period: three to 21 days.
A person with tetanus is not infectious to
others.
The disease is incurable. While the person is acutely unwell only supportive care can be provided to reduce complications associated
with paralysis. Once recovered, rehabilitation can prevent or reduce post-polio deformities and increase independence.
The Global Polio Eradication Initiative aims to immunise every last child on the globe with polio vaccine and ensure a polio-free world
for future generations. Until eradication throughout the world is confirmed, there is a risk of polio returning to New Zealand. New
Zealand started immunising against polio in 1961 using the oral polio vaccine, which was replaced in 2002 by the inactivated polio
vaccine. Worldwide rates of polio have decreased by 99% since 1988. Polio is still endemic in Afghanistan, Nigeria and Pakistan.
Most years, several previously polio-free countries are reinfected due to imports of the virus from endemic countries infecting nonimmune
people.
Strict hygiene is vital in preventing transmission. Hands should be thoroughly washed after changing nappies or cleaning up
diarrhoea or vomit. Vaccination with the oral rotavirus vaccine is the most effective way to prevent infection.
There is no specific treatment for rotavirus infection. The most important thing is to prevent dehydration by replacing fluid lost
through diarrhoea and vomiting.
Rubella is usually a mild disease in children; adults tend to have more complications. The most serious complication of rubella
infection is Congenital Rubella Syndrome (CRS), which results when the rubella virus attacks a developing foetus. When infection
occurs during the first trimester of pregnancy, up to 85% of infants will be born with some type of birth defect, including deafness,
eye defects, heart defects, mental retardation and more. Defects are rare when infection occurs after 20 weeks’ gestation.
Rubella vaccine, as contained in the combined measles, mumps, and rubella vaccine, is 95%–96% effective at preventing disease.
Those who are not protected after the first dose almost always develop protection after the second dose.
The last rubella outbreak in New Zealand was 1995/96 where 306 cases were notified (mostly involving young men).
Intensive care treatment is required and recovery can take months.
Almost all of the recent cases of tetanus reported in New Zealand occurred in individuals who had not received their primary
immunisation course of a tetanus-containing vaccine. In 2010, seven cases of tetanus were notified, the highest number since 1992
and one person died. One case had received a primary course of tetanus vaccines but had not received a booster dose for 15 years.
Most years between zero and two cases are notified.
Booster doses should also be given to people travelling overseas if it has been more than 10 years since their last dose.
To complete the work book assessment
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Page 31

Childhood Pain and Baby Teething
Pain in children is a common problem, but it often goes unrecognised or is under
treated. Infants and children of all ages, including premature babies, are capable
of feeling pain. In a typical month, an average healthy child will have about four
episodes of pain related to injuries, disease or infections (eg, falls, sprains, sore
throats) and one “ache”, eg, headache or stomach ache. Some children may
also experience recurrent pain (headaches, stomach aches), up to three or four
times a week.
The younger the child is, the less likely they are to receive adequate pain relief.
Social, family and cultural factors, and prior experience with medicines or of pain
can also affect how a child reports pain, or how family members react to their
child's self-reported pain.
Initial assessment
Listen carefully to a caregiver's description of their child's pain and observe the
child's behaviour. Is the child:
• crying, agitated, anxious, angry or frightened?
• difficult to comfort or distract?
• holding the sore part of their body (eg, clutching at their stomach)?
• quiet, withdrawn or lying very still and not wanting to move?
• refusing food and drink?
• tugging on the ears (ear pain) or protecting a body area?
Ask the caregiver how the child is sleeping as the only cues in very young
children may be frequent awakening, irritability, or excessive, inconsolable crying.
Children over three may be able to indicate how their pain makes them feel
using a scale of smiley faces, where a happy face indicates no hurt and a sad face
indicates it hurts the most.
Always involve the pharmacist in any discussion about pain relief for a child.
Treatment
Pain relief does not necessarily only mean medicines like paracetamol or
ibuprofen.
Integrative, non-pharmacological treatments, such as distraction, abdominal
breathing, heat and cold therapy, and aromatherapy all have a place in the
mangement of children's pain, especially chronic or recurring pain.
Baby teething
Baby teeth start to erupt through the gums between the ages of six months
and two-and-a-half years. This is usually painful for the baby and may cause
irritability, drooling, swollen red gums and cheeks, and the child may be fussy
with food or restless. All 20 baby teeth will be through by about three to four
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Non-steroidal antiinflammatory
drugs
(NSAIDs)
Topical oral analgesics
for baby/child teething
Topical anaesthetics
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, paracetamol – less than 20 tablets,
(Panadol, Paracare, Parafast)
[PHARMACY ONLY MEDICINE]
eg, paracetamol – greater than 20 tablets,
suspension (Pamol All Ages*, Pamol Infant
Drops*, Paracare For Babies & Young
Children 3 months–6 years*, Paracare For
Children 6 + years & Adults*)
[PHARMACY ONLY MEDICINE]
eg, ibuprofen (Advil, Fenpaed, Nurofen,
Nurofen for Children*, Nurofen for
Children Soft Chewable Capsules 7*)
[GENERAL SALE]
eg, choline salicylate (Bonjela Teething
Gel*, Orased Jel)
[GENERAL SALE]
eg, lignocaine (Soov cream)
[PHARMACY ONLY MEDICINE]
eg, lignocaine/prilocaine (Emla cream)
Homeopathic teething medicines (eg,
NaturoPharm Teethmed relief, Weleda
Baby Teething powder)
Kiwiherb Kid's Calm
Paracetamol has very few side effects and is safe for most people to use at recommended dosages.
Take care to avoid overdose. Check strength, formulation and dosage instructions on the back of the product
packet.
Paracetamol is not recommended for routine use before or after vaccination as it may reduce the effectiveness
of childhood vaccinations to stimulate lasting immunity (infection-fighting ability).
Avoid aspirin in children or adolescents under the age of 18. This is because of the risk of Reye’s syndrome.
Reye’s syndrome is a rare and serious condition which most commonly occurs after viral infections which
have been treated with aspirin. Symptoms include vomiting or constant nausea, drowsiness, confusion,
hallucinations, agitation and seizures. Urgent medical attention is required.
Ibuprofen is the NSAID least likely to cause stomach irritation. May be used in conjunction with paracetamol.
Refer children on certain other medications or with some medical conditions (eg, asthma, kidney disease) to
the pharmacist before selling (may not be suitable). Discontinue use if stomach upsets, increased bruising or
prolonged bleeding occur. Take care to avoid overdose. Ensure children stay well hydrated.
Helpful in infants and both older and younger children with localised pain caused by new teeth breaking the
skin surface. Do not use in babies younger than four months and not more frequently than every three hours.
Apply only a small amount directly to gums and do not exceed recommended dosages.
Lignocaine can be used to relieve skin pain due to sunburn, minor scalds or burns, and cuts and grazes.
Lignocaine/prilocaine creams can be used before procedures (eg, injections or taking blood samples). Apply
to the skin 45–60 minutes before the procedure to allow time for the lignocaine to numb the pain response.
Lignocaine creams should be used with caution in infants up to three months of age as adverse effects are
more likely in this age group.
Homeopathic teething medicines may help relieve the discomfort and restlessness of teething in infants and
children. Contain homeopathic ingredients such as belladonna, chamomilla, conchae and magnesium carb.
Kid's Calm contains chamomile and helps soothe colic and teething symptoms.
Products with an asterisk have a detailed listing in the Childhood Pain & Baby Teethingsection of OTC Products, starting on page 222.
Effective relief
you can trust
Nurofen for Childen is now available
in Liquids 3 months+...
Use: For the temporary relief of mild to moderate pain & fever. Nurofen for Children Liquid contains: 100 mg ibuprofen per 5 ml. Nurofen for Children Soft Chewable Capsules contains: 100 mg per capsule. Contra: Stomach ulcer, allergy to aspirin/NSAIDs,
impaired renal function or heart failure, GI disorder, dehydration,3rd. trimester of pregnancy, Children < 3 months. Prec: Adults 65 years and over, asthma, the first 6 months of pregnancy, use for more than a few days at a time. Use lowest effective dose for shortest possible
time. Keep to recommended dose. Excessive use may be harmful and increase the risk of heart attack, stroke and liver damage. Nurofen for Children Soft Chewable Capsules children 7 < years; Nurofen for Children Liquid Children < 12 mths. Adverse: GI ulcer, bleeding,
Page 32 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Helpful numbers and websites
••
PlunketLine 0800 933 922 – for advice about child health and parenting. All calls are
answered by a plunket nurse, 24 hours a day, 7 days a week.
••
Healthline 0800 611 116 – for advice on what to do for a sick child or adult. Interpretation
service available. All calls are answered by a registered nurse, 24 hours a day, 7 days a week.
••
The Australian Pain Society: Pain in Childhood Special Interest Group (www.apsoc.
org.au/pain-in-childhood) – aims to share and improve knowledge about pain in childhood.
••
Department of Pain Medicine, Palliative Care & Integrative Medicine (http://bit.
ly/1qvp0vv) – A paediatrician's top 10 Apps for pain management.
years of age.
Permanent teeth start to come through around six or seven years of age. It is
important to begin caring for your children’s teeth as soon as they have erupted,
to prevent tooth decay (see Toothache).
Relieve the pain of baby teething by giving the child something cold to chew
on (eg, a frozen banana wrapped in muslin, a cold teething ring), rubbing a
teething gel on the gums, or giving oral pain relief (eg, paracetamol) if necessary.
Advice for customers
• Seek urgent medical advice if the pain does not abate or the child is in distress.
• Research has identified four key ways pain relating to needles (such as during
vaccination) can be reduced or eliminated.
»»
Numbing with topical anaesthesia
»»
Giving an oral sucrose solution to children aged from birth to 12 months
»»
Positioning the child for comfort
»»
Distracting the child (includes the use of electronic devices).
• Chronic pain requires special management. For an excellent video for young
people about chronic pain see http://bit.ly/2gEj331
• Pain relievers should not be used regularly or continuously in children, except
on medical advice.
• Watch for “double-ups” when using other medications (eg, paracetamol can
be in both pain and cough/cold medications).
Refer to
PHARMACIST
Urgent medical advice should be sought for children who are floppy,
pale, hard to wake or unresponsive, with an unusual cry or who
develop a rash or complain of a stiff neck.
The following questions aim to identify children who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the child have any other health conditions (eg,
immunosuppression, diabetes)?
• Does the child take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Despite 24-hour treatment with OTC pain relievers, has the pain
persisted or become worse, or is the source of the pain unknown?
• Is the child crying, grizzling and tugging the ears (ear infection)?
• Does the child appear floppy, pale or is hard to wake up?
• Has the child had a fit (convulsion)?
• Is the child young (eg, under six years)?
• Has the child refused to eat for more than 24 hours or is vomiting?
• Does the child have a sore throat?
• Does the child feel too hot or too cold?
• Do you or the caregiver feel “things are not quite right” (pain
relievers can cover up symptoms of serious pain)?
• Does the child have any allergies to medicines?
Nurofen for Children Chewable Capsules 7+
On-the-go pain relief
Provides the right dose for 7+ years
No need for water, easy to chew
7 +
...and Chewable Capsules years
perforation, acute renal injury, hypertension, oedema, severe skin reaction. Nurofen for Children Liquid dosage: Measure dose with syringe provided.
Use lowest effective dose for shortest possible duration. Read pack for dosing details. Repeat dose every 8 hrs as nec (max 3 doses/day). Nurofen for Children Soft Chewable Capsules dosage:
Children: 7 – 10 yrs (22-32kg) 2 capsules every 6 to 8 hrs (Max 8 capsules/24 hrs); 10 – 12 yrs (32 – 40 kg) 3 capsules every 6 to 8 hrs (Max 12 capsules/24 hrs). Reckitt Benckiser, Auckland. 0800 40 30 30. TAPS DA1704JD.
Page 33

Colds
A cold is a contagious viral illness that affects the mucous membranes of the
head and chest, including the nose, throat, sinuses and ears. Most colds last
around one to two weeks and do not usually cause serious problems in healthy
people. Some people may get a bacterial infection after a cold – such as an ear
or sinus infection – which may make them unwell for longer.
Colds are easily transmitted through direct contact with the infected person
or infected surfaces or objects, or by breathing in infectious airborne droplets
created through sneezing and coughing.
Colds can happen at any time of the year but are more common during the
colder months (autumn through spring), when people are more likely to spend
more time indoors, in close proximity to other people. Factors which contribute
to a lower immunity, such as a poor diet, stress and smoking, also make a person
more susceptible to viral infection. Older people get fewer colds as they have
built up an immunity to some of the viruses that cause colds.
Colds generally get better by themselves, but over-the-counter medicines may
be taken to improve symptoms.
Symptoms
There are over 200 different viruses that can cause colds so symptoms of a cold
can vary. The most classic presenting symptom is that of a runny, congested nose
with sneezing. Cough, sore throat, mild fever, headache, earache and red, watery
eyes may also occur.
Initial assessment
Deciding if your customer has a cold, influenza (the flu) or allergic rhinitis can
be difficult. What do you immediately notice as their most obvious symptom?
Do their eyes appear red or watery or look sore? Are they sneezing a lot or is
their nose just runny? Do they actually look unwell and
are complaining of a sore throat or body aches and
pains?
Symptoms of a cold that are similar to those of
allergic rhinitis include an itchy nose, roof of the
mouth or eyes; sneezing; a blocked or
runny nose; a sore or tickly throat;
and red, itchy or watery eyes.
However, colds generally present
with other symptoms in addition to
nasal symptoms, such as a cough
or a headache.
People with colds generally do
not report symptoms such as a
high fever, joint pains, or body
chills; these are more typical of
flu symptoms. Colds can also
occur at any time throughout
the year, whereas the flu is more
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is only one nostril affected or is the discharge thick, cloudy or smelly?
• Does the customer have a high temperature, body chills, joint
aches or pains and/or feel unwell?
• Does the customer have earache or facial/sinus pain?
• Has the cold lasted more than a week?
• Is the sufferer a child under 12 years old or elderly?
• Do the symptoms seem to occur seasonally (it may be hay fever)?
• Does the customer have any allergies to medicines?
Cough and cold medicines in children
Colds occur frequently in children (up to six to eight times a year). Nasal symptoms usually
improve within seven to 10 days; however, coughs may persist for three weeks or more following
a cold. Advise parents or caregivers not to give cough and cold medicines to children aged less
than six years, and to seek pharmacist advice before using these preparations in children aged
six to 12 years. Instead, paracetamol may be used occasionally to relieve any pain or discomfort,
and natural remedies containing ingredients such as glycerol, honey, or lemon can be suggested
to help soothe irritated throats in children older than one year (see Sore Throat for more
information about recognising Strep. Throat and who to refer).
prevalent from May to September. Sneezing is common with colds, and coughs
associated with colds are more likely to be productive. The symptoms of a cold
usually take a few days to develop, compared with flu symptoms that usually
come on within three to four hours.
Advice for customers
• See your doctor if symptoms worsen or persist for longer than a week.
• Keep warm and rest and practise good hygiene (eg, wash hands frequently,
sneeze or cough into a tissue).
1
Benrimoj et al. Clin Drug Invest 2001;21:183-93 [BH5009]
2
Blagden M et al. Int J Clin Prac 2002; 56(2):95-100.
Pharmacy Medicine. Contains: Flurbiprofen 8.75mg. Prec: Asthma or regular concomitant
medications, history of peptic ulcer, GI bleeding, first 6 months of pregnancy. Contra:
Stomach disorder incl ulcer, renal and/or liver impairment, heart failure, pregnancy 3rd
trimester, prolonged use (> 3 days), hypersensitivity to NSAIDs/aspirin. Dosage: Use lowest
effective dose for shortest possible duration. Adults & children > 12 yrs: 1 loz every 3-6 hrs
(max 8 loz/day). Reckitt Benckiser, Auckland. 0800 40 30 30 TAPS DA1703DB.
Page 34 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Saline products
Decongestant nasal
sprays
Single and combination
products
Inhalations
[GENERAL SALE] eg, paracetamol (Pamol range, Paracare
range, Panadol, Lemsip Cold & Flu Original Lemon Sachets)
[GENERAL SALE] eg, saline products (Dimetapp Saline Nasal
Drops/Spray, Otrivin Clear Saline Plus)
[PHARMACY ONLY MEDICINE] eg, oxymetazoline (Dimetapp
12 Hour, Drixine No Drip), xylometazoline (Otrivin Junior*,
Otrivin Adult*, Otrivin Plus* [+ ipratropium])
[GENERAL SALE]
eg, guaiphenesin (Mucinex Expectorant/Maximum Strength)
eg, phenylephrine (Dimetapp PE Nasal Decongestant)
eg, phenylephrine + paracetamol (Codral Relief Max Strength Cold
& Flu + Decongestant*, Lemsip Cold & Flu)
eg, phenylephrine + ibuprofen (Nurofen Cold & Flu PE*)
eg, phenylephrine + paracetamol + guaiphenesin (Codral
Relief Max Strength 6 Signs Cold & Flu*, Lemsip All in One
Capsules*, Lemsip Cough Max Mucus Hot Drink*
eg, paracetamol + phenylephrine + caffeine (Lemsip Max Cold
& Flu Day & Night Capsules*)
[PHARMACY ONLY MEDICINE]
eg, phenylephrine + paracetamol (Maxiclear Cold & Flu Relief)
eg, phenylephrine + paracetamol + cough suppressant (Codral
Cold & Flu*)
eg, phenylephrine + paracetamol + antihistamine (Codral
Nightime Cold & Flu*)
eg, phenylephrine + paracetamol + antihistamine + cough
suppressant (Codral All in One*, Codral Cold & Flu + Cough*,
Coldrex PE Cold & Flu Day & Night)
eg, phenylephrine + antihistamine (Demazin Syrup, Dimetapp
Elixir Cold & Allergy, Maxiclear Cold & Nasal Relief*)
eg, decongestant + antihistamine + cough suppressant
(Dimetapp DM Elixir)
eg, phenylephrine + paracetamol + codeine + antihistamine
(Codral Multi Action Cold & Flu*, Codral Day & Night*)
eg, paracetamol + antihistamine + cough suppressant
(Dimetapp Daytime Nightime)
[GENERAL SALE] eg, combinations of volatile oils (Olbas Oil
Inhalant Decongestant, Vicks Vapo Steam Inhalant)
Use for headache or general sinus pain relief.
Saline drops/spray help liquefy mucus and soothe irritated nasal membranes. Safe for
infants, toddlers, pregnant women or those with chronic congestion.
The topical decongestants oxymetazoline and xylometazoline are effective at unblocking
congested nasal passages. Decongestants should not be used for longer than three days
at one time because they may cause rebound congestion when discontinued.
Refer to the packet for ingredients which may include a decongestant to unblock a congested
nose (eg, phenylephrine), an analgesic, an antihistamine to dry up runny noses (eg, loratadine,
chlorpheniramine), a cough suppressant to stop a dry cough (eg, pholcodine, dextromethorphan),
an expectorant to help expel mucus from the lungs (eg, guaiphenesin), or a mucolytic (eg,
bromhexine) to liquefy mucus and phlegm.
Analgesics (eg, paracetamol, ibuprofen, codeine) can help make a person feel more
comfortable if they are in pain. Watch for double-ups with other analgesic medicines.
Pharmacy staff should monitor sales of codeine and be alert for misuse. Warn customers
that codeine is an addictive substance and should not be used for more than three days
at a time. Constipation or drowsiness may also occur.
Some antihistamines may cause drowsiness and affect a person’s ability to drive or
operate machinery. Avoid alcohol.
Cough suppressants (eg, pholcodine, dextromethorphan) control or suppress the cough
reflex and can provide relief from a dry, unproductive cough. Dextromethorphan can
interact with other medicines that also have serotonergic activity (eg, antidepressants,
tramadol, lithium, St John’s wort).
Cough expectorants (eg, guaiphenesin) loosen mucus and phlegm, allowing it to be
coughed up more easily and can help a chesty cough.
Mucolytics (eg, bromhexine) are often included with cough expectorants as these help to
liquefy the mucus and phlegm aiding its passage from the lungs to the mouth.
Coughs associated with colds are more likely to be productive.
People who take other medicines or have other medical conditions may be unable
to take cold and flu tablets – check with your pharmacist. Products containing
guaiphenesin, ipecacuanha, dextromethorphan, pholcodine, phenylephrine,
pseudoephedrine [PRESCRIPTION], doxylamine, brompheniramine, promethazine,
chlorphenamine, triprolidine or diphenhydramine should NOT be given to children aged
less than six years and pharmacist advice should be sought before using them in children
aged less than 12 years.
Place a few drops in a bowl of hot water and inhale the steam, or on a tissue tucked
inside a pillow case at night. Avoid in very young children.
Antibacterial prophylaxis [PHARMACIST ONLY] eg, Buccaline May help protect against bacterial complications from a cold.
Other products eg, Bonnington's Irish Moss*
eg, Neil Med Naspira Nasal-Oral Aspirator
Bonnington's Irish Moss contains menthol, camphor, liquorice extract and carrageenan
(a seaweed extract).
Nasal-oral aspirators allow nasal mucus to be removed efficiently.
Natural / herbal products
/ supplements
Andrographis, echinacea, garlic, honey, ivy leaf, olive leaf, probiotics,
propolis, Siberian ginseng, vitamin C, zinc
Viralex* (contains olive leaf, Saccharomyces cerevisia, zinc,
vitamin D3, and astragalus
Andrographis, garlic, and Siberian ginseng may reduce cold symptoms if started within 72
hours of symptom onset. Note: allergic reactions, including anaphylaxis, have been reported
with andrographis use. Echinacea may reduce cold severity and duration by 10%–30%; longterm
use not recommended. Honey can help soothe a dry throat and relieve cough in children
older than one year – a single night-time dose of 2.5–10ml was as effective in children as
dextromethorphan.
Ivy leaf is an expectorant and is commonly used in Germany alongside conventional medicines
for asthma and bronchitis. Olive leaf can help boost the immune system. Probiotics may
reduce the frequency of colds. Propolis may decrease cold duration. Vitamin C (1–3g/day)
may decrease cold symptom duration by one to one and-a-half days. Zinc lozenges may
decrease cold duration.
Viralex may help to strengthen the immune system.
Products with an asterisk have a detailed listing in the Colds section in OTC Products, starting on page 224.
TACKLE PAINFUL SORE THROATS
WITH STREPFEN INTENSIVE
Strepfen Intensive’s Pharmacy only formula contains an anti-inflammatory
ingredient to tackle the signs of inflammation associated with painful sore throats:
Swelling 1 • Pain 1,2 • Difficulty Swallowing 2
Page 35

Cold Sores
Cold sores are fluid-filled blisters caused by the herpes simplex virus that commonly
appear on the lips or bottom edge of the nose. Most start with a tingling sensation in
the affected area, followed by the appearance of blisters that pop soon after to form
clusters of fluid filled pockets. Some people may also complain of a sore throat, fever
or swollen lymph nodes in the neck.
There are two types of herpes simplex virus: Type 1 (HSV-1) and Type 2 (HSV-
2). While HSV-1 is mainly associated with facial herpes (cold sores), and HSV-2
with genital and rectal infections, either virus can infect almost any area of skin
or mucous membrane.
The World Health Organization (WHO) estimates two-thirds of the worlds’
population under 50 are infected with HSV-1. Most people first acquire HSV-1
during childhood; in crowded, undeveloped areas of the world most children
have been infected by age five. Gingivostomatitis (an inflammation of the oral
palate and gums) is the most common presentation of primary HSV-1. Symptoms
include a high fever, excessive dribbling, red and swollen gums which bleed
easily, and whitish-yellowish ulcers may be present on the tongue or inside
cheeks or roof of the mouth. The fever usually subsides within three to five days,
although recovery may take two weeks. Some children may have no noticeable
symptoms at all. HSV-2 infections are mainly transmitted sexually and are more
likely to occur after puberty.
Once acquired, HSV remains in the body for the person’s lifetime in a latent
state in the spinal dorsal root nerves. Triggers are environmental or individual
factors that can cause virus reactivation. Common ones include other viral
infections (such as the cold or flu), stress, dental work, the sun, or hormonal
changes in women. Recurrences are more common in people with a weakened
immune system and outbreaks tend to become less frequent as people get older,
as the body makes antibodies to the virus. During an attack, the virus can be
inoculated into new areas of skin or transferred directly or indirectly to other
people. For example, a thumb sucker may transmit the virus from their mouth
to their thumb or an infected rugby player may infect others during a scrum
(“scrum pox”).
Initial assessment
Take a look at the cold sore and ask the customer if they have experienced cold
sores in the past. If you are not sure if it is actually a cold sore, or if the person
TREATMENT OPTIONS
Category Examples Comments
Medicated ointments
Antiviral agents
[GENERAL SALE]
eg, Blistex Medicated Relief* (contains camphor,
padimate and oxybenzone)
[GENERAL SALE]
eg, aciclovir (Viraban*, Viratac Cold Sore
Cream, Zovirax Cold Sore Cream), idoxuridine +
lignocaine (Virasolve), povidone iodine (Betadine
Cold Sore Paint)
[PHARMACY ONLY MEDICINE]
eg. penciclovir (Vectavir)
Helps protects the lips from sun, wind and cold. May help prevent recurrence of cold sores
induced by the sun. Relieves cold sore discomfort.
May prevent the cold sore appearing when applied at the first signs of a cold sore (the
tingling stage). Even if used after this, they can reduce healing time; however, they do not
eradicate the virus from its resting state within the nerve cells so will not prevent future
attacks.
Apply treatments exactly as directed by the manufacturer (some may specify as frequently as
every two hours while awake).
Healing/protective plasters
Natural / herbal products /
supplements
[GENERAL SALE]
eg, Compeed Invisible Cold Sore Patch
Lemon balm, propolis, rhubarb & sage, lysine,
pelargonium
Keeps the cold sore moist, creating a beneficial wound-healing environment. Relieves pain,
burning and itching, and prevents scabbing. Hides and protects the cold sore and stops the spread
to other people. Change patch when it starts to detach from the skin (usually after eight to 12
hours).
Lip balms containing either lemon balm, propolis or rhubarb & sage have been found to be
effective at reducing cold sore duration and symptoms. Oral lysine can reduce recurrences
of cold sores, and both oral and topical lysine can reduce the duration and symptoms of
developed cold sores. Pelargonium has some antiviral activity.
Products with an asterisk have a detailed listing in the Cold Sores section of OTC Products, starting on page 228.
Page 36 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
answers yes to any appropriate Refer to pharmacist questions (see opposite
page), refer the customer to a pharmacist. For all other customers, explain the
treatment options available to them.
Treatment
Most cold sores heal themselves within seven to 10 days; however, customers
who wish to shorten the duration of treatment or hide the cold sore may request
over-the-counter topical products.
Topical antivirals such as aciclovir and penciclovir help shorten symptom
duration if started early (at the first tingle). Effectiveness of iodine-based
preparations such as idoxuridine and povidone-iodine is questionable; however,
one product also contains an anaesthetic that can help relieve pain and itching
associated with the sore. Hydrocolloid patches create a beneficial healing
environment for the cold sore, help reduce viral transmission, and also keep nerve
ending moist, helping to relieve pain. Make-up can also be applied over the
patch, helping to hide the cold sore.
Prescription oral antiviral agents such as aciclovir and valaciclovir are more
likely to be prescribed for people with genital herpes, although may be used to
treat severe facial infection or infection in immunocompromised people. They
stop HSV from multiplying so can shorten and prevent attacks; however, cannot
eradicate it from its resting state within nerve cells. Valaciclovir is converted
into aciclovir in the body and has the advantage of two to three times daily
dosing instead of the five times daily dosing required for aciclovir. People with
a weakened immune system are more prone to developing severe and recurrent
cold sores.
Advice for customers
• Use a lip balm containing sunscreen on your lips before going outside if you
find sunlight tends to reactivate the virus.
• Have treatment on hand, ready to use at the first “tingle”.
• Keep the cold sore moisturised to prevent the affected area drying out and
cracking, and do not pick off the scab.
• People who get repeat attacks of severe cold sores may need to see their
doctor for a prescription medicine.
Tips to avoid spreading a cold sore
• Cold sores are easily spread from person to person, especially when the sore
is still weeping. Advise your customers that while they have the cold sore they
should:
»»
avoid kissing or other intimate contact
»»
avoid sharing towels, face flannels, or eating and drinking utensils
»»
take care not to touch the cold sore, then touch or rub their eyes. Extra care
should be taken if they wear contact lenses
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Does the cold sore cover a large area, eg, as big as a 10 cent piece,
or does the person have more than one cold sore?
• Are the cold sores recurring frequently?
• Are there any cold sores in the mouth?
• Are there similar lesions elsewhere on the body?
• Are there any other symptoms (eg, fever, feeling unwell)?
• Do the cold sores look infected (eg, pus or swelling)?
• Have the sores spread near to or into the eyes?
• Is the customer a young child?
• Does the customer also have dermatitis or other skin conditions
near the cold sore?
• Has the cold sore lasted more than 10 days or persisted despite
treatment?
• Does the person have any allergies to topical medicines?
»»
wash their hands before and after applying cold sore products, before
preparing food or eating, and before attending to other people
»»
avoid using the same finger when applying cold sore products as they may
contaminate the cream
»»
not share their cold sore cream with other people
»»
not share cosmetics, especially lipsticks.
Page 37

Constipation
Constipation is the term used to describe difficulty or infrequency in passing
faeces (poo). A person with constipation goes to the toilet to pass faeces less
often than normal for them, and their faeces are hard, small, and usually a strain
to pass. It is important to realise that not everybody has a daily bowel motion; it
may be natural for some people to go every second or third day, so the passage
of time between bowel motions before constipation occurs varies from individual
to individual.
The most common reasons for constipation are:
• being immobile – forced bedrest or disability
• dehydration – drinking too little fluid, vomiting or excessive sweating
• diet – eating too little, or eating low bulk or milky foods
• pain or other medical conditions (eg, Parkinson’s disease, irritable bowel
syndrome)
• pregnancy
• medicines such as diuretics, iron supplements, and opioid pain relievers.
People with no apparent reason for their constipation should be referred to a
doctor for further advice if it persists. Some people are found to have a generally
underactive bowel, and may need long-term laxatives prescribed.
Occasionally, some people complaining of diarrhoea may in fact have
“overflow” diarrhoea as a result of severe constipation (refer to a pharmacist).
People who suffer from constipation may also complain of stomach cramps,
frequent passing of wind (flatulence) or bloating. Haemorrhoids can also occur
with constipation as a result of straining when passing a bowel motion (see
Haemorrhoids).
Initial assessment
Observe how your customer holds themselves – are they doubled over with
stomach cramps or is their mobility limited? Do they look well hydrated or does
their skin appear dry? Could they possibly be pregnant?
It is important to identify which customers you need to refer to the pharmacist
as some products may not be suitable for them.
Treatment
Products used to treat constipation are called laxatives and several different
types are available. Most need to be given on a regular basis and some take
up to three days to work properly (see Treatment options for more information).
Advice for customers
• Fibre is important for our health, and a high-fibre diet should be recommended
for most people, although it may not be appropriate for the very young or very
old.
»»
Wholegrain breads and cereals, nuts, beans, lentils, fresh and dried fruits
(not fruit juices) and vegetables are high in fibre.
»»
Men should aim for around 30g/day of fibre and women 25g/day.
»»
Children aged between four and 18 need only slightly less than adults
(about 18–28g/day).
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the sufferer a baby or young child?
• Has the constipation continued for longer than seven days?
• Is there any vomiting?
• Has the customer lost any weight?
• Are the bowel motions dark and tarry-looking or contain blood?
• Has the constipation been recurrent, persistent or is worsening?
• Is there any abdominal pain or bloating?
• Has the person been buying or using large amounts of laxatives?
• Does the constipation alternate with diarrhoea?
• Does the person have a fever?
• Does the person have any allergies to medicines?
Refer also if you suspect laxatives are being abused, perhaps as a
method of losing weight.
»»
Increase fibre intake once the current constipation problem has resolved.
• Regular exercise and sufficient fluid intake – at least six glasses of water a
day – also prevents constipation.
• Avoid long-term use of stimulant laxatives unless under medical advice.
• Seek medical advice if problems with bowel motions persist.
• Don’t put off going to the toilet if you feel the urge as this can lead to
constipation or make it worse.
• Remind the customer that not everyone has a daily bowel motion and offer
advice about haemorrhoids (see Haemorrhoids) if these are also present.
PharmacyToday
A part of your
everyday
Page 38 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
TREATMENT OPTIONS
Category Examples Comments
Bulk-forming laxatives
Faecal softeners
Osmotic laxatives
Iso-osmotic laxatives
Stimulant laxatives
[GENERAL SALE]
eg, psyllium husk (Metamucil [sugar-free
available])
eg, sterculia (Normacol, Normacol Plus [also
contains frangula bark, a stimulant laxative])
[GENERAL SALE]
eg, docusate sodium (Coloxyl*, Coloxyl Drops*,
Laxofast), glycerol suppositories
[PHARMACY ONLY MEDICINE]
eg, lactulose (Laevolac), Microlax
[GENERAL SALE]
eg, macrogol 3350 with electrolytes (Movicol,
Movicol-Half)
eg, Lax-Sachets
[PHARMACY ONLY MEDICINE]
eg, bisacodyl (Dulcolax*, Lax-Tab), senna
(Senokot*), senna + docusate (Coloxyl with
Senna*, Laxsol)
These contain soluble fibre which swells on contact with fluid, bulking out the stool and
encouraging peristalsis (the symmetrical contraction and relaxation of the muscles in the
bowel). Good as first-line agents since there are very few interactions with medicines or
long-term side effects. Avoid in people with bowel obstructions or when faecal matter is
impacted, in bed-ridden patients, and in people unable to drink the required amount of fluid.
May take two or three days to start working. Advise customers to take with plenty of fluid
and to keep up the fluid intake (at least six glasses a day) to avoid worsening constipation.
Most are safe in pregnancy, except Normacol Plus (it contains a stimulant – frangula – that is
not recommended in pregnancy or for long-term use).
These act like detergents, encouraging a mixture of dietary fat and water within the stool
and allowing it to pass through the bowel more easily. They are most effective for mild
constipation that has recently occurred and may be beneficial for people with haemorrhoids
(piles). Usually take about one to three days to work properly.
Osmotic laxatives attract large amounts of water into the bowel, making the stool soft, loose
and easier to pass. May take up to 48 hours to start regular bowel motions and should be
given on a regular basis.
Safe for use in pregnancy.
Microlax enemas work within 30 minutes.
Iso-osmotic laxatives deliver liquid to the bowel rather than drawing it in from the
surrounding tissue. They hydrate and soften the stool, with no net loss of electrolytes. The
onset of effect is one or two days.
Speed up colonic muscle movement which moves the stool along by contraction.
Combination products (such as Coloxyl with Senna) also contain a faecal softener. The onset
of effect is eight to 10 hours for tablets (one to two hours for suppositories).
Long-term use not recommended. Avoid in pregnancy unless under medical advice.
Food supplements eg, gluten-free wheat dextrin (eg, Benefiber) Fine powder with minimum taste. Can be sprinkled on foods and in cooking without premixing.
Can be used long term to increase fibre in diet. Recommended for treatment and
prevention of mild constipation and for people unable to eat fibrous food.
Works within two or three days and help re-establish and maintain normal bowel motions.
Probiotics
Natural / herbal products /
supplements
Bowel cleansing
eg, Bifidobacterium lactis (ProbioFX Gut Restore,
Radiance Pro-B Regularity), Lactobacillus reuteri
(Nature's Way Primadophilus Reuteri)
Bifidobacteria + lactobacilli (Inner Health,
Lifestream BowelBiotics, Nutralife Probiotic)
eg, cape aloes, cascara, chia, European
buckthorn, flaxseed oil, glycerol, magnesium
(Good Health Mg Lax), psyllium, senna leaf (Nu-
Lax Fruit Laxative), olive oil
eg, kiwifruit extract (Kiwi Crush, Phloe Bowel
Health)
[PHARMACIST ONLY MEDICINE]
eg, MoviPrep
Contain probiotics +/- prebiotics (see Probiotics and Prebiotics). Help restore levels of
naturally occurring bacteria in the bowel. An imbalance in bacteria may lead to constipation,
diarrhoea, or bloating. Useful following a course of antibiotics. For daily use in adults.
Many commercial products for constipation are based on natural ingredients. Psyllium works
as a bulk laxative, senna as a stimulant, glycerol as a softener, and magnesium can help
soften faeces. European buckthorn acts as a mild stimulant, and olive oil effectively softens
stools.
Kiwifruit extract contains prebiotics, enzymes and dietary fibre to optimise bowel health.
MoviPrep is used to thoroughly cleanse the bowel before investigative procedures.
Products with an asterisk have a detailed listing in the Constipation section of OTC Products, starting on page 229-230.
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Page 39

Contraception & Sexual Wellbeing
Contraception: barrier contraception
Barrier contraceptives prevent sperm from reaching a woman’s uterus and
fallopian tubes. Condoms are currently the only type of barrier contraceptive
available in New Zealand; diaphragms (silicone domes which cover the cervix)
are no longer sold here.
Condoms are made of either latex rubber, polyurethane, or polyisoprene. They
are put on over a man’s erect penis before intercourse to stop sperm entering a
woman’s vagina.
Latex condoms are more widely available and usually less expensive than nonlatex
polyurethane or polyisoprene condoms. However, they perish easily and can
only be used with water or silicone-based lubricants. Oil-based lubricants, such as
vaseline or baby oil can break down the latex increasing the risk of contraceptive
failure. Latex condoms must also be stored away from heat and sunlight, and
used before their expiry date.
Polyurethane is a non-latex plastic material. They tend to be thinner than some latex
condoms, so may offer better sensitivity; however, they are usually more expensive
than latex condoms and slightly less flexible so more lubrication may be needed. Oil,
water or silicone-based lubricants can be used with polyurethane condoms.
Polyisoprene is a synthetic material and condoms made from polyisoprene
have a soft, natural feel and conform to the skin easily, in a similar way to latex
condoms. They are suitable for people with latex allergies but must be kept away
from heat and sunlight. Strength is comparable to latex condoms and they are
reportedly easier to use than polyurethane condoms.
Although not 100% effective, condoms greatly reduce the risk of sexually
transmitted infections (STIs) such as HIV, chlamydia, and gonorrhoea, and lessen
the chances of contracting syphilis, herpes and genital warts. Male condom use
should be encouraged even during sex with women taking hormonal methods
of contraception or who are postmenopausal to reduce the risk of contracting
an STI. Hormonal contraceptives protect only against pregnancy, not STIs. The
chance of becoming pregnant depends a lot on how carefully the condom is
used; most sources quote a failure rate of between 2% and 18%. Spermicides
are no longer recommended to be used with condoms as they can cause irritation
and increase the risk of acquiring an STI.
The only type of female condom currently available in New Zealand is the FC2,
made of nitrile (latex-free). A flexible ring at each end keeps it in place.
Advice for customers
• If unprotected sex occurs, or if a condom breaks, women should see a doctor
as soon as possible.
»»
The ECP is available from accredited pharmacists and accredited nurses
without prescription, but must be taken within 72 hours of unprotected
sexual intercourse (see Contraception: Emergency).
• Remind customers to store condoms away from heat and sunlight (ie, not in a car
glove box), and to only use condoms that have not passed their expiry date.
• Suggest water-based lubricants to decrease the risk of latex condom breakage.
TREATMENT OPTIONS
Category Examples Comments
Male condoms (latex)
eg, Durex Extra Safe*, Ansell range, Marquis
Condoms
Home-made lubricants, such as vaseline or cooking oils, may damage latex condoms.
Condoms routinely no longer contain spermicide. Some vaginal antifungal creams can
damage condoms and diaphragms – refer to the pharmacist if the customer or their partner
is using this type of product. Many brands are fully subsidised on a prescription (144
condoms per script).
Male condoms (non-latex) eg, polyisoprene (Durex Real Feel*) Non-latex condoms are suitable for people with latex allergies and are safe to use with both
water and oil-based lubricants.
Female condoms eg, FC2 Latex-free. Strong, odourless and causes no allergic reactions. May be used with water or oil
based lubricants. Can be inserted up to eight hours prior to sex.
Lubricants eg, Anime Lubricant*, Durex Perfect Glide* Reduce friction during sexual intercourse enhancing pleasure and reducing the risk of
condom damage. Use only water or silicone-based lubricants with latex condoms.
Oral contraceptives (OC)
(desogestrel, ethinylestradiol,
levonorgestrel,
norethisterone)
Products for erectile
dysfunction
[Restricted when sold by suitably trained
pharmacists for women over the age of
16 previously prescribed an OC within the
last three years]
[Prescription medicine except when
supplied by a pharmacist who has
successfully completed training in the
treatment of ED in males aged 35–70]
eg, sildenafil (Silvasta, Vedafil)
Selected OCs must be supplied in a pack approved as a restricted medicine, containing no
more than six months' supply and including an explanation of side effects and when to seek
further medical advice. Refer women with newly identified contraindications to the OC to a
doctor and encourage regular cervical screenings and cardiovascular risk assessments.
Use the recommended screening tool to screen out at-risk men who are smokers, have
self-reported high cholesterol, have diabetes, and who have had a previous coronary
intervention. Provide encouragement for all men presenting with ED to visit their doctor for a
heart health and diabetes check.
Products with an asterisk have a detailed listing in the Sexual Wellbeing, Contraception and Lubricant section of OTC Products, starting on page 257.
EXPLORE THE
DUREX RANGE
OF CONDOMS
Page 40 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Contraception: oral contraceptives
Oral contraceptives (OC) – also called birth control pills – contain hormones that
prevent pregnancy.
The combined OC (COC) contains an oestrogen and a progestogen to prevent
ovulation (the release of eggs from the ovaries), thin the uterine lining, and
thicken cervical mucus making it impenetrable to sperm.
The progestogen-only pill (POP) – also called the mini-pill – contains just
one hormone, progestogen. Most POPs work by thickening cervical mucus,
preventing sperm from entering the womb. Some POPs (eg, desogestrel) also
prevent ovulation, and offer a higher level of contraceptive efficacy than other
POPs, and may be preferred in women unable to tolerate oestrogens or who are
breastfeeding.
Although oral contraceptives are a very effective method of birth control they
do not prevent the spread of diseases (such as HIV or other STIs), so use with
condoms should be encouraged.
Sexual wellbeing
Sex is an important part of being human, and it is also one of the biggest
influences on our physical, mental and emotional health. When sex is part of
a mutual, loving relationship, it improves cardiovascular function, boosts the
immune system and relieves stress. However, sex also carries a risk of illnesses,
mixed emotions, and unintended consequences that can all negatively impact on
our quality of life.
Sexually transmitted infections (STIs) are most prevalent in young people under
the age of 25; however, rates have dramatically increased in the past decade
among 40 to 50 year olds, perhaps due to a lack of safe sex practices including
poor condom use. While chlamydia remains the most frequently diagnosed
infection, genital herpes, genital warts and gonorrhea are also common.
Testing for STIs is free for those under the age of 22 from many providers
throughout New Zealand. Encourage anyone not in a monogamous relationship
to use condoms and to consider regular STI testing.
Vaginal health
Good vaginal health is an important contributor to a woman's overall state of
health and a change in the colour, smell, or consistency of vaginal discharge is
often the first sign that something is wrong (see Vaginal Health).
Lubricants may help reduce sexual discomfort associated with menopause.
Erectile dysfunction
Erectile dysfunction (ED) refers to an inability to get or keep an erection firm
enough to have sexual intercourse. Occasional ED is not uncommon and can
occur if a man is stressed, tired, distracted, or after drinking too much alcohol.
Persistent ED becomes more common with age, affecting approximately 50% of
men aged 40–70 and up to 70% of men over the age of 70.
ED can be caused by an underlying condition (organic cause) or have a
psychological cause. Men with an organic cause are more likely to complain of
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Has the customer had unprotected sex and wants information
about the emergency contraceptive pill (ECP)?
• Has the customer had unprotected sex and is worried about having
been exposed to a sexually transmittable infection?
• Has the customer had sex against her will and is wanting further
advice?
• Is the customer wanting to buy a supply of oral contraceptive pills
over-the-counter?
• Is the customer wanting information about erectile dysfunction
treatments?
a gradual onset and progressive worsening of their symptoms as well as a lack
of early morning erections. These customers need to be referred to a doctor.
Psychological ED tends to present suddenly or vary depending on the partner or
situation. Early morning erections are usually maintained. However, both causes
are not mutually exclusive and many men have components of the two.
Customers wishing to purchase sildenafil over-the-counter need to undergo
screening for eligibility from a pharmacist trained in the management of ED.
Initial assessment
While some people have no qualms about discussing their sexual health with
pharmacy staff, others do. Politely asking if you can help or would they prefer
to talk to a pharmacist may be the best approach in people who appear
embarrassed or shy.
All women requesting oral contraceptives and all men requesting treatments
for ED must be referred to a pharmacist. For customers wanting more information
about condoms, explain the different types available (latex or latex-free) and
offer Family Planning information leaflets. Advise the person to read the packet
instructions to ensure the condom is used correctly.
EASY-ON
S H A P E
Durex condoms are a method of contraception that may help reduce the risk of pregnancy and transmission of STIs.
No method of contraception can give you 100% protection against pregnancy, HIV or STIs.
Always read the label. Use only as directed. Reckitt Benckiser, Auckland. TAPS DA1703DB.
EASY-ON
Page 41

Contraception: Emergency
Emergency contraception is a way of preventing pregnancy after unprotected
sex or when contraception has failed. It is also called the “morning after pill”,
although a woman does not need to wait until the morning after to take it.
It is not intended for use as a regular way of preventing pregnancy. There
are two main types of emergency contraception – the emergency hormonal
contraceptive pill (ECP) and the intrauterine contraceptive device (IUD). A copper
IUD inserted within five days of unprotected intercourse has almost 100%
effectiveness but must be fitted by a doctor. It has the advantage of providing
long-term contraception and being effective for heavier women.
When should the ECP be taken?
The ECP is approved to be taken up to 72 hours after unprotected sex (three
days) in New Zealand. According to the World Health Organization it can be
used up to five days after unprotected sex; however, failure rates are higher. The
ECP is most effective if taken within 12–24 hours. Pregnancy rates of between
0.7% and 1.6% have been reported when the ECP is taken within 72 hours. The
effectiveness of the ECP appears reduced in women with a BMI of 30 or more
and these women are best referred to a doctor for a post-coital IUD.
Who can sell the ECP?
Only pharmacists who have successfully completed an education programme
accredited by the Pharmacy Council to become providers of emergency hormonal
contraception may supply the ECP. Pharmacists who have not completed this
training may not sell the ECP and must instead direct women wanting the ECP
to a pharmacy where an accredited pharmacist is working (or to her doctor or
a family planning clinic). Pharmacies may display an ECP decal to advertise the
ECP is available from an accredited pharmacist practising there. Refer to the
Pharmacy Council of New Zealand website (www.pharmacycouncil.org.nz)
for the nine standards prescribed by the council for the non-prescription supply
by pharmacists of the levonorgestrel ECP. Nurses who have competency in the
field of sexual and reproductive health may also provide the ECP.
Women seeking the ECP should be spoken to in a private area where the
conversation cannot be overheard by others. All necessary advice and information
should be provided in an appropriate manner. Pharmacists must attend to the request
for the ECP personally, and not just oversee the sale. Details of the sale should be
recorded; however, it is optional for the woman to supply identifying details.
The ECP may be sold to women of any age and should be sold directly to the
woman requiring it; unless unusual circumstances prevent direct supply and then
it may be supplied to another person. Reasonable efforts must be made by the
pharmacist to inform the woman about the limitations of the ECP as an ongoing
method of contraception, and refer her to the appropriate health professional if
further investigations or long-term contraception is required.
Pharmacists must advise the woman buying the ECP that it is not 100%
effective and to seek further advice from a doctor or family planning clinic if
her next period is lighter than usual, late or different in any way, or if any other
unusual bleeding or lower abdominal pain occurs.
The ECP may also be supplied to women for future use.
When would emergency contraception be used?
Pregnancy is most likely to occur if intercourse happens up to five to seven days
before, or one day after ovulation. This is because some sperm can survive up to
seven days (average three to four days) inside a woman, whereas the ovum (egg)
has a life span of only about 12–24 hours.
However, many women have irregular cycles or are unsure of the date of their
last period, so, unless they have periods like clockwork, or are taking a contraceptive
pill, it is best to assume unprotected sex on any day of the cycle might result in
pregnancy.
Emergency contraception should also be considered with incorrect use,
dislodgement or breakage of a barrier method (condom or diaphragm), part or
complete expulsion of an IUD, vomiting or diarrhoea while on a contraceptive pill,
a missed Depo Provera injection, or with missed contraceptive pills (as outlined
below).
Emergency contraception should be made available to any woman who feels
she needs it.
Missed contraceptive pills
With the combined oral contraceptive pill (OCP) data sheets consider a “missed
pill” to be one that is taken more than 12 hours later than the usual time.
However, research has shown that this advice is very conservative and that
contraceptive efficacy is only compromised when missing two pills in a row. The
loss of efficacy also depends on which week of hormone pills is involved.
• Efficacy is compromised if two or more pills are missed from the first seven
TREATMENT OPTIONS
Category Examples Comments
Emergency Contraceptive Pill
Antiemetics
[PHARMACIST ONLY] (Accredited ECP pharmacists)
eg, levonorgestrel 1.5mg (Postinor-1)
[PRESCRIPTION] (Except when sold by accredited ECP
pharmacists for the treatment of nausea associated with emergency
contraception) eg, prochlorperazine (Antinaus)
The tablet should be taken as soon as possible (and no later than 72 hours)
after unprotected sex. Readminister if vomiting occurs within three hours of
the dose.
Up to 10 tablets may be supplied without prescription for nausea associated
with the ECP.
READY, SET, LEARN!
Page 42 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
active tablets in a packet.
• If two or more pills are missed from the last seven active tablets in a packet,
emergency contraception is not needed provided that the pill-free break is
omitted.
• As long as the hormone pills in the first and last week have been taken
correctly, there is no concern about missed pills in the middle week of the
combined pill packet.
With the progesterone-only pill (POP), the pills are taken continuously and
within a strict time frame, so for most POPs, a missed pill is defined as one or
more pills taken three or more hours late, or missed altogether. The ECP should
be considered if this has occurred along with sexual intercourse.
For both types of contraceptive pills, when pills have been missed, additional
means of contraception (ie, condoms) are required until contraceptive
effectiveness is re-established. For combined OCPs this is recommended for
seven days and for most POPs, at least two days.
How does the ECP work?
• The ECP prevents pregnancy by:
»»
interfering with the mobility of sperm
»»
delaying ovulation (the release of the egg from an ovary) until sperm are
no longer active
»»
changing the lining of the uterus (corpus luteum) so a fertilised egg cannot
implant and develop.
• The ECP cannot interrupt or harm an established pregnancy.
• The ECP can be used more than once in a menstrual cycle.
Warnings
• Do not give the ECP to women who are allergic to levonorgestrel or any
inactive substances used in the manufacture of the tablet.
• Consider an increased dose of ECP for women taking medications that induce
hepatic enzymes (eg, carbamazepine, phenytoin, topiramate, St John’s wort,
rifampicin, rifabutin, ritonavir), or with malabsorption syndromes. Discuss or
refer to a doctor or family planning clinic.
• The ECP is considered safe to take while breastfeeding, although a women
should talk further with a doctor or a pharmacist if she is concerned.
• If the woman vomits within three hours of taking the ECP, she should be
referred to the pharmacist, her doctor or a family planning clinic for advice
and further tablets.
• Around 25% of women taking the ECP feel nauseous and 5% may vomit.
Taking the medicine with food may help. The pharmacist supplying the
ECP may also sell up to 10 prochlorperazine tablets to prevent nausea and
vomiting associated with taking the ECP.
• Advise women that their next period may be later or earlier than usual, or
there may be spotting or irregular bleeding before their period occurs. She
should see her doctor if her next period is late or lighter than usual.
Refer to
PHARMACIST
All customers seeking the ECP must be referred to a pharmacist,
who should then refer a woman to a doctor or family planning clinic
if she:
• has severe liver disease, severe hypertension, diabetes, stroke, heart
disease, or a past history of breast cancer and the pharmacist is not
comfortable supplying the ECP.
• is pregnant, thinks she is pregnant or her period is late or unusual.
• has a period that is more than five days late, is unusually light or
heavy, or is painful.
• has a BMI of 30 or more
• is at risk of contracting a sexually transmitted infection (this can be
screened for at about two weeks after unprotected sex).
• needs to consider long-term contraception.
• has an allergy to levonorgestrel.
• Other side effects of the ECP include tender breasts, headaches, lower
abdominal pain, dizziness and fatigue.
Initial assessment
While some women may confidently ask for the ECP, others may not. Politely
asking if you can help or would they prefer to talk to a pharmacist may be the
best approach in women who appear embarrassed or shy.
All women requesting the ECP must be referred to a pharmacist.
Advice for customers
• Advise customers that the ECP:
»»
is not 100% effective. The woman should carry out a pregnancy test if her
next period is late
»»
does not protect the woman from sexually transmitted infections
»»
is not recommended as an ongoing source of contraception.
Women seeking multiple dispensings of the ECP should be referred to a doctor
or family planning clinic for other methods of regular contraception.
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Page 43

Coughs: Dry
Coughs are called dry or non-productive when no mucus is produced or coughed
up. Dry coughs are a reaction of the body to an irritated airway and most people
describe having a dry or tickly throat, or wanting to ah-hem all the time. Their
voice may also sound hoarse or raspy. Generally, if a person’s chest also feels
congested and/or breathing is tight or impaired, then the cough is probably
productive in nature and should be treated as such (see Coughs: Productive).
Coughing is common, especially among children. It is usually a symptom of an
underlying problem. Common causes of a dry cough include:
• viral infections (dry coughs commonly occur with the flu)
• atmospheric conditions (eg, dry air) or a change in temperature
• chronic medical conditions (eg, asthma)
• exposure to cigarette smoke or pollution
• medicines (eg, ACE inhibitors).
Treatment is usually with a cough suppressant (eg, dextrome thorphan or
pholcodine). Combination products should only be used if other troublesome
symptoms are present.
Most coughs resolve themselves, although some adults and children may
continue coughing for several weeks after a viral infection has cleared. Refer
to the pharmacist anybody with a cough lasting longer than 10 days for further
advice. Any cough that lasts longer than four weeks is not normal and should be
referred to a doctor.
Initial assessment
Sometimes, deciding what type of cough your customer has may be difficult. Ask
if they mind coughing into a tissue for you and listen to the sound their cough
makes. People with dry coughs have nothing to cough up, so the cough sounds
like it is just coming from the back of the throat. With productive coughs, you can
usually hear the rattle of secretions while the person is coughing.
Children with whooping cough usually cough continuously for several
seconds, followed by a "whoop" sound as they attempt to breathe in air. Croup
causes more of a "barking" cough that gets worse at night. Use the Refer to
pharmacist questions to help identify which customers to refer to a pharmacist.
Advice for customers
• Avoid dry environments and drink plenty of water. Hot steam from a shower
creates a humid environment that may help ease croup symptoms.
• One to two teaspoonfuls of honey taken at night is effective at relieving cough,
but make sure honey is from a reliable source and do not give to children aged
less than one year.
• Always cover your mouth when you cough, preferably with a tissue, or cough
into the crook of your arm.
• Wash your hands after coughing, before preparing food, and before touching
other people if the cough is from an infectious source.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the customer a child aged less than 12 years or elderly?
• Are there any other symptoms, eg, fever, ongoing headache, sore
ears or rash?
• Is blood or pink-tinged mucus (phlegm) being coughed up?
• Is the customer very short of breath or wheezy?
• Does the customer have any chest pain or does it hurt to breathe
in?
• Does the cough occur mainly at night?
• Has the cough changed, lasted longer than 10 days or does it recur
on a regular basis?
• Does the customer smoke?
• Has the customer recently lost weight?
• Have any new medications been started recently?
• Does the customer have any allergies to medicines?
Cough and cold medicines in children
Coughs frequently occur in children, most commonly as a symptom of a cold. While nasal
symptoms of a cold usually improve within seven to 10 days, coughs may persist for up to three
weeks or more. Advise parents or caregivers not to give cough and cold medicines to children
aged less than six years, and to seek pharmacist advice before using these preparations in
children aged six to 12 years. Instead, paracetamol may be used to relieve any pain or discomfort,
and natural remedies containing ingredients such as glycerol, honey, or lemon can be suggested
to help soothe irritated throats in children older than one year (see Sore Throat for more
information about recognising Strep. Throat and who to refer).
Page 44 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
TREATMENT OPTIONS
Category Examples Comments
Cough suppressants
Demulcents and other
Combination lozenges
Combination liquids
Combination tablets
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, dextromethorphan (Strepsils Dry
Cough Lozenges)
[PHARMACY ONLY MEDICINE]
eg, dextromethorphan (Robitussin Dry
Cough Forte)
[PHARMACY ONLY MEDICINE]
eg, pholcodine, (Benadryl Dry Tickly
Cough, Duro-Tuss Range, Pharmacy
Health Stubborn Dry Tickly Cough*),
Pholcodine linctus
[GENERAL SALE]
eg, glycerol (Lemsip Dry Cough)
eg, Bonnington's Irish Moss*
[PHARMACY ONLY MEDICINE]
Duro-Tuss Dry Cough Lozenges, Difflam
Cough Lozenges
[PHARMACY ONLY MEDICINE]
eg, dextromethorphan + phenylephrine
(Benadryl PE Dry Cough & Nasal
Congestion*), dextromethorphan +
phenylephrine + brompheniramine
(Pharmacy Health Congested Cold &
Cough*), pholcodine + phenylephrine
(Duro-Tuss PE Dry Cough Plus
Nasal Decongestant), pholcodine +
bromhexine (Duro-Tuss Expectorant),
dextromethorphan + guaiphenesin
(Robitussin Cough & Chest Congestion)
[PHARMACY ONLY MEDICINE]
eg, paracetamol + dextromethorphan +
phenylephrine (Panadol Cold & Flu Relief
+ Cough)
eg, paracetamol + dextromethorphan +
doxylamine (night) (Dimetapp Daytime
Night-time)
eg, paracetamol + phenylephrine +
dextromethorphan +chlorpheniramine (at
night) (Codral Cold & Flu + Cough*)
eg, Kaloba, Comvita Winter Wellness,
Duro-Tuss Child Ivy leaf Extract, Kiwiherb
Children's Chest Syrup, honey
Cough suppressants (eg, pholcodine, dextromethorphan) control or suppress the cough reflex and can provide
relief from a dry, unproductive cough. Be aware that dextromethorphan can interact with other medicines
that also have serotonergic activity (eg, antidepressants, tramadol, lithium, St John’s wort).
Linctuses (eg, pholcodine) are best taken in warm water and sipped slowly.
Sucking lozenges helps stimulate saliva flow to lubricate irritated throats.
Lozenges are easier to carry around than bottles of syrup.
Glycerol is a demulcent which coats the mucosa of the pharynx and provides short-term relief from the
irritation that promotes reflex coughing.
Bonnington's Irish Moss contains menthol, camphor, liquorice extract and carrageenan (a seaweed extract).
Lozenges contain either pholcodine or dextromethorphan and usually various other combinations of
ingredients, eg, antiseptics, analgesics, anti-inflammatories or anaesthetics. The action of sucking also
stimulates saliva production, which soothes the throat, reducing irritation and coughing.
Products containing combinations of ingredients should only be used if other symptoms are present and
troublesome.
Expectorants (eg, guaiphenesin) or mucolytics (eg, bromhexine) may be useful for unproductive coughs due
to a soothing effect, but a combination expectorant and cough suppressant should not be used for productive
coughs (see Coughs: Productive).
Phenylephrine is a decongestant that can help relieve congestion in the nose and sinuses.
Products containing guaiphenesin, ipecacuanha, dextromethorphan, pholcodine, phenylephrine,
pseudoephedrine [PRESCRIPTION], doxylamine, brompheniramine, promethazine, chlorphenamine,
triprolidine or diphenhydramine should NOT be given to children aged less than six years and pharmacist
advice should be sought before using them in children aged less than 12 years.
Products containing combinations of ingredients should only be used if other symptoms are present and
troublesome. May be useful for a dry cough associated with the flu.
Antihistamines (eg, doxylamine, chlorpheniramine) may cause drowsiness and affect a person’s ability to drive
or operate machinery. They may also dry out the mucous membranes and have the potential to irritate a dry
cough further. Avoid alcohol with sedating antihistamines.
See text above for more information on the various ingredients contained in these products.
Supplements may help natural body defences fight against winter ailments, ills and chills.
Kaloba’s plant-based active ingredient relieves symptoms, boosts the immune system and shortens the
duration of a cold or the flu. Ivy leaf soothes and moistens dry irritated airways.
Comvita Winter Wellness products contain Unique Manuka Factor (UMF) manuka honey.
Honey can help soothe a dry throat and relieve cough – a single night-time dose of 2.5–10ml was as effective in
children as dextromethorphan.
Products with an asterisk have a detailed listing in Coughs: Drysection of OTC Products, starting on page 230
Now you can complete
your ENHANCE modules on
your phone or tablet
www.pharmacytoday.co.nz
Page 45

Coughs: Productive
Coughs are considered productive, chesty or wet when secretions such as phlegm
or mucus (sputum) are coughed up. The secretions may have drained from the
nasal passages (postnasal drip) or come up from the lungs. Most people also
feel congested, tight or sore in their chest. Symptoms are typically worse on
awakening, while talking or during exercise. Since coughing is the body’s way
of removing excess secretions from the airways, a productive cough should
generally not be suppressed. Common causes of a productive cough include:
• viral infections (productive coughs commonly occur with a cold)
• bacterial and other infections (eg, pneumonia, bronchitis, rarely tuberculosis)
• chronic lung disease or congestive heart failure
• gastroesophageal reflux disease
• smoking or other tobacco use.
Treatment is usually with an expectorant to help expel secretions from the
lungs (eg, guaiphenesin) and/or a mucolytic (eg, bromhexine) which helps liquefy
mucus, allowing easier clearance. Combination products (eg, those containing
decongestants) should be used only if other troublesome symptoms are present.
Avoid antihistamines, since these tend to dry up and thicken secretions, making
it difficult to cough them up. Cough suppressants are also not recommended
for a productive cough because they suppress the cough reflex, taking away a
person’s ability to cough up excessive secretions.
Initial assessment
Sometimes, deciding what type of cough your customer has may be difficult. Ask
if they mind coughing into a tissue for you and listen to the sound their cough
makes. With productive coughs, you can usually hear the rattle of secretions while
the person is coughing. People with dry coughs have nothing to cough up, so the
cough sounds like it is just coming from the back of the throat.
Children with whooping cough usually cough continuously for several
TREATMENT OPTIONS
Category Examples Comments
Expectorants
Mucolytics
Steam inhalations
Natural / herbal products /
supplements
[GENERAL SALE] eg, guaiphenesin (Mucinex
Maximum Strength*, Robitussin Chesty Cough,
Coldrex PE Cough, Cold & Flu (with paracetamol
and phenylephrine)
[PHARMACY ONLY MEDICINE]
eg, guaiphenesin-containing mixtures
+ bromhexine (Benadryl Chesty Forte*, Benadryl
Mucus Relief Double Action Forte Cough
Liquid*)
+ phenylephrine (Benadryl Mucus Relief Plus
Decongestant*, Benadryl PE Chesty Cough &
Nasal Congestion*, Robitussin Chesty Cough &
Nasal Congestion PE)
eg, anhydrous morphine + squill (Pharmacy
Health Gees Linctus*)
eg, other (Bonnington's Irish Moss)
[PHARMACY ONLY MEDICINE]
eg, bromhexine (Bisolvon Chesty Forte*, Duro-
Tuss Chesty Cough Liquid – Regular/Lozenges),
+ guaiphenesin (Benadryl Chesty Forte, Duro-
Tuss Chesty Cough Forte, Robitussin Chesty
Cough Forte, Robitussin Mucus Relief Double
Action)
[GENERAL SALE]
eg, combinations of volatile oils (Olbas Oil
Inhalant Decongestant, Vicks Vapo Steam
Inhalant)
eg, GoVir Defence, Kaloba, Comvita Winter
Wellness range (Herbal elixir, Cof Ex, Children’s
Elixir, Lozenges)
Camphor, ivy leaf, olive leaf
Expectorants (eg, guaiphenesin, anhydrous morphine + squill) help expel mucus from the
lungs. Bromhexine is a mucolytic which helps to liquefy mucus.
Phenylephrine is a decongestant that can help relieve congestion in the nose and sinuses.
Mucolytics (eg, bromhexine) are often included with cough expectorants as these help to
liquefy the mucus and phlegm aiding its passage from the lungs to the mouth.
Products containing other ingredients, such as decongestants (eg, phenylephrine), should
only be used if nasal symptoms (ie, blocked nose, sinus congestion) are present and
troublesome.
Products containing guaiphenesin, ipecacuanha, dextromethorphan, pholcodine,
phenylephrine, pseudoephedrine [PRESCRIPTION], doxylamine, brompheniramine,
promethazine, chlorphenamine, triprolidine or diphenhydramine should NOT be given to
children aged less than six years and pharmacist advice should be sought before using them
in children aged less than 12 years.
Mucolytics help break down thick, sticky chest phlegm, making it easier to cough up.
Guaiphenesin helps to expel mucus from the lungs.
Steam helps break down mucus and also aids in expectoration (coughing it up).
Place a few drops of the oil or inhalation either in a bowl of hot water and the steam
inhaled, or on a tissue which is held near the face or tucked inside a pillow case at night.
Avoid in very young children.
Natural ingredients found in GoVir Defence and Kaloba relieve symptoms, boost the immune
system and shorten the duration of a cold or the flu.
Comvita Winter Wellness products contain Unique Manuka Factor (UMF) manuka honey.
Camphor used in a topical rub can reduce chest pain caused by coughing.
Ivy leaf is an expectorant and is commonly used in Germany alongside conventional medicines for
asthma and bronchitis. Olive leaf boosts the immune system.
Products with an asterisk have a detailed listing in the Coughs: Productive section of OTC Products, starting on page 231.
Page 46 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Cough and cold medicines in children
Coughs frequently occur in children, most commonly as a symptom of a cold. While nasal
symptoms of a cold usually improve within seven to 10 days, coughs may persist for up to three
weeks or more. Advise parents or caregivers not to give cough and cold medicines to children
aged less than six years, and to seek pharmacist advice before using these preparations in
children aged six to 12 years. Instead, paracetamol may be used to relieve any pain or discomfort,
and natural remedies containing ingredients such as glycerol, honey, or lemon can be suggested
to help soothe irritated throats in children older than one year (see Sore Throat for more
information about recognising Strep. Throat and who to refer).
seconds, followed by a "whoop" sound as they attempt to breathe in air. Croup
causes more of a "barking" cough that gets worse at night. Use the Refer to
pharmacist questions to help identify which customers to refer to a pharmacist.
Advice for customers
• Keep warm and rest.
• Drink plenty of fluids such as water, diluted non-sweetened fruit juice and
clear, warm soups. Liquids help thin the mucus in the throat and lungs and
make it easier to cough up.
• Gargle with plain water for one minute, three times a day – this can ease
symptoms.
• Humidify the air if it is dry. If a humidifier is not available, steam from a hot
shower will also help break down mucus.
• Combination cough suppressant/expectorant cough mixtures are not
recommended for productive coughs; however, may be soothing for
unproductive coughs (see Coughs: Dry).
• Always cover your mouth when you cough, preferably with a tissue, or cough
into the crook of your arm.
• Wash your hands after coughing, before preparing food, and before touching
other people to reduce spread if the cough is from an infectious source.
• Always use tissues (not handkerchiefs) and dispose of them hygienically
following a single use.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the customer a child aged less than 12 years or elderly?
• Are there any other symptoms, eg, fever, ongoing headache, sore
ears or rash?
• Is blood or pink-tinged mucus (phlegm) being coughed up?
• Is the customer very short of breath or wheezy?
• Does the customer have any chest pain or does it hurt to breathe
in?
• Does the cough occur mainly at night?
• Has the cough changed, lasted longer than five days or does it
recur on a regular basis?
• Does the customer smoke?
• Has the customer recently lost weight or have general muscle
aches?
• Have any new medications been started recently?
• Does the customer have any allergies to medicines?
Mucinex Maximum Strength fights mucus with one tablet
to break up chest congestion and relieve chesty coughs.
✔ FAST ACTING
✔ Convenient vs Cough Liquids
✔ LONG LASTING HOURS
✔ Supports Patient Compliance
Mucinex is indicated for the relief of chest congestion by thinning and loosening mucus. Not recommended for children under 12 years. Precautions are asthma, bronchitis, COPD, emphysema
pregnancy and lactation. Possible side effects are GI upset. Guaiphenesin 1200mg. Dosage 1200mg every 12 hours. Reckitt Benckiser, Auckland. 0508 731 234. TAPS DA1540DB
Page 47

Cuts, Abrasions and Blisters
This topic deals with minor cuts, abrasions (grazes) and blisters. For information
about more serious wounds, see Wound Care.
Most cuts, abrasions and blisters can be treated with simple first aid. Wounds
are best covered with breathable dressings that encourage moisture retention.
This allows them to heal faster with less scarring.
Initial assessment
First look at the wound if possible, as long as it is easy to do so without making it
worse. Immediately refer any severe wounds or ones that are bleeding profusely
to a doctor or pharmacist. Run through the Refer to pharmacist questions
(opposite page) and decide who else needs referring. For all other customers,
discuss the appropriate treatment options.
Cuts
Cuts are usually caused by sharp objects such as knives or shards of glass slicing
into the skin. Depending on the cause, they can either be minor or severe.
• Apply pressure to the cut with a clean dressing pad, cloth, or non-linting tissue.
• Elevate the wound if necessary to stop the bleeding.
• Seek immediate medical attention if the wound is serious, extensive, or won’t
stop bleeding after 15 to 20 minutes of continuous pressure.
»»
Do not remove blood-soaked dressings but keep putting new ones on top
and renewing the pressure.
• Once the bleeding has subsided or stopped, apply wound closure strips and
cover minor cuts with a dressing strip or dry non-stick wound pad.
»»
Before applying a dressing, make sure the cut is clean. Clean carefully with
warm water, saline, or a low-toxicity antiseptic solution if necessary, but
be careful not to encourage further bleeding. Apply a topical antiseptic (see
Wound Care for detailed information).
»»
Cuts heal faster if the edges of the wound are brought together with wound
closure strips.
»»
Cover deeper cuts with island or film dressings and seek medical advice as
stitches may be needed.
• Some people may require a booster tetanus shot if the wound is considered
a high tetanus risk and it has been more than five years since their last
vaccination.
• Seek medical attention if the cut was caused by a dirty object and is unable
to be cleaned properly.
Abrasions
Abrasions (grazes) occur when the upper layers of the skin get damaged and
broken, usually as a result of friction or rubbing against a hard rough surface.
They commonly happen in children and on more thin-skinned, bony parts of the
body (eg, knees, ankles and elbows).
• Since abrasions usually contain particles of dirt, gently rinse the area clean
using tap water, saline solution, or a low-toxicity antiseptic solution.
»»
Tweezers may be used to remove surface debris but seek medical attention
if anything is embedded in the wound or the wound is particularly dirty and
is unable to be cleaned properly.
TREATMENT OPTIONS
Wound type Dressing Dressing feature
Blisters
Cuts and
abrasions
Natural / herbal products /
supplements
Hydrocolloid dressings (Compeed Blister Pack range,
Coverplast Hydrocolloid Heel Blisters, Nexcare Blister
Waterproof Plaster)
Dressing strips (Elastoplast, Nexcare)
Dry, non-stick wound pads (Cutilin, Melolin, Telfa)
Blister prevention (Scholl range, Spenco range)
Saline 0.9% (GP Wound Wash Saline)
Dressing strips (Elastoplast, Nexcare)
Wound closure strips (Leukostrip, Steri-strips)
Dry non-stick pad dressings (Cutilin, Melolin, Telfa)
Dry self-adhesive pad island dressings (Cutiplast Sterile,
Primapore, Tegaderm with pad)
Film dressings (Cutifilm Plus, Opsite Flexigrid, Tegaderm)
Dressings impregnated with honey (ApiNate Dressing)
Topical antiseptics (see Wound Care for detailed
information)
Honey, trypsin, St John’s wort, zinc cream, vitamin A cream,
calendula ointment
Hydrocolloid dressings keep the blister moist, easing pain and protecting
from further damage and infection.
Dressing strips protect the injured area.
Dry, non-stick pads absorb any discharging fluid without sticking to skin.
Blister prevention dressings either cushion an area prone to rubbing or
prevent friction.
Normal saline (sodium chloride 0.9% solution), tap water, or a low-toxicity
antiseptic solution may be used to clean wounds. Dressing strips protect an
injured area.
Wound closures keep wound edges together to help healing and reduce
scarring – the strips are hypoallergenic.
Island dressings are self-adhesive and have a non-stick wound pad.
Film dressings are made of a clear waterproof film which is applied and left
on until the dressing falls off, leaving the wound moist and undisturbed.
Waterproof and bacteria-proof island and film dressings are also available.
Topical antiseptics reduce the risk of infection.
Lignocaine, a local anaesthetic, helps reduce pain.
Honey improves skin healing and reduces odours, exudate, pain and risk of
infection. Topical trypsin cleanses necrotic wounds and enhances healing.
Ointment containing St John’s wort has been shown to improve wound
healing and reduce scar formation. Other natural ingredients may also help
healing.
Because the good
stuff can also be
the rough stuff
Also available in a 25g pack
Page 48 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
• Apply a topical antiseptic to the area before covering minor abrasions with a
sterile dressing strip or non-stick wound pad.
»»
Cover more extensive abrasions with island or film dressings to keep the
area moist and undisturbed.
Blisters
Blisters are fluid-filled sacs which form when the skin has been damaged (either
by friction, rubbing, poor-fitting shoes, heat, cold or chemical exposure), if the
skin is crushed or pinched (eg, blood blister) or as a result of a medical condition
(eg, chickenpox).
• Most blisters heal themselves after three to seven days.
• There is controversy over whether blisters should be popped and drained;
however, most experts agree that small blisters are best left intact if possible.
»»
The blister fluid protects the delicate skin underneath, promoting healing.
»»
The roof of the blister provides a natural barrier to bacteria and protects
against infection.
»»
Hydrocolloid plasters are good at relieving blister pain.
»»
If pain persists, a clean, sharp needle sterilised over an open flame or with
boiling water may be used to carefully prick the blister near its edge. Press
the blister carefully to allow the fluid to drain but leave the overlying skin
intact. Hydrocolloid dressings offer the best healing and protection.
»»
If the blister is already broken, clean with warm water and allow to dry.
»»
Apply the hydrocolloid dressing. This will cushion the damaged skin, prevent
further damage, aid healing and prevent infection. Leave the dressing on
until it falls off by itself.
»»
If hydrocolloid plasters are not available, a dressing strip (plaster) or dry
non-stick wound pad may be used to protect the area from further damage.
• People with diabetes or poor circulation are at a higher risk of infection from
even minor foot wounds and should be referred to a doctor.
Advice for customers
Cuts and abrasions
• Use tap water or a saline solution to clean the wound. Apply a topical
antiseptic. Seek medical advice if the wound is extensive or difficult to clean.
• Watch for signs of infection (eg, redness spreading out from the wound or
yellow drainage from the area) and seek medical advice if this occurs.
• Do not pick scabs off as the wound heals – this can cause scarring. Keep scabs
moist with film dressings.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial
assessment or a caregiver's history may have already provided
some answers. Decide if any further questions still need to be
asked and refer any “yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes)?
• Is there severe bleeding?
• Is the wound extensive, deep or dirty?
• Are there any foreign objects embedded in the cut, or unable to
be removed easily?
• Does the customer have fever or flu-like symptoms?
• Is the affected area very red and angry-looking, really painful or
is pus present?
• Has the person had a tetanus vaccination in the past five years?
• Is the person elderly or very young?
• Does the customer have any known allergies to any topical
agents, eg, iodine?
»»
Do not wear untested socks on a long walk and never wear unwashed
socks. Follow the manufacturer’s instructions for laundering.
»»
Consider applying moleskin, hydrocolloid plasters or other types of
protective plasters to specific areas prone to rubbing prior to long walks.
Blisters
• Watch for signs of infection (eg, redness spreading out from the wound or
yellow drainage from the area) and seek medical advice if this occurs.
• Wear proper fitting shoes to avoid blisters on the feet.
»»
Ensure the heel does not slip during walking.
»»
Select socks that fit the foot without being too tight or too loose and
choose ones made of soft wicking fabric.
Make Crystaderm the first choice for first aid
No known bacterial resistance 1
Effectively treats mild to moderate acne
Prevents infection in cuts and scrapes, school sores
(impetigo), body piercings, insect bites and burns
Reference: 1. Lipsky, B. A., and Hoey, C., Topical Antimicrobial Therapy for Treating Chronic Wounds, 2009, 49:1541-1549.
Crystaderm® First Aid Cream (Hydrogen Peroxide 1% w/w, 10g, 15g and 25g) is a General Sale Medicine for the treatment and
prevention of minor skin infections such as acne, cuts, scrapes, burns or school sores. AFT Pharmaceuticals, Auckland. TAPS 1733HA.
Page 49

Cystitis [Bladder Infection]
Cystitis is an infection of the bladder, usually caused by bacteria, which causes
the bladder wall to become inflamed. The term urinary tract infection (UTI) may
be used interchangeably with cystitis; however, a UTI infection technically means
an infection in some part of the urinary tract system (ie, ureters, kidneys, urethra
or bladder), not just the bladder.
Common symptoms include a burning pain or stinging sensation on urination
and a frequent urge to pass small volumes of urine. The urine may also be cloudy
and strong smelling. Lower back pain, discomfort just above the pubic area,
nocturia (getting up repeatedly during the night to urinate) and haematuria
(blood in the urine) may also occur.
Cystitis is caused in most cases by the person’s own bowel flora ascending the
urethra from the perineal and perianal areas. The bacteria most often involved
are Escherichia coli (responsible for up to 80% of uncomplicated cystitis),
Staphylococcus and enterococci. If infection spreads to the kidneys, it can
cause serious problems, eg, pyelonephritis (inflammation of the kidneys and
pelvis).
Women are most commonly affected because they have a shorter urethra
than men, so it is easier for bacteria to travel up the urethra to reach the
bladder. The condition is more prevalent in women aged 15–40 and in elderly
women living in aged-care facilities. Cystitis is rare in men, but may occur in men
aged over 50 due to prostate enlargement. Refer all men with suspected cystitis
to a doctor.
Children or adults with recurrent UTIs may require further investigations to
look for abnormalities in the structure or function of the urinary tract.
Initial assessment
All men and children with suspected cystitis will need to be referred to a doctor,
and all women will need to be referred to a pharmacist who will ask a series of
questions to decide whether trimethoprim is appropriate for them.
Treatment
Cystitis can often come right on its own; however, antibiotics will help this
happen faster. Trimethoprim can be sold under the following conditions by
pharmacists who have successfully completed the Trimethoprim Accreditation
Training Programme.
• Treatment must be for a woman aged between 16 and 65 years.
• She must not be pregnant.
• She must not have taken antibiotics within the past six months.
• Her symptoms must be consistent with those of uncomplicated cystitis and
include two or more of:
»»
painful urination
»»
urinary frequency
»»
urinary urgency
»»
suprapubic pain.
• Refer to a doctor any woman with:
»»
vaginal symptoms such as itch or discharge (may be vaginal thrush or a
TREATMENT OPTIONS
Category Examples Comments
Urinary alkalinisers
Preventive
[GENERAL SALE]
eg, contain a mixture of sodium and potassium
salts (eg, Ural*)
[GENERAL SALE] eg, methenamine hippurate
(eg, Hiprex)
Dissolve sachets in a glass of water and drink up to four times a day. There are a lack of
good quality trials regarding the safety and effectiveness of urinary alkalinisers. Should not
be used in pregnancy, renal impairment, cardiac disease, and with some medicines. Contain
sodium and potassium; exercise caution when giving to people on potassium-sparing
medicine or a sodium-restricted diet. Do not take with methenamine hippurate because an
acidic urine is needed for methenamine to work.
Methenamine hippurate has antibacterial properties and evidence suggests it may help
prevent recurrent UTIs when used short-term (less than one week) in people without
renal tract abnormalities. Evidence is lacking regarding long-term use. Not effective for
neuropathic bladder.
Preventive/Treatment eg, d-mannose (UroFem D-mannose*) UroFem D-mannose is a concentrated form of d-mannose, a naturally occurring carbohydrate
that is thought to work by preventing bacteria from adhering to the bladder wall. D-mannose
powder (2gm) was as effective as nitrofurantoin at preventing recurrent UTIs over a six
month period. Some evidence suggests D-mannose is also effective for reducing symptoms of
an acute UTI such as dysuria, urgency, supra-pubic pain, tenesmus, and nocturia.
Antibiotics
(treatment)
Natural / herbal products /
supplements
[PRESCRIPTION]- unless sold by an accredited
pharmacist ie, Trimethoprim (3)
eg, Cranclense, Cranstat, Ethical Nutrients
Urinary Tract Support
See Treatment above for conditions under which a pharmacist may dispense trimethoprim.
Dosage: one tablet at bedtime for three days. Drink plenty of fluid.
Evidence for cranberry extracts is conflicting and recent reports suggest little or no benefit for
the prevention (or treatment) of bladder infections.
Probiotics may help support urinary health.
Products with an asterisk have a detailed listing in the Cystitis (Urinary Tract Infections) section of OTC Products, starting on page 233.
Clinically Researched, Specialist Recommended.
Available without prescription from your pharmacy.
Page 50 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
sexually transmitted infection [STI]). Treatment for vaginal thrush may be
sold by a pharmacist if the woman has had it before
»»
risk factors for an STI (eg, recent change in partner, unprotected sex)
»»
systemic symptoms (eg, fever, chills, nausea, vomiting, feeling particularly
unwell, pain in sides or back)
»»
more than three occurrences of cystitis or a UTI in the past year, or within
the past two weeks
»»
renal impairment, an abnormal urinary tract, a catheter, history of kidney
problems or kidney stones, who is immunocompromised or taking
immunosuppressants (eg, azathioprine, ciclosporin, cyclophosphamide,
methotrexate), a spinal cord injury, diabetes
»»
a history of hospitalisation in the past four weeks
»»
recent travel to a developing country.
A wait-and-see approach is recommended for women with prior trimethoprim
failure or hypersensitivity, blood dyscrasias, porphyria, who are breastfeeding,
who take clozapine, warfarin or phenytoin or who have been prescribed
antibiotics in the past six months. These women should be instructed to drink
plenty of water (although the benefits of this have not been proven) and to
see their doctor if there is no response in 48 hours or their symptoms worsen.
A Cochrane review could not recommend the use of urinary alkalinisers for UTI
symptoms because there was a lack of good quality trials.
Advice for customers
• Keep up your intake of fluids, although there is no evidence that drinking more
fluids than normal decreases the duration of a UTI.
• Rest and a hot water bottle on the stomach may help relieve pain. Paracetamol
or an anti-inflammatory agent is a suitable analgesic. Avoid aspirin.
• Consider D-mannose to reduce UTI symptoms such as dysuria, urinary urgency,
supra-pubic pain, and nocturia (excessive night-time urination).
• “Honeymoon cystitis”, caused by repeated trauma in the genital area, may
be prevented by using a water-based lubricant if the vaginal area is dry. Avoid
irritants such as perfumed douches. Clean the anogenital area before and
after sex.
• Avoid bath products and toiletries (bubble baths, bath oils, vaginal deodorants)
if they cause irritation.
• Some medications may result in inefficient emptying of the bladder. Talk to
your doctor if the cystitis seems to have coincided with a recently started
medicine.
• Incorrect toileting may cause cystitis. Wipe “front to back”, preferably using
a “blotting” technique. Respond to the urge to urinate – do not “hold on”
as this can cause urine to concentrate and give bacteria an opportunity to
multiply.
• Acidic drinks (eg, fruit juices, fizzy drinks) and spicy foods may irritate the
bladder in some people.
• Wear loose-fitting cotton underpants and trousers. Tight clothing can make
the anogenital area moist, encouraging bacterial growth.
Refer to
PHARMACIST
All people with suspected cystitis should be referred to a pharmacist.
Pharmacists should ask specific questions relating to the cystitis, and
refer any “yes” answers to a doctor. People for whom trimethoprim
or urinary alkalinisers are found to be unsuitable should also be
referred to a doctor.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, kidney problems including kidney
stones, spinal cord injury)?
• Is the customer a child aged less than 16 years or an adult aged
over 65 years?
• Is the customer male?
• Is the customer pregnant?
• Does the customer have an abnormal urinary tract or a urinary
catheter in place?
• Does the customer have fever, nausea, vomiting, or pain on the
sides of the lower back over the kidney area (likely to be a kidney
infection)?
• Is there any haematuria (blood in the urine)?
• Are vaginal symptoms also present, such as itch or discharge (there
may be a fungal or sexually transmitted infection) and over-thecounter
treatment is not available or appropriate?
• Have the symptoms lasted longer than two to three days?
• Does the customer have recurrent cystitis (repeated UTIs can lead
to kidney infection)?
• Have the symptoms persisted despite treatment?
• Does the customer have an allergy to trimethoprim?
• If antibiotics are prescribed, encourage compliance, especially the need to
complete the course. Ensure the customer understands any drug interactions
and how to avoid or minimise them, and can recognise common adverse
effects. Once-daily doses are best taken before bed after emptying the bladder.
• Evidence is conflicting regarding the benefits of cranberry juice at reducing
the incidence of UTIs.
»»
Recent reports suggest benefit is minor or non-existent.
»»
Evidence supporting D-mannose is more robust.
Guidelines now specifically do not recommend:
Cranberry containing products
Urinary Alkalisers
Choose to recommend UroFem for your customers.
Always read the label and take as directed. If symptoms persist see your healthcare professional. 1. NICE Guidelines UK 2009.
2.
Cochrane Review 2012. 3. Cochrane Review 2016. Te Arai BioFarma Ltd, Auckland. 0800 TE ARAI 832 724 enquiries@tearaibiofarma.com
Page 51

Dandruff
Dandruff is a common condition in which numerous small flakes of dry skin are
shed from the scalp and are visible in the hair or on the shoulders. Dandruff
affects around 15%–20% of the population.
Dandruff may be caused by hair products, over or under-shampooing, not
enough hair brushing, a poor diet, illnesses such as Parkinson's disease or HIV,
a weakened immune system, stress, or an overgrowth of the yeast Malassezia.
Malassezia feeds on the natural oils of the scalp and excretes a fatty acid
byproduct which irritates the scalp causing flaking and itching and a faster-thannormal
shedding of skin cells. Skin cells are shed as quickly as every two to seven
days, as opposed to people without dandruff, who shed only monthly.
Certain skin conditions (such as dry skin, psoriasis, or eczema/dermatitis)
can also cause dandruff. Seborrhoeic dermatitis of the scalp is a severe form
of dandruff which causes larger, greasier flakes than other causes of dandruff.
Seborrhoeic dermatitis usually affects skin on other parts of the body as well,
such as the eyebrows (see Dermatitis and Eczema).
Dandruff is more common after puberty and is rare in children, although
newborns may get a form of dandruff called cradle cap (see Dermatitis and
TREATMENT OPTIONS
Category Examples Comments
Medicated shampoos
Antifungal shampoos
Topical applications
Mild cleansing shampoos
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, zinc pyrithione (Head &
Shoulders Dry Scalp),
eg, coal tar (Neutrogena T Gel,
Sebitar Scalp Treatment)
eg, piroctone olamine (Sebamed
Anti-Dandruff Shampoo)
eg, selenium sulphide (Selsun Blue
Shampoo range)
[GENERAL SALE]
eg, ketoconazole 1% (Nizoral Blue
1%, Sebizole Dandruff 1%)
[PHARMACY ONLY MEDICINE]
eg, ketoconazole 2% (Nizoral 2%,
Sebizole Dandruff 2%)
[GENERAL SALE]
eg, Coco-Scalp*
eg, lauryl polyglucose (Dermasoft
Moisturising)
Apple cider vinegar, calendula,
coconut oil, licorice, tea-tree oil
eg, Hopes Relief Shampoo
Medicated shampoos usually contain either zinc pyrithione, salicyclic acid, selenium sulfide or coal tar, or a
combination.
All reduce the rate of epithelial skin cell turnover, relieving scaling and itching. Selenium sulfide and zinc pyrithione
also have an antifungal effect although it is not as strong as ketoconazole or ciclopirox.
When using coal tar-based products it is important to use the accompanying rinse/conditioner as this helps remove
the coal tar smell. Coal tar also makes the scalp more susceptible to sunburn and can stain clothes. Coal tar
treatment products may also discolour blonde, grey, or white hair.
Piroctone olamine has antifungal and antibacterial properties.
Selenium sulfide can discolour hair and metallic jewellery as well as stain clothes.
Strictly use as directed on the label or by a doctor. Avoid the eyes. Most products are highly toxic if swallowed, so
keep products out of reach of children. Discontinue use if scalp irritation or stinging occurs.
Ketoconazole and ciclopirox are broad spectrum antifungals which stop the growth of the yeast Malassezia. They are
often successful when other treatments have failed.
Use according to the instructions on the packet. Generally the 1% ketoconazole product is for regular use, up to
twice a week, while the 2% strength is used twice a week for two to four weeks, with at least a four-week gap
before repeating the course. There is more evidence of an effect for the 2% formulation.
Ciclopirox is used in a similar way and is as effective and well tolerated as ketoconazole; however, dandruff may
relapse faster on discontinuation.
Ketoconazole and ciclopirox shampoos may occasionally cause discolouration of white, grey or artificially coloured or
damaged hair. Mild cleansing shampoos can be used in between shampooing with antifungal products.
Coco-Scalp contains coal tar, sulphur and salicylic acid in a coconut oil base. This product has a combined
antifungal and keratolytic (sloughs off dead skin cells) action. Apply to affected areas of scalp and remove
after one hour using warm water and a shampoo. Repeat the process daily for three to seven days. Not
suitable for children under six.
Lauryl polyglucose provides gentle yet effective cleansing without irritation. The neutral pH of 5.5 helps preserve the
protective acid mantle of the scalp. May benefit eczema sufferers.
Apple cider vinegar and tea-tree oil have antifungal properties. Coconut oil aids in the removal of dandruff, and also
moisturises and strengthens hair. Aloe vera and calendula help calm itchy, sensitive scalps. Daily shampooing with a
tea-tree oil shampoo may help reduce dandruff.
Products with an asterisk have a detailed listing in the Dandruff section of OTC Products, starting on page 234.
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Page 52 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Eczema). It is not infectious and is not caused by bad hygiene, although
infrequent hair washing can contribute to its severity.
Dandruff tends to come and go over time. The condition may be worse in
autumn and winter when indoor heating can contribute to dry skin and people
are not exposed to as much sunlight (UVA is effective at counteracting the effects
of the yeast).
Initial assessment
Examine the scalp to ensure that the symptoms the customer is describing are
the result of dandruff. A pink inflamed-looking scalp with greasy-looking flakes
is most likely seborrhoeic dermatitis (see Dermatitis and Eczema), or the
presence of thick silvery scales may indicate psoriasis (see Psoriasis). Both
should be referred to a pharmacist.
Ask about any concurrent skin conditions and if symptoms seem related to the
recent use of hair products.
Treatment
Dandruff is usually very responsive to treatment but often returns after
treatment stops. Mild cases usually respond to daily shampooing with a gentle
cleanser. More noticeable cases will require regular and ongoing treatment
with a medicated or antifungal shampoo. The majority of treatment products
have antifungal properties which control the presence of the yeast Malassezia.
Reduction in this yeast reduces the presence of fatty acids thereby reducing the
flaking and the itch of Malassezia-associated dandruff.
Dandruff is more of a cosmetic problem than a medical problem.
Advice for customers
• Regular hair washing (at least twice weekly) with a mild cleansing shampoo
will reduce flakes. However, treatment shampoos have a more dramatic effect
on reducing flakes.
»»
Follow directions exactly as directed on the shampoo label. If the product
irritates or burns your scalp, rinse it away thoroughly and do not use it
again. Refer to the pharmacist to help choose a different product.
»»
If one product does not appear to work, relief may be gained by using a
different type of anti-dandruff product.
»»
Do not use dandruff products if skin is broken, and avoid contact with eyes.
• Avoid wearing dark clothes while dandruff is particularly bad.
• Stress may trigger dandruff or worsen existing symptoms. Take time out to
relax and try to manage stress.
• Cut back on the use of styling products. Hair sprays, styling gels, mousses and
hair waxes can all build up on the hair and scalp.
• Eat a healthy, well-balanced diet.
• A little bit of sun on the hair is good for dandruff but avoid overexposure. Wear
a hat if outside for prolonged periods to avoid sunburn.
• Tea-tree oil is a natural antiseptic, antibiotic and antifungal agent. Daily
shampooing with tea-tree oil shampoos has been shown to reduce the
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, is pregnant or breastfeeding)?
• Does the scalp look red or have sores or crusts on it?
• Does the scalp feel lumpy or irregular?
• Are the symptoms confined to just the scalp or do they extend to
other parts of body (such as eyebrows, forehead or ears)?
• Is the person an infant or young child or elderly?
• Is there any hair loss?
• Has there been any recent use of new hair products (such as
shampoo, hair spray, gel or dye)?
• Have anti-dandruff shampoos been tried before without success?
• Does the person have any allergies to topical medicines?
incidence of dandruff.
»»
The oil may cause allergic reactions in some people.
• Treatment reduces symptoms but does not cure the problem long term –
customers may need to repeat treatment periodically.
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Page 53

Dermatitis/Eczema
Dermatitis is a general term used to describe skin inflammation. Some people use
the word “eczema” interchangeably with dermatitis. Dermatitis is common and
characteristic symptoms include an intense redness of the skin or scalp, with raised
bumpy areas and sometimes bleeding, blistered or weepy patches. These patches
can be incredibly itchy and may interfere with sleep and other activities. Constant
scratching can cause skin changes and affect pigmentation.
Dermatitis may flare-up occasionally, or be present all the time. It is usually
classified according to its known or suspected cause, for example, irritant
contact dermatitis, allergic contact dermatitis, atopic dermatitis, and seborrhoeic
dermatitis.
Irritant contact dermatitis
This is the most common form of dermatitis and frequently occurs in people
exposed to irritant substances such as chemicals, disinfectants, fragrances, and soaps
which remove natural oils from the skin. The skin may take on a glazed, parched,
or scalded appearance. The area is usually sharply circumscribed and healing begins
promptly on withdrawal of the offending agent. Hands are most commonly affected.
Allergic contact dermatitis
This is a skin reaction which results from contact with an allergen (eg, ingredients
in cosmetics, dyes in clothing or footwear, hair dyes, latex gloves or condoms, nail
polish, nickel in jewellery, plants, sticking plasters, sunscreen). A rash featuring red,
raised welts confined to the area contacted by the allergen is the most typical
symptom.
Atopic dermatitis
Atopic dermatitis (AD) is a skin condition characterised by recurring
dermatitis associated with itch. Most people with AD have a predisposition to
TREATMENT OPTIONS
Category Examples Comments
Soap substitutes
Moisturisers
Barrier creams
[GENERAL SALE] eg, Alpha Keri Clear Wash,
aqueous cream, Dermalab Gentle Cleansing,
Dermasoft, Dermaveen, emulsifying Ointment,
Hopes Relief, QV Gentle Wash*
[GENERAL SALE] eg, Alpha Keri, Dermalab
Stay Hydrated*, Dermasoft, Lipobase Cream,
Lucas Paw Paw ointment, QV Skin Lotion*,
Scratchy & Itchy Soothing Gel, XmaEase
[GENERAL SALE] eg, dimethicone (DU IT
Tough Hands, Silic 15), zinc (Mustela Vitamin
Barrier cream), zinc and castor oil
Use of a soap-free cleanser or soap substitute is important for people with dermatitis.
To use aqueous cream or emulsifying ointment as a soap substitute, put a small knob into a
jar, add hot water and shake, apply and wash off. Never use aqueous cream as a moisturiser
because it contains sodium lauryl sulphate (a detergent) which may aggravate dermatitis.
Regular use of a moisturiser improves the skin’s function as a barrier. The base used to make
the cream and dissolve any ingredients plays just as important a role as the active ingredients
themselves. Humectants (eg, glycerin, oatmeal, propylene glycol, phospholipids) hold water in
the skin. Ointments containing petrolatum or lanolin tend to be greasier than creams.
Provide a barrier between the skin and outside influences (eg, water, detergent). Apply
regularly, especially on hands just before immersing them in water.
Anti-pruritics (anti-itch) [GENERAL SALE] eg, Pinetarsol range* Tar-based pine oil products are useful to help reduce itching. Some people may be allergic.
Itchy scalp [GENERAL SALE] eg, Coco-Scalp* Contains ingredients that break down scalp scale, relieve itch, and condition the hair.
Bath/shower products
Anti-inflammatory products
[GENERAL SALE] eg, Alpha Keri Oil, Scratchy &
Itchy Soothing Bath, QV range
[PHARMACY ONLY MEDICINE]
eg, Oilatum Plus
[GENERAL SALE] eg, Ichthammol, (Egoderm
Cream, Egoderm Ointment [with zinc])
Bath oils containing antiseptics may be useful in dermatitis to reduce flare-ups due to
bacterial colonisation. Use no more than the recommended amount. Warn about slipping.
Half a cup of regular bleach added to a 20cm deep bath twice a week can help prevent
infection and improve dermatitis.
Can reduce flare-ups associated with eczema.
Topical corticosteroids
Products for cradle cap
Natural / herbal products /
supplements
[PHARMACY ONLY MEDICINE]
eg, hydrocortisone 0.5% (Derm-Aid Soft 0.5%,
Skincalm 0.5%)
[PHARMACIST ONLY MEDICINE]
eg, hydrocortisone 1% (Derm-Aid Soft 1%,
Skincalm 1%), Clobetasone 0.05% (Eumovate)
[GENERAL SALE] eg, Egozite Cradle Cap,
Mustela Stelaker, Kiwiherb Baby Balm
eg, Artemis Itch Calm, Eczema Comp, Mebo Antiitch,
Omega 3/6, Bifidobacterium, Lactobacillus
Do not apply to broken skin or to face. Apply a small amount no more than twice daily, and
limit use to one week at a time. Long-term use may result in skin thinning and stretch marks.
Loosens and removes the crusts due to cradle cap.
Natural ingredients soothe the skin and reduce the urge to scratch. Oral Bifidobacterium or
Lactobacillus can reduce atopic eczema severity in infants.
Products with an asterisk have a detailed listing in the Dermatitis/Eczema section of OTC Products, starting on page 234.
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CONTINUING OTC EDUCATION
hypersensitivity-type conditions such as hay fever, asthma, chronic urticaria,
or food allergies. AD tends to run in families and most commonly presents in
childhood, although may occur at any age.
AD tends to come and go with periods of activity (called flares) and periods
of relative skin normality in between, although in most people the skin always
appears slightly dry. Flares in AD usually occur following exposure to certain
allergens or trigger factors including grasses, pollen, animal dander, dust mites,
stress or temperature/climate change.
Skin flexures (eg, elbows or behind the knees) are more commonly affected
and usually symmetrically. Broken areas of skin are prone to infection, and raw or
weepy looking rashes should be referred to the pharmacist.
AD probably represents more than one condition, so there is no known single
cause. Ongoing research is currently investigating how our immune system,
digestive system, filaggrin gene mutations (filaggrin is a protein responsible for
maintaining an effective skin barrier), defective keratinocytes (skin cells), and
commensal microbes contribute to atopic dermatitis. Barrier defects appear to be
a key factor of AD. Environmental factors (eg, weather, temperature, allergens)
also play a part.
Treatment may be required for many months and possibly years. It nearly
always requires avoidance of trigger factors (where possible), regular moisturisers
(see Treatment Options, previous page) and intermittent, short course (five to
15 days) topical corticosteroids. Topical calcineurin inhibitors (ie, pimecrolimus,
tacrolimus), antibiotics, antihistamines, phototherapy or oral corticosteroids may
also be needed.
Seborrhoeic dermatitis
This is a common, harmless, salmon pink, scaling rash which can affect the
face, scalp, eyebrows, eyelid edges and other areas. It is most likely to occur
where the skin is oily. Topical antifungals, occasional topical corticosteroids, and
combination scalp products containing coal tar, coconut oil and other ingredients
may keep the condition under control but it may be quite persistent. Scalp
seborrhoeic dermatitis is a cause of dandruff.
Cradle cap (infantile seborrhoeic dermatitis of the scalp)
Cradle cap is a scaly, crusty, patchy, greasy, skin rash that occurs on the scalp of
recently born babies. It is not usually itchy and most babies are not bothered by it.
The cause is not clearly defined but may be due to overactive sebaceous glands in
the skin of newborn babies, or a relationship with Malassezia yeasts.
Mild baby shampoos and soft brushing can help remove the scales, although
the rash usually clears up by itself by the time a baby is a year old. Some people
use baby oil or paw paw ointment to soften the scales to allow easier removal.
Olive oil should not be used as this encourages proliferation of Malassezia.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the person with dermatitis a child?
• Is the skin broken or inflamed or are there signs of infection (ie, pus)?
• Could the condition be related to a regular habit (eg, washing hands)?
• Has the rash or cradle cap spread or worsened?
• Does the rash contain vesicles (little pimples with clear fluid)?
• Is the affected area covered with white patches or silvery scales?
• Has the skin become tough and leathery?
• Does the person have any allergies to topical medicines?
discuss the appropriate treatment options, such as soothing creams, topical
corticosteroids, and moisturisers.
Advice for customers
• Avoid factors which aggravate the dermatitis where possible.
»»
Limit contact if avoidance is not possible (eg, gloves, barrier creams).
• Moisturise the skin often and liberally, especially after bathing (see also Dry
Skin).
• Replace soap with soap-free alternatives.
Initial assessment
Look at the dermatitis if possible and run through the Refer to pharmacist
questions (this page) to decide who needs referring. For all other customers,
Page 55

Diabetes
Diabetes is a condition in which the body fails to produce enough insulin to keep
blood glucose (sugar) levels in the normal range. Insulin is a hormone that is
produced by special cells (called beta cells) in the pancreas. Insulin facilitates the
entry of glucose into muscle, adipose (fat) and several other tissue types, where it
can be used for energy, and also switches off the release of glucose by the liver.
Glucose comes from the carbohydrates we eat, and is present in the blood as
an energy source. Glucose also comes from the liver, where it is stored in order
to provide a constant supply for when we are not eating. In people without
diabetes, insulin keeps blood glucose levels fairly stable (between 4.0mmol/L
and 7.5mmol/L). In people with untreated diabetes, blood glucose levels can
regularly go dangerously high (11mmol/L and higher). There are three different
types of diabetes.
Type 1 diabetes
Type 1 diabetes is most commonly diagnosed in children aged seven to 12 years,
although it can occur at any age. It is an autoimmune condition where the immune
system of the body rejects or destroys its own insulin-producing cells. People with
type 1 diabetes produce very little or no insulin hormone, resulting in a life-long
dependence on exogenous insulin. It is unknown what first starts this cascade of
immune events, but evidence suggests that both a genetic predisposition and
environmental factors, such as a viral infection, are involved. Of all the people with
diabetes about 10% of them have type 1 diabetes.
Symptoms include excessive or constant thirst (polydipsia), excessive and
frequent urination (polyuria), tiredness or weakness and mood changes. People
with type 1 diabetes often experience rapid weight loss because their body is
actually being starved. Some people may also have abdominal pain, nausea
or vomiting, skin infections (such as thrush), extreme hunger or have difficulty
concentrating. Symptoms usually develop quickly and urgent hospitalisation may
be necessary.
Diagnosis of type 1 diabetes is by blood and urine tests, and treatment is with
multiple daily injections of insulin or a continuous insulin pump. Lifestyle changes
are usually necessary and insulin treatment may need to be managed around
sport and eating times.
Type 2 diabetes
This is the most common type of diabetes and usually affects people who are
middle-aged or older, although can occur earlier in people who carry excess
weight, do limited exercise, or of certain ethnicities.
Unlike people with type 1 diabetes, people with type 2 diabetes produce insulin;
however, it is either not enough to mop up all the glucose in the blood or their body is
unable to recognise the insulin and use it properly (insulin resistance).
Type 2 diabetes comes on gradually and symptoms may be so subtle that many
people are unaware that they have the condition. In addition to feeling thirsty
and going to the toilet often, people with type 2 diabetes get tired, feel hungry
and lack energy. Other common symptoms include more frequent infections and
infections which are hard to heal, and some may have noticed a deterioration or
blurring of their vision.
Some people are able to manage their type 2 diabetes by altering their diet and
losing weight. Most people will need to take oral medicines which stimulate the
production of insulin or help cells uptake glucose. Many eventually require insulin
injections as the disease progresses.
About one-third of people with type 2 diabetes also have hypertension (high
blood pressure) and dyslipidaemia (see also Heart Health). This combination of
conditions is often referred to as “the metabolic syndrome".
Diabetes in pregnancy (gestational diabetes)
Gestational diabetes happens when a pregnant woman cannot produce enough
insulin to cope with her body’s increased needs during pregnancy (a pregnant
woman’s insulin needs are two to three times that of someone who is not pregnant).
It affects around 4%–8% of pregnant women, and is routinely screened for during
pregnancy at around 26 to 28 weeks’ gestation.
In most cases, gestational diabetes is able to be managed by diet and exercise
during the pregnancy; however, some women will require insulin injections. It usually
disappears after the baby is born. Women who have had gestational diabetes are at
greater risk of developing type 2 diabetes later in life.
Long-term complications of diabetes
When sugar levels in the blood remain high for a long period of time, permanent
damage can occur to most of the blood vessels in the body, leading to an
increased risk of heart attack and stroke, erectile dysfunction, foot problems, gum
disease, infections, kidney disease, nerve damage and visual problems.
Initial assessment for risk factors
There are certain factors that increase the risk of type 2 diabetes, although not
everybody with these risk factors goes on to develop the disease. Type 2 diabetes
is more common in people who are overweight – especially if the extra weight
is around the waist; in those who are inactive; and in people of an older age.
Maori, Asian, Middle Eastern or Pacific Island people tend to develop type 2
diabetes at a younger age than those of European descent. People with a family
history of diabetes or women who had gestational diabetes or gave birth to baby
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CONTINUING OTC EDUCATION
weighing more than 4kg are also more likely to develop the condition.
Some over-the-counter medicines such as NSAIDs (for example, ibuprofen)
and sugar-containing cough syrups may not be suitable for people with diabetes.
If you don't know the medical history of the customer, and they have obvious risk
factors for the disease, tactfully ask if they have any known medical conditions
or have ever been tested for diabetes. Refer anybody with suspected diabetes to
a pharmacist.
Screening for diabetes
Doctors may order a glycated haemoglobin (HbA 1C
) test if they suspect diabetes.
The test indicates how good a person's long-term blood glucose control has been
and has less biological variability than a fasting plasma glucose (FPG) test. It also
does not require fasting. However, FPG remains a valuble test.
Range for HbA 1C
An HbA 1C
of greater than or equal to 50 mmol/mol is considered the threshold for
the diagnosis of diabetes by the New Zealand Society for the Study of Diabetes
(NZSSD) and the Ministry of Health. In people with symptoms (eg, polyuria,
polydipsia), a single HbA 1C
of >/=50 mmol/mol is considered diagnostic of
diabetes for the majority of people (some exceptions exist).
In people without symptoms, an HbA 1C
of >/=50 mmol/mol strongly indicates
diabetes; however, a second test (ideally another HbA 1C
at least three months
later or FPG) is needed for confirmation. Lifestyle interventions should be
encouraged during the three-month wait for a second test.
Home blood glucose testing
Home blood glucose testing allows customers with diabetes to better manage
their diabetes at home. If your pharmacy offers a blood glucose testing service
your standard operating procedure (SOP) should clearly outline how to conduct
the test and when to refer people to a doctor for an HbA 1C
.
Hyperglycaemia (high blood glucose)
Customers reporting frequent high blood sugar readings (hyperglycaemia)
should be referred to their doctor for further investigation. Reasons for high
blood glucose recordings in known diabetics include increased carbohydrate
intake, inadequate diabetes medicine or insulin, illness or decreased exercise.
• ketones on the breath (fruity, acetone smell)
• confusion, an alteration in consciousness or unconsciousness.
People with diabetes who are sick may have difficulty managing their blood
glucose levels, especially if they do not feel like eating. This can place them at risk
of DKA or HHS. Advise people with diabetes to discuss with their doctor a “sickday
plan” which details what changes to make to their insulin regimen and how
frequently to measure their blood glucose.
Hypoglycaemia (low blood glucose)
Low blood glucose levels (usually less than 4mmol/L) in a diabetic may indicate
the dosage of their diabetes medicine or insulin is too high or that a meal has
been missed.
Symptoms of hypoglycaemia include blurred vision, sweating, feeling lightheaded,
confusion, trembling, tingling fingers and lips, and loss of consciousness.
Management of suspected hypoglycaemia includes giving simple sugars (two
to three glucose tablets, half a glass of fruit juice, two to three teaspoons of jam,
honey or sugar in water, seven to eight jelly beans) every 10 minutes until the
blood glucose reading is satisfactory. Follow with a meal or complex carbohydrate
(slice of bread, piece of raw fruit, two crackers or biscuits). If a person has lost
consciousness consult a doctor immediately.
Advice for customers
Ensure customers:
• Know how to use their blood glucose meter and to contact a pharmacist or
diabetes educator if the equipment is not working correctly.
• Wear a personalised medical bracelet (eg, Bupa, Mediband, MedicAlert).
Funded blood glucose meters
NAME OF METER TYPE OF STRIP USED NOTES
CareSens N
CareSens N Strip
Requires no coding
CareSens N POP
CareSens II CareSens Strip Requires manual coding
AccuChek Combo
FreeStyle Optium
Sensocard Plus Talking
Meter
AccuChek Performa Test
Freestyle Optium
SensoCard Test Strips
Only fully funded for people
already using prior to 1
June 2012
Only subsidised for the
severely visually impaired
Hyperglycaemic emergencies
Diabetic ketoacidosis (DKA) and hyperosmolar hyperglycaemic state (HHS) are
acute and potentially life-threatening complications of hyperglycaemia that
can occur with either type 1 or type 2 diabetes. Both require urgent medical
attention. Symptoms of DKA and HHS are generally preceded by a few days of
unwellness but may develop suddenly and include:
• signs of dehydration (thirst, dry mouth, lack of skin elasticity)
• abdominal pain, nausea and vomiting, polydipsia
• deep and laboured breathing
Page 57

Diarrhoea and Vomiting
Diarrhoea and vomiting are two conditions that can occur either at the
same time or separately. Viral gastroenteritis, a highly contagious infection
readily spread through direct contact with an infected person or by ingesting
contaminated food or water, is the most common cause of combined
diarrhoea and vomiting.
Diarrhoea
The main symptom of diarrhoea is frequent, loose, watery bowel motions which
are usually accompanied by an urgent need to go to the toilet. Abdominal pain
or cramping may also occur, and sometimes nausea and/or vomiting. Common
causes of diarrhoea include:
• viruses (eg, norovirus, rotavirus)
• bacteria – as in food poisoning – or other non-viral infections (eg, salmonella,
campylobacter, giardia, E. coli)
• certain medical conditions (eg, inflammatory bowel disease, coeliac disease)
• diet or food intolerance (eg, spicy food, lactose in milk, too much fruit juice)
• medicines (eg, antibiotics, antacids containing magnesium)
• excessive alcohol.
People with diarrhoea should be given fluids, preferably electrolyte replacement
solutions to prevent dehydration, and anti-diarrhoeal medicines to stop or slow
the diarrhoea. Refer to the pharmacist all children with diarrhoea or adults whose
diarrhoea has lasted more than two days.
For more information about avoiding diarrhoea while travelling (see Travel
Health and Vaccinations).
Rotavirus
Rotavirus is a highly contagious virus of the gut which is the leading cause of
severe vomiting and diarrhoea in babies and young children in New Zealand.
Symptoms can range from a short period of mild, watery diarrhoea to severe
dehydrating diarrhoea with vomiting, fever and shock. Before immunisation,
more than 90% of all children were infected by this virus by the age of three.
Rotavirus vaccine is funded on the National Immunisation Schedule (see
Childhood Diseases and Immunisation: Rotavirus) and the first dose
should be given before a child is 15 weeks of age.
Vomiting
Vomiting (throwing up) is when the contents of the stomach are forcefully
expelled by the body through the mouth, usually involuntarily. Nausea is the term
used to describe the feeling of being about to vomit.
Common causes of vomiting include gastroenteritis, overindulgence in alcohol,
food allergies, food poisoning, travel sickness, migraines, pregnancy, influenza
and some medicines.
Antiemetics are medicines which can be used to control vomiting, but these
are only available over the counter under special circumstances (such as nausea
or vomiting associated with migraine or use of the emergency contraceptive pill).
TREATMENT OPTIONS
Category Examples Comments
Electrolyte replacement
therapy (ERT)
Anti-diarrhoea
medications
Combination products
Vaccination
Other
Natural / herbal /
supplements
[GENERAL SALE]
eg, Enerlyte, Ethical Nutrients Rehydrate,
Gastrolyte*, Hydralyte, Pedialyte
[PHARMACY ONLY MEDICINE]
eg, loperamide (Diamide, Nodia,
Imodium, Imodium Zapid), loperamide +
simethicone (Imodium Advanced)
[PHARMACY ONLY] Rapid Restore
Gastro Pack (Enerlyte + Nodia)
[PRESCRIPTION]
eg, rotavirus vaccine (Rotarix)
Lacteeze Extra Strength Chewable
eg, MicroCleanz hand sanitiser
Bifidobacterium lactis, Gastro Relief,
Lactobacillus acidophillus, Psyllium hulls,
Saccharomyces boulardii, Slippery Elm
Bark, zinc
Electrolyte solutions replace fluid and electrolytes and prevent dehydration. They contain sodium, potassium,
glucose and citrates/bicarbonates in concentrations easily absorbed by the body. Suitable for people of all
ages. Sachets must be mixed up exactly to the manufacturer’s instructions and ONLY with water. Use freshly
boiled and cooled water for infants. Best given slightly chilled; the solution should be drunk in frequent small
sips. Comply with expiry and storage dates on container. Different flavours available.
Loperamide normalises the speed of the digestive system, helping to reduce the number and frequency of
bowel motions, and restore fluid resorption. Used to temporarily stop or slow diarrhoea. Should be used in
conjunction with ERT.
Simethicone helps to disperse gas, relieving bloating and flatulence.
Contains both Enerlyte sachets to correct and prevent dehydration and Nodia tablets to stop diarrhoea.
Funded on National Immunisation Schedule for babies, first dose must be given by 15 weeks of age (see
Childhood Diseases and Immunisation: Rotavirus).
Lacteeze replaces the enzyme lactase in people who are lactose intolerant. Use just before eating dairy
products (eg, cheese, ice cream, milk) as effects only last an hour.
Hand sanitisers may be used if hygienic hand washing facilities are unavailable.
Psyllium hulls are useful for both diarrhoea and constipation. The bulk fibre absorbs the extra fluid in the bowel.
Some probiotics can reduce the duration of diarrhoea. Zinc can reduce the duration and severity of persistent
diarrhoea in zinc-deficient children. Slippery Elm Bark can help soothe gastrointestinal irritation and normalise
bowel actions. Suitable for either diarrhoea or constipation.
Products with an asterisk have a detailed listing in the Diarrhoea and Vomiting section of OTC Products, on page 235.
PharmacyToday
A part of your
everyday
Page 58 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
As with diarrhoea, it is important to make sure the person with the vomiting does
not become dehydrated. If severe dehydration develops, intravenous fluids may
be needed to replace fluids lost through vomiting.
If vomiting is caused by motion (see Travel Sickness), a pharmacist can
advise on the best treatment for this.
Dehydration
The most common complication of diarrhoea or vomiting is dehydration, due to
water loss through the bowel or mouth, which can be up to four times greater
than usual. Important electrolytes, such as sodium and potassium, are also lost.
This can be particularly serious in the very young or very old, or in people who
have other illnesses, medical conditions or who take certain medicines.
Since up to 75% of the body’s weight is water, signs and symptoms of
dehydration can occur quickly if water is not replenished. A dry mouth or mild
thirst is a sign of mild dehydration and indicates that fluid intake is already
suboptimal.
Initial assessment
If the person with the diarrhoea or vomiting is a child or older adult, immediately
ask a pharmacist to be involved in the discussion. Signs of moderate-to-severe
dehydration which may require immediate medical help include:
• a sunken fontanelle (soft spot on a baby’s head), sunken eyes or no tears or
sweat
• cold hands or feet, or mottled bluish skin
• confusion (especially in the elderly)
• drowsiness or “floppiness” in children, or difficulty waking them
• loss of skin elasticity – it does not flatten after being pinched
• passing little or no urine (or unusually dry nappies), or very dark-coloured
urine.
For all other customers, run through the Refer to Pharmacist questions and
refer any "yes" answers.
Advice for customers
• Most infectious causes of diarrhoea and vomiting are easily spread.
»»
Regular and thorough handwashing by all household members and close
contacts of the infectious person helps reduce the risk of other people
becoming ill.
»»
Alcohol-based hand gels are useful but use in addition to hand washing not
as a substitute, unless hand washing facilities are not available.
• Electrolyte solutions should be drunk to help prevent dehydration because
water alone will not replace electrolytes lost through diarrhoea or vomiting.
• Undiluted fruit juices, soft drinks (eg, flat lemonade), sports drinks and cordials
can worsen dehydration due to their high sugar content.
• Mothers with sick babies who are still breastfeeding should continue with
feeds as normal. Any baby that is unable to keep fluids down (whether
breastfed or bottle-fed) needs to be referred to a doctor.
Refer to
PHARMACIST
Seek immediate medical help if a person with diarrhoea or vomiting
is unable to drink enough fluids to replace those lost, or if they show
any symptoms of moderate-to-severe dehydration.
In other non-urgent cases, ask the following specific questions and
refer any “yes” answers to the pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the person elderly, frail, or a child less than five years?
• Has the diarrhoea or vomiting lasted longer than 48 hours in
adults or 24 hours in children?
• Is the person with diarrhoea or vomiting refusing to drink fluids
or is unable to keep them down?
• Is there any blood or mucus in the faeces (blood may be seen as
dark tarry stools)?
• Does the vomit contain blood, dark brown material, or smell foul?
• Are faeces pale, greasy, foul-smelling, explosive or difficult to flush?
• Are there other symptoms such as severe abdominal pain, fever,
vomiting or a general feeling of being unwell?
• Has the person recently returned from overseas?
• Is there a history of recurrent diarrhoea or constipation?
• Does the person appear to be underweight?
• Does the person have any allergies to medicines?
• Food intake does not need to be restricted if the person feels like eating,
although bland and dry foods may be preferred initially.
• Be particularly careful with food hygiene, especially during the summer months
and when cooking barbecues – remember to Clean, Cook, Cover, Chill.
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Page 59

Dry Skin
Dry skin is skin that lacks moisture or oils, and is often characterised by wrinkling
or fine lines, scaling, cracking and itchiness. It is common, particularly as people
age and their skin becomes thinner and less able to retain moisture. Although it
is not usually a serious problem, it can be uncomfortable, itchy and unsightly, and
contribute to the appearance of ageing.
The outer layers of the skin are made up of skin cells, oil and water. This
outermost skin barrier can break down due to wear and tear from the
environment, such as from the wind, sun, frequent washing or exposure to
irritant substances. When this happens, oil and water are lost from the skin,
causing dryness and sometimes itching. The skin may also become rough or scaly
and small flakes of dead skin may be visible. If a red rash is present, this may
indicate the development of dermatitis/eczema (see Dermatitis/Eczema). Any
part of the body may be affected.
Some people are born with a tendency towards dry skin, whereas others may
develop it as a result of excessive bathing or swimming (particularly in water
that is chlorinated), overuse of soap or other products that strip natural oils from
the skin, or from spending too much time in dry air, such as in air-conditioned
rooms. Other causes include cold weather and artificial heat exposure (such as
heaters, fires, electric blankets), low humidity climates, over exposure to the sun
and wearing clothes that chafe the skin (eg, wool).
Initial assessment
Ask your customer for permission to touch their skin. Very dry skin feels quite
rough and firm to the touch. Redness and deep cracks, and large flakey scales
are usually also present when the skin is extremely dry. Thicker moisturisers with
a high oil content (eg, ointments) are best for very dry skin. However, people may
prefer less greasy creams and lotions, especially when the dryness is mild. Refer
any customers with allergies to topical products or with "yes" answers to the
Refer to Pharmacist questions to a pharmacist.
TREATMENT OPTIONS
Category Examples Comments
Soap substitutes
Moisturisers and emollients
Lip balms for dry lips/nasal gel
for dry nasal passages
Barrier creams
Anti-pruritic (anti-itch)
preparations
Bath/shower products
[GENERAL SALE]
eg, Alpha Keri range, Aqueous Cream, Baby
Body Soap, DermaLab Gentle Cleansing,
Ecostore Hand & Body Wash, Dermaveen,
Emulsifying Ointment, Hopes Relief, QV Gentle
Wash
[GENERAL SALE]
eg, Atoderm, DermaLab range, Ecostore range,
Hopes Relief Itchy Dry Skin, Lipobase Cream,
Lucas Paw Paw ointment, Palmer’s Skin Therapy
Oil*, QV Skin Lotion, Rosken Skin Repair Dry
Skin Cream, Trilogy range
[GENERAL SALE]
eg, Badger range, Carmex Lip Balm, Fess Nasal
Gel, HayMax, Nivea range, QV Lip Balm
[GENERAL SALE] eg, dimethicone (DU IT Tough
Hands, Silic 15), zinc (Mustela Vitamin Barrier
cream), zinc and castor oil
[GENERAL SALE]
eg, Pinetarsol
MOISTURISE ALL ALL OVER OVER
[GENERAL SALE] eg, Alpha Keri Oil, Scratchy &
Itchy Soothing Bath, QV range
[PHARMACY ONLY MEDICINE]
eg, Oilatum Plus
Soap substitutes are mild cleansers which do not strip the skin of its natural oils.
Use of a soap-free cleanser or soap substitute is important for people with dry skin to
prevent further drying. If using aqueous cream or emulsifying ointment put a small knob into
a jar, add hot water and shake to form a liquid soap substitute. Never use aqueous cream as
a moisturiser, only as a soap substitute as it contains sodium lauryl sulphate (a detergent)
which may aggravate dermatitis.
Regular use of a moisturiser improves the skin’s ability to function properly and act as a
barrier. Customers may need to try several products before they find one that they like
with the right amount of greasiness. The base used to make the cream and dissolve any
ingredients plays just as important a role as the active ingredients themselves. Humectants
(eg, glycerin, oatmeal, propylene glycol, phospholipids) hold water in the skin. Ointments
containing petrolatum or lanolin tend to be greasier than creams. Some people are allergic
to lanolin.
Formulated to adhere to mucus membranes of the lips or inside of the nose. Contain
moisturisers to help with chafing, cracking and soreness.
HayMax moisturises and prevents dust, pet dander, and pollen from entering the nose.
Provide qv a barrier Bath between oiL the skin and outside influences (eg, water, detergent). qv cReam
Apply regularly, especially on hands just before Recommend
immersing them in water.
with
Tar-based, pine-oil products are useful in the bath to help reduce itching. A few people are
allergic to pine oil and should avoid it.
Bath oils containing antiseptics may be useful in people with dry skin and dermatitis to
reduce flare-ups due to bacterial colonisation. Use no more than the recommended amount.
Warn about the danger of slipping.
Natural / herbal products / Almond oil, Aloe Vera, alphahydroxy acids
AHAs are natural acids found in foods that work by exfoliating the top layers of dead skin
supplements
(AHAs), avocado, coconut oil, honey, lecithin, cells, improving the skin’s appearance and reducing blemishes and age spots. Coconut oil
qv Bath qv oiL Bath oiL
mango, oatmeal, sesame oil qv cReam qv cReamimproves
skin moisture and oil levels. Lecithin is used in topical products as a humectant.
Recommend Recommend
Several other natural ingredients help restore moisture to dry skin.
with with
qv wash
Recommend
qv sKin Lotion
Products with an asterisk have a detailed listing in the Dry Skin section of OTC Products, starting on page 235. with
Ideal for normal, dry and sensitive skin
NORMAL TO TO DRY DRY
NORMAL TO DRY
MOISTURISE ALL OVER
NORMAL TO DRY
MOISTURISE DRIER ALL OVER
DRIER
qv wash qv wash
QV WASH
Recommend Recommend
with with
qv sKin qv Lotion sKin Lotion qv Bath oiL
qv GentLe wash
QV SKIN LOTION
QV GENTLE WASH
Recommend
Recommend with
with
qv cReam
qv cReam
QV CREAM
m
DRIER DRIER
Page 60 HEALTHCARE HANDBOOK 2017-2018 Common Disorders
DRIEST
NORMAL TO DRY
R

CONTINUING OTC EDUCATION
Treatment
There are many different types of moisturisers available; all aim to rehydrate the
outer layers of the skin and prevent further evaporation.
Moisturisers usually contain a water-retaining substance, called a humectant
(such as glycerin or hyaluronic acid), an emollient to smooth and lubricate the
skin (usually a type of fat or oil such as lanolin), fragrances and preservatives.
Some customers with sensitive skin may require hypoallergenic or unperfumed
moisturisers, whereas others may look for a product which only contains natural
or organic ingredients. Other ingredients commonly found in moisturisers include:
• antioxidants (eg, acai oil, CoQ-10, grape seed, green tea extract, resveratrol,
soy isoflavones, vitamin C & E)
• ceramides – help maintain the skin's natural moisture barrier enhancing
hydration
• keratolytics (eg, urea or ammonium lactate) – used to remove flakes of dead
skin but these may sting
• linoleic/linolenic acids/phospholipids – fats that support the skin structure and
reduce inflammation
• menthol – provides a cooling effect and reduces itching
• oatmeal – provides a protective barrier over the skin
• shea butter – a non-toxic, solid, fatty oil with skin healing and moisturising
benefits
MOISTURISE ALL ALL OVER OVER
• sunscreens – in day creams to protect against UV rays.
Overall choice of moisturiser depends on aesthetic appeal, previous sensitivity
reactions, cost, and personal preference, and customers may need to sample
several before making their choice.
qv Bath qv Bath oiL oiL
qv cReam qv cReam
Recommend Recommend
Ichthyosis
with with
Ichthyosis is a skin condition characterised by persistently dry, thickened, rough,
fish scale-like skin. There are over 20 different types of ichthyosis. The most
common is the inherited form, ichthyosis vulgaris which affects 1:250 people
with signs and symptoms usually becoming apparent in the first year of life.
Ichthyosis can also be NORMAL acquired in adulthood TO TO often DRY associated DRY with systemic
diseases such as hypothyroidism, sarcoidosis, lymphoma or HIV infection. It may
also be provoked by the use of kava, nicotinic acid and hydroxyurea.
There is no cure for ichthyosis and the main aim of treatment is to prevent
dryness, qv wash qv scaling, washcracking, and the Recommend build-up Recommend of skin. Daily skin moisturisation qv sKin qv Lotion sKin and Lotion
exfoliation is recommended and occasionally with withretinoids (acitretin, isotretinoin)
may be prescribed to reduce scaling. Rubbing wet skin with a pumice stone
before applying moisturiser may help to remove thickened crusty skin and trap in
moisture. Lanolin creams and products containing urea and alphahydroxy acids
can also be beneficial.
Advice for customers
DRIER DRIER
• Try to identify and limit any contributing cause(s) if possible.
• Avoid spending long periods Recommend
of time Recommend in the sun and always use sun protection
qv GentLe qv GentLe wash wash
qv cReam qv cReam
when outdoors during the day. with with
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant)?
• Is there a visible rash, eg, blistering, bumpy, red and/or inflamed
skin?
• Does the skin look infected or have pus or a discharge?
• Are there any thickened patches of skin and/or silvery scales
visible (eg, icthyosis, psoriasis)?
• Does the dryness and itching interfere with sleeping?
• Has the person already tried treatment products without success?
• Is the customer a child?
• Does the person have any allergies to topical medicines?
• Bathe or shower less frequently – once a day is plenty – and use lukewarm
water. Pat skin dry with a towel rather than vigorously rubbing.
• Choose a mild soap or soap substitute, even when the skin is in good condition
– normal soap is very alkaline and can irritate or dry the skin.
• Dress appropriately for the weather.
• Frequently moisturise.
• Keep hydrated by drinking plenty of fluids.
• Wear gloves or use a barrier cream if your hands are frequently in water.
• Hypoallergenic or unperfumed skin products may be less irritating.
Soap-free, irritant-free, fragrance-free
DRIEST DRIEST
MOISTURISE ALL ALL OVER OVER
MOISTURISE ALL OVER
qv intensive qv intensive
QV INTENSIVE
oistURisinG moistURisinG cLeanseR cLeanseR
MOISTURISING
CLEANSER
Recommend Recommend
with with
R R
qv intensive qv intensive qv Bath qv oiL Bath oiL
BodY QV INTENSIVE BodY moistURise moistURise
QV BATH OIL
BODY MOISTURISE
Recommend Recommend
with with
qv cReam qv cReam
QV CREAM
•
•
NORMAL TO TO DRY DRY
Page 61

Ear Conditions
Our ears allow us to hear and keep our balance. Each ear consists of three
parts: the outer, middle and inner ear. The outer ear collects sounds from the
environment and funnels them through the rest of the ear. It is composed of
the pinna (the flap of skin that channels sound), the external ear canal, and the
tympanic membrane (eardrum).
The tympanic membrane separates the outer ear from the middle ear. The
middle ear is an oval, air-filled space approximately 2cm 3 in volume that contains
three tiny bones (the hammer, anvil and stirrup) that form a chain which conducts
sound waves from the tympanic membrane to the inner ear.
The inner ear is a complex structure about the size of a pea that is responsible
for interpreting and transmitting sound and balance sensations to the brain. The
main components of the inner ear are the vestibule, semicircular canals and the
cochlea.
Ear problems can be caused by a number of different things including:
• improper cleaning with cotton buds or other objects that can damage the
delicate lining of the ear
• ineffective water drainage out of the ear after swimming or showering
• inherited structural defects
• infections (particularly infections such as tonsillitis and sinusitis) or sensitivity
reactions to topical products, ear plugs, jewellery or cosmetics
• medicines that may affect balance
• wax build-up.
Initial assessment
Only a visual examination of the outer ear is possible in a pharmacy setting as
specialised equipment is needed to look into the ear canal. Therefore treatment
is limited to conditions which affect the external ear, such as ear wax, swimmer’s
ear, and contact dermatitis from sensitivity reactions (see also Dermatitis/
Eczema). Obtain an accurate description of the problem from your customer
and refer those with a "yes" answer to the Refer to Pharmacist questions to
a pharmacist.
Ear wax (cerumen)
Many people do not realise how important ear wax is for helping to maintain the
natural function of the ear. It is formed from wax glands in the external ear canal as
well as other components, such as dead skin, sweat and oil, and helps to protect the
ear from water and infection. Customers should be discouraged from using cotton
buds or other devices (hairgrips, pens) to clean the wax out of their ears as this can
result in wax impaction and disrupt the thin skin layer that lines the ear, causing
infection. In addition, constantly poking things into the ear can actually increase the
production of ear wax.
The ears are typically self-cleansing and only a few people are genetically more
prone to excessive ear wax production. In these people, problematic wax should be
removed with drops, by irrigation with warm water, with gentle suction, or by a
doctor or audiologist. Preparations available OTC to soften ear wax, or for ear
irrigation, work better for people with small to moderate amounts of wax. Ear
candles are NOT recommended as there is no evidence that they are effective and
the risk of burns is high.
TREATMENT OPTIONS
Category Examples Comments
Ear wax removal drops
Ear cleansing products
Swimmer’s ear products
Natural / herbal products
/ supplements
[GENERAL SALE] eg, Audiclean, Otifleks,
NeilMed, Waxsol
[PHARMACY ONLY MEDICINE]
eg, Auralgan, Cerumol*, Ear Clear*
[GENERAL SALE] eg, Audiclean, Ear
Clear Ear Cleanser*, Earigate
[GENERAL SALE]
eg, isopropyl alcohol ear drops (Audiclean
Swimmers Ear), propylene glycol/acetic
acid (Vosol)
eg, ear plugs (Hush A Foam, Macks range)
eg, Swim Seal Ear Drops
Ear wax removal and swimmer’s ear
Warm olive oil (eg, Cerumol Olive Oil)
Glue ear
Echinacea (eg, Kiwiherb De-Stuff)
Tinnitus
Gingko biloba (eg, Tebonin EGb 761)
Helps soften or loosen ear wax. Warming of drops prior to use may improve effectiveness. Once drops are
administered, the patient should lie with the ear containing the solution uppermost for five to 10 minutes.
Some drops contain a local anaesthetic to relieve ear pain. Prolonged use of these medicines may lead to
hypersensitivity and irritation. Consult a doctor if pain occurs when using these medicines.
Contain purified sea water to wash away dirt and excess wax instead of pushing it into the ear canal.
These products are safer than cotton buds (cotton buds are not recommended for cleaning out ears).
Products may contain acetic acid, propylene glycol or isopropyl alcohol to dry up any water in the ear. These
products are usually more effective at preventing rather than relieving swimmer’s ear.
Ear plugs help keep water out of the ears during swimming and showering.
Swim Seal ear drops contain a mixutre of polysiloxane and tea tree oil that coats the ear canal, providing a
barrier against water. Self-removing.
Olive oil may help soften wax aiding removal. One drop placed in the ears is also good for relieving an itch
and is better than sticking cotton buds or other objects into the ear.
Echinacea root preparations may help prevent or relieve upper respiratory tract infections, reducing the risk
of otitis media and the development of glue ear. There is no evidence that ear candling is effective and it may
leave deposits of candle wax in the ear or burn skin.
Ginkgo biloba extract may help with balance and inner ear noise.
Cemurol 13/9/02 10:12 AM Page 1
Products with an asterisk have a detailed listing in the Ear Conditions section of OTC Products, starting on page 235.
®
CERUMOL
“I said, you
need Cerumol
ear wax
remover.”
For the easy
removal of ear wax
Contains: Chlorbutal 5% w/v; Ortho-dichlorobenzene 14% w/v; Para-dichlorobenzene 2% w/v; and
Arachis Oil 57% w/v; Contra-indications; Otitis Externa, Seborrhoeic Dermatitis and Eczema affecting
the external ear. * Fraser JG: Jouirnal of Larying and Otol. 1970;34: 1055-64
Page 62 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Swimmer’s ear (otitis externa)
Swimmer’s ear is a condition of the outer ear canal that commonly occurs in
swimmers. Water, humidity, heat and moisture can cause the thin layer of skin
that lines the ear canal to soften and swell, making it prone to infection by
bacteria.
Early symptoms include an itching within the ear and a slight redness
of the ear canal. Pain and drainage of fluid suggest infection. Attempts to
remove water or scratch inside the ear with cotton buds or other objects may
cause further disruption to the skin lining and make the condition worse.
Referral to a doctor for antibiotics is often necessary.
Swimmer’s ear is best prevented by drying the ears thoroughly after
exposure to water and using a product containing a water-evaporating
agent (see Treatment options: swimmer's ear) to remove any moisture
collected within the external ear canal. People prone to swimmer’s ear should
also wear ear plugs during swimming or showering.
Otitis media
Otitis media is inflammation of the middle ear, causing a build-up of fluid, with
or without infection. If there is an infection it is often viral. Many children have
several bouts of otitis media before they are seven years old. Symptoms include
crying, ear-pulling, mild fever and irritability.
It is important for children to see a doctor, who will investigate ear pressure
since chronic unrelieved pressure within the ear may result in glue ear. Antibiotics
are not necessarily prescribed routinely for otitis media, but paracetamol or
ibuprofen may be given to help relieve pain.
Glue ear
Glue ear is a type of chronic otitis media. Long-term build-up of thick or “sticky”
fluid in the middle ear, behind the eardrum, causes hearing loss, which may
affect socialisation skills and/or learning ability, especially if hearing loss is not
recognised in early childhood.
Any suspicion of hearing impairment in a child, such as inattention at school,
lack of response to instructions, apparent disobedience or wanting the television
very loud, should be checked by a doctor.
Advice for customers
• Cotton buds or other devices should not be used for cleaning ears since they
can result in the wax becoming more deeply impacted.
• For people prone to ear wax impaction, regular ear wax removal by a doctor
every six to 12 months is recommended.
• Check any suspected hearing loss, especially in children.
»»
Free ear checks are available for preschool children up until the age of five.
»»
Children aged five to 16 with suspected hearing loss may be entitled to a
free hearing assessment through a hospital audiology clinic.
»»
Free hearing checks are available for New Zealanders over the age of 16
Cemurol 13/9/02 10:12 AM Page 2
through Life Unlimited Hearing Therapy Services (0800 008 011).
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications) that may be possibly associated with
the ear condition (eg, tinnitus and salicylates)?
• Is the customer a child?
• Was there any trauma to the ear preceding the current problem
(eg, insertion of a cleaning tool), or could the eardrum be
perforated?
• Is there any pain or discharge (eg, pus or blood)?
• Did any neck or head injury occur before the ear pain started?
• Is the customer experiencing any middle-ear pain, tinnitus (ringing
in the ear), and/or dizziness?
• Is there any unusual growth visible (especially in elderly people)?
• Is the customer feeling generally unwell or has a fever?
• Is hearing acutely impaired or has it been gradually deteriorating?
• Is it possible a foreign object may be lodged in the ear?
• Have the symptoms persisted despite treatment, or has the ear
become itchy with treatment?
• Does the person have any allergies to topical medicines?
• Constant low noise, eg, lawn mowing, may impair hearing long term. Use ear
protectors if working in a noisy environment, including the home environment.
• Ensure correct nose-blowing technique. Regular blowing (instead of sniffing)
may help prevent glue ear incidence in children.
is the easy way to remove ear wax. Clinical trials confirm that
CCerumol is efficient and reliable and is especially effective in softening
and removing hard wax.*
Cerumol is so easy to use, patients can administer it themselves. The loosened
wax may clear from the ear after the application of five drops of Cerumol;
otherwise, after 10 to 30 minutes, the softened wax can be removed by
gentle syringing.
Proven effective and easy to use for over 40 years, Cerumol is the treatment
you can recommend with confidence.
For further information please contact:
BDM Grange Limited
PO Box 40-147, Glenfield, Auckland
Tel: (09) 443 9300 Fax: (09) 443 9301
TAPS PP2836
Page 63

Eye Conditions
Almost two-thirds of New Zealanders will have an eye problem at some stage of
their lives. Some of the more common conditions seen in the pharmacy include
red eye, dry eye, conjunctivitis (allergic, bacterial, viral), minor eye irritations,
blepharitis and styes. These conditions together with treatment options are
discussed in more detail on the following pages.
Initial assessment
If the eye problem is not immediately obvious, ask your customer if they are
willing for a pharmacist to perform a basic eye examination. Even for minor or
ongoing conditions, a customer may benefit from further input from a pharmacist.
Basic eye examination: Notes for pharmacists
Wash your hands and ask the customer to sit down in a private area with good
light. Ask the patient to look straight ahead and pull down the lower eyelid.
Instruct the patient to look up, then down, to the left and right while you examine
the conjunctiva. Look for signs of redness, dryness, foreign bodies (eg, wood
splinters), and infection. Use the charts on the following pages to identify the most
likely condition and recommended treatment. For foreign bodies, consider using
an eye wash to flush out the object or refer the customer to the doctor if the object
is strongly embedded or difficult to remove. Base your product recommendation
or decision to refer on information gained during the examination. Customers
wearing contact lenses, with eye or eyelid swelling, pupils that do not react to
light, reporting vision disturbances or with an uncertain diagnosis should always
be referred to a doctor or an optometrist holding a Therapeutic Pharmaceutical
Agents (TPA) endorsement (able to prescribe a range of ophthalmic medicines).
Advice for customers
Applying eye drops
• Wash hands first.
• Shake the container if instructed to do so to mix the eye drops, then open.
• Pull the lower eyelid down gently with the index finger to form a pocket. Tilt
head slightly back and look up.
• Hold the bottle between thumb and index finger and squeeze it gently to
release the recommended number of drops into the pouch.
• Do not touch eye with the dropper tip.
• Do not blink (this draws the eye drop into the tear duct).
• Close eye and press gently over the corner of the eye for a few minutes to
stop the drop draining through the tear duct. Remove excess drops with a
clean tissue.
• Wait 10 minutes before adding other eye products to the eyes. Put eye drops
into the eye before putting in eye ointment.
Applying eye ointment
• Hold tube between thumb and index finger and rest hand against base of nose
to position the ointment tube tip.
• Apply a small blob of ointment into the lower eyelid pocket. Do not touch the
eye with tube tip.
• Eye ointment may blur vision for a short time after use. Do not drive or operate
machinery until vision is clear.
TREATMENT OPTIONS
Category Examples Comments
Natural / herbal products
/ supplements
Bilberry
Euphrasia (eyebright)
Vitamin C with bioflavonoids
Styes
Black tea
Pulsatilla
Dry eyes
Omega 3 & 6
Flaxseed oil
Bilberry is used for improving visual acuity including night vision, cataracts, degenerative retinal conditions.
Euphrasia can help relieve sore and irritated eyes.
Vitamin C may help decrease the risk of age-related macular degeneration.
Several herbs have infection-fighting properties; however, eye washes containing these ingredients should
only be made by a herbal practitioner trained in botanical medicine.
Topically applied Pulsatilla may help with styes.
A tea bag applied to the stye may help clear it.
Increasing omega 3 and 6 intake can lower risk of developing dry eye syndrome.
For severe or
chronic dry eye
Page 64 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Eye mist sprays
• Usually formulated to relieve dry eyes.
• Spray directly onto closed eyelids. Moisturising particles are then swept into
the eye with every blink.
• Easier to use and last longer than regular eye drops; however, may be more
expensive.
Useful tips
• Some eye products contain preservatives or ingredients that can affect contact
lenses, or may cause a sensitivity with continued use.
»»
Check with the pharmacist or optometrist regarding compatibility.
»»
Preservative-free eye drops may be more suitable.
»»
Discontinue products that make eyes red or even more irritated.
• Damage to the eyes can easily occur if eye conditions are left untreated.
»»
Without the protection of the tear film, the cornea can scratch easily which
can result in infection, ulcers, scarring and potentially permanent vision
loss.
• Protect eyes from wind and sun by wearing sunglasses.
• Discard multi-use eye products one month after opening unless otherwise
stated. Single-use products are sterile until they are opened. Eye mist sprays
are designed to keep the product sterile even when in use. Refer to package
instructions for discard date.
• Replace eye make-up frequently and do not share.
• Contact lens wearers should always follow their optometrist's instructions
with regards to lens hygiene (see Eye Conditions: Contact Lenses)
• Consider visiting an optometrist every two years for an eye examination.
»»
Eye problems are more likely as people age.
»»
Eye diseases can be detected earlier, eg, glaucoma is symptomless.
»»
Contact lens wearers should see an optometrist at least yearly.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions that may cause
eye problems (eg, immunosuppression, diabetes)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications) which might have adverse effects on
the eyes?
• Does the customer wear contact lenses?
• Does the customer have a family history of eye problems (eg,
glaucoma)?
• Does the customer have pain in the eye(s) or is sensitive to light?
• Is only one eye affected?
• Do they have any deterioration, alteration or loss of sight?
• Do they see halos or yellow/green colours around lights?
• Is there any swelling of the iris or eyeball?
• Are the pupils different sizes or an irregular shape?
• Is there any coloured discharge or mucus from the eye?
• Is there redness localised around the pupil?
• Are the tissues around the eye(s) swollen, red or sore (indicates a
more serious infection in the skin and underlying tissue)
• Are there any systemic symptoms (eg, headache, vomiting)?
• Is the cornea cloudy?
• Has the problem persisted despite treatment?
• Has the eye problem been ongoing or recurrent?
• Is there or has there been a foreign body in the eye?
• Is the customer a baby, young child, pregnant, menopausal or
elderly?
• Could the customer have a herpes zoster infection (shingles),
indicated by a painful rash on the forehead or near the affected
eye?
• Does the customer have any allergies to topical eye products or
preservatives?
For mild or
moderate dry eye
Preservative and phosphate-free
At least 300 sterile drops per bottle
Use for 6 months after opening
Use with all contact lenses
Delivered through the
unique COMOD ® multidose
application system
HYLO®-FRESH (Sodium hyaluronate 0.1% w/v, 10mL) and HYLO-FORTE® (Sodium hyaluronate
0.2% w/v, 10mL) eye drops are General Sales Medicines to improve the lubrication of the eye, in eyes
that are dry, irritated and tired from external factors. AFT Pharmaceuticals, Auckland. TAPS 1733HA.
Page 65

Eye Conditions (continued)
Type Symptoms Advice for customers Treatment options
AGE-RELATED
MACULAR
DEGENERATION
(AMD)
BACTERIAL
CONJUNCTIVITIS
ALLERGIC
CONJUNCTIVITIS
VIRAL
CONJUNCTIVITIS
Loss of vision or blurred area near the
center of vision in one or both eyes. Vision
loss may occur gradually, or suddenly.
Blurred area may become larger or blank
spots may develop in the central vision.
Loss of vision may interfere with everyday
activities. Objects may not appear as sharp
or bright as they used to be.
AMD is common and the leading cause
of vision loss among people over the age
of 50.
Symptoms are red, burning, sore eyes often
with puffy eyelids and a thick white/yellow
discharge. Eyelids may be stuck together on
awakening.
Symptoms come on suddenly and both eyes
are usually infected (it is very contagious),
although one eye may be affected a day
or so before the other. Symptoms usually
resolve themselves within about one to two
weeks. Antibacterial eye drops may hasten
recovery by a couple of days.
Symptoms include very itchy, burning, sore
red eyes with puffy eyelids and maybe dark
pouches below the eyes, and clear, copious
discharge that may be watery or sticky.
There is often a history of other allergic
symptoms, eg, sneezing and runny or
congested nose (see Hay Fever).
Symptoms are red, sore and gritty eyes
with a clear watery discharge. Some itching
and swelling may be present, with some
crusting on the eyelids. One or both eyes
may be infected.
Frequently caused by the common cold
virus or adenoviruses; other viral symptoms
may also be present (eg, fever, sore throat).
Symptoms may last two to three weeks. If
herpes simplex is involved, there will be no
other viral symptoms but there may be cold
sores elsewhere (see Cold Sores). Refer to
a doctor immediately as herpes simplex can
cause scarring and perforation of the cornea.
AMD is more common in people over the
age of 50, in caucasians compared with
African-Americans or Hispanics/Latinos and
in people with a family history of AMD.
Stop smoking if you smoke; smoking
doubles the risk of AMD.
Exercise regularly, keep blood pressure and
cholesterol under control, and eat a diet rich
in green, leafy vegetables and fish.
Get a comprehensive dilated eye exam at
least once a year.
Bathe eyelids with warm water or saline
solution and use warm compresses. Soak
cloth in nappy solution and wash thoroughly
after each use.
Do not share face cloths, towels or eye
drops. Dispose of tissues carefully.
Do not use a decongestant eye drop as it
can mask the redness and thereby mask
worsening infection.
Wash hands frequently and after any contact
with the eyes.
Apply a cold flannel to soothe the eyes.
Avoid triggers (eg, pollen, animal dander)
where possible.
Wash hands frequently and after any contact
with the eyes.
Combination eye drops containing
decongestants should not be used for
more than three days, to avoid rebound
congestion in the eyes.
Viral conjunctivitis is contagious so do
not share face cloths, towels or eye drops.
Dispose of tissues carefully.
Wash hands frequently and after any contact
with the eyes.
If symptoms do not improve or get worse
seek medical advice.
Consider taking supplements shown in trials to reduce the risk
of late AMD by 25%. Known as AREDS and AREDS2 these
substances contained clinically effective dosages of vitamin C.
vitamin E, zinc oxide, cupric oxide, and beta-carotene, lutein,
or zeaxanthin.
[GENERAL SALE]
eg, Macu-Vision Blackmores* (contains ascorbic acid, cupric
oxide, zinc oxide, vitamin E)
Bacterial conjunctivitis can be treated with antibacterial/
antibiotic eye drops. Consider using single-use wipes to keep
eyes clean.
Hypoallergenic pH-balanced wipes eg, Clear Eyes, Fess
Antibacterial eye drops
[PHARMACY ONLY MEDICINE]
eg, propamidine isethionate (Brolene Eye Drops*)
[PHARMACIST ONLY MEDICINES]
eg, Chloramphenicol eye drops 0.5% (Chlorafast),
Chloramphenicol eye ointment 1% (Chlorsig)
Treat with antihistamine tablets or eye drops (see Hay Fever).
Hypoallergenic pH-balanced wipes eg, Clear Eyes, Fess
Mast cell stabilisers (eye drops)
[PHARMACY ONLY MEDICINE]
eg, cromoglycate (Cromo-Fresh), lodoxamide (Lomide)
Preventive medicines used four times daily on an ongoing basis.
Antihistamines (eye drops)
[PHARMACY ONLY MEDICINE]
eg, levocabastine (Livostin), ketotifen (Zaditen)
Decongestant combinations (eye drops)
[PHARMACY ONLY MEDICINE]
eg, naphazoline (+ antazoline: Albalon A Allergy; +
pheniramine: Visine Allergy; + zinc: Clear Eyes Allergy)
There are no OTC preparations available to treat viral
conjunctivitis. Treat symptomatically using soothing lubricant
eye drops and bathing the eyes. Consider using single-use
wipes to keep eyes clean.
Hypoallergenic pH-balanced wipes eg, Clear Eyes Wipes, Fess
Little Eyes Wipes
[GENERAL SALE]
eg, Celluvisc Drops (PF) , Clear Eyes-D, Clear Eyes Eye Mist Spray
(PF)
, Hylo-Fresh* (PF) , GenTeal (PF) , Optive, Optrex Actimist 2 in1
Tired & Uncomfortable Eye Spray,Refresh Plus (PF) , Refresh Tears
Plus, Refresh Liquigel, Systane
Products with an asterisk have a detailed listing in the Eye Conditions section of OTC Products, starting on page 235-237.
READY, SET, LEARN!
Page 66 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Type Symptoms Advice for customers Treatment options
MINOR EYE
IRRITATIONS
RED EYES
DRY EYES
BLEPHARITIS
STYES
PF = Preservative-free
Symptoms are red, sore, watering eyes, with
or without itch.
Causes are numerous, including allergies,
late nights (“party eyes”), wind, dust,
smoke, air conditioning, air pollution,
chemicals, sunlamps, glare (snow, sand,
sun, sea), staring at a computer.
A patch of bright red in the whites
of the eye is called a subconjunctival
haemorrhage. It usually causes no pain and
is self-limiting, clearing in about one week.
Symptoms are dry and gritty eyes (feels like
sand in the eye). Caused by an imbalance
in the tear film that lubricates the eye
between blinks so may also cause eyes
to water as tear film now ineffective for
lubrication. Eyes may look slightly pink or
have a fine crusting on the lids. Contact
lenses may not sit properly on the eye.
Caused by ageing, contact lens wear,
hormone fluctuations (eg, with menopause,
oral contraceptive use, pregnancy), medical
conditions (eg, rheumatoid arthritis),
irritants (eg, smoke, dust, wind), surgery,
trauma, and certain medicines (eg, diuretics,
antihistamines, decongestants and tricyclic
antidepressants).
Symptoms include inflammation of the
eyelids, with crusting or scales at lid
margins.
The eyelids are usually red, thickened,
burning, sore and feel itchy, and may be
stuck together in the mornings.
There may be photophobia (sensitivity to
light).
The condition is often chronic and tends to
be associated with dandruff and/or dry eye.
A stye is an infected gland at the base of
an eyelash. Symptoms include a localised
painful, swelling in the upper or lower
edge of the eyelid, which is sensitive to
touch. The eyes may water and be sensitive
to light. A person with a stye may report
feeling as if they have a foreign body in the
eye. Most styes resolve spontaneously.
Allergy is a common cause of red eye (see
allergic conjunctivitis previous page).
Avoid the cause if possible.
Eye drops containing decongestants should
not be used for more than three days, to
avoid rebound congestion in the eyes.
Treat cause if possible and keep wellhydrated.
Damage to the eyes can occur if
left untreated for too long, as the cornea can
easily get scratched.
Protect eyes from the wind and wear
sunglasses when outside. Use an eye wash
to soothe sore, irritated and tired eyes. Use
lubricant eye drops (artificial tears) during
day and lubricant eye ointment at night.
Throw multi-use eye drops away one month
after opening unless otherwise stated.
Consider using preservative-free eye drops
long term as sensitivities can develop with
regular use of preservative-containing drops.
Daily eyelid hygiene is important for control.
Baby shampoo (not soap) may be used to
make an effective eyelid wash solution. Put
about half a teaspoon of baby shampoo
into a bowl of hot, not boiling, water. Wet a
clean cloth with the solution. Place the cloth
over the eyes as a compress for two minutes.
Clean around the eyelashes gently, using a
cotton bud dipped in the hot baby shampoo
solution. Undertake this treatment twice
a day, then less often as the blepharitis
settles. Rinse the cloth first in nappy wash
solution and then fresh water before use to
avoid bacterial contamination of the cloth.
Treat any dandruff (see Dandruff).
Most styes resolve themselves when they
rupture and pus is released.
Warm-to-hot (but NOT boiling) compresses,
using a clean cloth applied three to six times
daily, can hasten the “pointing” of the stye.
Avoid touching the stye, or squeezing it, or
using make-up near it.
Treat minor eye irritations with lubricants or decongestant eye drops.
Lubricant eye drops/eye spray
[GENERAL SALE]
eg, Celluvisc (PF) , Clear Eyes Eye Mist Spray (PF) , GenTeal (PF , Hylo-
Fresh (PF , Optrex ActiMist 2 in 1 for Dry & irritated Eyes, Optrex
Actimist 2 in1 Itchy & Watery Eye Spray, Refresh Plus (PF) , Systane
Decongestant eye drops
[PHARMACY ONLY MEDICINE]
eg, Albalon A Allergy (with antihistamine), Albalon Relief (PF) ,
Albalon, Clear Eyes, Clear Eyes Allergy, Optrex Red Eyes Eye
Drops*, Visine Clear, Visine Advanced
Eye wash
[GENERAL SALE]
eg, Optrex Eye Wash with Eye Bath
Lubricant eye products do not cure dry eyes but mimic the
effect of natural tears so can relieve the symptoms. Regular eye
washes may help improve symptoms.
Eye wash
[GENERAL SALE]
eg, Optrex Eye Wash with Eye Bath*
Lubricant eye drops/eye spray
[GENERAL SALE]
eg, Celluvisc Drops (PF) , Clear Eyes-D, Clear Eyes Eye Mist Spray
(PF)
, Hylo-Fresh* (PF) , GenTeal (PF) , Optive, Optrex Actimist 2 in1
Dry & Irritated Eye Spray, Optrex Actimist 2 in1 Itchy & Watery
Eye Spray, Optrex Actimist 2 in1 Tired & Uncomfortable Eye
Spray, Optrex Sore Eyes*, Refresh Plus (PF) , Refresh Tears Plus,
Refresh Liquigel, Systane
[GENERAL SALE]
eg, lubricant eye ointment (Refresh Night Time Eye Ointment (PF) ,
Viscotears Gel)
These may temporarily blur vision after instillation.
Blepharitis is not curable but daily lid hygiene can help control
the symptoms. Lubricating eye drops also help to supplement the
inadequate natural tear film. Antibiotic drops are only required if
the blepharitis is not kept under control with lid hygiene.
Lubricant eye drops
[GENERAL SALE]
eg, Celluvisc Drops (PF) , Clear Eyes Eye Mist Spray (PF) , GenTeal (PF
, Optive, Optrex ActiMist 2 in 1 for Dry & irritated Eyes, Refresh
Plus (PF) , Refresh Tears Plus, Refresh Liquigel, Systane
Antibacterial eye drops
[PHARMACY ONLY MEDICINE]
eg, propamidine isethionate (Brolene Eye Drops)
Consider using single-use wipes to keep eyes clean. Topical
antibacterial/antibiotic drops may prevent secondary infection
occurring when the stye ruptures, but are usually not necessary.
Hypoallergenic pH-balanced wipes eg, Clear Eyes Wipes, Fess
Little Eyes Wipes
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Page 67

Eyes: Contact Lenses
Contact lenses are an alternative to wearing glasses for poor eyesight, although
some are worn for cosmetic reasons (eg, to change colour of the eyes).
There are two general categories of contact lenses: soft and rigid gas
permeable (RGP) lenses. Hard contact lenses are now obsolete.
Disposable and extended-wear lenses are types of soft contact lens. These are
the most common, as they are usually better tolerated; however, RGP lenses offer
advantages for people with certain eye conditions.
Disposable and extended-wear (soft) lenses
Disposable and extended-wear lenses are made from soft, flexible materials
that allow oxygen to pass through to the cornea. They are quick to get used to
wearing, so can be used occasionally (ie, just for sport). They have a high water
content, are more stable on the eye during exercise, and are easy to remove.
They are less likely to trap dust and eyelashes than RGP lenses, although they
can be easily torn if not cared for properly. Various types are available.
Vision-correcting disposable lenses
These are worn for a set period of time (eg, daily, two-weekly, monthly) then
thrown away. Daily disposable lenses remove the need for cleaning, while weekly
or monthly lenses require nightly care so should be removed each night.
Vision-correcting leave-in (extended-wear) lenses
These are designed to be worn continuously, day and night, for up to 30 days
and then thrown away. They are made from silicone hydrogel, which allows more
oxygen to reach the cornea than standard soft lenses. This means the eye can
breathe, even while you sleep.
“Cosmetic” lenses
Soft lenses are also available that enhance the colour of the eyes or add special effects
(such as designs) to them. The middle of the lens is left clear so the person can still see;
however, vision may be affected if the lens slips from its correct position.
Customers wanting advice about cosmetic lenses should always check with an
optometrist before using them, as some people have eye conditions that make
them unsuitable.
People who wear cosmetic lenses are prone to the same infections as visioncorrecting
lens wearers, so lenses must be cleaned and disposed of as instructed.
Cosmetic lenses should never be shared.
Rigid gas permeable (RGP) lenses
RGP lenses are made of durable plastic that has a high permeability to oxygen.
They are smaller in diameter than the cornea (8–10mm). The good oxygen
transmission maintains corneal health and the risk of corneal infections and
allergic reactions is lower than with soft lenses. RGP lenses also provide better
vision, durability, and deposit resistance than soft contact lenses. They usually
take longer to get used to initially (soft lenses are instantly comfortable) which is
the main reason they are not as popular as soft contacts.
RGP lenses may be better suited to people with astigmatism (although soft
toric lenses are available) or those with presbyopia since bifocal and multifocal
types are available. Patients with keratoconus (a cone-shaped cornea that causes
severe visual disturbances) may require a RGP lens to achieve reasonable vision,
as may people requiring contact lenses after refractive surgery. Although RGP
lenses are more expensive initially than soft lenses, they can last for years so
can work out cheaper in the long run. An ophthalmologist may be able to apply
for a government subsidy to help with the costs of contact lens wear in certain
TREATMENT OPTIONS
Category Examples Comments
Disinfecting/cleaning
products
For soft lenses only, eg, Bausch & Lomb
ReNu Fresh, BioTrue, MeniCare Soft, Opti-
Free PureMoist, Oxysept
RGP lenses only, eg, Total Care 1 Solution,
Boston Advance Conditioning Solution, Lobob
Optimum, MeniCare Plus
Cleaning products include multi-purpose solution, daily cleaner, hydrogen peroxide solution, cleaning/
disinfecting devices.
Immediately after removing lenses each day, clean them with a cleaning solution to remove eye-produced
build-up such as protein, cosmetics and other debris.
Place lens in the palm of the hand, put two or three drops of the cleaner on it and rub well for 20 to 30
seconds. Note some cleaners are ‘no rub’ cleaners. Leave for as long as recommended.
Saline solutions
Protein removal tablets
Suitable for both soft and RGP lenses eg,
Lens Plus Saline
RGP lenses only eg, Menicon Progent
Soft lenses eg, AMO Ultrazyme Protein
Remover Tabs
Useful for rinsing lenses or dissolving protein tablets.
Rinse lens for recommended time to remove cleaner and loosened debris.
Removes excess protein deposits from lenses that are worn for longer periods of time.
If used with correct cleaning products some lenses do not require separate protein removal.
Lubricants, artificial
tears, wetting agents
Suitable for all types of lenses, eg, Complete
Blink-N-Clean, Blink Contacts, Refresh
Contacts, Vistil Eye Drops
Lubricants can help improve dry eye in contact lens wearers although referral to an optometrist is
recommended as dry eye in contact lens wearers can sometimes be resolved by changing the lens type or
improving gland function around the eye.
Page 68 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
conditions.
Because they can last for years, RGP lenses require scrupulous cleaning and
disinfecting to keep the wearer safe from eye infections.
Initial assessment
All customers with contact lenses should be refered to a pharmacist as they are
prone to more serious eye conditions. Contact-lens wearing customers whose
eyes are red, uncomfortable, painful, sensitive to light or who have abnormal
vision should see a doctor or optometrist immediately. It is especially important
that pharmacy staff do not sell a lens cleaning or rewetting product if they are
not 100% sure that it is compatible with the customer's lens type.
Laser eye surgery
Photo-refractive keratectomy (PRK) and laser in situ keratomileusis (LASIK) are
two laser eye surgery techniques that are commonly used for correcting shortsightedness
(myopia), long-sightedness (hyperopia), astigmatism and presbyopia.
PRK is more suitable for treating mild degrees of myopia. A layer of cells
covering the cornea is removed then a laser is used to alter the shape of the
front of the cornea.
LASIK uses a highly specialised laser underneath a corneal flap to reshape the
cornea, and provides improved results for people with greater degrees of myopia,
hyperopia and astigmatism.
Orthokeratology
Orthokeratology (also called Corneal Refractive Therapy) is a non-surgical, noninvasive
and reversible process of using a specially designed contact lens to
reshape the cornea during sleep, allowing lens-free clear vision throughout the
next day.
Research has shown that orthokeratology can slow down and even stop the
progression of short-sightedness in children and teenagers. Effects are usually
noticed after the first night, and lenses are worn nightly initially, reducing to two
or three nights a week to maintain the effect long term.
Orthokeratology is available throughout New Zealand.
»»
Dry lenses may be rehydrated with saline, rewetting solution, or lubricant
drops before reinsertion. Soft lenses become brittle if they dry out.
»»
Do not exceed the recommended wearing time of your lenses.
»»
Never share contact lenses.
• If contact lenses make eyes drier than normal, lubricant eye drops are available
that are compatable with contact lenses.
»»
Consider using preservative-free products long term.
• Insert lenses before applying make-up and remove them before removing
make-up.
»»
Cream or gel eye shadows are less likely than powders to fall into the eye.
»»
Avoid mascara with lash-building fibres.
• Do not use lens-care products or eye products (especially make-up) past their
expiry date.
• If you lose or drop a lens:
»»
For a RGP lens, use a vacuum cleaner with pantyhose over the inlet to catch
the lens
»»
For a soft lens, turn out the light and shine a torch around the room (the
light will reflect off the lens).
Eye products and contact lenses
• Remove contact lenses before using eye drops or ointments, except when
using lens-wetting agents or when directed by the optometrist to keep the
lenses in.
• Soft lenses in particular may become stained when exposed to chemicals in
diagnostic eye drops, some medicated eye drops and some medicines taken by
mouth that are then secreted in tears (eg, rifampicin, sulfasalazine).
Advice for customers
• See an optometrist for an eye check regularly (at least every 12 months).
• Always wash, rinse and dry hands before handling lenses.
• Do not use tap water or saliva on contact lenses.
»»
A naturally occurring amoeba found in water can cause an infection that
can be difficult to treat and has the potential to lead to blindness.
»»
Dirty storage cases, incorrect cleaning of lenses and using tap water or
saliva on lenses or lens cases are common sources of infection.
»»
Use an unused toothbrush to clean the lens case every week before rinsing
with lens cleaner. Replace the case every month.
»»
Never touch lens solution bottle tips to any surface as they may become
contaminated.
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Page 69

Fever
What is fever
Fever is defined as a rise in the normal body temperature and is generally
considered present when body temperature rises above 38°C. Normal body
temperature varies by person, age, activity, and time of day (usually lower in the
morning and higher at night). Many other factors, such as the menstrual cycle,
can also affect temperature.
The average normal body temperature in adults is considered to be 37°C,
with a range of 36.1 to 37.2°C. Temperature measured under the arm or in the
ear is usually about 0.5°C lower than oral body temperature, and that in the
rectum about 0.5°C higher. It is important to remember that the reading on a
thermometer is not the most important indication as to how sick a person is. Do
not underestimate or dismiss a perception that a person feels hot when a hand
is placed on their forehead or looks “off-colour”.
Other symptoms
Depending on the cause of the fever, other symptoms may also be present such
as aching muscles, cough, earache, enlarged lymph glands, headache, loss of
appetite, pain (which may cause irritability in a child), shivering, tiredness or a
rash.
Causes
Fever is a common medical symptom that is most often associated with infection
although it may occur with a number of other conditions such as:
• allergic reactions
• cancer (most commonly leukaemia, lymphomas, renal cancer)
• cerebral haemorrhage (stroke)
• immunological disorders (eg, lupus erythematosus)
• metabolic disorders (eg, gout, porphyria)
• myocardial infarction (heart attack)
• thromboembolic events (eg, deep venous thrombosis, pulmonary embolism).
Vaccinations, some medicines, and extreme sunburn can also cause a fever.
Body temperature is controlled by an area of the brain called the hypothalamus
which acts like a thermostat. Body temperature is normal when the heat
produced within the body, particulary by the liver and muscles, is in balance
with the heat lost by the body. A fever occurs when the hypothalamus resets
body temperature in response to infection (as part of the inflammatory response)
or other body condition. Usually, as a person’s temperature is rising, there is a
feeling of cold until it reaches the new set temperature, when there becomes a
feeling of warmth. Later, when the thermostat is reset to its normal level, the
body eliminates excess heat through sweating and shunting of blood to the skin.
Initial assessment
Customers presenting with symptoms such as skin discolouration (pale, ashen,
blue, or mottled), respiratory changes (faster breathing rate or visible use of chest
muscles), reduced activity levels (difficulty in rousing, lack of response to social
cues, continuous crying), a faster heart rate, or reduced skin turgor (degree of
skin elasticity) are likely to have a serious underlying reason for their fever and
should be referred to a doctor immediately. For all other customers, run through
the Refer to Pharmacist questions and refer those with a "yes" answer to a
pharmacist.
Treatment
Controversy surrounds the usefulness of fever and whether it should be treated
with antipyretic (temperature-lowering) medicines (eg, paracetamol, ibuprofen)
or not. Research has shown that fever can help fight infection by enhancing
the body’s immunological response, and creating an unbearable environment
for some pathogens. Most experts recommend that antipyretics be used only
occasionally, if at all, in low-grade fevers to relieve discomfort rather than
specifically to lower body temperature. These medicines will not shorten the
duration of an illness.
TREATMENT OPTIONS
Category Examples Comments
Antipyretics
[GENERAL SALE]
eg, aspirin (Aspro, Disprin range)
eg, ibuprofen 25s (Nurofen range)
eg, ibuprofen suspensions (Fenpaed,
Nurofen for Children)
eg, ibuprofen + paracetamol >25s
(Maxigesic, Nuromol)
eg, paracetamol suspensions (Pamol,
Panadol Colour Free, Paracare)
Consider occasional antipyretic use to make the person feel more comfortable. Paracetamol is not
recommended for routine use before or after vaccination as it may reduce the effectiveness of childhood
vaccinations to stimulate lasting immunity (infection-fighting ability). If taking paracetamol for pain relief, be
careful not to double-up with other combination medicines containing paracetamol.
All non-steroidal anti-inflammatory drugs (NSAIDs, eg, ibuprofen, aspirin) have risks involved with use and
may not be suitable for people on certain other medications or with some medical conditions (eg, asthma,
kidney disease). Advise customers to stop taking if stomach upsets, increased bruising or prolonged bleeding
occur. Aspirin has an increased risk compared with ibuprofen and is generally not the preferred NSAID.
Aspirin is not recommended for children or adolescents under 18 years old (see Childhood Pain and Baby
Teething: Treatment options).
Ibuprofen may be used in children aged over three months, but caregivers should seek medical advice before
using if the child is aged less than one year.
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CONTINUING OTC EDUCATION
Most people just require bedrest and supportive care (such as keeping up fluid
intake, keeping bedding light) to recover from a fever, although other treatments
(eg, antibiotics) may be warranted depending on the cause.
Anybody with a particularly high fever (above 39°C), who is extremely sleepy or
appears very unwell, is refusing fluids, aged under six months or with symptoms
suggestive of meningitis (see Childhood Diseases and Immunisation)
should aways seek medical attention.
Febrile seizures
About 2%–5% of children aged three months to six years will experience a tonicclonic
seizure during a fever. Children aged eight to 20 months are more at risk.
Febrile seizures usually involve loss of consciousness and shaking of the limbs
on both sides of the body. Less commonly, a child may become rigid and twitch
only part of his or her body.
Febrile seizures are thought to be due to a sudden rise in body temperature,
and often occur before the caregiver even realises the child is ill. Cool compresses
or fever-reducing medicines such as paracetamol or ibuprofen will not prevent
a febrile seizure. Most of these seizures resolve themselves after one to five
minutes, are harmless, do not require daily medication, and do not cause brain
damage, although caregivers should seek further medical advice to establish the
source of fever.
If a febrile seizure occurs, the caregiver should lay the child on their side,
somewhere safe, and stay with them while they recover. Any sharp objects near
the child should be removed, and tight clothing loosened. Objects (eg, pacifiers)
should not be placed in the child’s mouth and attempts should not be made to
stop the seizure.
Although most seizures stop on their own, if the seizure persists for longer
than five minutes, caregivers should ring for medical advice. Emergency medical
assistance should be sought if a seizure lasts longer than 10 minutes. Although
alarming for parents, the vast majority of febrile seizures cause no lasting effects.
Advice for customers
• Be alert for symptoms that may indicate meningitis and seek urgent medical
attention if any worrying signs are present or if you are unsure (see Childhood
Diseases and Immunisation).
»»
Classic signs include a fever, stiff neck, headache, sensitivity to light and
nausea or vomiting. A rash may or may not be present.
• A luke-warm bath or cool compresses may provide comfort.
• Dress the person in light clothing and keep bedding light.
• Drink plenty of water and/or electrolyte replacement fluids since fever can
cause dehydration.
• When using a mercury thermometer, always shake before use. Wait 10 minutes
after eating anything hot or cold before taking the temperature.
»»
Tympanic thermometers measure the temperature of the ear drum, but may
underestimate temperature if not used properly.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the child aged less than six years or has pain with the fever?
• Is the fever accompanied by a stiff neck, headache, sensitivity to
light, irritability and/or vomiting? This may indicate meningitis
(see Childhood Diseases and Immunisation)
• Does the person have a temperature above 38°C?
• Is the person quite unwell, very lethargic, difficult to arouse, sleepy
or appearing delirious?
• Is the fever accompanied by a painful, persistent sore throat?
• Is the person experiencing heavy night sweats?
• Does the person also have diarrhoea?
• Has the person been overseas recently?
• Is the person with the fever refusing fluids?
• Does the person have a rash?
• Is fever the only symptom?
• Has the fever lasted more than 48 hours?
• Does the person have any allergies to medicines?
»»
Digital thermometers are preferred in children as there is a risk children may
bite the glass bulb of a mercury thermometer, releasing its contents.
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Page 71

Foot Care
Common foot problems include athlete’s foot, smelly feet, fungal toenail infections,
verrucae, corns and calluses, cracked heels, and blisters.
Athlete’s foot
Athlete’s foot is most frequently caused by a dermatophyte fungal infection
which can infect the skin between the toes and the soles of the feet. The skin may
look white and soggy or scaly, red and itchy. Cracks may be visible and there may
be a slight odour. Dermatophyte fungi live in shed skin scales and are contagious
via direct contact with wet floors and shared footwear or towels. Treatment is
with topical antifungal preparations.
Smelly feet
Feet have more sweat glands than any other part of the body and feet can start
to smell when the sweat cannot evaporate and becomes trapped inside footwear,
providing a warm and moist environment for odour-producing fungi and bacteria
to grow.
Advise customers to avoid wearing the same pair of shoes every day, instead
allow at least 24 hours for shoes to dry out. Socks should also be changed daily.
People prone to more sweaty feet (see also Sweating, excessive [Hyperhidrosis])
may need to use a foot antiperspirant. Any athlete’s foot should be treated and
shoe deodorisers can be used to treat shoes that are also smelly.
Fungal toenail infections
Infected toenails are common and difficult to treat. The nail looks thick and
discoloured, white or yellowish. It may be brittle or crumbly and parts, or all of it,
may fall off (see Fungal Nail Infections [Onychomycosis] for more extensive
information).
Verrucae
Verrucae are warts that occur on the soles of the feet. They are typically grey or
TREATMENT OPTIONS
Category Examples Comments
Topical antifungals
(athlete’s foot)
Antiperspirants and
deodorants (for smelly
feet)
Topical nail preparations
[GENERAL SALE]
eg, zinc undecenoate (Mycota)
[PHARMACY ONLY MEDICINE]
eg, bifonazole (Canesten Bifonazole), clotrimazole
(Canesten), econazole (Pevaryl), ketoconazole
(Daktagold), miconazole (Resolve, Daktarin),
terbinafine (Lamisil, SolvEasy Tinea Cream*)
eg, aluminium chlorohydrate (Neat Feet Roll-On
Foot Deodorant/Cool Foot Spray)
eg, various ingredients (Actifresh Foot Spray,
Gran’s Remedy Powder, Neat Feet Odour Guard
insoles, NODOUR, Scholl range)
See Fungal Nail Infections (Onychomycosis):
Treatment options
Terbinafine is fungicidal and can resolve athlete’s foot with once-daily applications. Most other
antifungals are fungistatic and also effective, although more frequent application and longer treatment
courses (continuing for one to two weeks after the infection has cleared) are required.
Creams are easy to apply. They are good if the skin is moist, because they are water-soluble.
Spray powders can give even cover over the sole and between the toes. Non-spray powders may clump,
but are good for putting in shoes or socks to help reduce reinfection.
Antifungal creams containing hydrocortisone (ie, Canesten Plus, Resolve Plus) also calm inflammation.
A strong antiperspirant deodorant will stop feet sweating, reduce foot odour, soggy skin, and help
prevent athlete’s foot from developing. If athlete’s foot is present, treat. Do not use the same container
on feet and underarms because of the risk of cross-infection.
Powders are long-lasting and may be used on the feet or put into socks.
Cushioned inner soles that contain charcoal may also be effective.
Products for corns,
calluses, verrucae and
warts
[PHARMACY ONLY MEDICINE]
eg, salicylic acid products (Carnation Corn Caps,
Duofilm [+ lactic acid], Scholl range), dimethyl
ether propane spray (Wartner)
Do not use these products on moles or birthmarks. Soak corn or callus in warm water and remove dead
skin with pumice. Protect unaffected skin around the corn, wart or verruca with Vaseline or a plaster
before applying product. Some conditions may need four to 12 weeks’ treatment. Wartner is applied
directly to the wart with a repeat treatment in 15 days if necessary.
Cracked heels
Blisters
[GENERAL SALE] eg, DU’It Foot & Heel Balm,
Ellgy Plus Cracked Heel Cream, Eulactol Heel
Balm range, Neat Feat Foot & Heel, Scholl
Express Pedi, Softening Socks
[GENERAL SALE] eg, hydrocolloid (Compeed
Blister Patch, Scholl range, Spenco range)
Use heel balms regularly to treat or prevent cracked heels. Usually contain either urea, lactic acid or
allantoin which are keratolytic, loosening surface skin cells. which then shed, exposing new skin.
Electronic foot files make it easier to remove dead skin. Softening socks may speed recovery of cracked
heels, particularly if used with a heel balm.
Protects blister from further rubbing, relieves pain and accelerates healing.
Other Orthotic inserts (eg, Scholl range) Correcting poor foot posture and alignment can improve heel and knee pain.
Natural / herbal /
supplements
Apricot kernel, Bitter orange, cider vinegar,
garlic, Kolorex Horopito, tea-tree oil
Various natural topical products have been used in the treatment of athlete’s foot and related fungal
infections.
Products with an asterisk have a detailed listing in the Foot Caresection of OTC Products, starting on page 238.
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CONTINUING OTC EDUCATION
brown and have a cauliflower-like appearance. Small black dots may be visible
near the middle of the wart which is caused by bleeding. Verrucae are caused
by the human papilloma virus which is contagious via wet floors. Although they
can disappear spontaneously, this may take up to two years. Some people may
require surgery to remove painful veruccae.
Corns and calluses
Corns and calluses are areas of hard, thickened skin which build up on areas of
the feet subject to pressure and rubbing. Corns are smaller than calluses and
develop on non-weight bearing parts of the foot, such as the tops of the toes.
They have a hard centre and can be very painful. Calluses are flatter than corns
and are often found on the heel or ball of the foot. Protect corns and calluses
with moleskin or thin podiatry felt and advise customers to wear well-fitting
shoes to reduce pressure and rubbing. A podiatrist may need to cut away the
corn or callus to permanently remove it.
Cracked heels
Cracked heels are common in summer when people wear sandals or go barefoot
and the feet dry out. Treat with a thick, oil-based moisturiser, applied twice daily,
after using a pumice stone or foot file to remove any thickened skin.
Blisters
Blisters can form on the feet when the skin has been damaged (either by friction,
rubbing or poor-fitting shoes), see Cuts, Abrasions and Blisters. Fluid collects
between the upper skin layers and forms a small bubble or pocket. Most blisters will
heal by themselves within three to seven days. Hydrocolloid dressings can be used to
heal blisters, relieve pain and protect the area from further damage.
Initial assessment
If necessary, offer to take the customer into a private area where they can sit down and
you can have a proper look at their feet. Wear gloves and examine the affected area,
noting what symptoms correspond to the conditions above. Refer any customers with
"yes" answers to the Refer to Pharmacist questions to a pharmacist. Also refer
if you are unsure what the condition is, or do not know the appropriate treatment.
Advice for customers
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Is there any bleeding with the problem?
• Has the condition persisted or recurred despite treatment?
• Is a large area involved or are several nails infected?
• Is the condition affecting other parts of the body (eg, face, scalp)?
• Is the condition affecting the person’s ability to walk?
• Is the corn soft and present between the person’s toes?
• Are there any other symptoms (such as itching or a colour change
in a suspected wart)?
• Is the person aged over 50 and is this the first time they have
experienced a wart?
• Is the cracked heel severe or are there signs of infection?
• Does the blister look inflamed or is there any sign of pus?
• Does the person have any allergies to topical medicines?
towels at a high temperature.
• Wear leather shoes or open shoes, such as sandals, to reduce sweating.
• Apply a foot antiperspirant daily if feet sweat a lot.
Cracked heels
• Inspect feet daily and apply a moisturising cream two to three times daily at
the first signs of cracking.
Athlete’s foot, infected nails, verrucae
• Bleach the shower/bath area regularly to kill fungi and viruses.
• Wash socks and towels in hot water and allow to dry in the sun.
• Wear jandals in communal changing areas (ie, at public pools).
Smelly feet
• Wash feet twice daily with an antibacterial soap and dry thoroughly,
particularly between the toes. Use a clean towel.
• Change socks daily and wear cotton, not synthetic, socks. Wash socks and
Page 73

Fungal Infections: Superficial
Superficial fungal infections affect the outer layers of the skin, nails or scalp.
These type of infections are generally mild in healthy people, but may become
severe in people who are very sick or with lowered immunity.
The three main groups of fungi that cause these infections are dermatophytes,
yeasts and moulds. Most fungal infections are treated empirically (ie, diagnosis
is assumed based on history and symptoms). A definite diagnosis requires skin
scrapings and/or nail clippings to be sent for mycology culture and is usually not
done unless there has been no response to typical therapy.
Dermatophyte infections
Dermatophytes feed off keratin and are the main group of fungi to cause
infection of the skin, hair and nails. There are more than 40 different species
of this fungi and they can live for up to a year off the body in shed human skin
scales. They are common in areas with high temperature and humidity, and may
be transmitted either by direct body contact, via towels or clothing, or through
wet surfaces (eg, swimming pool or bathroom floors). Dermatophyte infections
are commonly seen on the scalp (tinea capitis), feet (tinea pedis), groin (tinea
cruris), nails (tinea unguium) and other body surfaces (tinea corporis). Topical
antifungals are effective for treating most dermatophyte infections.
Tinea capitis (ringworm of the scalp)
Symptoms of tinea capitis include scaling and loss of hair on the scalp. More
common in children, it is usually due to contact with an infected kitten or, rarely,
an older dog or cat. It is usually treated with an oral antifungal agent.
Tinea pedis (athlete’s foot)
Dermatophytes are the most common cause of athlete’s foot (see Foot Care).
Tinea cruris (jock itch)
Dermatophyte infections of the groin are more common in men than women.
Symptoms typically include an intensely itchy, reddish/brown rash with a scaly
raised border that spreads down the inner thighs from the groin or scrotum.
Infection often originates from the feet (tinea pedis) or nails (tinea unguium) and
is transferred by scratching or when the person dries themselves with a towel.
Treatment is with antifungal creams or powders.
Tinea unguium
Dermatophytes are a common cause of fungal nail infections (also called tinea
unguium or onychomycosis), although infection can also be caused by yeasts
or moulds. Fungal nail infections are more common as people age and often
spread from dermatophyte infections of the feet, or less commonly, the hands.
Infection most commonly involves the great toenail or little toenail (see Fungal
Nail Infections [Onychomycosis] for more extensive information).
Tinea corporis (ringworm)
Tinea corporis infections usually occur on the trunk or limbs. It is often called
ringworm as infection causes a circular, red and itchy rash that looks like a worm
under the skin. Edges of the rash are usually raised with an area of clear skin
in the middle. Infection can originate from the feet (tinea pedis) or nails (tinea
unguium) or from cats, dogs or cattle. Treatment is with antifungal creams.
Yeast infections
Candida and Malassezia are two common types of yeast.
Candida infections
Candida are white-coloured yeasts which are normal inhabitants of the
TREATMENT OPTIONS
Category Examples Comments
Topical antifungals
Topical nail preparations
[GENERAL SALE] eg, zinc undecenoate
(Mycota)
[PHARMACY ONLY MEDICINE]
eg, bifonazole (Canesten Bifonazole),
clotrimazole (Canesten range),
ketoconazole (Daktagold, Nizoral),
miconazole (Resolve Tinea, Daktarin),
terbinafine (Dermafex Cream, Lamisil
Cream*, Lamisil Dermgel*, Lamisil range,
SolvEasy Tinea Cream)
See Fungal Nail Infections
(Onychomycosis): Treatment options
Terbinafine is fungicidal and can resolve superficial skin infections with once-daily applications. Most other
antifungals are fungistatic and also effective, although more frequent application and longer treatment
courses (continuing for one to two weeks after the infection has cleared) are required.
Each product should be used according to the manufacturer’s instructions. Creams are easy to apply. They are
good if the skin is moist, because they are water soluble. Lotions are suitable for hairy areas. Spray powders
can give even cover on difficult to reach places (eg, under breasts or groin). Non-spray powders may clump,
but may be useful for putting in clothing (eg, bras) to help reduce reinfection. Tinctures may sting if the skin
is broken or irritated.
Antifungal creams containing hydrocortisone (ie, Canesten Plus, Resolve Plus) also calm inflammation.
Natural products Acetic acid, tea-tree oil, garlic Various natural topical products have been used in the treatment of athlete’s foot and related fungal
infections.
Products with an asterisk have a detailed listing in the Fungal Infections: Superficial section of OTC Products, starting on page 238.
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human digestive tract. Most of the time, they cause no symptoms or disease;
however, occasionally, a proliferation of the yeast may be triggered by certain
environmental factors (eg, humid weather, plastic overpants in babies) or when a
person’s natural immunity is lowered. Candida infections (also called candidiasis)
can affect the mucosa (ie, the lining of the mouth, anus and genitals), nail folds,
skin, and rarely the whole body.
Oral candidiasis (also called oral thrush) usually presents as creamy-white soft
elevated patches on the tongue or palate that can be removed to reveal inflamed
mucosa underneath. It is an unusual infection in healthy adults but commonly
occurs in babies, people prescribed inhaled corticosteroids or those who are
immunosuppressed (see Oral Health).
Vaginal candidiasis (also called vaginal thrush or a vaginal yeast infection) is
common in women (see Vaginal Thrush).
Candida is a common cause of chronic paronychia (inflammation of the nail
fold). It causes the nail fold to become swollen and lifted off the nail plate. It
may be red and tender and sometimes a little pus can be expressed. The nail
plate becomes distorted and ridged as it grows. Treatment may take months
and oral antifungal agents may be necessary if topical antifungal creams are not
successful (see Fungal Nail Infections [Onychomycosis] for more extensive
information). Candida infections can also cause or exacerbate nappy rash (see
Nappy Rash).
More severe systemic infections are not covered by this handbook.
Malassezia infections
Malassezia are a normal inhabitant of the skin that are associated with several
conditions such as dandruff (see Dandruff), seborrhoeic dermatitis (see
Dermatitis/Eczema), and pityriasis versicolor.
In pityriasis versicolor, the Malassezia yeast causes pink, coppery brown or pale
patches to form on the skin, typically on the trunk, neck or shoulders. It may be
mildly itchy and more noticeable in dark-skinned people. This infection is more
common in hot, humid climates or in those who sweat heavily, so may recur each
summer. Selenium sulfide (found in some anti-dandruff shampoos) or a topical
antifungal product is usually effective if applied overnight for at least two weeks.
Oral antifungal agents prescribed by a doctor may be needed for extensive pityriasis
versicolor or when topical treatments have failed. Partaking in vigorous exercise
an hour after taking the medicine may help sweat the antifungal agents onto the
skin surface, increasing effectiveness.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
or a caregiver's history may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers or elderly people to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Is the infection in a nail or is the mouth, scalp or beard involved?
• Is there any oozing, blisters, crusting, swelling, or a foul odour?
• Is this a recurring infection or is the infected area extensive?
• Is the infection vaginal?
• Is the itching severe with broken, chapped skin?
• Has previous treatment been unsuccessful?
• Does the person have any other symptoms (eg, flu-like symptoms,
increased thirst or urination)?
• Does the person have any allergies to topical medicines?
Initial assessment
Decide if you can appropriately and respectfully discuss or visualise the customer's
skin condition in the pharmacy. If not, involve a pharmacist. Refer other customers
with "yes" answers to the Refer to Pharmacist questions to a pharmacist;
also refer if you are unsure what the condition is, or do not know the appropriate
treatment product.
Mould infections
Moulds can be picked up through soil contact and can occasionally infect the skin
or nails. Mould infections of the feet can appear similar to tinea pedis and in the
nails may be indistinguishable from other types of fungal nail infection, although
mould infections commonly cause inflamed nail beds, unlike dermatophyte
infections. Mould infections are often difficult to treat and should be suspected if
antifungal treatment has been ineffective. Refer to the pharmacist.
Page 75

Fungal Nail Infections (Onychomycosis)
Fungal nail infections (also known as onychomycosis or Tinea Unguium) account
for 15%–40% of all nail diseases. Prevalence increases with age and the
condition affects almost 20% of people older than 60 and over 50% of people
in their seventies.
The infection actually resides in the nail bed and on the underside of the nail
plate. Symptoms can vary but may include:
• nail discolouration or white or yellow streaks on the nail
• a crumbly or brittle nail edge or lifting or thickening of the nail
• complete nail destruction.
Either fingernails or toenails may be infected and usually more than one nail
is involved. Fungal fingernail infections may occur with paronychia (infection of
the nail fold, see below) and fungal toenail infections commonly coexist with
athlete's foot (see Foot Care). People with diabetes are three times more likely
to develop onychomycosis than people without diabetes. People with diabetes
are also prone to complications such as foot ulcers, osteomyelitis, cellulitis and
gangrene which may or may not originate from fungal nail infections.
Onychomycosis is also more common among people who sweat excessively,
athletes, men, people with psoriasis or with immunodeficiencies such as HIV.
Dermatophytes are the main group of fungi responsible, although some
fungal nail infections may be caused by yeasts (eg, Candida albicans) or moulds
(eg, Scopulariopsis brevicaulis). Trichophyton rubrum is the most common
dermatophyte implicated, and this fungus is prevalent and hard to eliminate from
carpeting, showers and changing-room floors.
Paronychia
This, usually painful, condition affects the nail fold (skin at the sides of the nail).
Redness and swelling are key features of paronychia and sometimes pus or a
discharge may be present. Staphylococcus aureus are the most likely bacterial
cause. Occasionally, the cold sore virus (herpes simplex), C. albicans, or moulds
may be responsible. Risk of paronychia is highest in people who have constantly
cold and wet hands (eg, dairy farmers, fisherman, cleaners), after manicuring,
and in children who bite or pick their nails.
Paronychia may also affect the way the nail grows, especially if it remains
untreated for long periods of time. It may cause distortions, ridges, or
discolouration of the nail. Topical antibiotics may be needed for severe or
prolonged bacterial infection, and it may take up to a year for the nail to grow
back after recovery.
Initial assessment
If the customer has onychomycosis of the toenails, offer to take them to a private area
where they can sit down and you can have a proper look at their feet. Determining
the severity of the infection is important, as severely infected toenails or fingernails
are unlikely to respond to pharmacy-sold treatment products.
Some fungal nail infections are also difficult to distinguish from other types
of infections or medical conditions, such as psoriasis (usually affects all nails
and tends to exist elsewhere on body), dermatitis (fingers or toes are typically
TREATMENT OPTIONS
Category Examples Comments
Topical nail preparations
Fungal nails
[PHARMACY ONLY MEDICINE]
eg, amorolfine (Loceryl Nail Lacquer),
bifonazole (Canesten Fungal Nail),
ciclopirox (Apo-Ciclopirox Nail Lacquer),
poly-ureaurethane (RestoraNail*)
eg, Excilor Fungal Nail, Nailclin Antifungal
Nail Treatment, Pronail Fungal Nail Pen
Discoloured and damaged nails
eg, Loceryl Nail Gel
eg, poly-ureaurethane (RestoraNail*)
Products for infected nails usually work better if most of the infected part of the nail is removed or extensively
thinned before application. Application needs to be regular and consistent and according to manufacturer’s
instructions.
RestoraNail contains poly-ureaurethane, a unique substance that covers and protects the nail, treating both
the fungal infection and repairing damage.
Excilor and Nailclin contain a mixture of ingredients designed to penetrate the nail plate and alter the pH of
the nail bed preventing fungal growth.
Loceryl Nail Gel visibly improves discoloured nails and restores natural water content. Also promotes healthy
regrowth. It is not an antifungal treatment like Loceryl Nail Lacquer.
Natural products Tea-tree oil, garlic Tea-tree oil has been effective at treating fungal nail infections. Garlic reportedly has antifungal properties.
Products with an asterisk have a detailed listing in the Fungal Nail Infections section of OTC Products, starting on page 238.
TREATS DAMAGED
NAILS AND FUNGAL
NAIL INFECTIONS
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CONTINUING OTC EDUCATION
also affected by dermatitis), or Lichen planus (this autoimmune disease causes
thinning of the nail plate, and grooves and ridges in the nail. The nails may shed
or stop growing altogether).
Refer all customers with "yes" answers to the Refer to Pharmacist questions
to a pharmacist.
Treatment
Treatment is important not only for cosmetic reasons. Unsightly nails can have
a significant impact on a person's quality of life and can cause significant
discomfort, difficulty in walking or wearing footwear, embarrassment, and
lower self-esteem. Infected nails also serve as a reservoir for fungi with a
potential to spread to the feet, hands, and groin, and to other members of the
same household. Interestingly, children rather than spouses of infected people
are more likely to become infected, indicating some genetic susceptibility.
Treatment of onychomycosis, particularly toenail infections, can be difficult.
Options available in a pharmacy are limited to topical antifungal products, but
oral antifungal agents, chemical or surgical removal of the nail, and laser or other
therapies may also be considered. Pharmacy-marketed topical treatments should
only be attempted if the fungal infection involves less than 50% of the distal part
of the nail (not the matrix or growth centre), no more than three nails, and the
cuticle is not affected. Refer all other customers to a doctor or podiatrist.
Unfortunately, topical antifungal agents such as amorolfine 5% and ciclopirox
8% have a clinical cure rate (nail clearing) of only about 8%–38%. The low
efficacy appears to be due to inability of the drug to penetrate through the nail
plate to the nail bed where the infection resides. Although treatment sheets advise
filing of the nail before application, thickening of the nail is often extensive and
filing almost an impossibility for some people with limited sight and flexibility.
One fungal nail treatment uses urea cream initially to debride the nail before
topical bifonazole is applied. Reported clinical cure rates for this combined
approach are high, indicating the importance of nail debridement with urea.
Despite claims of treatment success within two months or less, make customers
aware that although the infection may be gone, it can take six to 18 months for
nails to grow back.
Other nail treatment solutions are formulated to allow direct penetration
through the nail plate and lower the pH of the nail bed, preventing fungal
growth. No filing of the nail is required before use.
Referral to a doctor is needed for more extensive nail involvement or with
treatment failure. Oral antifungal tablets with good distribution in skin and nails
include terbinafine and itraconazole. The British Association of Dermatology
Guidelines considers terbinafine first choice if not contraindicated, due to a higher
efficacy and tolerability. Since both drugs persist in the nail for a considerable
length of time after dosing, intermittent or “pulse” therapy regimens are also
effective. Several months of treatment is needed.
Other fungal nail treatments include laser devices, photodynamic therapy,
iontophoresis, and ultrasound.
Refer to
PHARMACIST
Ask specific questions relating to the apparent infection, and refer
any “yes” answers or elderly customers to the pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Does the infection involve more than three nails or more than 50%
of any one nail?
• Does the infection involve the matrix (growth part of the nail)?
• Is there any oozing, blisters, crusting, swelling, or a foul odour?
• Has the person had fungal nail infections before?
• Has previous treatment been unsuccessful?
• Does the person have any other symptoms (eg, flu-like symptoms,
increased thirst or urination)?
• Does the person have any allergies to topical medicines?
Customer advice
Lifelong preventive measures are recommended for people with a history of
nail infections once the current infection has resolved. Protective footwear should
always be worn in hotel bedrooms, gyms, and changing rooms of public bathing
facilities where T. rubrum commonly resides. Absorbent antifungal powders
should be used regularly in shoes and on the feet. Nails should be kept as short
as possible and nail clippers should not be shared with family members or friends.
Advise customers to wear comfortable, well-fitting shoes to avoid trauma to the
nail and to discard old and mouldy shoes to prevent reinfection.
Frequent manicures and pedicures predispose many people to a variety of nail
problems and customers should be advised to only choose nail salons with good
sterilisation techniques.
Treats the damage
Easy and convenient
Treats the fungal infection
Covers and protects the nail
Proven to kill fungal infections in as little as a month 1
Reference: 1. Nasir, A., Swick, L., et al., “Clinical Evaluation of Safety and Efficacy of a New Topical Treatment for Onychomycosis”. J. of Drugs in Dermatology.
2011;10;10;1186-1191. RestoraNail Nail Solution (Poly-ureaurethane 16% in organic solvents, 15mL) is a nail treatment solution for use with nail dystrophy
and fungal infections. AFT Pharmaceuticals Ltd, Auckland. TAPS 1733HA
Page 77

Gout
Historically known as the “disease of kings” due to its association with rich foods,
alcohol and wealth, gout is common today among New Zealanders of a wide
socioeconomic range. Gout affects four times as many men than women and
Maori and Pacific Island men are disproportionately affected (10–15% affected
compared with 1%–2% of men with European ancestry). Gout is uncommon in
women until after menopause.
Gout is a form of arthritis that can easily be mistaken for a bacterial cellulitis
(an infection in the first two layers of skin). An acute attack causes sudden
intense swelling, redness and warmth in a joint, most commonly the big toe,
although it can occur in the ball of the foot, instep, ankle, knee, wrist, tip of the
elbow or fingers. Gout is considered the most painful of all types of arthritis with
the patient unable to weight-bear or wear shoes if the gout is present in the
foot. In addition to localised pain, a person with gout may also have a mild fever
or feel unwell.
Left untreated, gout can lead to permanent joint destruction and kidney
damage and can double the risk of a heart attack or stroke.
Causes of gout
Although the most common reason gout occurs is due to high uric acid levels
(hyperuricaemia) in the blood, the relationship between uric acid and gout is
not clear-cut, as many people with hyperuricaemia never develop gout, while
some patients with repeated gout attacks have normal or low blood uric acid
levels. An inherited tendency to excrete less uric acid through the kidneys is the
primary reason people have high uric acid levels. See table opposite page for
other common causes of hyperuricaemia.
Gout occurs when uric acid accumulates in a joint and saturates out to form
tiny needle-shaped crystals. The body mounts an inflammatory response to the
crystals in that joint leading to the characteristic gout symptoms of inflammation
and pain. Most early gout attacks resolve spontaneously after seven to 10 days,
but in practice the severe pain usually forces people to seek treatment earlier.
The length of time between attacks can vary widely, with some patients only
ever having one attack. For the majority of patients, a second attack will occur
within a year. If a patient’s uric acid level remains high (>0.36mmol/L) despite
the patient being symptom free, there can be ongoing joint inflammation which
results in joint damage and tophi formation.
Tophi
Years of unresolved gout can lead to chronic tophaceous gout. Tophi are firm
white translucent nodules that can occur around the joints or on the external ear
and arise from the deposition of urate crystals. They usually take at least five to 10
years after the initial attack to develop. As well as causing joint destruction, they
are disfiguring and also cause physical hindrance. Although effective treatment
can lead to the regression of tophi, they are far more difficult to manage once
they have developed.
Risk factors for gout
Research has located a specific genetic variant within a gene that doubles the
risk of gout in Europeans and increases the risk by more than five times in people
TREATMENT OPTIONS
Category Examples Comments
Acute gout
[PHARMACY ONLY] or
[PRESCRIPTION](higher dosages)
Non-steroidal anti-inflammatory
drugs (NSAIDs) eg, diclofenac,
naproxen
[PRESCRIPTION]
Oral corticosteroids eg, prednisone
Intra-articular corticosteroids, eg,
methylprednisolone, triamcinolone
[PRESCRIPTION]
eg, Colchicine (Colgout)
Give regularly until severe pain reduces then decrease dosage (ie, diclofenac 75mg bd or naproxen 500mg bd initially).
May not be suitable for some people taking other medicines or with some medical conditions (eg, asthma, kidney
disease), and should be discontinued if stomach upsets, increased bruising or prolonged bleeding occur.
See Reference section, OTC Medicines – Precautions.
Alternative if NSAIDs are contraindicated. Infection should be excluded before using.
Intra-articular corticosteroids may be considered if gout localised to single joints.
No longer considered first-line treatment for acute gout, but may be used as an alternative treatment, or as an adjunct
to NSAID treatment. Can also be used as a prophylactic. Overdosage can cause diarrhoea.
Prevention of gout
[PRESCRIPTION]
eg, allopurinol
[PRESCRIPTION]
eg, febuxostat (Adenuric)
eg, benzbromarone
[PRESCRIPTION]
eg, probenecid (Probenecid AFT)
Usually started at least two weeks after an acute gout attack. 1%–2% of people develop a rash (more common in
patients with renal impairment). Regular allopurinol taken before the start of an acute attack should be continued.
Available on special authority for those with special conditions, contraindications, intolerance, or who have failed to
respond to treatment with other preventative drugs.
Useful for patients with normal renal function and urate under-excretion. May be used in combination with allopurinol
in certain people (ie, with persistent hyperuricaemia). Contraindicated in patients with a history of renal stones. Ensure
good fluid intake (eight glasses of water per day). If a patient has been taking probenecid regularly at the time of an
acute attack, it should be continued.
PharmacyToday
A part of your
everyday
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CONTINUING OTC EDUCATION
of Maori or Pacific ancestry. People who drink soft drinks sweetened with high
fructose corn syrup (HFCS) or consume diets rich in fruit or fruit juice are also at
increased risk. In addition, certain medical conditions (eg, type 2 diabetes, kidney
problems, elevated blood pressure), some medicines (eg, diuretics, cytotoxics),
large intakes of purine-rich foods or alcohol (particularly beer) and joint injury
also contribute to the risk.
Treating a gout attack
Non-steroidal anti-inflammatory drugs (NSAIDs) are recommended first line
(unless contraindicated) as pain relief for acute attacks of gout (see Treatment
Options previous page). Corticosteroids or low dose colchicine can be used as
an alternative to NSAIDs.
Any medicine used to treat acute attacks should be taken at the first sign of
an attack at an effective dose. In most people, pain and inflammation caused by
the gout can be controlled within 12–24 hours and treatment discontinued after
a few days.
Drugs used for gout attacks have no effect on reducing uric acid levels and all
customers with symptoms suggestive of gout should be referred to a doctor for
consideration of allopurinol or probenecid. Early prevention of gout, before the
onset of tophi, erosive disease and renal impairment, is vital.
Preventing gout
Most experts agree preventive therapies should aim to reduce serum uric
acid concentration to below 0.36mmol/L (some experts aim for as low as

Haemorrhoids
Haemorrhoids (also called “piles”) are common, affecting around one in two
adults at some point in their lives. They occur when the anal cushions (pillows
of vein-containing tissues that seal the anal canal and maintain continence)
become engorged and swollen. They can be classified into two types:
• internal haemorrhoids, which occur inside the lower rectum and are not
usually visible. They can cause a feeling of pressure in the rectum and often
bleed but are usually painless. Occasionally, they may prolapse (pop out)
through the rectum with a bowel motion, which can be quite painful. Some
easily “pop back in”, either by themselves or when pushed with a finger, but
others may remain prolapsed which can lead to complications
• external haemorrhoids, which develop under the skin around the anus.
These are typically visible surrounding the anal sphincter. They look like small
bunches of grapes and when inflamed become red and very tender, itchy and/
or painful and usually bleed with every bowel motion. Occasionally a blood
clot forms inside an external haemorrhoid, and can be felt as a firm, tender
mass in the anal area, about the size of a pea. It can cause severe pain. If the
clot does not go away by itself with haemorrhoid creams, it can be removed by
a doctor in a minor office procedure. When the clot dissolves, excess skin may
be left behind which may itch or become easily irritated.
Causes of haemorrhoids
Haemorrhoids are thought to be caused by certain factors that increase pressure
in the anal cushions or degenerate the elastic tissue around the anus. Chronic
(long-lasting) constipation, straining during bowel movements, and prolonged
sitting on the toilet all interfere with blood flow to and from the rectal area and
carry the most risk. Pressure or tissue degeneration in the anal region can also
be due to aging, obesity, heavy lifting, chronic diarrhoea or a low-fibre diet, poor
posture, pregnancy or childbirth, sitting or standing for long periods of time,
spinal cord injury, anal intercourse and, rarely, rectal or bowel tumours.
Some families may be genetically more susceptible to developing haemorrhoids.
Symptoms of haemorrhoids
The most reported symptom is bleeding from the rectal area, especially after a
bowel motion. This may be visible either as bright red blood on toilet tissue, in
the toilet bowl, or on the outside of the stools.
Constant wiping of protruding haemorrhoids can cause an irritation called
pruritus ani which results in itching. Some people may also report a burning or
dull pain in the rectal area, especially when trying to pass a bowel motion, or
when sitting for long periods.
Constipation is often associated with haemorrhoids.
Initial assessment
Many people with haemorrhoids are reluctant to discuss their condition and
may prefer to self-select a product. However, a tactful enquiry such as "Are
you managing your condition okay or would you like further information from a
pharmacist", may be appreciated. Always refer patients reporting rectal bleeding
who have not yet seen a doctor to a pharmacist.
TREATMENT OPTIONS
Category Examples Comments
Products for
haemorrhoids
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, Anusol ointment and suppositories
(contains zinc oxide, Peruvian balsam,
benzyl benzoate)
eg, Rectogesic finger protectors
[PHARMACY ONLY]
eg, Proctosedyl ointment and
suppositories* (contains cinchocaine and
hydrocortisone)
[PHARMACIST ONLY]
eg, Rectogesic ointment (contains glyceryl
trinitrate)
[PRESCRIPTION]
eg, Ultraproct ointment and suppositories
(contains fluocortolone and cinchocaine)
Artemis Vein Support, Calendula, grape
seed extract, horse chestnut, witch
hazel, Lucas Papaw ointment, Weleda
Haemorrhoid ointment
Products are usually made up of a combination of different ingredients.
Anaesthetics (eg, cinchocaine) numb the area to relieve pain, burning and itching.
Astringents (eg, zinc oxide) reduce secretion of mucus and fluids from damaged skin cells and provide a
protective barrier.
Anti-inflammatories (eg, hydrocortisone) reduce inflammation and swelling of the haemorrhoid, but are
recommended only for short-term use as they can cause skin atrophy.
Skin protectants (eg, Peruvian balsam) provide a protective coating over the damaged skin, preventing further
irritation and relieving itchiness.
Benzyl benzoate has weak antiseptic properties and is also used as a vehicle for dissolving other active
ingredients.
Suppositories may be better for internal haemorrhoids. Remind customers to always remove the foil or plastic
wrap before inserting the suppository. Products are best used after a bowel motion.
For some treatment products the dosage may change over days or weeks; always follow instructions.
Most products are well tolerated but discontinue use if skin irritation or sensitivity develops.
Finger protectors protect fingers when applying ointments to the anal area.
Glyceryl trinitrate relaxes the internal and sphincter muscle, allowing anal fissures to heal.
Antioxidants (eg, grape seed extract) and astringents (eg, witch hazel) can help relieve haemorrhoids.
Weleda ointment contains horse chestnut, witch hazel and calendula which can help temporarily relieve the
itching, burning and discomfort associated with haemorrhoids.
Papaw ointment can temporarily relieve the discomfort of haemorrhoids.
Products with an asterisk have a detailed listing in the Haemorrhoids section of OTC Products, starting on page 239.
READY, SET, LEARN!
Page 80 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Treatment of haemorrhoids
Treatment generally relieves symptoms such as itching, pain and swelling, but
will not cure haemorrhoids. The choice of treatment depends on the severity of
symptoms and if the haemorrhoids are internal or external.
Suppositories or topical ointments that are packaged with a nozzle for
internal rectal use are used to treat internal haemorrhoids. Initially it may be
more comfortable to apply ointment with a finger rather than use the nozzle,
particularly if the haemorrhoids are very inflamed and painful. Topical ointments
can be applied directly to external haemorrhoids using a fingertip.
Products are best applied after defecation once the anal area has been
thoroughly cleaned (unfragranced wet wipes are usually more effective and
kinder at cleaning the region than toilet paper).
It can take up to one week for external haemorrhoids to disappear or improve.
Many patients will require further specialised therapy, such as sclerotherapy
(injection of a substance into the haemorrhoid), rubber-band ligation therapy
(small rubber bands are placed around the haemorrhoid causing it to shrink), laser
or infrared coagulation (causes the haemorrhoid to harden and shrivel), stapled
haemorrhoidopexy (staples are used to anchor the haemorrhoid in place) or surgery
for persistent haemorrhoids.
Advice for customers
• Keeping the stools soft helps prevent haemorrhoids from occurring.
»»
Eat a diet high in fibre (fruit, vegetables, wholegrains).
»»
Maintain a reasonable fluid intake (six glasses of water a day).
»»
Treat any constipation if present (see Constipation) and avoid straining
when passing a bowel motion if possible.
• Avoid foods and drinks that may make haemorrhoids worse, including spicy
foods, nuts and seeds, and alcohol.
• Get plenty of exercise and avoid sitting for long periods.
• Do not ignore the urge to go to the toilet (“holding-on” can lead to increased
pressure inside the anus).
• Use unfragranced wet wipes instead of toilet paper to clean the anal area.
»»
Avoid soap as this may further aggravate the problem.
»»
Ensure used wipes are discarded appropriately and not flushed as they can
easily block sanitary systems.
• Apply products only as directed and for the recommended time. If treatment
fails to improve haemorrhoids, seek further medical advice.
• A cold compress applied to the area may help with symptoms.
»»
Alternatively sitting in a warm bath for 15–20 minutes at a time (a sitz
bath) after each bowel movement may provide relief.
»»
Gently pat the area to dry afterward, or alternatively use a hair dryer.
• Wear cotton underwear to minimise discomfort.
• Avoid scratching the anal area.
• Sit on a cushion rather than a hard surface to reduce the swelling of existing
haemorrhoids and prevent the formation of new ones.
Refer to
PHARMACIST
Generally, all patients with rectal bleeding who have not received
a formal diagnosis should be referred to a doctor. Pharmacists
should also refer any customers with “yes” answers to the following
questions to a doctor.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications) that may be causing constipation?
• Is the person unsure of the diagnosis?
• Is there any rectal bleeding not related to bowel motions?
• Is blood mixed into the stool (not just sitting on top of it)?
• Have the symptoms lasted more than three weeks?
• Have the symptoms not improved after a week of treatment?
• Does the haemorrhoid prolapse and have to be pushed back in, or
can’t be pushed back in with a finger?
• Is there any pus or other signs of infection around the anal area?
• Is there any severe sharp pain with bowel motions or a feeling of
not being able to completely empty the bowel?
• Are any other symptoms present (eg, abdominal pain, fever,
vomiting, nausea, loss of appetite)?
• Has the person with the haemorrhoids noticed an unexplained
weight loss or feels tired all the time?
• Have there been any recent changes in bowel habits (eg, onset of
constipation or diarrhoea for the first time)?
• Is the person buying for a child with supposed haemorrhoids?
• Does the person have any allergies to topical medicines?
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Page 81

Hair Loss
Alopecia is the medical term for hair loss. Hair loss is common, with almost 60%
of men and up to 40% of women experiencing it at some point in their lives.
While genetic inheritence plays a major role in most cases, many other factors
contribute to hair loss, some of which are only temporary.
Stages of hair growth
We are born with all the hair follicles we are ever going to have, and these
follicles usually continue to produce hair for the rest of our lives. However, as we
age, some follicles start replacing longer hairs with finer, almost invisible hairs –
this may look like we are losing hair, but in fact the hair has just become smaller.
Human hair has three different growth phases: anagen, catagen and telogen.
At any given time, hairs will be in various stages of growth or shedding.
Anagen (growing) phase
The anagen phase is the active or growing stage of hair growth. On average, hair
grows 0.3–0.4mm/day or around 12–15cm per year. During this phase the hair
root is long, white and tapered.
How long hair stays in this growing stage is genetically predetermined and
explains why some people’s hair grows longer than others. Around 85% of hair
follicles are in this phase at any given time, although hair on different parts of the
body varies as to how long it stays in this phase. On the scalp, the anagen phase
can last for two to seven years, whereas on the arms, legs, eyelashes, and eyebrows
this anagen growth phase only lasts around 30–45 days. At some point in the anagen
phase, an unknown signal causes hair to go into the catagen phase.
Catagen (transition) phase
Hair growth stops in the catagen phase as the hair root sheath begins to shrink
and becomes rounded as the follicle prepares to enter the telogen phase. This
phase lasts for about two to three weeks, but can be as short as two days.
Telogen (resting and new hair growth) phase
This is the final stage of hair growth, also called the resting stage. The hair is fully
grown and the root of the hair is now completely rounded. Pulling out a hair in
this phase will reveal a solid, hard, dry, white material at the root.
This phase lasts about three to four months for scalp hair but much longer for
hairs on other parts of the body – around nine months for eyebrow hair. Hair is
shed when a new anagen hair begins to grow under the resting telogen hair. Fifty
to 100 telogen hairs are shed daily from a normal scalp.
Common types of hair loss
Hair loss can affect localised areas of the scalp or occur evenly over the whole
area. Other hairy parts of the body may also be affected.
Male-pattern hair loss
Male-pattern hair loss (androgenetic alopecia) is an inherited condition, caused
by a genetically determined sensitivity to the effects of dihydrotestosterone
(DHT). DHT is thought to shorten the anagen phase of the hair cycle, causing
progressively finer hairs to be produced. The disorder is characterised by a
receding hairline and/or hair loss on the top of the head, and male Caucasians
are more likely to be affected.
Female-pattern hair loss
The hereditary female-pattern of balding is characterised by a diffuse thinning
of the hair on the scalp due to an increase in hair shedding or a reduction in
hair volume. It is more common during or after menopause with around 40% of
women by age 50 showing signs of hair loss. The hair loss process is not usually
constant and there are often accelerated phases of hair loss for three to six
months, followed by periods of stability lasting six to 18 months.
Telogen effluvium
Excessive shedding of telogen hairs occurs. This may be acute and temporary
or chronic and persistent. Although the thickness and length of the hair may
be reduced, because new hair continues to grow, it does not result in baldness.
Acute telogen effluvium usually follows some major shock to the body and as
many as 70% of the anagen hairs can be precipitated into the telogen phase.
The telogen hairs remain firmly attached to the scalp at first. It is only about two
months after the initial shock that the new anagen hairs growing up through the
scalp push out the dead telogen hairs and increased hair shedding is noticed.
Causes are numerous, including accidents, childbirth, surgery, certain
medicines (eg, discontinuing the oral contraceptive pill), excessive sun exposure,
TREATMENT OPTIONS
Category Examples Comments
Products for hair
regrowth
Natural / herbal products
/ supplements
[PHARMACY ONLY MEDICINE]
eg, minoxidil 5% topical solution/foam
(Regaine Extra Strength Foam/Solution,
Regro Hair Growth Spray)
Gingko biloba (Sebamed Anti-Hairloss
Shampoo), lavender oil, thyme, rosemary,
cedarwood, saw palmetto, zinc
Minoxidil is recommended for men who have a general thinning of hair on the top of the scalp (vertex pattern
only). Not intended for frontal baldness or a receding hairline. Hair shedding may temporarily increase during
the first few weeks of use. Some men may see regrowth after two months; in others it may take up to four
months. Continued use is required to maintain hair regrowth.
Some oils and herbs may help maintain a healthy scalp, encouraging hair growth.
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excessive weight loss or major dietary changes, illness (especially with fever),
and jet lag. In most cases the condition is self-correcting and complete recovery
occurs within six to nine months, although it may be incomplete in some cases.
Chronic telogen effluvium is characterised by a persistent or cyclical diffuse
hair loss and inability to grow the hair long. There may be fluctuations in severity
of the shedding (eg, cyclical variations) similar to moulting that occurs in other
mammals. Although chronic telogen effluvium does not cause baldness, bitemporal
recession of hair is common (high forehead).
In some cases of telogen effluvium, tests may be done to exclude thyroid
disease and to check levels of iron, vitamin B12 and folic acid, as any deficiency
in these can slow hair growth.
Anogen effluvium
Hair shedding occurs due to interruption of the anagen phase of growth, and
can result in baldness. Most common causes are chemotherapy, toxins or
inflammation.
Alopecia areata
Round bald patches appear suddenly, most often on the scalp, although any
hair-bearing areas can be affected (eg, eyebrows, eyelashes, beard). May occur at
any age, including childhood. It is thought to be due to an autoimmune disorder,
and commonly affects more than one member of the family, or in people with
chromosomal disorders eg, Down’s syndrome.
Alopecia areata is often first noticed by hairdressers, as the initial bald patch
may be small. This enlarges over time before new growth occurs. Complete
regrowth may take months, or sometimes years to occur; one patch can be falling
out while another is regrowing.
Various forms of the condition can exist including alopecia totalis when all
scalp hair is lost, and alopecia universalis where the entire body hair is shed.
Initial assessment
Take an empathic approach when talking with a customer about their hair
loss, as they may be distressed by it. Take a look at their hair and listen to their
history to determine if they have any of the more common conditions listed
above. Reassurrance that the hair should grow back may be all that is needed
in customers with a temporary cause for their hair loss (such as illness, jet lag,
childbirth). Before selling minoxidil to men, make sure the product is appropriate
for their pattern of hair loss and they are aware of the pros and cons. Refer
any customers with "yes" answers to the Refer to Pharmacist questions to a
pharmacist; also refer if you are unsure what treatment would be best.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Has the person been diagnosed with another health disorder (eg,
iron deficiency, thyroid disease, systemic lupus erythematosus)?
• Has the person had chemotherapy or take any medication
(including herbal/complementary medications) that may be
contributing to the hair loss?
• Does the scalp look flaky, scaly or does it itch?
• Is the person younger than 18 years?
• Does the person compulsively twist or pull out his own hair?
• Has minoxidil been used for 12 months without success?
• Does the person have any allergies to topical medicines?
[PRESCRIPTION MEDICINE], hair replacement or transplantation, laser therapy,
keratin treatment, hairpieces, or hormonal treatments.
Advice for customers
• Handle hair gently and avoid over-vigorous combing, brushing, tying up and
any type of scalp massage.
• Treat dandruff or psoriasis if present.
• If using a hairdryer, use on a low setting to avoid damaging the hair shaft.
• Relaxation techniques may help with hair loss caused by stress.
• Eat a well-balanced diet and consider supplements with deficiencies.
Treatment for hair loss
Better results are achieved by people who seek help as soon as they notice their
hair starting to thin out, fall out or becoming thinner or shorter than normal. Early
treatment is the key to successful regrowth. Treatment options vary according
to the type of hair loss but may include minoxidil solution, finasteride tablets
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Page 83

Hay Fever
Hay fever (also called intermittent or seasonal allergic rhinitis) is an allergic
reaction that occurs seasonally, most commonly in spring and summer. Hay fever
can have a huge impact on a person's quality of life, with 20% of sufferers
experiencing symptoms for more than nine months of the year. Customers with
symptoms that happen continuously throughout the year are more likely to have
another form of rhinitis, called persistent allergic rhinitis (see Sinus and Nasal
Problems).
Hay fever is mostly associated with grass or tree pollens which are only
present for part of the year. People whose symptoms tend to come on in late
winter or early spring are more likely to have an allergy to tree pollen. People
whose symptoms present in late spring or early summer are typically allergic to
grass or weed pollen. Pollen season at the top of the North Island usually starts
in October and ends in February, approximately one month earlier than that at
the bottom of the South Island.
Causes
Wind-pollinated plants produce masses of light, buoyant pollen grains which
are easily distributed through the air. These plants are more likely to cause hay
fever than brightly coloured plants that attract bees and other insects for their
pollination. The most common causes of hay fever in New Zealand are perennial
rye grass, English plantain and the silver birch tree.
Perennial rye grass
First introduced to New Zealand in the 19th century, perennial rye grass is the
most widely sown turf and pasture grass in this country. It is the biggest pollen
producer of all and the most common cause of springtime hay fever. The pollen is
small and can remain windborne for many miles. How badly a person is affected
depends on their proximity to grasslands and the prevailing wind.
A huge amount of pine pollen comes from our widespread forestry plantations
of pinus radiata. Thankfully it is not very allergenic and only a small proportion of
people with hay fever will be sensitised to it.
Some fruit and vegetables have a similar molecular structure to pollen, so
cross-reactivity can occur. This most frequently affects people with a silver birch
allergy. Oral allergy symptoms (ie, itching or swelling of lips, tongue, throat, or
roof of the mouth) develop on exposure to raw apples, stone fruit, wheat, carrots
and some other vegetables. Cooking or canning destroys the allergens causing
these reactions.
How does hay fever develop
Hay fever develops in a similar way to other allergies. When the body comes
into contact with an allergen it produces immunoglobulin antibodies to it, as
it perceives it as being harmful. This antibody combines with the allergen and
causes mast cells to release histamine. Histamine irritates the tissues of the
throat and nose which results in the symptoms of hay fever.
Grass pollen allergies usually develop around the ages of three or four
whereas tree pollen allergies typically develop about age seven. It is not unusual
for adults to develop hay fever as it can take two to three seasons to become
sensitised to pollen. People moving from relatively pollen-free coastal areas to
inland farming areas are most at risk. It is not known why some people are more
atopic (genetically predisposed towards allergies) than others.
Symptoms
Symptoms of hay fever may be similar to those of a cold and can include an itchy
nose, roof of the mouth, throat or eyes; sneezing and a blocked or runny nose; red
English plantain
English plantain is an abundant weed in New Zealand growing in parks, lawns
and roadside verges. Although it produces only small amounts of pollen, the
pollen is highly allergenic and is a common cause of hay fever.
Silver birch
The silver birch is an popular introduced species that produces copious amounts
of pollen. It is the main cause of tree pollen allergies.
Other causes
Privet is commonly seen throughout our countryside and produces a highly
scented flower. However, it is not a strong allergen and many people who think
they are allergic to privet are actually allergic to ryegrass which is not as visible
as privet.
Cupressus macrocarpa is commonly cultivated as shelter belts on farms or
individually in gardens. Although the tree produces a lot of pollen it is not as
allergenic as silver birch but may be responsible for a lot of early spring hay fever.
OUTPERFORMS
ANTIHISTAMINE TABLETS 1-3
TARGETS 6 ALLERGIC
SUBSTANCES, NOT JUST 1 1,4,5
GSK Healthcare HAndbook Adverts.indd 4
Page 84 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
or watery eyes. Frequent rubbing of itchy eyes may also lead to the development
of conjunctivitis (see Eye Conditions).
Some people may also complain of a headache or sinusitis. Symptoms can be
troublesome enough to interfere with sleep, work performance, learning ability
and participation in social activity. Symptoms are often worse in the morning or
evening, or in hot, humid or windy weather, and particularly after thunderstorms
when pollen levels are high. Symptoms often get worse as the season goes on.
Research has found that allergic rhinitis is a very common trigger for
asthma and responsible for thousands of asthma-related hospitalisations
and hundreds of asthma-related deaths each year. It is estimated that up to
80% of people with asthma also have hay fever, and up to 40% of people
with hay fever, will go on to develop asthma. Guidelines recommend that
all asthma patients be evaluated for allergic rhinitis and vice versa, and in
planning treatment, both conditions should be considered together.
Initial assessment
Clarify that your customer's symptoms are the result of hay fever, and not from a
cold. Itchiness of the eyes, ears, mouth or throat is typical of pollen allergies, and
hay fever is a seasonal condition, that generally occurs around the same time
each year. Offer lifestyle advice and refer any customers with "yes" answers to
the Refer to Pharmacist questions. For other customers, base product selection
on most troublesome symptom, for example, itchy eyes – an antihistamine eye
drop; blocked nose – an oral decongestant; runny nose – an oral antihistamine;
multiple eye and ear symptoms – a nasal corticosteroid.
Encourage everybody presenting with hay fever to talk with their doctor at
their next appointment about its link with asthma. Further investigations may
be warranted.
Treatment
Treatment consists of treating or preventing the allergic reaction with
antihistamines, corticosteroid nasal sprays or mast cell stabilisers and relieving
symptoms using decongestants, pain relievers or antihistamines. See Treatment
Options next page.
Non-sedating antihistamines prevent histamine release and are available as
liquids, tablets and nasal sprays. All relieve sneezing, itching, and help dry up a
runny nose but only levocetirizine has shown to be effective at relieving nasal
congestion. Experts recommend antihistamines as a first-line treatment for mild
hay fever symptoms. Antihistamine eye drops are also available to help soothe
and relieve the redness and itch of allergic conjunctivitis commonly associated
with hay fever (see also Eye Conditions).
Corticosteroid nasal sprays reduce inflammation in the lining of the nose and
work better when used as a preventative, ie, taken before symptoms develop.
They can be used continuously for weeks or months throughout the hay fever
season and are the best treatment for moderate-to-severe hay fever symptoms.
Decongestant nasal sprays and tablets unblock the nose and relieve nasal
congestion. Only use occasionally and not for more than three days at a time as
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication or herbal remedy,
either prescribed by a doctor or bought from a shop?
• Does the person also have shortness of breath, a cough or wheeze?
• Are there any other symptoms (eg, swollen glands, fever and/or a
persistent headache)?
• Is there any coloured or yellow discharge from the nose or eyes?
• Is only one side of the nose or eye affected?
• Are the ears or sinuses painful?
• Have symptoms persisted despite treatment or do symptoms
occur all year round?
• Is the person a child?
• Does the person have any allergies to medicines?
prolonged use can result in a worsening of nasal congestion.
Desensitisation or immunotherapy may be considered for people with
particulary severe hay fever if none of the above treatment options work (see
also Allergies).
Advice for customers
• Start preventive treatment for hay fever early in the season and take it
regularly, especially if triggers that set off hay fever are unavoidable.
• Eye symptoms generally reduce once nasal symptoms are controlled.
• Corticosteroid nasal sprays must be used regularly since maximum relief may
not be obtained for several days.
• Wear sunglasses and possibly a mask or scarf outside and wash hands and
face on returning. Avoid parks and pollen-abundant areas (especially if just
mowed). Stay indoors if pollen counts are high (see www.metservice.com).
• Wipe pets down with a damp cloth to remove pollen collected on their fur.
1. Australian Medicines Handbook 2016, AMH Pty Ltd; Adelaide.
2. Bousquet J et al. Allergy 2008; 63(Suppl 86):8–160.
3. Wallace DV et al. J Allergy Clin Immunol 2008;122:S1–84.
4. Bachert C & Geveart P. Allergy 1999;54(Suppl 57):116–23.
5. Wiseman LR & Benfield P. Drugs 1997;53:885–907.
Always read the label. Use only as directed. For the treatment and prevention
of allergic rhinitis. If symptoms persist, see your healthcare professional.
Pharmacy Medicine. Flixonase Allergy and Hay fever contains fluticasone
propionate 50mcg per spray. For the prevention and treatment of seasonal and
allergic rhinitis including hayfever. Precautions: Nose bleeds, nasal infection,
pregnancy and lactation. For adults 18 years and over two sprays in each
nostril once daily. FLIXONASE is a registered trade mark of the GSK group of
companies or its licensor. Auckland, New Zealand. TAPS PP9392.
15/03/17 10:08 am
Page 85

Hay Fever (continued)
TREATMENT OPTIONS
Category Examples Comments
Oral antihistamines
Topical (nasal and
ocular) antihistamines
Nasal corticosteroids
Other nasal products
Decongestants
Mast cell stabilisers
Saline nasal products
Natural / herbal
products / supplements
Non-sedating
[PHARMACY ONLY MEDICINE]
eg, cetirizine (Razene, Allerid-C, Arrowcare Zetop,
Histaclear, Zyrtec tablets & liquid), desloratadine
(Aerius), fexofenadine (Telfast range*, Telfast Oral
Liquid, Hayfexo, Fexaclear, Xergic), levocetirizine (Levrix),
loratadine (Apo-Loratadine, Loraclear, Lorafix, Lorapaed
Liquid, Lora-Tabs)
Sedating
[PHARMACIST ONLY MEDICINE]
eg, dexchlorpheniramine (Polaramine), promethazine
(Allersoothe, Phenergan)
[PHARMACY ONLY MEDICINE]
eg, levocabastine (Livostin Eye Drops*, Livostin Nasal
Spray*), naphazoline + pheniramine (Naphcon-A, Visine
Allergy), naphazoline + zinc (Clear eyes-A), antazoline +
naphazoline (Albalon A Allergy), ketotifen (Zaditen)
[PHARMACY ONLY MEDICINE]
eg, beclomethasone (Alanase, Beconase Allergy
& Hayfever*), budesonide (Butacort), fluticasone
(Flixonase*), triamcinolone acetonide (Telnase)
eg, cellulose and peppermint powder (Nasaleze)
eg, ipratropium bromide (Univent Nasal Spray)
eg, protective nasal balm (Botanica Hayfever Gel,
HayMax)
Topical (nasal)
[PHARMACY ONLY MEDICINE]
eg, oxymetazoline (Dimetapp 12 Hour Nasal Spray,
Drixine No Drip), xylometazoline (Otrivin)
Oral eg, phenylephrine + paracetamol
[GENERAL SALE]
eg, Panadol Sinus Relief PE
[PHARMACY ONLY MEDICINE]
eg, Sudafed PE Sinus Day & Night Relief (contains
chlorpheniramine in night tablet)
eg, phenylephrine + loratadine (Dimetapp Elixir, Dimetapp
Elixir Colour-free, Maxiclear Hayfever & Sinus Relief*)
[PHARMACY ONLY MEDICINE]
eg, lodoxamide (Lomide eye drops)
eg, sodium cromoglycate (Cromo-Fresh, Rexacrom)
[GENERAL SALE]
eg, Otrivin Clear Saline Plus, Fess Nasal range, NeilMed
Butterbur, pycnogenol, quercetin, saline nasal irrigation,
tinospora cordifolia, vitamin C
eg, KI Hayfever*
Useful for symptoms that persist during the day.
May be taken before hay fever occurs to avoid any slight delay in response. All relieve sneezing,
itching, and help dry up a runny nose but only levocetirizine has shown to relieve nasal
congestion.
Although drowsiness with these products is rare, it may still occasionally occur in some people.
Always warn customers about driving or operating machinery if feeling drowsy.
May not be suitable for children of certain ages.
May be useful when symptoms are more problematic at night, to aid sleep. Warn about
drowsiness and the risk of driving or operating machinery. Refer people on medications or with
certain health conditions to the pharmacist since these products may not be suitable for them.
(See Reference section, OTC Medicines – Precautions). Avoid alcohol.
Sedating antihistamines are prescription medicines for children under two.
Have a localised effect and a rapid onset of action.
Contact lenses may need to be removed before applying eye drops – check instructions.
Use eye drops combining antihistamines with decongestants short term only (ie, less than three
days).
Throw drops away one month after opening.
Stinging and a bitter taste after application have been reported.
Useful for treatment and prevention and as a first-line therapy for moderate-to-severe allergic
rhinitis.
Use at the start of the hay fever season to prevent symptoms occurring. A decongestant or
antihistamine may also be required initially as relief may be delayed two to three days.
Cellulose powder is delivered as a fine mist into the nasal passages where it forms an
impermeable barrier to allergens.
Ipratropium relieves a runny nose but does not treat sneezing or congestion.
Protective balms help prevent pollen entering the nasal cavity and lessen allergic reactions.
Best reserved for when nasal congestion needs to be treated quickly. Useful for symptom relief
while waiting for nasal corticosteroids to take effect. Rebound congestion can occur with
extended use. Topical decongestants should not be used for longer than three days. Children’s
formulations of intranasal oxymetazoline and xylometazoline are still considered safe to give to
children two years of age and older.
Combination tablets contain a variety of different ingredients. Refer to the packet for the list of
ingredients which may include a decongestant (eg, phenylephrine), analgesic (eg, paracetamol)
or antihistamine (to dry up runny noses). (See also Reference section, OTC Medicines –
Precautions).
Stabilise mast cells to prevent histamine release. Frequent administration (four to six times
daily) is needed. Can be used as a preventative up to one week before allergy symptoms occur.
Saline thins nasal mucus and moisturises dry nasal passages. It allows mucus to break down
faster and washes away pollen, animal dander and dust.
May be effective at either stabilising the allergic response or relieving symptoms of hay fever.
KI Hayfever contains Rhin-mp, astragalus-membranaceus, ginger, magnolia and quercetin and
may help relieve and prevent the symptoms of hay fever.
Products with an asterisk have a detailed listing in the Hay Fever section of the OTC Products, starting on page 239.
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Headache
Headaches are common and can be triggered by a number of different things.
The term headache refers to any pain that occurs in the head or upper neck.
Headaches are classified into different types, depending on the location of the
pain, how severe it is, how long it lasts, how often it occurs, and sometimes what
brings on the pain. Knowing what type of headache a customer has can help in the
management and treatment of their headache. Most headaches are self-limiting and
usually resolve themselves, with or without treatment.
Analgesics are available over the counter (OTC), and stronger analgesics and
other treatments are available as pharmacist-only medicines or on prescription
from the doctor.
The following questions can help determine what sort of headache the customer is
suffering and whether or not an OTC product is suitable.
• Where is the pain?
»»
Frontal pain: headache, sinusitis.
»»
Back of the head: tension headache.
»»
Unilateral (on one side): sinusitis, migraine, shingles (around eye or scalp),
trigeminal neuralgia (on side of face).
»»
Within the eye: acute glaucoma.
»»
Behind the eye: sinusitis, shingles (around eye or scalp), migraine.
»»
Temple area: arteritis (inflamed temporal artery).
• What is the pain like?
»»
Sudden pain like a blow to the head: haemorrhage.
»»
Throbbing, pounding: fever, migraine.
»»
Constant, nagging: tension headache.
Initial assessment and warning signs
Many customers request assistance from pharmacy staff when choosing a
headache medicine. Asking a few Refer to Pharmacist questions can help you
decide which customers are amenable to self-treatment and who needs to be
referred to the pharmacist. Warning signs that demand an immediate referral are:
• headaches described as “the worst headache of my life” (needs urgent
medical attention, even if the person habitually suffers from headaches)
• a first headache in a person over 50
• headaches that worsen over time (months) or a new or different headache
• headaches that are severe right from the start
• headaches that develop after a head injury or major trauma
• headaches brought on by lying down, a cough, bending or with certain
activities (eg, weightlifting, jogging, sex).
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Non-steroidal antiinflammatory
drugs (NSAIDs)
Combination analgesics
Natural / herbal products /
supplements
[GENERAL SALE]
eg, paracetamol (Panadol, Panadol Rapid*, Paracare* [up to
20 tablets])
[PHARMACY ONLY MEDICINE]
eg, paracetamol (larger pack sizes) (Panadol, Panadol Rapid*,
Paracare*, Panadol Optizorb*)
[GENERAL SALE] eg, aspirin (Aspro, Disprin), ibuprofen up to
25s (Advil, Nurofen*, Nurofen Zavance*)
[PHARMACY ONLY MEDICINE]
eg, diclofenac (Voltaren Rapid 12.5*), ibuprofen >25s
(Advil, Nurofen*, Nurofen Zavance*, Nurofen Zavance Liquid
Capsules), naproxen (Sonaflam*)
[PHARMACIST ONLY]
eg, diclofenac (Voltaren Rapid 25*)
[GENERAL SALE] eg, paracetamol + caffeine (Panadol Extra)
eg, ibuprofen + paracetamol (Maxigesic* [16], Nuromol* [12])
[PHARMACY ONLY MEDICINE]
eg, paracetamol + caffeine (Parafast Extra [36]),
eg, ibuprofen + paracetamol (Maxigesic*, Nuromol*)
[PHARMACIST ONLY MEDICINE]
eg, paracetamol + codeine (Panadeine, Panadeine Extra),
ibuprofen + codeine (Nurofen Plus*), paracetamol +
doxylamine + codeine (Mersyndol)
Butterbur, caffeine, cayenne, feverfew, peppermint
Products with an asterisk have a detailed listing in the Headache section of OTC Products, starting on page 241.
Effective for most people with very few adverse effects. Avoid duplication of
paracetamol-containing medications (present in combination cold/flu and sinus
products).
NSAIDs generally last longer than paracetamol. Ibuprofen is the NSAID least
likely to cause stomach irritation. NSAIDs may not be suitable for people on
certain other medications or with some medical conditions (eg, asthma, kidney
disease – see Refer to pharmacist). Advise customer to stop taking if stomach
upsets, increased bruising or prolonged bleeding occur. Aspirin products require
the same warnings as other NSAID products. Aspirin is not recommended for
adolescents or children under 12 years old, or for children under 16 years old with
a viral-related fever, or fever with chickenpox (see Childhood Pain and Baby
Teething: Treatment options). See also Reference Section, OTC Medicines
– Precautions.
Try simple analgesics and NSAIDs first.
Warn customers codeine is an addictive substance and should not be used for more
than three days at a time. Constipation or drowsiness may also occur. Monitor
sales and be alert for any customers who may be misusing codeine-containing
preparations.
Mersyndol also contains doxylamine, so can cause drowsiness.
See also Migraine.
Caffeine in combination with analgesics is effective at relieving simple headache.
Several other natural remedies have been used for headache relief.
CHOOSE PANADOL WITH OPTIZORB
FOR ADVANCED ABSORPTION *
*FASTER ABSORPTION COMPARED WITH STANDARD PARACETAMOL TABLETS.
Panadol ® with Optizorb ® Formulation contains 500mg paracetamol per tablet/caplet. Indications and dosage: For the temporary relief of pain and fever. Adults and children 12 years: 1 – 2 tablets/caplets every 4-6 hours (maximum 8 tablets/caplets in 24 hrs). Children 7 –12 years: ½ – 1 tablet/caplet every
4-6 hours (maximum 8 tablets/caplets in 24 hrs). Contraindications: Patients with a previous history of hypersensitivity to paracetamol or to any of the excipients; in children under 7 years. Adverse reactions (very rare): Thrombocytopenia; anaphylaxis, cutaneous hypersensitivity reactions including skin rashes,
angioedema and Stevens Johnson syndrome; bronchospasm, especially in patients sensitive to aspirin and other NSAIDs; hepatic dysfunction. Panadol, Optizorb and the beacon device are registered trade marks of the GSK group of companies or its licensor. GSK Auckland, NZ. TAPS NA 9036. CHANZ/CHPAN/0135/17.
Voltaren Rapid 25 390x45.indd 3
Page 88 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
• symptoms such as fever, high blood pressure, muscle aches, weight loss, or
scalp tenderness (may suggest a whole body disorder)
• seizures, confusion, slurred speech, memory loss, loss of balance, changes in
consciousness or difficulty waking.
Common types of headache
Migraine
A migraine typically occurs just on one side of the head, with the pain usually
starting as a dull throb or tightening which then intensifies into a concentrated
and severe pain (see Migraine for more information).
Tension headache
Tension headaches are the most common type of headache. Described as a mild,
aching pain that occurs on both sides of the head, the back of the head, or as a
tight band across the forehead, this headache tends to worsen as the day goes
on, or if the person is stressed. Avoiding eye strain or bad posture and using
relaxation techniques or massage to manage stress may help reduce the number
of tension headaches. Lying down in a warm, darkened, quiet room may also
help. Most tension headaches respond to OTC pain relief.
Sinusitis
Blocked nasal passages can lead to sinusitis, where mucus is unable to drain
causing pressure build-up and pain. Sinusitis is usually associated with a cold
(see Colds), and often causes a frontal headache or aching teeth. Bending,
coughing, or sneezing can make the headache worse. Decongestants and pain
relief may relieve the symptoms but antibiotics may be needed if the cause is due
to a bacterial infection.
Rebound headaches
Rebound headaches (medication-overuse headaches) are caused by taking
pain-relieving medicines too frequently for headaches. They are the third most
common cause of headache after migraine and tension-type headaches.
Avoidance of pain-relief tablets for a period of time is necessary to revert the
headaches back to a normal pattern. Non-medicine-related, self-help measures
(see advice for customers) may help during this period of pain-relief avoidance.
Refer to
PHARMACIST
Seek urgent medical advice for anybody with warning signs (see
text).
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Have the symptoms persisted despite treatment with adequate
doses of analgesics or lasted longer than 24 hours?
• Is the person a child under 12?
• Is the person elderly with a recurring headache originating from
the temples (may be temporal arteritis)?
• Does the person have a fever, rash or a stiff or sore neck (see
Childhood Diseases and Immunisation: Meningococcal
disease).
• Are there any other symptoms (eg, nausea, visual disturbances)?
• Does the person have frequent headaches (more than one a
month) and/or is buying a lot of analgesics?
• Does the person have any allergies to medicines?
Advice for customers
• Identify and avoid factors that trigger the headache if possible.
• Rest in a quiet, darkened room. Reusable heat pads may provide relief.
• Be careful not to overuse pain-relief medicines.
• Drink plenty of water, maintain regular exercise and a healthy diet.
• Try muscle relaxation exercises, or spend at least half an hour each day relaxing
(eg, listening to music, reading).
• Track your headaches.
»»
Keep a diary of when headaches occur to help identify their cause.
THINK PARACETAMOL TABLETS ARE ALL THE SAME?
PANADOL WITH
OPTIZORB®
STANDARD
PARACETAMOL
10/04/17 5:17 pm
Page 89

Head Lice
Head lice (pediculosis capitis) are small, brownish-grey, wingless insects, about
the size of a sesame seed (2–3mm), which feed on blood from the scalp. They are
most common in children, but can also spread to adults.
Their stumpy legs make them incapable of jumping and they cannot fly,
instead they use their single claw and “opposing thumb” on their legs to
grasp the hair shaft and quickly crawl from head to head. Most are grey,
although some may look black and after feeding their body may take on a
reddish colour. They spread easily among people in close contact, such as
family members and school friends. Head lice only feed on human blood and
only infect the scalp – they are a different species to body lice and pubic
lice and in the natural environment will not interbreed. Unlike body lice,
they do not carry disease, and apart from a risk of secondary infection from
scratching, are unlikely to cause medical harm. Some experts regard head lice
as more of a cosmetic, rather than a medical, problem.
An itchy scalp is the most common symptom of head lice, caused by a delayed
allergic reaction to the lice’s saliva or faeces. This reaction may take between a week
and three months to develop which means that many customers may have been
infested for some time without knowing. Some people may not actually itch at all.
Female head lice can lay up to eight eggs per day. These egg cases are brown
and hard to see until the louse nymph hatches seven to 10 days later. By this time
the empty egg case has moved up the hair shaft as the hair has grown and now
appears white, so is much more easy to detect. When people talk about nits, they
are actually referring to the empty egg cases. The nit is stuck on the hair shaft
close to the scalp with a strong, highly insoluble cement which makes it hard to
get off, but easy to distinguish from flakey bits of skin, dried hairspray or dandruff.
Females may lay 50–100 eggs during their lifespan of around 30–40 days.
It takes about 10 days for a nymph to mature and be able to breed, and each
louse lives for about a month on the scalp, but for only 48 hours off it. Optimum
conditions and a moderate temperature and humidity are required for hatching
which explains why head lice are more prevalent over summer.
TREATMENT OPTIONS
Category Examples Comments
Egg removal products and
combs
Products to detect head lice
Products with a physical
action
Products with a neurological
action
Products with both a physical
and neurological action
(usually contain essential oils)
Preventive products
[GENERAL SALE] eg, NeutraLice Conditioner
Shampoo Lice Egg Remover*, Neutralice
Nitcomb, Parasidose Long Tooth Comb, Robi
Comb Pro
[GENERAL SALE] eg, Moov Combing
Conditioner for Head Lice Detection
[GENERAL SALE]
eg, benzyl alcohol 5% (eg, NeutraLice Advance
Lotion*) biococidine (eg, Parasidose Lice-Nits
Treatment), isopropyl myristate (eg, Moov Head
Lice Treatment Sensitive)
[GENERAL SALE]
eg, permethrin (Lice Clear*), d-Phenothrine
(Parasidose Extra-Strength Shampoo)
[GENERAL SALE]
eg, combination of essential oils (Moov Head
Lice Solution*, NeutraLice Natural Spray*, Nit-
Enz Organic)
eg, neem oil (Licener Single Treatment)
eg, anise oil, cinnamon leaf, citronella,
eucalyptus oil, geranium, lavender oil, mint,
tea-tree oil, thyme
[GENERAL SALE]
eg, Ladibugs Mint Spray, Moov Head Lice
Defence Spray, Nit-Enz Head Lice Repellant,
Parasidose Lice Repellant Spray
Egg removal products allow eggs to be brushed out easily from the hair. Fine metal-toothed
combs with rounded teeth are used to detect and remove head lice. Use on wet hair with
conditioner. Not usually 100% effective if used without treatment products. Electric combs
stun or kill lice and are used on dry hair. Hard to use on very thick and curly hair or on young
children.
Combing conditioners stun lice and help detect the presence of head lice and eggs.
These products do not kill lice or nits.
Benzyl alcohol suffocates lice by affecting their respiratory spiracles; dimeticone coats the
louse, disrupting its ability to manage air and water exchange across its body surface;
and isopropyl myristate kills lice by dehydrating them. Biococidine claims to suffocate
and dehydrate head lice; however, the actual active ingredient is undisclosed, making it
impossible to check for allergies. Some may be used in children as young as three months
and in pregnant women. Most are suitable for asthma sufferers.
Permethrin, phenothrin, and malathion are all neurological agents, each with a slightly
different mode of action, although the end result is usually paralysis of the louse, preventing
it from feeding. Resistance is common.
Products with both a neurological and physical effect include most products that contain
essential oils, including neem oil. Neem oil interferes with the growth and reproduction of
head lice, and also suffocates their eggs. Essential oils such as eucalyptus, tea tree, lavender,
and clove oil can also be toxic if misused, and strong evidence for their effectiveness at
killing head lice or their eggs is lacking, although combinations with vegetable oils may be
more effective.
Either contain essential oils that repel lice or coat the hair making it difficult for lice to attach.
Usually used every two to three days or weekly to keep lice from infesting hair. Will not treat
already established infestations.
Other products Air Alle (www.nitcrew.co.nz) Controlled heated air is directed onto dry hair by a trained technician. Process takes 30
minutes and effectively kills head lice and nits. May need to be repeated.
Products with an asterisk have a detailed listing in the Head Lice section of OTC Products, starting on page 243.
Page 90 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Initial assessment
If a customer asks you to check their head for head lice, move them to a private
area, put on gloves, and start by looking for nits which are more commonly found
behind the ears, under the fringe, and at the nape of the neck.
Advise customers who wish to do their own checking that the most reliable
way to check for head lice is by using a conditioner and a fine-toothed nit comb,
especially in children with curly hair. The conditioner should be applied to the hair
for 10 minutes before combing through. The conditioner stuns the lice, forcing
them to let go of the hair, and they readily show up against the white conditioner.
Theoretically, if done meticulously (every three days until no lice are seen for
three consecutive sessions), this method can be used as a non-pharmacological
way to remove head lice; however, in practice, failure rates are high because of
the heavy commitment involved.
Advise use of a treatment product if lice or a viable egg (solid in colour and
within 1cm of the scalp) is found and reassure customers that head lice are not a
sign of dirty hair or poor hygiene, and are just as likely to be found in clean hair.
Girls with long hair are more likely to get head lice if their hair is not tied back.
Advice for customers
• Ensure the hair is free of conditioner and completely dry before applying
treatment products.
• Apply products strictly as directed on the label. Many products are not 100%
effective on nits and need repeating after seven days. Note that some products
are flammable and treated hair should be kept away from heat sources.
• Use all products with a fine-toothed nit comb to improve success.
»»
Combing (or regular brushing) damages their legs and other body parts
which prevents them gripping onto the hair shaft to lay their eggs.
• Wash bed linen, head coverings, and clothes in a hot wash; soak combs and
grooming aids in hot water for 10–15 minutes; and vacuum furniture and
floors.
• Never use fly spray or pet treatment products to treat head lice.
• Avoid washing the hair or using a hairdryer for 24 hours after applying
chemical treatment products.
• Parents or caregivers should inform their child’s teacher and friends that their
child has head lice so that other close contacts can be checked at the same
time.
»»
Outbreaks can continue for months because of one untreated head.
• Presence of empty egg cases (translucent in colour and found further than
1cm from the scalp) does not mean treatment failure since most treatment
products do not remove the egg cases from the hair.
»»
Grasp each case between thumb and forefinger and slide off the hair shaft.
• Hair straighteners can be effective at “popping” eggs but must be used
regularly and as close to the scalp as possible.
• Shaving the head is effective but not usually necessary and won’t prevent
reinfestation. Some hairdressers may refuse to cut infested hair.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist. Refer all pregnant women and babies to a pharmacist
as they should not be treated with, nor exposed to, chemical
insecticides or certain essential oils.
• Does the person have any other health conditions (eg, lung
problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Are there any sores on the scalp (may indicate a secondary
bacterial infection)?
• Does the person have a particularly heavy infestation or matted
hair?
• Could there be another reason for the itching (skin conditions, eg,
dandruff and psoriasis may be confused with head lice)?
• Have products been tried before without apparent success?
• Does the person have any allergies to topical medicines?
Prevention
• Hair should be kept short, if possible, or tied back and plaited if long.
• Regular brushing can help prevent head lice since they have no defence
against disease or injury, and can be damaged by combing or brushing.
» » Encourage children not to share hats and combs, although the chances of
catching head lice from objects is remote.
• A couple of drops of tea-tree or lavender oil added to conditioner or on a hair
brush before brushing may deter lice from settling on the hair.
Page 91

Heart Health
Cardiovascular (CV) disease (which means everything pertaining to and involving
the heart and blood vessels) is the leading cause of death in New Zealand,
accounting for more than 33% of deaths annually. Every 90 minutes one New
Zealander dies as a result of CV disease.
Simply getting older increases a person’s risk and males are more likely than
females to develop CV disease, although the risk for women increases after
menopause. CV disease is more likely to develop in people with a family history
of type 2 diabetes or premature coronary heart disease or ischaemic stroke in a firstdegree
relative. Personal history factors that also increase risk include:
• diabetes or prediabetes (see also Diabetes)
• high blood pressure (BP)
• high cholesterol and high density lipoprotein (HDL) ratio of 7
• kidney disease (eGFR less than 60 ml/min/1.73m 2 )
• obesity: a BMI of 30 or more or truncal obesity (see also Weight Loss)
• smoking or a history of smoking within the last 12 months
• women with a history of gestational diabetes or polycystic ovary syndrome.
Several non-traditional risk factors have also been identified including high
blood levels of C-reactive protein (CRP), lipoprotein A, fibrinogen or homocysteine.
Cardiovascular Disease Risk Assessment (CVDRA)
All men should have a CVDRA from at least the age of 45 and women by the
age of 55. If risk factors are present, or the person is Maori, or from the Pacific
Islands or Indian subcontinent, a CVDRA should be carried out at 35 (men) or 45
(women). These assessments may be free for certain people.
Annual assessments are recommended for people with diabetes, those on lipid or
blood pressure medication, and in people with risk factors of clinical concern. Refer
customers who fit these criteria to their doctor. During this check-up, the doctor will
determine their five-year risk of having a heart attack or stroke. Risk ranges from mild
(less than 10%) to very high (20% or over). Anybody who has had a previous CV
event, such as a heart attack, stroke, transient ischaemic attack (mini stroke), angina
or narrowing in the arteries of the legs is at clinically high risk. Your Heart Age
Forecast (available through www.knowyournumbers.co.nz) can help a person
forecast their risk of having a heart attack or stroke as they get older. Successful
interventions can dramatically reduce CV risk.
Signs of a heart attack
Heart attack symptoms are not always described as painful, and may be described as
a heaviness, tightness, pressure or discomfort in the upper half of the torso, neck, or
arms. Call an ambulance for anybody with symptoms that are not relieved with rest
or appear to be getting worse.
Cholesterol
Cholesterol is a white, waxy substance manufactured naturally mainly by the
liver. It has a crucial role in the production of steroid hormones (eg, testosterone,
oestrogen) and absorption of fat soluble vitamins. Its largest use is as a vital
building block of the body’s cells. People with too much cholesterol generally
do not have any symptoms until a major event occurs (eg, heart attack or
stroke). This highlights the importance of regular screening tests for cholesterol,
TREATMENT OPTIONS
Category Examples Comments
Cholesterol and
triglyceride treatments
Blood pressure
treatments
Antiplatelet agents
Natural / herbal products
/ supplements
[PRESCRIPTION MEDICINE]
eg, acipimox, atorvastatin, bezafibrate,
colestipol, ezetimibe, gemfibrozil,
nicotinic acid, pravastatin, simvastatin
[PRESCRIPTION MEDICINE]
Includes beta-blockers, diuretics, ACE
inhibitors, angiotensin II antagonists,
calcium channel blockers, alphablockers
and nitrates
[GENERAL SALE]
eg, Aspirin (Aspec 75mg*, Cartia*,
Ethics Aspirin)
[PRESCRIPTION MEDICINE]
eg, clopidogrel, dipyridamole,
prasugrel, ticagrelor
Co-enzyme Q10, English walnut, fish
oil, Ginkgo Biloba, quercetin, red krill
oil, resveratrol
Statins (eg, atorvastatin, pravastatin, simvastatin) reduce LDL cholesterol, total cholesterol and triglycerides
(moderately) and increase HDL (very moderately). Report any muscle pain promptly to a doctor. Fibrates (eg,
bezafibrate) decrease triglycerides effectively, increase HDL cholesterol and improve cholesterol moderately.
Colestipol binds cholesterol preventing its absorption into the blood. Mainly lowers LDL but can increase HDL
slightly.
Most people will need more than one medicine to reduce their blood pressure sufficiently.
As this condition generally has no symptoms, compliance can be a problem.
Despite the fact aspirin can be bought on general sale, it is important people discuss taking it with their doctor.
Usual daily dosage is 75–150mg to help prevent heart attacks and stroke.
Aspirin is contraindicated in those who are sensitive to aspirin or NSAIDs, have a peptic ulcer, have bleeding risks
or have uncontrolled high blood pressure (See also Reference Section, OTC Medicines – Precautions).
Walnuts and other nuts may reduce risk of coronary heart disease. Fish oil may reduce mortality in some people
with congestive heart failure. A higher dietary intake of quercetin has been associated with a reduced risk of death
from coronary heart disease. Red krill oil is a source of phospholipids, omega-3 fatty acids and antioxidants.
Products with an asterisk have a detailed listing in the Heart Health section of OTC Products, on page 245.
Significant learning
opportunity: Wound care
Your new Group 3 CPD project
Page 92 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
especially for people at high risk.
There is only one type of cholesterol; however, a standard cholesterol test
measures the different carriers that transport cholesterol around the body. There
are two types of carriers: LDL (low density lipoprotein) transports cholesterol
around the body and through blood vessels and HDL (high density lipoprotein)
transports cholesterol back to the liver where it is broken down. Traditionally, LDL
cholesterol has been termed “bad cholesterol” and HDL cholesterol has been
described as "good cholesterol".
Recently, experts have recognised the need for a better lipid target than LDL
cholesterol that more accurately reflects the amount of cholesterol within all
lipid-containing particles. Some countries now report non-HDL cholesterol, in
addition to HDL cholesterol and total cholesterol.
Most of the cholesterol contained in our bloodstream is manufactured within
our body, with only a limited amount coming from diet. Experts no longer suggest
an upper limit for daily dietary cholesterol consumption because available
evidence does not show a relationship between dietary intake of cholesterol
and serum cholesterol. Alcohol excesses, high sugar or fructose-containing diets,
hypothyroidism, diabetes, liver disease, nephrotic syndrome and steroid treatment
can also influence lipid levels. Any identifiable cause of a raised cholesterol should
be treated and a diet high in vegetables should be encouraged for everyone, not
only those people with high cholesterol.
A rise in cholesterol is normal in pregnancy and a cholesterol level should not
be measured at this time.
What is blood pressure?
BP is usually measured from the arm with a device called a sphygmomanometer
which may be manual or electronic. An inflatable cuff creates pressure on the arm
causing the blood flow to stop briefly in the arm. As the air is released from the
cuff, blood starts to flow again through the artery.
The first recording is called the systolic pressure and it measures the force
the heart has to pump against (resistance) to get the blood to flow around the
body (indicated by the pressure around the arm, which stops the blood flow).
The second sound recorded is the diastolic pressure. This measures the resting
pressure when the heart relaxes.
High BP (hypertension) affects nearly one in five New Zealanders, and is more
common in older age groups. Most people have no symptoms, even if their BP
is quite high, although some people may develop a headache or feel unwell. BP
should be checked regularly, as part of a cardiovascular risk assessment.
Persistent high BP can cause the heart to enlarge and weaken. It also
contributes to blood vessel damage, especially in people with diabetes, high
cholesterol or who smoke. If blood vessels become narrowed or blocked, a heart
attack or stroke may occur. High BP is also linked to kidney and eye damage, and
poor circulation in the arteries of the legs.
A “normal BP” is generally stated as 120/80mmHg. Ideally, a person’s BP should be
below 130/80mmHg, although actual recommendations vary depending on individual
risk factors. Lifestyle changes (eg, improving diet, limiting alcohol, exercising, losing
Refer to
DOCTOR
• Refer all customers with CV risk factors to their doctor for ongoing
monitoring and treatment.
• Get urgent medical attention for any customer with chest pain.
weight, smoking cessation) should be made alongside BP medication (if needed).
Sleep apnoea (see Sleep Problems and Snoring), use of certain medicines (eg,
oestrogen, anti-inflammatory agents), and other disorders can also impact on BP
and should be corrected if possible.
Initial assessment
If a customer complains of chest pain or discomfort, provide them with a chair
to sit on and ask if they take pills or a spray for angina. Call both an ambulance
and a pharmacist if rest or their own medication does not relieve their discomfort.
Refer any other customers requiring information about CV disease to a pharmacist.
Advice to customers
• Know your risk of having a heart attack or stroke. Be aware of how healthy
your heart is and the effect your lifestyle is having on your body.
• Follow the Ministry of Health's Eating and Activity Guidelines. Eat plenty of
vegetables and fruit; grain foods (mostly wholegrain and those naturally high in
fibre); some milk and milk products (mostly low or reduced fat); some legumes,
nuts, seeds, fish, poultry and lean meat.
»»
Cut back on foods high in sugar, salt, and trans fats.
»»
Make water your preferred drink.
• Partake in at least 150 minutes of moderate or 75 minutes of vigorous intensity
physical activity throughout the week. Do muscle strengthening exercises on
at least two days per week. Break up long periods of sitting with activity.
• Stop smoking, lose weight, keep alcohol intake low, and maintain good blood
glucose control if you have diabetes.
Visit ELearning to start your project
www.pharmacytoday.co.nz
Facilitated by Dr Alesha Smith
Page 93

Indigestion, Heartburn and Gastritis
Indigestion, heartburn and gastritis are common gastrointestinal disorders that
may produce similar symptoms.
Indigestion (dyspepsia)
Indigestion – also known as dyspepsia – is a description of symptoms, rather
than a diagnosis. It is the general term used to describe pain or discomfort
centred in the upper abdomen, often after meals. It most commonly occurs
soon after eating and usually happens when people eat too much or too fast,
or when certain foods or medicines don’t agree with them. Other symptoms
often associated with indigestion include feeling full within a few minutes of
beginning a meal, bloating, belching, nausea and vomiting. Symptoms can occur
ocassionally or happen all the time.
Indigestion can also occur after smoking or drinking alcohol and may also
be caused by certain stomach problems such as gastritis or a stomach ulcer. To
be considered significant, symptoms need to recur regularly, usually for at least
three months.
Very rarely, indigestion can be a symptom of stomach cancer. Stomach cancer
affects less than 0.5% of people with indigestion, and is mostly found in those
aged older than 50. In 70% of people, no cause is found for the dyspepsia (called
functional dyspepsia).
Heartburn (reflux)
Heartburn is usually described as a burning sensation behind the sternum,
often with a feeling of regurgitation of acid. This burning feeling may
extend to the neck and jaw and tends to worsen when bending over or
lying down. Most cases are attributed to gastro-oesophageal reflux disease
(GORD), which is thought to be caused by an ineffective lower oesophageal
sphincter muscle. This muscle is unable to prevent regurgitation of stomach
acid contents up the oesophagus. Symptoms generally occur after eating,
exercising, bending over or lying down and are often associated with
indigestion. Obesity is a risk factor and the condition is more common in
women who are pregnant and in those who eat a high-fat diet, who smoke,
or who are under stress. Although the term heartburn has nothing to do with
the heart, it is important to realise that symptoms of a heart attack (chest
pain or discomfort that radiates up the neck and to the jaw) may be similar.
Refer to the pharmacist if you are unsure.
Babies can also get reflux, and symptoms include vomiting straight after a
feed, failure to thrive, and prolonged bouts of crying. Refer any children under 12
with symptoms of reflux or indigestion to the pharmacist.
Gastritis
Gastritis has similar symptoms to indigestion, except the pain or burning feeling
TREATMENT OPTIONS
Category Examples Comments
Antacids
Alginates
H2 antagonists
Proton pump inhibitors
Anti-flatulence agents
Natural / herbal products /
supplements
[GENERAL SALE]
eg, aluminium, magnesium and simethicone
(Mylanta Original/Double Strength)
[GENERAL SALE]
eg, Gaviscon Liquid*/Tablets*, Gaviscon Double
Strength Liquid*/Tablets*, Gaviscon Dual Action
Liquid*/Tablets*, Gaviscon Infant*)
[PHARMACY ONLY MEDICINE]
eg, ranitidine (Ranitidine Relief, Zantac*, Zantac
Extra)
[PHARMACY ONLY MEDICINE]
eg, omeprazole 10mg (Dr Reddy's, Losec)
eg, omeprazole 20mg (Dr Reddy's, Losec Extra)
[GENERAL SALE]
eg, simethicone (De-Gas)
eg, apple cider vinegar and manuka honey
(Radiance ManukaGuard Nutralize)
eg, kawakawa and hoheria (Kiwiherb Herbal
Digestive)
eg, ginger, slippery elm
eg, digestive enzymes (Nutralife, Radiance
DigestAid, Thompson's Digestion Manager)
Antacids neutralise stomach acid and are recommended for people with mild, occasional,
indigestion-like symptoms. Most contain two to four constituents with different onsets and
durations of action.
The alginate precipitates out when in contact with gastric acid forming a raft that sits on
top of the stomach contents. It protects the lining of the oesophagus when the contents
regurgitate upwards. Many products also contain calcium carbonate and/or sodium
bicarbonate so are effective for the treatment of indigestion as well.
Block the action of histamine on gastric acid cells, reducing acid release. Delayed onset of
effect, compared with antacids, but they can last for up to 12 hours. May be used before meals
if meal likely to result in indigestion. Restrict use to two weeks unless under medical advice.
Used for the short-term symptomatic relief of reflux-like symptoms in adults aged 18 years and over.
Act directly on gastric acid releasing cells in stomach. Seek further medical advice if symptoms don’t
improve after two weeks.Take in the morning, 30 minutes before food, for optimal acid suppression.
Simethicone breaks up large bubbles of air in the stomach and relieves burping and
flatulence.
Apple cider vinegar has an acid/alkaline balancing effect and manuka honey has a natural
antibacterial action.
Kawakawa and Hoheria may help soothe the digestive tract.
Slippery elm tablets may help soothe heartburn.
Ginger may help with the absorption of food and symptoms of indigestion.
Digestive enzymes help reduce symptoms of indigestion and bloating associated with low
stomach acid. Take with food.
Products with an asterisk have a detailed listing in the Indigestion, Heartburn & Gastritis section of OTC Products, starting on page 245.
HEARTBURN?
TRY
Please see product packaging for further information and full product details. Reckitt Benckiser, Auckland. 0800 40 30 30. TAPS DA1703DB.
®
Page 94 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
felt around the stomach area tends to be present for most of the day. Some
people may feel nauseous, and/or vomit.
Gastritis can occur as a result of increased acid production, certain medicines,
alcohol, stomach ulcers, or a bacterium called Helicobacter pylori. As with
indigestion, very rarely it may be a symptom of stomach cancer. Refer anybody
with suspected gastritis to the pharmacist.
Initial assessment
Although many customers self-select their own indigestion and heartburn
treatments; many would probably benefit from further information about the
condition and some lifestyle advice, which could be offered at the point of sale.
Refer any customers with obvious RED FLAGS (see Refer to the Pharmacist)
to a pharmacist, as these increase the likelihood that the customer has a
more serious condition requiring further investigation. Asking other Refer to
Pharmacist questions can help you decide which customers are amenable to
self-treatment and who else needs to be referred to the pharmacist.
Treatment
Many people are able to manage their indigestion and heartburn by making
simple lifestyle adjustments, such as including more vegetables and fibre
in their diet and reducing fat intake; limiting the intake of caffeine, spicy
or acidic foods known to exacerbate symptoms; losing weight; stopping
smoking; limiting alcohol intake or NSAID use; and staying upright for a
period of time after a meal.
Proton pump inhibitors (PPIs) are the preferred treatment for both heartburn
due to GORD, and indigestion. Customers who don't respond or those with
recurring symptoms should be referred to a doctor for further evaluation and
possible H. pylori testing. H2 antagonist therapy may be used as an alternative
to PPIs for maintenance therapy in customers with GORD who experience relief
with these medicines. Antacids or alginates should be reserved for intermittent
use in customers with infrequent symptoms.
Advice for customers
• Avoid tight waistbands, bending over or lying down soon after a meal.
• Talk to your doctor if you suspect your medicines may be causing your
symptoms.
»»
Iron tablets, bisphosphonates, calcium channel blockers, oral corticosteroids,
NSAIDs and aspirin can aggravate indigestion or heartburn.
• Antacids and alginates may reduce the absorption of some medicines so need
to be taken two hours apart from them – check with your pharmacist.
• Raising the bed head and avoidance of meals two to three hours before bed
may help people with nocturnal symptoms.
Refer to
PHARMACIST
Seek urgent medical help for anyone describing pain which radiates
through their jaw, neck, shoulders or arm and/or gets worse with
exercise, since symptoms of a heart attack can be similar to those
seen with indigestion or heartburn.
RED FLAGS (ALARM SIGNALS) – REFER TO A DOCTOR
• Age 50 years or older (or 40 years or older if of Maori, Pacific
Island or Asian descent) and first presentation
• Coughing spells or nocturnal aspiration
• Difficulty in swallowing, persistent/protracted vomiting
• Family history of gastric cancer before the age of 50
• Iron deficiency anaemia
• NSAID use, including aspirin and OTC use
• Palpable abdominal mass
• Previous peptic ulcer disease, especially if complicated
• Severe or persistent symptoms
• Signs of bleeding from rectum or blood in vomit
• Unexplained weight loss.
For all other customers, ask the following questions (if appropriate)
and refer any people with “yes” answers to the pharmacist.
• Does the person have any other health conditions?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the person aged less than 12 years?
• Do their stools look black or contain black flecks (like kiwifruit
pips or coffee granules)?
• Are there other symptoms, eg, pain (especially in the neck or arm),
shortness of breath, sweating, or constipation?
• Is the person on a sodium-restricted diet?
• Does the person have any allergies to medicines?
• Alginate forms a protective barrier
• Antacid helps neutralise stomach acid
INDIGESTION?
Page 95

Influenza
Influenza (flu) is a common contagious viral infection that spreads quickly and
can cause serious illness and sometimes death. Older people, young children,
pregnant women and people with certain medical conditions (such as heart
disease, asthma, or an autoimmune disease) are at a higher risk of developing
serious complications from influenza.
Influenza can be spread through the air – coughing and sneezing releases
tiny droplets – or by direct contact with an infected person. People are infectious
usually one day before the symptoms start and up to five days after they become
sick. Flu season in New Zealand is usually from May to September, although can
start earlier or last longer. Each year, the majority of influenza cases are caused
by three to four major viruses. Our flu season tends to reflect that experienced
in the Northern hemisphere. The seasonal influenza vaccine for 2017 includes a
different H1N1-like strain to last year (see Immunisation box opposite).
Symptoms usually come on suddenly and commonly include high fever (38.8–
40°C), body chills, headache, dry cough, sore throat, runny or stuffy nose, chest
discomfort, muscle and joint aches and pains, tiredness and weakness. Stomach
symptoms, such as nausea, vomiting and diarrhoea, are more common in children
than in adults. Secondary infections (eg, bronchitis, pneumonia) are common.
Medicines are available over the counter to help improve flu symptoms,
such as fever, body aches, headaches, coughs and joint pains. Oseltamivir is an
antiviral which is available as a pharmacist–only medicine year round. Oseltamivir
can shorten the time to flu resolution and reduce the risk of hospitalisation and
complications from influenza; however, the occurrence of nausea and vomiting
is increased (see Treatment options next page).
masks readily available should you need to don one when talking with customers
who are actively coughing. Run through the Refer to Pharmacist questions to
help you decide which customers are amenable to self-treatment and who needs
to be referred to the pharmacist.
Advice for customers
• Consider yearly influenza vaccinations, which are free for some people
from their doctor (see text box Immunisation, next page for specific
recommendations).
• Recommend bedrest, increased fluid intake and symptom control using
analgesics and other treatment options for people who have already
contracted the flu.
• Warn sufferers the flu is contagious and they should refrain from going to
work and avoid public places where possible for up to five days.
• Refer patients to the doctor if symptoms worsen or persist for longer than a
week.
• Many cold and flu remedies contain paracetamol, a decongestant and/or a
cough suppressant. Watch for double-dosing with these products.
• Turn to page 98 to see Treatment options.
Initial assessment
During the flu season, you will be exposed on a daily basis to people with the
flu. However, determining whether a customer has the flu or a cold can be
challenging. Colds generally do not present with fever, joint pains, or body chills,
and can occur at any time throughout the year (see also Colds). Sneezing is
common with colds, and coughs associated with colds are more likely to be
productive. The symptoms of a cold usually take a few days to develop, compared
with flu symptoms that usually come on within three to four hours.
Always take precautions to protect your own health during flu season. Yearly
vaccination is the best form of protection, and you should always wash your
hands before and after direct contact with customers. Consider having face
Important note: Cough, cold and flu medicines in
children
Parents or caregivers should not give cough, cold or flu medicines to children aged less than six
years, and should seek pharmacist advice before using these preparations in children aged less
than 12 years. Instead, paracetamol may be used to relieve any pain or discomfort, and natural
remedies containing ingredients such as glycerol, honey, or lemon can be suggested to help
soothe irritated throats or coughs in children older than one year.
MANAGING PAIN
FREE
PROFESSIONAL DEVELOPMENT FOR
Pharmacy assistants, technicians and students
4
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CONTINUING OTC EDUCATION
Immunisation
The New Zealand Ministry of Health recommends annual vaccination against influenza. The
following groups are eligible for free influenza vaccination (through a doctor) in 2017 with
Influvac:
••
anyone aged 65 years or over
••
anyone aged less than 65 years with:
»»
cardiovascular disease (ischaemic heart disease, congestive heart failure, rheumatic heart
disease, congenital heart disease and cerebrovascular disease)
»»
chronic respiratory disease (asthma if on regular preventive therapy; other chronic
respiratory disease with impaired lung function)
»»
diabetes
»»
chronic renal disease
»»
any type of cancer, excluding basal and squamous skin cancers if not invasive
»»
other conditions (autoimmune disease, haemaglo binopathies, immune suppression, HIV,
neuromuscular and central nervous system disease, transplant recipients, children on longterm
aspirin)
••
pregnant women
••
children aged four or less who have been hospitalised for a respiratory illness or have a history
of significant respiratory illness.
The 2017 influenza vaccine varies from the 2016 vaccine and provides protection against the
following three virus strains:
••
A/Michigan/45/2015 (H1N1)-like virus (new strain)
••
A/Hong Kong/4801/2014 (H3N2)-like virus
••
B/Brisbane/60/2008-like virus.
Quadrivalent vaccines contain an additional B virus (B/Phuket/3073/2013-like strain).
Pharmacists who have qualified as an authorised vaccinator are able to give privately purchased
influenza immunisations within a community pharmacy setting to individuals aged 13 and older.
Some pharmacists may also be able to vaccinate adults who meet specified eligibility criteria for
funded influenza vaccination.
Useful websites
••
Immunisation Advisory Centre (IMAC) – www.immune.org.nz
»»
Provides independent, factual information about vaccine-preventable diseases and the
benefits and risks of immunisation.
••
National Influenza Specialists Group (NISG) – influenza.org.nz
»»
Not-for-profit group of expert New Zealand doctors, nurses, and pharmacists whose aim is
to promote the benefits of immunisation for those most at risk.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the person under 12 years or elderly?
• Does the person have a fever, rash or a stiff or sore neck (see
Childhood Diseases and Immunisation: Meningococcal
disease).
• Does the person have a high fever that doesn’t reduce?
• Does the person have chills or severe shaking, or a purple or bluish
discolouration of their lips, skin, fingers or toes?
• Does the person have difficulty breathing?
• Does the person appear confused or is their mental functioning
impaired?
• Does the person also have vomiting or diarrhoea?
• Is the person having trouble eating or drinking?
• Have the symptoms continued to get worse or persisted for longer
than a week?
• Does the person have a productive cough?
• Has the person recently travelled overseas?
• Is the person particularly unwell, eg, unable to get out of bed?
• Does the person have any allergies to medicines?
To complete the work book assessment
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Page 97

Influenza (continued)
TREATMENT OPTIONS
Category Examples Comments
Analgesic/antipyretics
Cough suppressants
(antitussives)
Combination products
Antiviral
Influenza vaccinations
Natural / herbal products /
supplements
[GENERAL SALE]
eg, paracetamol (Lemsip range, Panadol), ibuprofen up to
25s (Advil range, Nurofen range)
[PHARMACY ONLY MEDICINE]
eg, ibuprofen >25s (Advil range, Nurofen range),
ibuprofen suspension (Fenpaed, Nurofen for Children),
paracetamol suspension (Pamol, Panadol suspension)
[PHARMACY]
eg, Pholcodine (Duro-Tuss Dry Cough Range, Difflam
Cough Lozenges, Pholcodine linctus)
eg, dextromethorphan (Robitussin Dry Cough Forte,
Strepsils Dry Cough Lozenges)
[GENERAL SALE]
eg, phenylephrine + paracetamol (Codral Relief Max
Strength Cold & Flu Plus Decongestant*, Lemsip Max
Cold & Flu With Decongestant)
eg, decongestant + paracetamol + expectorant (Codral
Relief Max Strength 6 Signs Cold & Flu*, Lemsip Max All
In One Hot Drink)
[PHARMACY ONLY MEDICINE]
eg, decongestant + paracetamol (Maxiclear Cold & Flu
Relief, Sudafed PE Sinus + Pain Relief)
eg, decongestant + paracetamol + cough suppressant
(Panadol Cold & Flu Relief PE)
eg, decongestant + paracetamol + antihistamine (Codral
Nighttime Cold & Flu*, Sudafed PE Sinus Day & Night
Relief)
eg, decongestant + paracetamol + antihistamine + cough
suppressant (Codral All in One*,Codral Cold & Flu +
Cough*, Coldrex PE Cold & Flu Day & Night)
eg, decongestant + paracetamol + codeine (Codral Cold
and Flu*)
eg, decongestant + paracetamol + codeine +
antihistamine (Codral Day & Night*, Codral Multi Action
Cold & Flu*)
eg, paracetamol + phenylephrine + caffeine (Lemsip Max
Cold & Flu Day & Night Capsules*)
[PRESCRIPTION MEDICINE]
[PHARMACIST ONLY under certain conditions (see
comments)]
eg, oseltamivir (Tamiflu capsules)
[PRESCRIPTION MEDICINE] – except when
administered by a registered pharmacist vaccinator to
adults and children aged over 13 eg, Fluarix, Fluvax,
Influvac, Intanza, Vaxigrip
Comvita range, honey, Bifidobacterium, Lactobacillus,
ginseng (American), elderberry, echinacea, N-acetyl
cysteine, olive leaf, vitamin D
Products with an asterisk have a detailed listing in the Influenza section of OTC Products, on page 247.
Analgesics can make a person feel more comfortable. Paracetamol is effective for most
people. However, remind the customer not to exceed the recommended dose. Ibuprofen
can provide longer symptom relief and is the NSAID least likely to cause stomach irritation.
NSAIDs may be unsuitable for people on certain other medications or with some conditions
(eg, asthma, kidney disease – see Refer to pharmacist). Advise the person to stop
taking if stomach upsets, increased bruising or prolonged bleeding occur (see Reference
Section, OTC Medicine – Precautions). Aspirin is not recommended for adolescents or
children under 12 years old, or for children under 16 years old with a viral-related fever, or
fever with chickenpox (see Childhood Pain and Baby Teething: Treatment options).
Cough suppressants (eg, pholcodine, dextromethorphan) control or suppress the
cough reflex and can provide relief from a dry, unproductive cough. Be aware that
dextromethorphan can interact with other medicines that also have serotonergic activity
(eg, antidepressants, tramadol, lithium, St John’s wort) (see also Coughs: Dry).
Refer to the packet for ingredients which may include a decongestant to relieve nasal
congestion (eg, phenylephrine), an analgesic for pain relief, an antihistamine to dry up
runny noses (eg, loratadine, chlorpheniramine), a cough suppressant to stop a dry cough (eg,
pholcodine, dextromethorphan), or an expectorant to help expel mucus from the lungs (eg,
guaiphenesin).
Analgesics (eg, paracetamol, ibuprofen, codeine) can help make a person feel more
comfortable if they are in pain. Warn customers that codeine is an addictive substance and
should not be used for more than three days at a time. Constipation or drowsiness may
also occur. Monitor sales and be alert for any customers who may be misusing codeinecontaining
preparations.
Some antihistamines may cause drowsiness and affect a person’s ability to drive or operate
machinery. Avoid alcohol.
Cough suppressants (eg, pholcodine, dextromethorphan) can provide relief from a dry,
unproductive cough and expectorants (eg, guaiphenesin) can help a chesty cough. Coughs
associated with flu are more likely to be dry.
People who take other medicines or have other medical conditions may be unable to take
cold and flu tablets – check with your pharmacist.
Products containing guaiphenesin, ipecacuanha, dextromethorphan, pholcodine,
phenylephrine, pseudoephedrine [PRESCRIPTION], doxylamine, brompheniramine,
promethazine, chlorphenamine, triprolidine or diphenhydramine should NOT be given to
children aged less than six years, and pharmacist advice should be sought before using
them in children aged less than 12 years.
Shorten the duration and reduce the risk of complications of flu. Best when started within
48 hours of symptom onset. Can be sold by a pharmacist year round to adults and children
aged 13 or older who have been exposed to the influenza virus. Available on prescription
for younger children or for the prevention of influenza. Tamiflu is unfunded (customers pay
full cost).
For customers unable to swallow, Tamiflu capsules may be given by opening the capsule up
over a small bowl and mixing the contents with a teaspoonful of sweetened food product
(regular or sugar free), eg, honey, condensed milk, apple sauce, yoghurt to mask the taste.
Privately purchased influenza immunisations may be given by pharmacists who are
approved vaccinators. Funded influenza vaccinations may be given by pharmacist
vaccinators to pregnant women and those aged 65 and over.
Honey soothes the throat and stops cough. Bifidobacterium, Lactobacillus, ginseng and
vitamin D appear to protect against flu. Elderberry and echinacea root extracts and
N-acetyl cysteine may reduce flu symptoms. Olive leaf contains five times the antioxidant
capacity of vitamin C and helps boost immunity.
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Page 98 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
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Page 99

Iron Deficiency
Iron is an essential mineral found in every cell of the body. Iron boosts the immune
system, helps fight infections and is vital for normal child growth and intellectual
development. It is also used to make haemoglobin, which is the substance in red
blood cells responsible for transporting oxygen around the body.
Iron is stored in the liver, spleen and bone marrow. Iron requirements are higher
during periods of rapid growth and development – such as during early childhood,
adolescence and pregnancy. Low body iron levels can also be caused by:
• surgery, medical conditions that cause blood loss (eg, heavy menstruation,
haemorrhoids, gastrointestinal bleeding), or clotting disorders
• frequent blood donation, especially in women of child-bearing age
• chronic malabsorption syndromes (ie, people with coeliac disease)
• kidney failure
• poor dietary intake (eg, vegetarians).
People who engage in regular, intense exercise – especially if they are female
or vegetarian – are also at a higher risk of iron deficiency. It is uncommon for
adult men or postmenopausal women to become iron deficient.
Symptoms of iron deficiency include tiredness, pallor (pale complexion)
and weakness. A person’s ability to exercise may be reduced and shortness
of breath, fast heart rate, fainting and unusual food cravings may also be
present. The condition usually comes on slowly, so may go unrecognised for
some time. Iron-deficiency anaemia (IDA) occurs when the iron deficiency is
severe enough to affect the production of red blood cells. Blood tests are
required to confirm IDA, so it is important to refer people who suspect they
are iron deficient to the doctor.
The amount of haemoglobin in the blood will be measured, along with the
amount of iron present within the blood or stored. The doctor will also carry out a
physical examination and conduct a history to try to determine the cause of IDA.
Many other types of anaemia and even haemochromatosis (a medical
condition where too much iron is absorbed) can cause similar symptoms, so do
not assume the diagnosis is iron-deficiency anaemia without blood test results.
Too much iron can be toxic, especially to children, and iron supplements should
not be taken routinely without a doctor's advice.
Haem iron and non-haem iron
Two types of iron exist. Haem iron and non–haem iron. Haem iron is the
iron contained within myoglobin and the blood pigment haemoglobin, and
approximately 30% of haem iron ingested is absorbed. It is found in animal
foods, such as beef, lamb, chicken, egg yolks and fish. Offal foods (eg, liver,
kidneys) are particularly good sources of haem iron; however, these offal meats
also contain large amounts of vitamin A which is known to cause birth defects,
so should not be eaten in large quantities by pregnant women. Red meat also
contains non-haem iron.
Non-haem iron is found in plant foods such as dried beans, dark green leafy
vegetables, tofu, fortified breakfast cereals, flours and whole grains. In the past,
non-haem iron was considered inferior to haem-iron because less is absorbed.
However, our bodies have more control over plant-based sources of iron and
absorption can be improved if non-haem iron is consumed with products high
in vitamin C such as kiwifruit, citrus fruit, orange juice, and capsicums. Research
has also found that vegans are no more susceptible to iron deficiency than the
general population.
TREATMENT OPTIONS
Category Examples Comments
Iron supplements
Iron supplements in
combination with other
minerals or vitamins
[GENERAL SALE]
eg, Douglas Carbonyl Iron (=elemental iron
18mg), Natures Own Liquid iron (=elemental
iron 7.5mg), Sanderson Superior Organic
Iron (=elemental iron 24mg), Spatone 100%
Natural* (=elemental iron 5mg),
[PHARMACY ONLY MEDICINE]
eg, Ferrograd (=105mg elemental iron)
[GENERAL SALE]
eg, Blackmores Bio Iron, Clinicians Iron Boost,
Fab Iron, Floradix Floravital Liquid Iron and
Vitamin Formula, Incremin Iron Mixture, Iron
Melts, Solgar Gentle Iron, Spirulina
[PHARMACY ONLY MEDICINE]
eg, Elevit with Iodine, FabFol Plus with Iodine
(=elemental iron 60mg)
eg, Ferrograd C (=105mg elemental iron +
vitamin C 500mg)
eg, Ferrograd F (=105mg elemental iron + folic
acid 0.35g)
Iron supplements contain either the ferrous or ferric form of iron. Of the two, the ferrous
form is better absorbed and is available as either ferrous sulphate, ferrous fumurate or
ferrous gluconate. Each one of these ferrous salts contains a different amount of available
iron, called elemental iron. Iron dosages should be based on the amount of elemental iron
contained within the product, not the amount of ferrous salt present.
Recommended daily intakes (RDIs) of iron vary according to age and gender. Pregnant
women also require higher daily intakes of iron. RDIs can be found on the NZ Nutrition
Foundation’s website (www.nutritionfoundation.org.nz).
Higher dosages of iron are best taken as divided doses as the amount of iron absorbed
decreases as dosages get larger. Iron supplements prescribed for anaemia may need to be
taken for up to six months, or for three months after haemoglobin concentration is normal, to
build up iron stores.
Iron supplements may cause nausea, constipation and/or diarrhoea, and make the stools a
dark colour. Taking iron tablets with food may help settle gastrointestinal problems.
Be aware iron is dangerous in overdose and tablets must be taken as directed for the
recommended course. Keep all iron products out of reach of children.
Sip iron liquid through a straw to avoid tooth discolouration.
Combination formulations may contain vitamin C, folic acid, B vitamins (ie, B1, B6, or B12)
and other vitamins. Many act as co-factors to facilitate absorption.
If iron levels are very low, follow a doctor’s advice with regards to dosage.
Products with an asterisk have a detailed listing in the Iron Deficiency section of OTC Products, starting on page 249.
READY, SET, LEARN!
Page 100 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Iron
••
Iron deficiency is reasonably common among New Zealand children.
»»
Maori and Pacific Island children are more at risk.
••
Supplements may be appropriate for some customers, but pharmacists should oversee all new
sales to determine need, and refer customers to a doctor for further investigation.
••
Supplements are used to treat people with confirmed iron deficiency from blood tests, or people
at high risk of becoming iron deficient.
Initial assessment
Iron supplementation is not without controversy and is not generally recommended
unless a customer has a formal diagnosis of IDA. Iron supplementation is also
best done under medical supervision as absorption of other nutrients (ie, calcium,
zinc) may be reduced.
Advise customers that iron-rich foods are preferred over supplements and
suggest ways to improve iron absorption from their diet. Refer any customers
with "yes" answers to the Refer to Pharmacist questions to a pharmacist.
Advice for customers
• Lean red meat is the best source of easily-absorbed iron. Chicken, other
poultry, pork and fish also contain easy-to-absorb iron.
• Combine vitamin C rich foods with sources of non-haem iron to increase
absorption (eg, kiwifruit and cereal, beans and tomatoes, tofu and broccoli).
• Combining haem foods with non-haem foods also increases iron absorption
(eg, meat and salad).
• Avoid drinking tea and coffee at mealtimes as they both reduce iron absorption.
• Babies are born with sufficient iron supplies to last for approximately six
months. After that time, iron-rich foods should be gradually added to their
diets to meet their body’s iron requirements.
• Ensure children and teenagers going through growth spurts are getting
enough iron in their diet.
• Iron stores in pregnant women have to serve the increased blood volume of
the mother as well as the needs of the growing baby.
»»
Some pregnant women may be prescribed iron supplements by their doctor;
however, there is controversy regarding routine supplementation.
• Supplemental iron may cause gastrointestinal side effects such as nausea and
constipation.
• Some forms of supplemental iron (eg, heme iron polypeptides, carbonyl iron,
iron amino-acid chelates) may have fewer side effects than ferrous or ferric
salts.
Refer to
PHARMACIST
All customers who have not had a formal diagnosis of iron-deficiency
anaemia (eg, with blood tests) will need to speak to a pharmacist
who should then refer them to a doctor.
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, haemochromatosis,
is pregnant or breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the person a baby or a child?
• Has the person had any other symptoms (eg, joint pain,
unexplained weight loss)?
• Has the person noticed blood in the stools (note that iron tablets
will make the stools look dark)?
• Have the symptoms persisted despite regular iron tablets?
• Is the person an elderly person?
• Are the iron tablets causing unacceptable side effects?
• Does the person have a good reason for wanting iron supplements?
• Is the person unsure of what dosage of iron is needed?
• Does the person have any allergies to medicines?
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Page 101

Irritable Bowel Syndrome
Irritable bowel syndrome (IBS) is a common gastrointestinal disorder with
a worldwide prevalence of 10%–20%. Symptoms can range from minor and
occasional to severe and disabling. Because the symptoms of IBS are similar to
the symptoms of many other conditions, it often takes years to exclude other
conditions and to diagnose a person’s symptoms as IBS.
IBS is more common in women than in men and occurs more often in people in
the 20 to 40-year-old age group. IBS can occur in children and many people can
trace the onset of their symptoms back to childhood. Onset in old age is rare. The
exact cause of IBS is not known but experts suggest it may stem from a problem
with nerves that control the bowel.
Symptoms of IBS
The difficulty with diagnosing IBS is that symptoms can vary, although alternating
diarrhoea and constipation is considered a key symptom for diagnosis. Sufferers
typically describe three to four days of constipation followed by one to two days
of loose bowel motions. Other symptoms typical of IBS include:
• abdominal bloating – may more commonly occur in the evening, and may
be accompanied by increased gurgling and rumbling. Clothing may become
uncomfortable
• cramping, often just prior to a bowel movement; also increased flatulence
• mucus in the stools
• sensation of incomplete evacuation of the bowel or an urgent need to
evacuate the bowel
• tiredness.
IBS may also cause lower back pain and has been associated with painful
periods, pain with sexual intercourse, fibromyalgia, and bladder symptoms.
IBS triggers
Certain things can trigger IBS symptoms, including:
• change of routine
• food intolerance
»»
Lactose is the most common dietary trigger for IBS. Fructose and sorbitol
may also trigger IBS.
»»
Alcohol, caffeine, carbonated drinks, dairy products, fried or fatty foods,
low-fibre diets and preserved foods have also been implicated.
• hormones
»»
Some women are prone to IBS symptoms around the time of their period,
although endometriosis should be excluded as the cause.
• infection or food poisoning
»»
Bowel symptoms may persist long after the offending bacteria or virus has
been eliminated. Estimated to be responsible for up to 25% of IBS cases.
• smoking
• some medicines (eg, antibiotics, antacids, painkillers)
• stress, depression or anxiety.
TREATMENT OPTIONS
Category Examples Comments
Antispasmodics
Smooth muscle relaxants
Probiotics
Food supplements
Laxatives
Anti-diarrhoea products
Natural / herbal products /
supplements
[GENERAL SALE]
eg, peppermint oil (Colpermin, Mintec*)
[PHARMACIST ONLY MEDICINE]
eg, hyoscine (Gastro-Soothe*)
[SUPPLEMENT]
eg, IBS Support, Primadophilus Reuteri
eg, gluten-free wheat dextrin (Benefiber)
eg, inulin fibre (Metamucil Fibresure)
[GENERAL SALE]
eg, docusate (Coloxyl), lactulose (Laevolac),
psyllium husk (Metamucil), sterculia (Normacol)
[PHARMACY ONLY MEDICINE]
eg, loperamide (Diamide, Imodium Zapid)
eg, guar gum, kiwifruit extract, peppermint,
slippery elm, turmeric
Peppermint oil provides natural relief of abdominal bloating, distension and cramping.
May be helpful for abdominal pain or cramping.
May help to regulate the digestive system, reduce abdominal pain and bloating, and
encourage more uniform stools. Studies have indicated a benefit for probiotics species such
as Bifidobacterium, Lactobacillus, and Propionibacterium.
Fine powder with minimum taste. Can be sprinkled on foods and in cooking without
premixing to increase fibre content of the diet, encouraging more uniform stools.
Most laxatives only treat constipation; however, bulk-forming laxatives (containing psyllium
or sterculia) can also be used to bulk up watery unformed stools. When used to regulate
stool consistency, less water can be drunk as the fibre absorbs fluid from the bowel.
See Constipation for more information about constipation.
Slow down bowel movements, allowing reabsorption of fluid by body. Can help reduce
cramping, abdominal pain and the frequency of bowel motions. May be used regularly in
people with IBS to regulate ongoing diarrhoea.
Many natural ingredients (including probiotics, guar gum, peppermint, turmeric) have been
shown to be effective in IBS. Kiwifruit extract contains prebiotics, enzymes and dietary fibre
to optimise bowel health.
Products with an asterisk have a detailed listing in the Irritable Bowel Syndrome section of OTC Products, on page 250.
Page 102 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Initial assessment
Politely ask customers who you notice repeatedly purchasing laxatives or
anti-diarrhoea products if they would like to talk their condition over with a
pharmacist. Symptoms of IBS are similar to many other conditions, some more
serious than others, and it is important to refer anybody with obvious RED FLAGS
(see Refer to Pharmacist) or with an undiagnosed condition to a doctor.
Treatments
IBS cannot be diagnosed until other conditions such as coeliac disease,
diverticulitis, or inflammatory bowel disease have been ruled out. Other tests –
such as a sigmoidoscopy or colonoscopy – may also be needed. For this reason
it is important all customers without a formal diagnosis be referred to a doctor,
particularly those customers with RED FLAGS (see Refer to Pharmacist).
Once the diagnosis has been established, diet and lifestyle changes should be
tried first. People with IBS should try eating smaller, scheduled meals throughout
the day, rather than just three big meals. Food should be eaten slowly and care
should be taken to avoid meals that are likely to over-stimulate the gut, such as
high-fat foods or large meals.
Scientific studies have shown that a low-FODMAP diet can significantly relieve
IBS symptoms for many sufferers. FODMAP is an acronym for the indigestable
sugars that can cause the bowel to distend by drawing in more fluid and rapidly
generating gas when fermented by bowel bacteria:
• Fermentable – those sugars that are rapidly broken down by bowel bacteria
• Oligosaccharides – fructans and galacto-oligosaccharides
• Disaccharides – lactose
• Monosaccharides – fructose
• And
• Polyols – mannitol, maltitol, sorbitol, xylitol.
However, these diets are not suitable for everybody with IBS and can be
difficult to follow as well as being restrictive nutritionally. Seek expert advice (for
more information see www.ibsdiets.org).
Other lifestyle changes include avoiding triggers, learning how to handle
stress and increasing physical activity.
Medication may also be used to manage IBS. Doctors may treat IBS that
has developed following a gastroenteritis illness with antibiotics or probiotics
although it typically takes one to two years for the condition to completely
resolve. Other treatments target the most predominant symptom (ie, constipation
or diarrhoea) and most treatments are given only when needed. Stronger
medicines are available on prescription.
Refer to
PHARMACIST
Refer to the pharmacist anybody who has not had the diagnosis of
IBS confirmed by a doctor.
RED FLAGS (ALARM SIGNALS) – REFER TO A DOCTOR
• Abdominal or rectal mass
• Family history of gastrointestinal cancer, inflammatory bowel
disease or coeliac disease
• Iron deficiency anaemia
• Onset of symptoms in patients aged greater than 50 years
• Nocturnal symptoms (eg, waking from sleep with pain or the need
to defecate)
• Rectal bleeding that is not due to haemorrhoids
• Unintentional or unexplained weight loss.
For all other customers with previously diagnosed IBS, ask the
following questions, if appropriate, and refer any people with “yes”
answers to a pharmacist.
• Is there any rectal bleeding or blood mixed into the stools?
• If constipation is present, is it severe or has it persisted for longer
than a week?
• Do the stools float or are they hard to flush down the toilet?
• Are there other symptoms (eg, fever)?
• Could the person be anaemic?
• Has the person lost a significant amount of weight recently?
• Do the symptoms wake the person at night?
• Have the symptoms become worse over time or changed recently?
• Has the person recently travelled overseas?
• Does the person have any allergies to medicines?
Page 103

Menopause
Menopause – the “change of life” – is an unavoidable part of aging that every
woman who lives till middle age will experience. It literally means last period,
and signals the end of menstruation although the term is commonly used to
describe the years leading up to the menopause as well. This transition phase is
more correctly called the perimenopause and describes the period of time during
which the ovaries release fewer eggs and produce fewer hormones causing a
change in menstrual patterns.
Menopause is generally considered complete in a woman with an intact uterus
if she has not had a period for at least a year. Although high levels of follicle
stimulating hormone (FSH) and luteinizing hormone (LH) provide additional
evidence that menopause is impending, the diagnosis is not confirmed until a
year has passed.
Signs of natural perimenopause usually start to occur between the ages of 45
and 55 with an average age of onset of 52. In more than 50% of women, the
timing of their menopause is similar to that of the age at which their mother or
sister underwent the transition.
Early onset or premature menopause is the term used to describe menopause
occurring in a woman before the age of 40 and is more likely to occur in women
who:
• are overweight
• come from certain countries with noticeably earlier ages of menopause (eg,
Latin America)
• have a family history of early menopause
• have certain medical conditions or illnesses
• have had none or only one child
• smoke.
Artificial menopause is that caused by surgical removal of both ovaries or
the destruction of the ovaries by some cancer treatments. Hormone levels drop
suddenly resulting in an abrupt onset of menopausal symptoms which are often
more severe than those experienced with natural or premature menopause.
Symptoms
A change in menstrual patterns is usually the first symptom of perimenopause.
Periods become lighter or heavier, longer or shorter, with an increased length of
time between cycles. Hot flushes (also called hot flashes in some countries) are
experienced by more than 60% of women. A hot flush is a momentary sensation
of heat that may be accompanied by a red, flushed face and sweating. Night
TREATMENT OPTIONS
Category Examples Comments
Magnetic devices
Vaginal dryness
Supplements
[GENERAL SALE]
eg, Ladycare
[GENERAL SALE]
eg, Vagisil Intimate Moisturiser, Sylk
[SUPPLEMENT]
eg, Harmony Menopause*, Amberen Menopause
Relief, Clinicians Menopause Balance, Nutralife
Meno-life, Promensil, Remifemin
eg, EPA, flaxseed, pycnogenol, soy, St John’s wort
Ladycare Menopause is a drug-free magnetic device designed to reduce the symptoms of
menopause. Attaches discreetly and comfortably to the underwear.
Relieves uncomfortable vaginal dryness and can be used during sexual intercourse. Waterbased
and safe to use with condoms.
Contain various ingredients including angelica polymorpha (Dong Quai), cimicifuga racemosa
(black cohosh), peony, shatavari, trifolium pretense (red clover extract), vitex agnus-castus
(Chaste tree) to help relieve symptoms of menopause such as night sweats and hot flushes.
There is some evidence for the effectiveness of other supplements (ie, EPA, flaxseed, soy, St
John’s wort) for relieving menopausal symptoms.
Products with an asterisk have a detailed listing in the Menopause section of OTC Products, starting on page 250.
Page 104 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
sweats are also common and may interfere with sleep. Other physical and
psychological symptoms that may be experienced include:
• aching legs/cramps
• body hair growth
• breast tenderness
• fluid retention (eg, swollen ankles, weight gain, bloating)
• forgetfulness
• increased anxiety and stress
• irritability and mood swings
• itchy skin
• joint and bone pain
• low sex drive
• migraines/headaches
• more noticeable skin ageing (ie, wrinkles)
• tinnitus (ringing in the ears)
• vaginal dryness (can result in painful intercourse)
• vertigo.
Urinary tract infections (see Cystitis) and incontinence (see Urinary
Incontinence) are also more common due to thinning of the vaginal and bladder
walls. Women are at greater risk of medical conditions such as osteoporosis, heart
disease (see Heart Health), and breast cancer after menopause. Perimenopausal
symptoms may last anywhere from a few months to several years (average three
to five years).
Initial assessment
Not all women have problems during perimenopause and many who seek advice
may just require information about possible symptoms and duration of the
transition. Some may wish to try complementary therapies. Some evidence of an
effect has been found for black cohosh, eicosapentaenoic acid (EPA), flaxseed,
pycnogenol, soy and St John’s wort. Many other complementary therapies such as
dong quai, evening primrose oil, panax ginseng or wild yam have less convincing
evidence although some women may obtain benefit.
Lifestyle changes (see Advice for customers) may go some way to
alleviating menopausal symptoms and pharmacy staff should advise women to
undergo recommended screening tests and Heart Health assessments.
Advise all women to talk to their doctor about their symptoms at their next
visit as other medical conditions can cause heavier periods or an absence of
periods (amenorrhoea). Bleeding that occurs after periods have been absent for
a year is not normal and medical investigation is warranted.
Treatment
Treatment for perimenopausal symptoms is not routinely offered or needed as
individual symptoms vary markedly. The decision to treat should be a collaborative
one made between doctor and patient after a thorough discussion of the relevant
risks and benefits.
Prescription medicines, including hormone replacement therapy (HRT) and
Refer to
PHARMACIST
Always refer any woman with particularly severe symptoms to the
pharmacist. Also refer:
• any woman who is aged less than 40
• women on HRT who are experiencing unusual uterine bleeding
• women with irregular periods who do not seem to have any other
menopausal symptoms.
non-hormonal treatment products (eg, SSRIs, venlafaxine, clonidine, gabapentin)
may be considered by a doctor for women who are suitable candidates for these
types of therapy.
Vaginal dryness is an uncomfortable and a common occurrence in menopausal
women and is due to a thinning of the vaginal wall (vaginal atrophy) brought
about by lower oestrogen levels. Local (vaginal) oestrogen treatments are
very effective at relieving this dryness while having a minimal impact on other
tissues of the body. Vaginal moisturising gels and use of lubricants during sexual
intercourse are non-hormonal options for managing vaginal discomfort.
Advice for customers
• Dress in light clothing and in layers to help with the hot flushes.
• Eat a balanced, healthy diet.
»»
Falling oestrogen levels shift fat storage in women from the hips to the
waist (truncal obesity) which increases their risk of cardiovascular disease.
»»
Women going through menopause should begin weight control (see
Weight Loss) before it becomes a problem. Eating frequent, smaller meals
throughout the day may satisfy appetite better than eating three large
meals.
»»
Women should partake in regular, weight-bearing exercise (ie, walking,
dancing, tennis, aerobics, golf) on most days of the week. Exercise is also
beneficial for reducing the risk of cardiovascular disease and osteoporosis
and in aiding sleep.
• Avoid foods which exacerbate menopausal symptoms or decrease sleep (eg,
caffeine, fatty or spicy foods and alcohol).
• Practise pelvic floor strengthening exercises (Kegel exercises) to help with
urinary incontinence.
• Use vaginal lubricants or moisturisers to help with vaginal dryness.
• Some women find yoga, massage, acupuncture or meditation beneficial.
• Stop smoking (see Smoking Cessation).
• Women going through early menopause may like to consider joining a local
support group (see www.earlymenopause.org.nz).
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Page 105

Migraine
Migraines are a type of severe headache, and one of the most common headache
disorders seen by doctors, occurring in 18% of women and 6% of men.
Symptoms of a migraine differ from other types of headache (see Headache).
Migraine attacks are typically unilateral (only one side of the head is affected),
although occasionally bilateral migraines (both sides of the head) occur. The pain is
usually described as a dull throb or tightening which intensifies into a concentrated
and severe pain. Most people feel sick; however, only about 30% will vomit. The exact
cause of migraines is unknown, but chemical and vascular changes within the brain
as well as strong genetic factors are thought to play a role.
An aura – which may take the form of a funny smell, taste, feeling or visual
disturbance – is experienced by almost one quarter of people with migraine.
This may be present for up to an an hour before the headache starts. Migraine
sufferers may also have difficulty seeing or speaking. Other common symptoms
that occur in addition to the pain of migraine include:
• osmophobia (sensitivity to smells)
• phonophobia (sensitivity to noise)
• photophobia (sensitivity to light)
• visual disturbances (blurred vision, flashes of light, zigzag lines, blind spots)
• weakness, numbness or tingling in the face, arm or leg
• yawning, sleepiness, lack of energy.
Migraines can last from four hours to two or three days and may occur once a
year to once every few days. Most people have a family history of migraine. First
attacks often occur in adolescence, and attacks tend to become less severe and
less frequent with age.
Migraine attacks can substantially impair a person's functioning during an
attack. Research has shown quality of life is also diminished between attacks.
Initial assessment
Ask your customer to "Tell me about your headache", and listen to their
response. A headache is more likely to be a migraine if nausea and/or vomiting
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Non-steroidal antiinflammatory
drugs (NSAIDs)
Combination analgesics
Antiemetics
Serotonin (5-HT) receptor
agonists
Natural / herbal products /
supplements
[GENERAL SALE] eg, paracetamol (Panadol
range, Paracare)
[GENERAL SALE]
eg, aspirin (Aspro, Disprin range), ibuprofen up
to 25s (Advil, Nurofen Migraine Pain, Nurofen
Zavance)
[PHARMACY ONLY MEDICINE]
eg, diclofenac (Voltaren Rapid 12.5), ibuprofen
>25s (Advil, Nurofen range), naproxen
(Sonaflam)
[PHARMACIST ONLY]
eg, diclofenac (Voltaren Rapid 25)
[GENERAL SALE] eg, ibuprofen + paracetamol
(Maxigesic [16], Nuromol [12])
[PHARMACY ONLY MEDICINE] eg, ibuprofen
+ paracetamol (Maxigesic [50, 100], Nuromol
[24])
[PHARMACIST ONLY MEDICINE]
eg, paracetamol + codeine (Panadeine,
Panadeine Extra), ibuprofen + codeine (Ibucode
Plus, Nurofen Plus), paracetamol + doxylamine
+ codeine (Mersyndol*)
[PHARMACIST ONLY MEDICINE]
eg, prochlorperazine (Antinaus)
[PHARMACIST ONLY MEDICINE]
eg, sumatriptan 50mg (Sumagran Active),
zolmitriptan nasal spray 5mg (Zomig)
5-HTP, caffeine, butterbur, coenzyme Q10,
feverfew, magnesium, riboflavin (Clinicians
MigraDol)
Generally effective at relieving mild-type pain. May not be strong enough as the sole
analgesic for migraine. Few adverse effects.
Products with an asterisk have a detailed listing in the Migraine section of OTC Products, starting on page 250.
NSAIDs generally last longer than paracetamol. Ibuprofen is the NSAID least likely to cause
stomach irritation. NSAIDs may not be suitable for people on certain other medications or
with some medical conditions (eg, asthma, kidney disease – see Refer to Pharmacist).
Advise customer to stop taking if stomach upsets, increased bruising or prolonged bleeding
occur. Aspirin products require the same warnings as other NSAID products. Aspirin is not
recommended for adolescents or children under 12 years old, or for children under 16 years
old with a viral-related fever, or fever with chickenpox (see Childhood Pain and Baby
Teething: Treatment options).
See also Reference Section, OTC Medicines – Precautions.
Try paracetamol or NSAIDs first.
Warn customers that codeine is an addictive substance and should not be used for more than
three days at a time. Constipation or drowsiness may also occur. Monitor sales and be alert
for any customers who may be misusing codeine-containing preparations.
Mersyndol also contains doxylamine, so can cause drowsiness.
Can be sold by a pharmacist in quantities of 10 or fewer tablets for nausea associated with
migraine.
Proven effectiveness in migraine. Small packs may be sold by a pharmacist for adults with
a stable, well-established pattern of migraine symptoms for relief of acute attacks. Follow
packet instructions strictly.
Caffeine in combination with analgesics is effective at treating migraine. Other supplements
may be more effective for preventing migraines when taken daily for at least three months.
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Page 106 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
are present in combination with two of the following three symptoms: sensitivity
to light, sensitivity to loud sounds, and sensitivity to smells. Many people also get
tension type headaches in addition to migraines (see Headache).
If the symptoms they are describing seem typical of migraine, and they
have never had a formal diagnosis of migraine from a doctor, refer them to a
pharmacist who may choose to refer them to a doctor for further tests. Also
refer any customers over 50 with a first episode of headache or customers with
other symptoms of concern (see RED FLAGS in the Refer to Pharmacist text
box). Treatment available over the counter includes analgesics, serotonin (5-
HT) agonists and antiemetics, many of which are Pharmacist Only. Stronger
analgesics and preventive medications are available from the doctor.
Causes or triggers
Although the cause of migraine is not fully understood, some people prone to
migraine have found exposure to certain things can trigger their migraine. These
are called trigger factors and the most common ones include:
• certain foods (eg, alcohol, cheese, chocolate, caffeine, artificial sweeteners)
• environment and temperature changes (eg, exposure to heat or cold, altitude)
• exercise
• flickering/flashing lights or loud noises
• hunger
• mood (eg, anxiety, stress) or hormonal changes (eg, menstruation)
• sleep – too little or too much
• strong smells (such as perfume, paint, cleaning solutions, fumes, smoke).
Advice for customers
• Rest in a quiet, darkened room. Reusable heat pads may provide relief.
• Keep a diary of when the migraines occur, paying particular attention to
occurrence with food, stress or other events (eg, menstrual cycle).
• Analgesics or serotonin agonists, with or without antiemetics, should be taken
at the first sign of an attack (once the attack has started gastric motility is
slowed, which decreases absorption of the medicine).
• Be careful not to overuse analgesics since medication overuse headache can
coexist with migraine (see Headache).
• Drink plenty of water, maintain regular exercise and a healthy diet.
• Consider acupuncture, hypnosis and relaxation training.
Refer to
PHARMACIST
Refer to the pharmacist anybody who has not had the diagnosis of
migraine confirmed by a doctor.
RED FLAGS (ALARM SIGNALS) – REFER TO A DOCTOR
• First episode of migraine in a person aged over 50
• Description of migraine as "The worst headache of my life"
(requires urgent referral)
• Headaches that have worsened over several months
• Any headache that is severe right from the start (as compared with
one that gradually develops)
• A headache that develops after a head injury or major trauma
• A headache that is brought on by lying down, a cough, sneeze,
bending or with exertion
• Concurrent symptoms such as fever, high blood pressure, muscle
aches, weight loss or scalp tenderness which may suggest a whole
body disorder
• Seizures, confusion, changes in consciousness or difficulty waking.
Other questions to ask
For customers with a previous diagnosis of migraine, decide if any
further questions still need to be asked and refer any “yes” answers to
a pharmacist.
• Does the person have any other health conditions (eg, heart
disease, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication or complementary
therapies, either prescribed by a doctor or bought from a shop?
• Does the person wish to purchase a migraine-specific medicine or
have their symptoms persisted despite taking analgesics?
• Is the person a child or young adult aged less than 18, or elderly?
• Does the person also have a fever, rash or a stiff or sore neck
(see Childhood Diseases and Immunisation: Meningococcal
Disease)?
• Does the person have frequent migraines (more than two a
month) or is buying a lot of analgesics?
• Is there any pain within the eye?
• Does the person have any allergies to medicines?
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Page 107

Muscular Aches, Pains and Tightness
Muscle aches and pains are typically caused by unaccustomed or overuse of
a muscle, but can also be due to tension or stress, or as a result of injury from
exercise or physically demanding work. Some conditions which affect the whole
body, such as the flu (see Influenza), and other chronic disorders (such as
fibromyalgia) can also cause muscle pain, but this tends to be a general type
of pain which affects most of the body’s muscles, not just specific sets, as in the
other causes listed above.
Tight muscles usually develop over time and progressively worsen. Some
people may be genetically more susceptible to them, or they may develop due
to bad posture, electrolyte imbalances, incorrect sporting techniques, muscle
fatigue, running style or poorly fitted shoes.
Muscle tightness
Muscle tightness can occur not only during or after exercise, but also after
prolonged periods of inactivity.
Cramps that occur during exercise are usually the result of muscle fatigue,
low sodium, or low potassium. Their incidence can be reduced through proper
hydration and nutrition before exercise and by drinking electrolyte replenishing
drinks during activities that last longer than 60 minutes.
Muscles are more likely to tighten following exercises that focus on eccentric
contractions where a weight is lowered or slowed such as running downhill or
the downward phase of a bicep curl. Gentle massage may ease the soreness and
gradually increasing the intensity of a new exercise programme can help prevent
it happening in the first place.
Muscles that tighten as a result of inactivity are often due to poor posture.
Long periods of time slouched at a desk can cause the chest muscles to shorten
and the upper back muscles to lengthen and weaken. Good posture should be
maintained throughout the day, strengthening exercises should target the small
muscles of the back, and stretching exercises should concentrate on lengthening
the chest muscles back to normal.
Initial assessment
Try to establish the cause and severity of your customer's muscle pain or tightness
to help decide whether further investigation is necessary. Symptoms of muscle
pain caused by unaccustomed or overuse of a muscle are typically confined to
specific groups of muscles, or a matching pair of muscles. The pain usually peaks
within 72 hours before subsiding.
More severe muscle pain accompanied by swelling and restricted movement
may indicate muscle, tendon, or ligament damage. Refer to a pharmacist (see also
Strains and Sprains).
Oral analgesics or topical rubs are the most common types of treatment
for general muscle pain caused by overuse, in addition to stretching and
strengthening exercises once the pain has gone.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, diabetes, is
pregnant or breastfeeding) or take any medications (particularly
medicine for high cholesterol).
• Does the person have a serious loss of movement or mobility?
• Is there an excessive range of movement in any joint (may suggest
major ligament disruption)?
• Did the injury swell immediately or become severely painful?
• Is the person unable to weight bear, or is a fracture suspected?
• Is the area swollen and/or warm to the touch now?
• Is the person a child aged less than 12 or elderly?
• Is the pain severe, getting worse or has it persisted despite
treatment?
• Has the pain lasted longer than three to four days?
• Is the pain from a back injury?
• Does the person have muscular pain with no specific cause?
• Does the person have any allergies to medicines?
Initial treatment of muscle aches and pain
• For muscle pain due to an injury.
»»
Follow the RICED approach immediately (see Strains and Sprains).
»»
Take paracetamol, or a NSAID (eg, ibuprofen) if directed by a doctor.
• For muscle aches due to overuse and fibromyalgia.
»»
Consider pain relief, topical heat rubs, massage therapy and stretching
exercises.
• For muscle pain due to an illness or infection, or for pain that has persisted
for a long time.
»»
Speak to a pharmacist or doctor.
Advice for customers
• Low-impact exercises such as walking, cycling, and swimming can help restore
proper muscle tone. Begin slowly and avoid high-impact activities initially.
• Warm up and stretch before and after exercise.
Page 108 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
TREATMENT OPTIONS
Category Examples Comments
Topical non-steroidal antiinflammatory
agents (NSAIDs)
Oral non-steroidal antiinflammatory
agents (NSAIDs)
Rubefacients (“heat” rubs)
Agents that reduce bruising
Simple analgesics
Other topical products
Muscle cramps
Natural / herbal products /
supplements
[GENERAL SALE]
eg, ibuprofen (Nurofen Topical Gel), diclofenac
(Voltaren Emulgel*)
[PHARMACY ONLY MEDICINE]
eg, etofenamate (Rheumon Gel)
[GENERAL SALE]
eg, ibuprofen up to 25s (Advil, Nurofen),
ibuprofen + paracetamol (Maxigesic* [16],
Nuromol [12])
[PHARMACY ONLY MEDICINE]
eg, diclofenac 12.5mg (Voltaren Rapid 12.5*),
ibuprofen >25s (Advil, Nurofen), naproxen
(Sonaflam), ibuprofen + paracetamol (Maxigesic
[50, 100], Nuromol [24, 48])
[PHARMACIST ONLY MEDICINE]
eg, diclofenac 25mg (Voltaren Rapid 25*),
ibuprofen + codeine (Ibucode Plus, Nurofen
Plus) paracetamol + codeine (Panadeine,
Panadeine Extra)
[GENERAL SALE]
eg, Deep Heat Relief, Metsal Cream, Ice Gel,
Tiger Balm Oil*, Tiger Balm Red Strength
Ointment*, Tiger Balm White Regular Strength
Ointment*
[GENERAL SALE]
eg, Arnica cream
eg, mucopolysaccharide polysulfate (eg,
Hirudoid)
[GENERAL SALE]
eg, paracetamol (Panadol Back + Neck Pain
Relief)
[PHARMACY ONLY MEDICINE]
eg, Panadol Back + Neck Long Lasting
[GENERAL SALE]
eg, Anti-Flamme range, Badger Sore Muscle
Rub, Dencorub Dual Action Cream, Flexagil Pain-
Relief, Muscle oil, Percutane, Rehab Fix, USL
Sport Linament, Zo-Rub
eg, Omron HV-F128 TENS Device
[GENERAL SALE]
eg, Crampeze Night Cramps, Muscle Magnesium
Capsaicin, camphor, willow bark, acupuncture,
chiropractic manipulation, yoga, magnesium, zinc
These treat the body’s inflammatory reaction to injury and reduce pain, but may delay tissue
healing if used for longer than three days after the injury. Consult a doctor for further advice.
Do not apply to broken skin or near the eyes or mucous membranes. Wash hands after
applying. Do not use under sealed dressings. May, rarely, cause the same adverse effects as
oral NSAIDs. Similar care and consideration before use is recommended.
These treat the body’s inflammatory reaction to injury and reduce pain, but may delay tissue
healing if used for longer than three days after the injury. Consult a doctor for further advice.
Ibuprofen is the NSAID least likely to cause stomach irritation.
NSAIDs may not be suitable for people on certain other medications or with some medical
conditions (eg, asthma, kidney disease – see Refer to Pharmacist). Advise customers to
stop taking if stomach upsets, increased bruising or prolonged bleeding occur.
Avoid aspirin in children under 12 years.
Warn customers that codeine is an addictive substance and should not be used for more than
three days at a time. Constipation or drowsiness may also occur. Monitor sales and be alert
for any customers who may be misusing codeine-containing preparations.
See Reference Section, OTC Medicines – Precautions.
Cause blood vessels in the treated area to open and create a sense of warmth, which masks
the sensation of pain. These are usually effective at relieving localised muscle aches or pains.
Do not apply to broken skin or near the eyes or mucous membranes. Wash hands after
applying. Do not use under sealed dressings.
Arnica cream contains a mixture of arnica flower and root and several essential oils to help
relieve bruising. Hirudoid contains enzymes that help disperse excess fluid in swollen areas.
Both creams also reduce swelling. Arnica also helps relieve pain.
Effective at relieving pain but not anti-inflammatory so will not relieve swelling or
inflammation in the area. Suitable for people with contraindications to NSAIDs.
Rubbing these preparations onto the skin helps stimulate blood flow and create a feeling of
warmth. Products contain ingredients such as arnica, cayenne pepper, chilli extracts, comfrey,
ginger, menthol, and peppermint oil to relieve bruising and soothe sore muscles and stretched
ligaments.
TENS (Transcutaneous Electrical Nerve Stimulation) devices are predominantly used for nerverelated
pain conditions.
Products used for relief of cramps generally contain magnesium but may also include other
ingredients such as rutin, citrus bioflavonoids and pyridoxine. May also help tired, aching and
restless legs.
Capsicum, camphor and willow bark have pain-relieving properties. Other types of therapies
that aim to correct structural problems or relieve muscle tension can also be effective.
Oral magnesium may be effective at relieving restless leg syndrome in some people.
Oral zinc may help relieve muscle cramps in zinc-deficient people.
Products with an asterisk have a detailed listing in the Muscular Aches & Pains section of OTC Products, starting on page 251.
Page 109

Nappy Rash
Nappy rash is a red rash that occurs on the skin covered by a baby’s nappy. Any
part of the groin area, particularly around the genitals and buttocks may be
affected. Symptoms vary, depending on how severe the rash is.
With mild nappy rash, only a small part of the nappy area is covered in either
small pink spots or blotches. Babies may experience a stinging sensation and cry
when passing urine or a bowel motion.
In more severe nappy rash, the rash may spread down the legs or up onto the
tummy. The skin may crack or break and blisters may appear. The baby may seem
more irritable than usual and cry more often.
Nappy rash is a very common problem – most babies will have it at some
time – and it is important to reassure caregivers it does not mean the baby is not
being looked after properly.
antibiotics, and residual detergents left in cotton nappies after washing may also
aggravate it.
Nappy rash due to a yeast infection
The warm, damp skin under a baby’s nappy provides a good place for microorganisms
to grow. Candida albicans is a yeast (a type of fungus) that is
Causes
Simple nappy rash
Simple nappy rash is most often due to irritation from urine and faeces touching
the baby’s sensitive skin for extended periods of time. Some babies may also
develop nappy rash when they start eating solid foods, particularly foods such as
citrus, peas and raisins which aren’t as easily digested.
Other triggers of nappy rash include diarrhoea, teething, or taking oral
TREATMENT OPTIONS
Category Examples Comments
Barrier creams
Soap alternatives
Antifungal preparations
Antifungal + hydrocortisone
combinations
Healing/soothing preparations
Natural / herbal products /
supplements
[GENERAL SALE] eg, dimethicone (Silic 15), vitamin
A and calamine (Ungvita Cream), zinc and castor
oil, zinc and shea butter (Mustela Vitamin Barrier
Cream), zinc oxide (Made 4 Baby Botty Barrier
Cream, Curash Anti-rash Cream)
[GENERAL SALE]
eg, Pinetarsol*, Aqueous Cream, DermaLab,
Dermaveen, Emulsifying Ointment, Epaderm
ointment, QV Gentle Wash
[PHARMACY ONLY MEDICINE]
eg, bifonazole (Canesten Bifonazole), clotrimazole
(Canesten range), miconazole (Daktarin, Resolve),
miconazole and zinc oxide (Daktozin)
[PHARMACY ONLY MEDICINE]
eg, Resolve Plus 0.5%
[PHARMACIST ONLY MEDICINE]
eg, Canesten Plus, Resolve Plus 1%
[GENERAL SALE]
eg, Bepanthen Ointment, Kiwiherb Baby Balm, Lucas
Papaw ointment, Mustela Cold Cream, Mustela
Stelactiv, Sudocrem, Re Gen cream, Weleda Nappy
Rash Cream
Aloe vera, calendula, chamomile (eg, Kiwiherb Baby
Balm), vitamin A, B & E, zinc
Products with an asterisk have a detailed listing in the Nappy Rash section of OTC Products, on page 252.
Provide a barrier between the baby’s skin and urine and faeces.
Apply with each nappy change, after first washing the area with a pH-neutral non-soap
cleanser, rinsing and allowing to dry thoroughly.
Use instead of soap to wash away urine and faeces from the area, without stripping oils
off the skin.
Use antifungal creams to treat the fungal infection and continue for one week after the rash
has cleared.
Use in combination with a barrier cream to protect and soothe the skin.
Useful if the skin is particularly inflamed and red, or if there is concurrent dermatitis.
Avoid use for longer than one week without seeking further advice. Always use corticosteroids
in combination with an antifungal when used in the nappy area.
Apply sparingly and change to a formulation without hydrocortisone as soon as possible.
Reduce redness, soothe, heal and protect the skin. Most contain a barrier-like agent.
Natural products with soothing properties help heal nappy rash.
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CONTINUING OTC EDUCATION
considered a normal part of a human’s bowel flora and is present in faeces. It is
usually kept in check by the infant’s immune system and the natural skin barrier.
A breakdown in the skin’s barrier may allow the yeast to penetrate and grow
unheeded.
Nappy rash due to a yeast infection tends to be brighter red than simple nappy
rash. There may be small red or white spots around the edge of the rash. The rash
often spreads into the skin folds or onto the skin not covered by a nappy. The
baby may also have oral thrush, which can sometimes affect a mother’s nipples
(see Oral Health).
Nappy rash complicated by a bacterial infection
Sometimes if a baby’s skin has been irritated and damaged by simple nappy rash
it can become infected by bacteria. The skin can be red, warm and swollen and
the baby may be very grumpy, cry a lot and develop a fever. Parts of the skin may
be broken and weeping, and a yellow crusting may be noticeable. This type of
nappy rash needs to be treated by a doctor.
Seborrhoeic dermatitis or eczema
Rashes in the nappy area may also be caused by seborrhoeic dermatitis, or other
skin conditions such as eczema. In these cases, there is also generally a rash
somewhere else on the body (see Dermatitis/Eczema).
Initial assessment
Ask the caregiver for a description of their baby's nappy rash and determine if
the baby seems more irritable than usual. Refer any descriptions of moderate to
severe nappy rash to the pharmacist.
Mild nappy rash can be treated with barrier creams, more frequent nappy
changing and nappy-free times. Advise caregivers to use only mild soap-free
washes when cleaning baby's bottom and suggest topical antifungal creams if
there is evidence of a yeast infection.
Advice for customers
• Change cloth or disposable nappies as soon as possible when wet or soiled.
»»
In older children with nappy rash sleeping through the night, consider
changing the nappy at least once in the night.
• Clean the skin gently to remove any urine or faeces from the area.
»»
If the baby’s nappy was wet, use warm water to clean.
»»
If the baby’s nappy was dirty, use a mild soap-free cleanser to clean and
rinse thoroughly.
»»
Baby wipes may sting if the skin is sore (use muslin cloths instead).
• Have frequent nappy-free times where the skin is exposed to air and filtered
sunlight.
• Use a barrier cream or ointment at each nappy change to prevent urine or
faeces from coming into contact with damaged skin.
»»
Barrier creams can be used over the top of antifungal or antibacterial
creams.
Refer to
PHARMACIST
The following questions aim to identify customers with babies who
would benefit from further input from a pharmacist. Your initial
assessment may have already provided some answers. Decide if any
further questions still need to be asked and refer any “yes” answers to
a pharmacist.
• Does the baby have any other health conditions (eg,
immunosuppression)?
• Is the baby being given any medicines (particularly antibiotic-type
medicines), either prescribed by a doctor or bought from a shop or
supermarket (including herbal/complementary medications)?
• Does the rash extend beyond the nappy area?
• Is there any unusual oozing, blisters, crusting or swelling?
• Does the rash look particularly severe?
• Has the rash persisted despite previous treatment or has it spread?
• Is the rash in other places as well, eg, baby’s mouth, scalp, other
skin folds, mother’s nipples?
• Has the baby had any prior reactions to topical products?
• Talcum powder is no longer recommended for use. It won't protect against
nappy rash, can cause friction and irritate a baby's skin, and may be associated
with breathing problems and other conditions.
• If using cloth nappies, use a nappy liner to keep baby’s skin dry.
» » If the nappy rash is particularly bad, consider changing to disposable
nappies for a while, or at least at night because these keep wetness away
from the baby’s skin more effectively.
• Avoid tight-fitting, plastic over-pants. These make the area warm and moist,
which is ideal for fungal growth.
• Sterilise and rinse cloth nappies meticulously, removing all traces of detergent,
and dry in direct sunlight, rather than in a clothes dryer.
• If possible, limit intake of any foods that appear to aggravate the condition
until the baby is older.
Page 111

Oral Health
Oral health disorders include bad breath, baby teething problems (see Childhood
Pain and Baby Teething), dry mouth, fungal infections (such as oral thrush),
gingivitis and periodontal disease, mouth ulcers, sore throat (see Sore Throat) and
tooth decay (see Toothache).
Bad breath
Bad breath – also called halitosis – can occur with abscesses, gingivitis,
indigestion or reflux, tooth decay, after eating spicy foods or garlic and when
saliva production is low. Check teeth cleaning regimen and consider chlorhexidine
mouthwashes. Refer to a dentist or doctor if a more serious underlying problem
is suspected.
Dry mouth
Dry mouth (xerostomia) is due to a lack of saliva. Medications, radiation therapy,
dehydration and poorly controlled diabetes are some of the more common
causes. If the cause cannot be corrected, saliva substitutes may provide some
relief.
Oral thrush
This usually presents as creamy-white, soft, elevated patches on the tongue or
oral palate that can be removed to reveal inflamed mucosa underneath. Pain and
soreness are also often present.
Commonly seen in babies, oral thrush is usually caused by the yeast Candida
albicans. Although it is unusual for adults to get oral thrush, it may occur in
people with asthma who fail to rinse their mouths after using steroid inhalers.
Immunosuppressed people or people who have a dry mouth, ill-fitting dentures or
who have had recent antibiotic therapy, are also more at risk. Anybody presenting
with oral thrush should be referred to the pharmacist. Treatment is with oral
antifungal mouth gels or liquids.
Gingivitis and periodontal disease
Swollen and red gums that bleed easily are a sign of gingivitis. If left untreated,
gingivitis can progress to periodontitis.
Periodontitis is a long-lasting bacterial infection that affects the gums and
the bones supporting the teeth, and may ultimately lead to tooth loss. People
over the age of 40, who smoke, don’t floss, with certain medical conditions (such
TREATMENT OPTIONS
Category Examples Comments
Mouth ulcer treatments
Oral thrush
Mouthwashes for gingivitis
Dry mouth
Products for maintaining or
restoring good oral and throat
health
Oral hygiene
Topical analgesics/anaesthetics
[GENERAL SALE] eg, Bonjela Mouth Ulcer Gel*, Orased Jel
[PHARMACY ONLY MEDICINE] eg, Difflam Mouth Gel,
Difflam-C Anti-Inflammatory Antiseptic, Frador*, Medijel*
Topical corticosteroids for oral use
[PHARMACIST ONLY MEDICINE] eg, Kenalog Dental Paste,
Oracort Dental Paste
Chemical cauteriser
[GENERAL SALE] eg, Oralmedic
[PHARMACIST ONLY MEDICINE] eg, miconazole (Daktarin Oral
Gel, Decozol Oral Gel), Nystatin (Nilstat Oral Drops)
eg, Cepacol, Cepacaine, Chlorhexidine 0.2%, Kiwiherb Manuka,
Savacol
[GENERAL SALE] eg, Aquae Dry Mouth Spray, Biotene range,
Oralube Saliva Substitute, Oral Seven range, Xerostom Range
[GENERAL SALE] eg, Air-Lift
[SUPPLEMENT] eg, BLIS K12 range, BLIS M18 range, Comvita
Oral Spray, Radiance ManukaGuard Honey Lozenges
eg, CareDent range, Colgate Total Interdental brushes,
MouthWatchers Anti-bacterial Toothbrushes, Piksters Interdental
brushes, TePe Interdental brushes, Waterpik range
Products with an asterisk have a detailed listing in the Oral Health section of OTC Products, starting on page 253.
Contain a topical oral pain reliever or anaesthetic (such as choline salicylate,
lignocaine, aminacrine, or benzydamine) to relieve the localised pain associated
with mouth ulcers.
Chlorbutol is a weak local anaesthetic with antibacterial and antifungal
properties.
Forms a protective paste over the ulcer to speed healing. Apply after food. Dab
onto ulcer and smooth over with saliva. Do not rub in.
Single-use treatment that extracts water from the damaged tissue and forms a
seal over it, quickly eliminating mouth ulcer pain and aiding healing.
Hold dose in the mouth for as long as possible before swallowing. Avoid food
and drink for half an hour before and one hour after taking a dose. Do not use
Decozol oral gel in babies under six months or people with poor swallowing.
Products containing chlorhexidine appear the most effective at reducing plaque
and gingivitis, but prolonged use may stain teeth and brown gums.
Help to relieve dry mouth (xerostomia) and increase unstimulated salivary flow.
Use as often as needed.
Air Lift uses oils to eliminate bad breath caused by foods or tobacco.
BLIS products restore the balance of naturally occurring bacteria.
Natural lozenges containing honey may help to maintain good throat health.
Brush teeth twice a day to remove plaque and keep gums healthy. Water jet
systems remove food debris and bacteria from where brushing and flossing can’t
reach. Interdental brushes help remove plaque and food from between teeth and
are an alternative to dental floss. Daily attention to oral hygiene can help reduce
tooth decay.
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CONTINUING OTC EDUCATION
Good oral hygiene
••
Use a soft toothbrush and brush teeth for two minutes twice a day.
••
Brush gently around the back and front of the teeth, including where the teeth meet the gums.
••
Change your toothbrush every three months.
••
Spit out after toothbrushing, and don’t rinse. A small amount of fluoride toothpaste left around
the teeth will help protect them.
••
Floss or use an interdental brush daily (minimum three times/week).
••
Fluoride mouth rinses may be used in adults and children aged older than six who are at high
risk of dental caries (see Toothache).
••
Eat a healthy diet and limit sugar intake.
••
Avoid sipping sweet drinks for prolonged periods and discourage snacking and grazing
throughout the day – teeth need a break!
••
Visit your dentist regularly (every six to 12 months) for check-ups.
••
Talk to your dentist about taking fluoride supplements or using topical fluoride products if your
water supply is not fluoridated.
as heart or respiratory disease, malnutrition, diabetes) or who have had gum
problems or tooth extractions in the past are more at risk. Certain family groups are
also more prone to periodontal disease either due to genetic susceptibility or through
transfer from family member to family member of causative bacteria through saliva.
It is important to recognise the signs of gingivitis and treat early. The most
likely cause of gingivitis is inadequate oral hygiene, and improvement in this (see
Good Oral Hygiene text above), in addition to professional treatment, will
usually reverse progression of the disease.
Refer to a dentist as soon as possible anybody presenting with signs of
gingivitis or with more advanced periodontal disease (recognised by gums
bleeding without any trauma, loose teeth or pus in between the teeth, persistent
bad breath, receding gums) as delays in treatment can result in loss of teeth.
Mouth ulcers
Mouth ulcers are common and usually occur on the inside of the lips and cheeks,
or underneath the tongue. They are usually grey-white in colour, up to 5mm in
diameter, very painful, and can occur singly or in clusters. Most appear suddenly
and will disappear by themselves within seven to 14 days; however, many people
seek OTC medications because of the pain.
Although the exact cause of mouth ulcers is unknown, links to stress, mouth
trauma (for example, from poorly fitted dentures), nutritional deficiencies
(particularly B vitamins, iron and folic acid), hormonal changes, infection and
certain medications have been found. Mouth ulcer treatments usually contain
topical corticosteroids which improve healing, local anaesthetics to numb the
pain, or chemical cauterisers to seal damaged tissue. Spicy or acidic foods may
worsen pain and delay healing of mouth ulcers.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Is the person on any medication or are there any ongoing health
problems?
• Is the mouth ulcer larger than typical, irregularly shaped or
relatively painless?
• Could the person have oral thrush?
• Is the person aged less than 10 years?
• Has the mouth problem been present for longer than seven days or
persisted despite treatment?
• Does the person have any other symptoms (eg, fever)?
• Is the condition extensive, persistently bleeds or bleeds
spontaneously, or is there swelling or pain?
• Have the injuries to the mouth been caused by trauma?
• Does the person smoke?
• Does the person have any allergies to topical products?
Initial assessment
Always inspect the mouth if possible to confirm the problem. Many oral health
conditions require further input from a pharmacist or dentist (as detailed in each
subsection above) and will need to be referred.
Where appropriate, encourage regular brushing and flossing and a healthy
diet to all customers as maintaining good oral health is the best prevention
against gingivitis, periodontal disease and tooth decay.
Page 113

Osteoarthritis
Osteoarthritis is the most common form of arthritis affecting almost 50% of all
people over 60 and almost everybody over the age of 80. It is sometimes called
"wear and tear" or degenerative arthritis.
Osteoarthritis occurs when the cartilage that covers the end of each bone
in a joint starts to break down and wear away, leaving the ends of the bones
unprotected. This affects the gliding surface of the bones in the joint and as a
result they become painful and difficult to move. After a while, the joint can
lose its shape and the bone underneath thickens and grows out the sides,
further reducing movement. The large weight-bearing joints (knees, hips and
spine) are most often affected, although osteoarthritis can also affect the
ankles, neck, hands, lower back, base of the toes, and, as a result of injury or
stress, the wrist, elbow, shoulder or jaw.
Osteoarthritis is caused by a combination of factors, such as aging, genetic
defects in joint cartilage, joint injury, joint stress or overuse through sports or
certain occupations, and being overweight. There is no one specific cause.
Symptoms
Osteoarthritis is often very mild and some people may not realise they have it
until an x-ray reveals joint changes. Symptoms tend to start in middle age and
morning stiffness in a joint (lasting less than 30 minutes), or a deep ache in a
joint which is hard to localise, may be the only initial sign.
Twinges of pain may be experienced in older people which tend to be relieved
with rest and warmth. People with more pronounced osteoarthritis are likely to
have a more persistent pain that increases with use and decreases with rest.
Other symptoms include:
• stiffness in a joint when the joint has been rested
• swelling of the joint caused by an increase in synovial fluid production
• bony growths (Heberden's nodes) in finger joints – more common in women
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
Oral non-steroidal
anti-inflammatory agents
(NSAIDs)
Combination analgesics
Topical non-steroidal
anti-inflammatory agents
(NSAIDs)
Rubefacients (‘heat’
rubs)
Other topical
applications
Natural / herbal products
/ supplements
[GENERAL SALE]
eg, paracetamol (Panadol range, Paracare)
[PHARMACY ONLY MEDICINE] eg, Panadol Osteo*
[GENERAL SALE]
eg, ibuprofen 25s (Advil, Nurofen), naproxen (Sonaflam)
[PHARMACIST ONLY MEDICINE]
eg, diclofenac 25mg (Voltaren Osteo Tabs, Voltaren
Rapid 25)
[GENERAL SALE] eg, ibuprofen + paracetamol
(Maxigesic [16], Nuromol [12])
[PHARMACY ONLY MEDICINE] eg, ibuprofen +
paracetamol (Maxigesic [50, 100], Nuromol [24, 48])
[PHARMACIST ONLY MEDICINE]
eg, ibuprofen + codeine (Ibucode Plus, Nurofen Plus)
paracetamol + codeine (Panadeine, Panadeine Extra)
[GENERAL SALE]
eg, ibuprofen (Nurofen Gel), diclofenac (Voltaren
Emulgel, Voltaren Osteo Gel 12 Hourly*)
[PHARMACY ONLY MEDICINE]
eg, etofenamate (Rheumon Gel)
[GENERAL SALE]
eg, Deep Heat range, Ice Gel, Tiger Balm range
[GENERAL SALE]
eg, capsaicin (Zostrix*), Anti-Flamme Creme, AntiFlamme
Extra
Avocado-soybean unsaponifiables (ASU), bromelain,
chondroitin, fish oil, folic acid, glucosamine, green
lipped mussel, turmeric (eg Turmeric Extra Strength*)
Regular paracetamol, two tablets (1g) three or four times daily, is the first choice of treatment
for mild-to-moderate osteoarthritis. In many cases regular dosing is more beneficial than taking
only when the pain is bad. Maximum dosage of 4g/day may need to be reduced in the elderly.
Osteoarthritis is not normally an inflammatory condition but occasionally when there is
inflammation a NSAID may provide added benefit to simple analgesia. Ibuprofen is the NSAID
least likely to cause stomach irritation. NSAIDs may not be suitable for people on certain
other medications or with some medical conditions (eg, asthma, kidney disease – see Refer
to Pharmacist). Advise customer to stop taking if stomach upsets, increased bruising or
prolonged bleeding occur. Stronger NSAIDs are available on prescription. See Reference
Section, OTC Medicines – Precautions.
Simple analgesics (eg, paracetamol) should be tried first.
Warn customers that codeine is an addictive substance and should not be used for more than
three days at a time. Constipation or drowsiness may also occur. Monitor sales and be alert for
any customers who may be misusing codeine-containing preparations.
NSAIDs may have gastric side effects, particularly long term. See Reference Section, OTC
Medicines – Precautions.
These treat the body’s inflammatory reaction to injury and reduce pain. These are usually
effective at relieving localised muscle aches or pains. Do not apply to broken skin or near the
eyes or mucous membranes. Wash hands after applying. Do not use under sealed dressings.
May, rarely, cause the same adverse effects as oral NSAIDs. Similar care and consideration
before use is recommended.
Cause blood vessels in the treated area to open and create a sense of warmth, which masks the
sensation of pain.
Capsaicin reduces levels of a chemical called substance P, which helps transmit pain impulses to
the brain. Has been used to relieve pain in osteoarthritis but may take up to four weeks for an
effect. Burning or tingling may occur briefly when applied to the skin.
Anti-Flamme helps to stimulate blood flow and has an anti-inflammatory and analgesic action.
ASUs help with pain and stiffness of osteoarthritis and may delay progression. Glucosamine
appears effective. Evidence for chondroitin has not been consistent.
Turmeric is reported to have a natural anti-inflammatory effect.
Products with an asterisk have a detailed listing in the Osteoarthritis section of OTC Products, starting on page 253.
Targeted Action
to relieve joint pain
Page 114 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
over 40.
With the progression of osteoarthritis, symptoms become more severe.
Inflammation is more common in advanced disease and the joint may feel hot
and inflamed. Osteoarthritis may come and go, and some people identify particular
times when the pain is worse, eg, in damp, cold or humid weather.
Initial assessment
When customers say they have “arthritis”, try and establish if they are talking
about osteoarthritis or rheumatoid arthritis. Rheumatoid arthritis is a chronic
inflammatory autoimmune condition affecting multiple joints, as well as organs
body wide, which is treated by a doctor.
Paracetamol is the safest long-term medicine for pain relief, and should be
tried first. Heat rubs and other topical applications may also help. Refer anybody
wishing to take a NSAID long-term to a pharmacist, as well as those with "yes"
answers to the Refer to Pharmacist questions.
Treatment
The aim of treatment is to control pain, maintain physical activity and mobility
and limit further injury. Although treatment cannot reverse the changes that have
already taken place in the joints, pain-relieving medicines can help the symptoms
and make it easier for people to get out and about.
Always encourage customers to seek medical advice early for a full assessment
and discussion of all treatment options.
Non-pharmacological therapy
A properly designed exercise programme is considered the most effective nonpharmacological
treatment for osteoarthritis. Excercise helps to keep joints
moving and reduce overall pain, improve flexibility and increase fitness. Evidence
also supports acupuncture as a treatment for osteoarthritis of the knee. Many
communities offer exercise programmes just for people with arthritis such as:
»»
gentle movement to music classes or t’ai chi
»»
walking groups
»»
water aerobics, hydrotherapy or swimming classes.
The ultimate treatment for osteoarthritis is joint replacement. However, hip
and knee replacements have a limited life – about 15 years – before another
replacement is required. Replacement is considered only when joint destruction
and pain is severe. The improved mobility and quality of life after these operations
is often dramatic.
Several complementary products claim to help with the symptoms of
osteoarthritis. Controversy exists regarding the effectiveness of many of these
products; however, they may benefit some individuals and are often worth a trial.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication or complementary
therapies, either prescribed by a doctor or bought from a shop or
supermarket?
• Is the pain severe, burning or interfering with movement?
• Was the pain caused by trauma or did it start suddenly?
• Is there any back pain?
• Does the joint look red or does the person feel unwell?
• Is the person young (under 40) or elderly?
• Has there been stiffness, pain or swelling for more than two weeks?
• Does the joint feel unstable or like it is about to give way?
• Is there any creaking or a cracking sensation with movement?
• Does the person have any allergies to medicines?
these joints.
• Weight control reduces the load on joints (see Weight Loss).
• Heat may be useful before exercise and ice packs after exercise.
• Special aids to help with everyday life, eg, opening jars, turning on taps, putting
on stockings and picking up objects, are available from some pharmacies and
Arthritis New Zealand, see Support Groups, page 212.
• Arthritits New Zealand also delivers regular information sessions in some main
centres New Zealand-wide (see www.arthritis.org.nz for more details).
• Medicines and their dosage should be reviewed every two to three months
because the severity of pain may increase or diminish.
Advice for customers
• If pain worsens or continues longer than two to three days, see a doctor.
• Supportive footwear will help protect joints. See an orthotics expert.
• A walking stick for osteoarthritis of the knee and hip helps reduce stress on
¤ No systemic side effects. 1,2 ¤ No drug-to-drug interaction. 2
¤ In monotherapy Zostrix ® reduces
pain by up to 50% and 80% of
sufferers experience pain relief. 1
¤ In combination therapy, Zostrix ® provides up to
33% more pain relief in addition to the analgesia
achieved with oral NSAID’s and Paracetamol alone. 2
Ref 1. Altman RD et al. Capsaicin Cream 0.025% as Monotherapy for Osteoarthritis: A Double-Blind Study. Seminars in Arthritis
and Rheumatism 1994; 23 (6): 25–33. 2. Deal CH et al. Treatment of arthritis with topical capsaicin: a double-blind trial. Clin Ther
1991: 13 (3): 383–395. AFT Pharmaceuticals, Auckland. TAPS 1733HA.
Page 115

Osteoporosis
Osteoporosis (meaning “porous bones”) is a common bone disease that
leads to an increased risk of fracture. One in three women and one in five
men over the age of 50 are affected by osteoporosis.
Bone is a living tissue made up of proteins and minerals, such as calcium and
phosphorus. Throughout life, bone is constantly being broken down and renewed.
Bone density – the amount of bone tissue in a certain volume of bone – reaches a
peak between 18 and 25 years of age. Higher peak bone masses are associated
with a lower risk of fracture or osteoporosis later in life. Women lose bone density
more quickly after menopause due to a decrease in oestrogen levels. Regular
weight-bearing exercise and an adequate dietary intake of calcium and other
minerals is also needed to maintain good bone density in addition to oestrogen
in women and testosterone in men.
Osteoporosis occurs when bone breaks down faster than it rebuilds. Although
bones remain the same size, they become thinner and more brittle. Osteoporosis
CALCIUM CONTENT OF SOME FOODS
CALCIUM CONTENT (MG)
1 cup cooked broccoli 59
½ cup cooked spinach 45
½ can baked beans 90
1 glass lite-blue top or trim milk, 250ml 310
1 cube Edam cheese, 8g 75
1 pottle yoghurt, 150g 195
1 cup ice cream, 157g 196
½ cup sour cream, 112g 124
tofu cubes, 100g 105
Soy drink, calcium fortified, 250ml 286
10 almonds 30
Sesame seeds, 1 tablespoon, 9g 88
6 mussels 136
½ cup salmon 110
1 sardine 66
Reference: Calcium Content of Foods. NZ Nutrition Foundation www.nutritionfoundation.org.nz
can cause significant disability and affect quality of life. Risk factors for
osteoporosis include:
• age (older than 50 years)
• being underweight
• coeliac disease, Crohn's disease or Rheumatoid arthritis
• early menopause or low testosterone levels
• excessive alcohol intake (more than 2 glasses wine/day)
• family history of osteoporosis and fractures
• female gender
• low dietary intakes of calcium
• physical inactivity (particularly lack of weight-bearing exercise)
• previous fracture as a result of a minor fall or bump
• smoking
• some medicines (eg, antiandrogens, aromatase inhibitors, corticosteroids)
• vitamin D deficiency.
Symptoms of osteoporosis
The condition is usually asymptomatic – it is not painful until there is a fracture.
Fractures usually occur in the spine, wrist or hip.
Hip fractures can have a dramatic effect on a person’s quality of life, with up to
50% of people unable to return to a fully independent lifestyle after a hip fracture
and requiring long-term ongoing care.
Bone mineral density (BMD)
BMD is a measure of the amount of bone in a particular part of the body and
can be calculated using a special type of x-ray, called DEXA. The World Health
Organization (WHO) defines osteoporosis in women as a BMD 2.5 standard
deviations below peak bone mass (20-year-old healthy female average) as
measured by DEXA.
Initial assessment
Customers who are more likely to have osteoporosis include those who look frail
or older adults with a current fracture. But all customers should be encouraged
to eat enough calcium in their diet while they are still young, with the aim of
TREATMENT OPTIONS
Category Examples Comments
Calcium +/- vitamin D
Vitamin D preparations
[GENERAL SALE]
eg, calcium (Caltrate, GO Calcium) calcium
+ vitamin D (Swisse Ultiboost) calcium +
other vitamins (Caltrate Plus)
[SUPPLEMENTS]
eg, vitamin D3 (Blackmores, Ethical
Nutrients Daily D, Swisse Ultiboost) eg,
vitamin D3 + other vitamins (Mvite,
Vitabdeck)
Milk and dairy products are the most readily available sources of dietary calcium and have the added
advantage of being high in protein and other micronutrients important for bone health. Dietary calcium is
preferred over supplements. Customers should talk with the pharmacist or their doctor before taking calcium
supplements.
The D3 form of vitamin D is most effective at maintaining body stores of vitamin D. This form is available as
supplements and also manufactured in specialised cells in the skin on exposure to sunlight. Vitamin D2 found
in foods and some supplements is not as well utilised. Certain groups of people (eg, elderly, dark skinned)
may require supplements (see also Vitamins and Dietary Supplements). There is no evidence that vitamin
D improves bone health in people who are not deficient. Usual supplemental dosage is 400–800IU/day.
PharmacyToday
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CONTINUING OTC EDUCATION
preventing osteoporosis. Continued calcium intake is also important to maintain
bone mass once people are over the age of 50.
Suggest ways to reduce falls in those with a high risk of fracture (see Reducing
the risk of falls opposite) and encourage safe weight-bearing exercise to
help with muscle tone and balance. Encourage smokers to stop smoking (see
Smoking cessation) and those who drink to limit their alcohol intake.
Prevention and treatment
Calcium is an important component of bone, so adequate dietary calcium is
needed in order to maintain good bone health. However, the actual recommended
daily intake is controversial (ranges from 500–1000mg). Calcium from dietary
sources is preferred over supplemental calcium. Research suggests there is no
added benefit in taking more calcium (in the form of supplements) than needed,
and in fact, too much calcium can be detrimental.
Vitamin D is made in the skin as a result of sunlight exposure. Supplements
may be beneficial in people who never go outside (eg, frail elderly), or with
reduced exposure to the sun (eg, veiled women, dark-skinned individuals). There
is no evidence that vitamin D supplements improve bone health in people who
are not deficient.
Most people with osteoporosis will need to see their doctor to establish
a medication regimen that ensures adequate bone protection. Prescription
medicines used for the treatment and prevention of osteoporosis include
cholecalciferol (vitamin D3), calcitriol (active vitamin D), bisphosphonates (eg,
alendronate, etidronate, pamidronate, risedronate, zoledronic acid), oestrogen
modulators (eg, raloxifene), and other hormones (eg, teriparatide).
Reducing the risk of falls
In people who have already had a fall, offer suggestions on how to reduce the
risk of further falls. Advise customers to:
• ask for a thorough medication review by a pharmacist or doctor to identify
medicines that may be detrimentally lowering their blood pressure or
interfering with balance, increasing their risk of falls
• review their furniture placement and use of rugs in their home or workplace to
lessen the risk of falls (see www.acc.co.nz)
• consider t’ai chi, which research shows can improve balance and prevent falls
• book in a comprehensive eye examination to check both their vision and eye
health; good eyesight is needed to avoid tripping over or bumping into objects
• wear shoes with non-slip soles and advise women to avoid high heels
• partake in regular weight-bearing exercise, to improve muscle strength and
balance
• consider a walking stick to help improve balance if falling remains a problem
• consider an alarm/alert system, worn around their neck or wrist, which could
be easily activated if a person has fallen and cannot move.
Ensure customers are getting enough vitamin D to help with the absorption of
calcium. Encourage some sun exposure without sunscreen in the early morning
or late afternoon every day in order to maintain adequate vitamin D levels.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Has the person had a previous fracture?
• Has the person been having frequent falls?
• Is the person elderly, or taking medicines that might cause dizziness
or drowsiness eg, benzodiazepines or blood pressure-lowering agents,
which may increase the risk of falls?
• Is the person unsure about what they should be taking for their
osteoporosis?
• Does the person have any allergies to medicines?
Supplements may be more suitable for some people (such as resthome residents).
Also see the Osteoporosis NZ website (www.osteoporosis.org.nz).
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Page 117

Period Pain and Endometriosis
Period pain and other menstruation-related symptoms are collectively called
dysmenorrhoea. Dysmenorrhoea affects around 70% of menstruating women
and usually starts in adolescence, once periods become regular (when ovulatory
menstrual cycles become established).
Primary dysmenorrhoea is the most common type of dysmenorrhoea and
occurs when a woman’s uterus is healthy but is behaving abnormally and causing
cramps. Secondary dysmenorrhoea is the term used for dysmenorrhoea that is
caused by an underlying condition or abnormality such as endometriosis, fibroids,
pelvic inflammatory disease or uterine anomalies.
Primary dysmenorrhoea
Lower abdominal cramping is the main symptom of primary dysmenorrhoea;
however, many women also suffer from additional symptoms such as:
• breast tenderness or pain
• depression, irritability, anxiety, or sleeplessness
• facial blemishes and flushing
• headaches, backaches or aching legs
• loss of appetite, weakness and dizziness
• nausea and vomiting.
Symptoms typically begin just before or just after the start of menstrual flow,
and persist for the first 24–48 hours. Period pain which causes discomfort is
considered normal. Period pain which causes distress and prevents women or
girls from doing activities, or going to school or work is considered abnormal and
most likely due to endometriosis, and should be referred to a doctor.
Endometriosis
Endometriosis is a condition where tissue similar to the lining of the uterus
is found growing in places outside of the uterus (eg, the ovaries, fallopian
tubes, and other pelvic structures). This tissue responds to the hormones that
trigger the menstrual cycle so thickens and sheds like the cells found inside
the uterus.
Debilitating pain during a period is the most common symptom. However,
other symptoms such as bloating, diarrhoea or constipation, bladder troubles,
pain associated with sexual intercourse, infertility, and very heavy bleeding (ie,
having to change a tampon or pad every one to two hours) can occur. Pain may
also occur intermittently throughout the month or around the time of ovulation.
Although more commonly diagnosed in adults, symptom onset is usually
experienced in the teen years with cases reported in menstruating girls as young
as 10.
Most women who suffer from endometriosis also have a female relative with
the same condition, although they may not realise it. There is often a long time
between first symptom onset and a definite diagnosis of endometriosis (average
TREATMENT OPTIONS
Category Examples Comments
Oral non-steroidal
anti-inflammatory agents
(NSAIDs)
Combination analgesics
Natural / herbal products /
supplements
[GENERAL SALE]
eg, ibuprofen 25s (Advil, Nurofen range),
mefenamic acid (Ponstan), naproxen
(Naprogesic)
[PHARMACIST ONLY MEDICINE]
eg, diclofenac 25mg (Voltaren Rapid 25)
[GENERAL SALE]
eg, ibuprofen + paracetamol (Maxigesic [16],
Nuromol [12])
[PHARMACY ONLY MEDICINE] eg, ibuprofen
+ paracetamol (Maxigesic [50, 100], Nuromol
[24, 48])
[PHARMACIST ONLY MEDICINE]
eg, ibuprofen + codeine (Ibucode Plus, Nurofen
Plus) paracetamol + codeine (Panadeine,
Panadeine Extra), paracetamol + codeine +
doxylamine (Mersyndol*)
Calcium, black cohosh, brewer’s yeast, cramp
bark, ginko, evening primrose oil, magnesium,
omega-3 fatty acids, pyridoxine (vitamin B6),
saffron, turmeric, vitamin D or E, vitex agnuscastus
NSAIDs reduce prostaglandin production, reducing uterine contractions and pain.
Start NSAID treatment at the first sign of pain or, if predictable, one to two days before the
period is due. Continue taking the NSAID regularly at the recommended dose for about two
days after bleeding starts. Ibuprofen is the NSAID least likely to cause stomach irritation.
NSAIDs may not be suitable for people on certain other medications or with some medical
conditions (eg, asthma, kidney disease – see Refer to Pharmacist). Advise customer to
stop taking if stomach upsets, increased bruising or prolonged bleeding occur. See Reference
Section, OTC Medicines – Precautions.
Combination products may help women who experience strong period pain. Some women
may get relief from a simple analgesic (eg, paracetamol), but as prostaglandins are
considered a primary cause of period pain, NSAIDs are usually preferred, providing these are
not contraindicated.
Warn customers that codeine is an addictive substance and should not be used for more than
three days at a time. Constipation or drowsiness may also occur. Monitor sales and be alert
for any customers who may be misusing codeine-containing preparations.
Several natural ingredients may help relieve symptoms of PMS. Magnesium may be effective
at relieving premenstrual migraine, fluid retention and mood in magnesium-deficient women.
Products with an asterisk have a detailed listing in the Period Pain & Endometriosis section of OTC Products, on page 254.
NUROFEN ZAVANCE*
IS ABSORBED UP TO
THAN STANDARD NUROFEN
*Applies to Nurofen Zavance tablets and caplets only. †2 tablets of Nuromol are stronger than and effective for longer than 2 tablets of paracetamol 500mg, or 2 tablets
of ibuprofen 200 mg + Codeine 12.8 mg in dental pain studies. 1. Mehlisch D et al. Clinical Therapeutics 2010;32(6):1033-49. 2. Daniels S et al. Pain 2011;152:632-42.
Always read the label. Use only as directed. Incorrect use could be harmful. Do not use if you have a stomach ulcer. If symptoms persist see your healthcare professional.
Reckitt Benckiser, Auckland. 0800 40 30 30. TAPS DA1704JD.
Page 118 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
time 8+ years) due in part to a general attitude of normalising menstrual pain,
the reluctance of some women to talk about their period problems, and not
recognising the wide range of presenting symptoms. Endometriosis commonly
impairs quality of life and can compromise fertility. Early intervention is
recommended. More information about endometriosis and treatment can be
found on the Endometriosis NZ website (www.nzendo.co.nz). Endometriosis
NZ also offers an award-winning presentation suitable for students in years
10–13 (All About ME).
Premenstrual syndrome
Premenstrual syndrome (PMS) is also known as premenstrual tension (PMT) and
refers to the group of symptoms that occur around the time of ovulation (14 days
or more after the first day of a woman’s last menstrual period). Symptoms include
mood swings, irritability, depression, anxiety and oversensitivity, and typically
resolve one or two days before menstruation starts.
PMS affects up to 80% of women and, for most, symptoms are mild. However,
in 5%–10% of women symptoms are so severe that they interfere with a
woman’s lifestyle and functioning. This severe form of PMS is called premenstrual
dysphoric disorder (PMDD).
Women with PMDD should be referred to their doctor. Women with mild PMS
may benefit from regular exercise, a low-fat, low-salt, caffeine and alcohol-free
diet, and supplements such as pyridoxine.
Initial assessment
Despite the high prevalence of period pain, many girls and women do not seek
medical advice or are undertreated. Pharmacy staff are in an ideal position to
offer advice about regular dosing of non-steroidal anti-inflammatory drugs
(NSAIDs) to manage period pain, and to advise women to seek further medical
investigation for pain that does not respond to over-the-counter treatment.
Direct women or girls with period concerns that are affecting their quality of
life to the Endometriosis NZ website (www.nzendo.co.nz) or to a doctor who
specialises in women's health.
Treatment
Prostaglandins are thought to be mainly responsible for period cramping and it
is for this reason that NSAIDs are generally more effective than simple analgesics
(such as paracetamol) for treating period pain. NSAIDs reduce prostaglandin
production which leads to a reduction in uterine contractions and therefore less
discomfort. Evidence has not shown any advantage of one NSAID over another;
however, if one preparation does not provide relief an alternative NSAID should
be tried.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial
assessment may have already provided some answers. Decide if any
further questions still need to be asked and refer any “yes” answers
to a pharmacist.
• Does the woman have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is breastfeeding)?
• Does the woman take any other medication, either prescribed
by a doctor or bought from a shop or supermarket (including
herbal/complementary medications)?
• Is the lower abdominal pain described as severe or distressing?
• Does the pain get worse with each period?
• Does the pain last longer than the first two days of the period?
• Are NSAIDs ineffective or only partially effective?
• Has menstrual bleeding become increasingly heavy?
• Is the pain accompanied by fever or sickness?
• Is there any abnormal discharge or bleeding?
• Does the pain occur at times unrelated to menstruation, or
during sexual intercourse?
• Is the woman in her 30s or older with new-onset period pains?
• Does the woman use an intrauterine device (IUD)?
• Does the woman find her moods are affecting her lifestyle?
• Is the woman pregnant or postmenopausal and experiencing
vaginal bleeding?
• Does the woman have any allergies to medicines?
• Eat a well-balanced diet, including plenty of fresh fruit and vegetables.
• Drink at least six glasses of water a day (especially during menstruation).
• Don’t put up with severe pain.
»»
Talk to a sympathetic doctor who is willing to do further investigations.
Advice for customers
• Physical activity may reduce period pain by improving uterine blood flow.
• Applying heat (eg, a hot water bottle or wheat pack) to the lower abdomen
over clothing may provide some relief.
3
CHOICES
FOR PAIN
RELIEF
EVERYDAY
PAIN RELIEF
Effective relief from pain,
fever and inflammation
FAST
PAIN RELIEF
Absorbed up to 2x FASTER
than standard Nurofen*
STRONGER
PAIN RELIEF
Stronger pain relief than
Paracetamol + Codeine†
Page 119

Poisonings
Any substance that has the potential to cause injury, illness, or death if it enters
the body, is considered a poison. This means that almost anything can be
poisonous if taken in a large enough quantity. Children and older adults and
people with coexisting medical conditions are at a much higher risk of fatality
from poisoning.
Poisoning in children
More than 300 children are admitted to hospital in New Zealand each year as a
result of unintentional poisoning; 81% of these poisonings occur in the home or
the home of a family friend or relative. Chemical or cleaner poisonings account
for most cases among children aged less than two, and prescription and over-thecounter
medicines (notably anti-inflammatories, antidepressants, multivitamins,
opioids, oral contraceptives, and paracetamol) are responsible for most incidents
in children under five.
Children aged one to four years are the most likely age group to be
poisoned, but fortunately, death from poisoning in children is relatively rare.
Poisoning in adults
The majority of adult poisonings are intentional. Most fatal intentional selfpoisoning
events involved carbon monoxide, while most poisoning admissions
involved prescription and over-the-counter medicines. Construction workers and
people who are exposed on a regular basis to chemicals or harmful dusts in the
course of their work are also at high risk of chronic poisoning.
Initial assessment
Remind all customers to store their medicines out of reach of children, even
people without children, as unintentional poisonings are just as likely to happen
in the home of a relative or friend.
Show concern if you notice that a customer, staff or family member appears
depressed. New Zealand has a relatively high rate of suicide – more than 500
people each year take their own lives, with many more attempting suicide. Most
people who commit suicide give some warning of their intentions to a friend,
family member, or someone they trust. Be willing to listen and take the initiative
to ask what is troubling them. Offer to source professional help and reassure
them that depression can be treated and problems can be solved.
If you suspect a person has ingested something poisonous call the Poisons
Centre for professional advice BEFORE administering any first aid: phone 0800
POISON (0800 764 766). Calls to the Poisons Centre take only a couple of
minutes, and provide the appropriate course of action, saving time and anxious
moments overall.
• NEVER induce vomiting unless told to do so by the Poisons Centre since this
can cause more damage.
• For non-urgent information, phone 03 479 7227 between 9am and 5pm.
National Poisons Centre
The NZ National Poisons Centre is New Zealand’s only poisons and hazardous
information centre and runs a 24-hour, seven-day-a-week hotline all year round
– 0800 POISON (0800 764 766).
TREATMENT OPTIONS
Type of poisoning
First aid
Poisons that have been swallowed Do NOT make the person vomit unless told to do so by a doctor or the Poisons Centre: 0800 POISON (0800 764 766).
Remain calm. Protect yourself from poisoning and seek first-aid advice from the Poisons Centre or call 111 if the person is displaying serious
symptoms of poisoning. If the person is unconscious, place in the recovery position and call 111. Bring the product container to the phone if you
can. Do not give fluids unless instructed to do so by the Poisons Centre. Fluids may cause a person to vomit. For some toxic substances this can
help the substance to be absorbed into the body and cause poisoning or may increase risk of burns to the throat. Do NOT rely on first-aid advice
on labels (this is sometimes incorrect or out of date). Wipe the mouth out to clear away any remaining substance.
Poisons that have been inhaled or
breathed in
Poisons that have been splashed
in the eye
Protect yourself from harm. Ventilate the area and quickly move the person away from the gas or fumes to fresh air if it is safe for you to do so.
Check skin and eyes for chemical burns. Flush with water if necessary. Call the Poisons Centre for advice. If the person becomes unconscious,
place in the recovery position and call 111. Do not attempt to remove an unconscious person from an area where highly toxic or unknown gas is
without proper safety equipment including breathing apparatus. Keep yourself safe at all times.
Flush immediately with clean room-temperature water poured from a jug, bottle, or low-pressure tap for at least 15 minutes. Pour water
continuously across the eye. Ask a bystander to contact the Poisons Centre for further advice while flushing if possible. Do not use eye baths or
solutions since these may react with the chemical. Take to a medical centre or hospital for an eye examination as soon as possible.
Poisons that have been splashed
onto the skin
Poisons that are bites or stings
Immediately flush the exposed area with lots of water for 15–20 minutes to remove all traces of the spilled poison. Seek medical attention if the
skin is damaged or the person is showing other worrying signs.
Treatment varies depending on type of bite or sting (see Bites and Stings for more detailed information), but generally the area should be
washed with mild soap and water. See a doctor if there are signs of infection (redness, swelling, blistering, pain) and seek immediate medical
attention if the person develops an allergic reaction (eg, rash, temperature, difficulty in breathing, swelling of the face and neck). DO NOT take
an analgesic for pain without advice from a doctor unless the sting is from a common non-venomous creature (see Bites and Stings).
PharmacyToday
A part of your
everyday
Page 120 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Every year the centre receives over 30,000 telephone enquiries. The majority of
people are able to be treated at home, but approximately 20% will require active
treatment or investigation in hospital.
The centre maintains TOXINZ (www.toxinz.com), a computerised
database listing over 200,000 chemical and medicinal products, plants and
hazardous creatures. TOXINZ is designed to be used both in a hospital and
pharmacy environment. It contains succint, comprehensive information and
delivers clear recommendations on patient management. Information is
continually reviewed and updated to accommodate new information. Full
access requires an annual subscription.
Safety Messages
• The Pharmaceutical Schedule (Section G) or the PSNZ Code of Ethics contains
information on medicines that should be dispensed with child safety caps.
»»
Although difficult to open for most children aged under five years, child
resistant packaging is not completely childproof, it merely delays access to
the medicine or poison.
»»
Safe storage of medicines and toxic substances, out of reach and sight
of children, remains essential. Always store medicines and other toxic
substances in their original container and separately from food. Encourage
customers to return unwanted medicines.
»»
Ensure customers know how to open and close safety caps correctly.
• Do not keep the dishwasher door open when not in use.
»»
Children will often get into the dishwasher and eat the powder or tablets
before or after the wash cycle. This can result in serious poisoning.
• When giving out medication, check the customer understands the medicine
instructions and maximum dosages.
»»
Check the customer has an appropriate medicine measure to use.
»»
Warn the customer of any potential “double-ups” of the same medicine in
different products.
• Do not use pesticides or lay baits where children might access them.
• Never spray garden chemicals on a windy day and always inform neighbours
of your intentions to spray.
• Be mindful of any substance that is potentially toxic (eg, antifoul for boats,
antifreeze) and take all recommended precautions.
In an emergency
••
If a child or adult is displaying serious symptoms of poisoning, treat as an emergency and dial
111 for an ambulance.
••
For other suspected poisonings, immediately call the National Poisons Centre Urgent Phoneline
24-hours a day, seven-days a week on 0800 POISON (0800 764 766).
••
Do NOT assume that first-aid information on the label is correct.
••
Do NOT induce vomiting unless told to do so by the Poisons Centre.
••
Bring the product container or plant to the phone if you can.
••
Save any vomit, containers and labels in case they are needed later to help identify the poison.
••
Always protect yourself from the poison.
Garden plants
Many plants commonly found in New Zealand gardens, parks and recreation areas may not be
safe for children or may cause skin irritation if children come into contact with them (eg, arum
lillies, black nightshade, daffodils, jonquils, snowflakes, snowdrops, swanplants, poinsettias,
rhododendrons).
Fortunately, fatalities in New Zealand from eating poisonous plants are extremely rare. Most
plants are not tempting for children to eat and usually a child does not eat enough of a poisonous
plant to cause serious illness. However, it is important to be aware of what poisonous plants may
be present near where young children play and to educate young children about the dangers of
eating new plants, particularly ones with fruits or berries, without the supervision of an adult.
For more information see www.landcareresearch.co.nz, search term "poisonous plants" for
the factsheets Plants in New Zealand Poisonous to Children and Safety in pre-school centres:
plants to avoid.
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www.pharmacytoday.co.nz
Page 121

Pregnancy Tests and Supplements
Home pregnancy tests detect the presence of human chorionic gonadotrophin
(HCG) – a hormone produced by the placenta within six to 10 days of implantation
of a fertilised egg – in a woman's urine.
The level of this hormone increases rapidly from conception, doubling every one
to two days until it peaks at around 10 to 12 weeks. It can be measured in the
urine of a pregnant woman from at least the first day of a missed period, with some
tests having the ability to measure it from as early as four days before an expected
period, or seven days after conception.
If instructions are followed correctly, home pregnancy tests are sensitive enough
to provide a reading that is at least 99% accurate. Alcohol, pain-killers, antibiotics
and oral contraceptives do not affect pregnancy tests. Some medicines, such as
fertility drugs, can cause false-positive pregnancy test results.
Traces of the HCG hormone may be found in urine for up to eight weeks after
a miscarriage or termination, and for up to four weeks after the birth of a child.
Home tests are also available to pinpoint the time of ovulation – the release
of eggs from the ovaries (see Product options below).
Fertility facts
• Technically, a woman can only get pregnant during the five days before
ovulation, up until the day of ovulation. This is called the "fertile window"
and reflects the lifespan of sperm (five days) and the lifespan of the ovum
(24 hours).
• Women are most likely to get pregnant two days before ovulation and the day
of ovulation. 12-24 hours after ovulation, the probability of pregnancy rapidly
declines and pregnancy will not be possible during that cycle.
• For women unaware of when their "fertile window" is, sexual intercourse is
recommended every two to three days to optimise their chances of conceiving.
• Age is the most important factor when it comes to conception.
»»
Women are most fertile between the ages of 16 and 25.
»»
At age 30, the chance of conceiving each month is around 20%. This
declines to approximately 5% by age 40.
»»
The risk of pregnancy and birth complications, caesarean section, stillbirth,
miscarriage and birth defects all increase with age.
• Obesity also affects the chance of conception and having a healthy baby.
PRODUCT OPTIONS
Category Examples Comments
Pregnancy testing
Folic acid supplements
Iodine
Ovulation testing
[GENERAL SALE]
eg, Discover Onestep Early Result, EasyCheck
Midstream Pregnancy Tests*, Pregnosis Early
Pregnancy Test Dip & Read*, Pregnosis In-
Stream Early Pregnancy Test*
[PHARMACY ONLY MEDICINE]
eg, folic acid (Apo-Folic 0.8, Blackmores Folic
Acid)
eg, folic acid with iodine, iron and other vitamins
and minerals (Elevit with Iodine, Blackmore’s
Conceive Well, FabFol)
eg, folic acid with iron (Ferrograd F)
[PHARMACY ONLY MEDICINE]
eg, NeuroTabs (contains equivalent iodine
150mcg), Elevit with iodine (contains potassium
iodine 250mcg), FabFol (contains equivalent
iodine 150mcg)
[GENERAL SALE]
eg, EasyCheck Ovulation Kit*, Ovuplan 10 Day
Pregnancy Planning Kit*, Ovuplan Scope*
Follow the manufacturer’s instructions exactly as stated on the packet. Some test sticks are
held in mid-stream urine, while others need a urine sample collected in a clean container,
which is tested with a dip-and-read stick. Test urine samples immediately after collection.
Some fertility drugs may give false-positive results.
Folic acid taken one month before and three months after conception reduces the incidence
of neural tube defects (eg, spina bifida). Women planning a pregnancy should take
supplements containing 0.8mg of folic acid. Women at high risk of a neural tube defect
(NTD) affected pregnancy (including spina bifida) may require more folic acid and should ask
their GP for advice. This includes those who have previously had an NTD-affected pregnancy,
have a family or personal history of NTD (or whose partner has a family or personal history),
who are on insulin treatment for diabetes, or women taking medications known to affect folate
metabolism (eg, carbamazepine, clomiphene, valproate, retinoids and etretinate).
The NZ MOH recommends healthy pregnant and breastfeeding women take a daily 150mcg
iodine-only tablet from confirmation of pregnancy until the discontinuation of breastfeeding
in addition to eating iodine-containing foods such as low-fat milk products, eggs, seafood,
and commercially prepared bread. Women with pre-existing thyroid disease or with currently
high iodine intakes should be referred for further medical advice.
Luteinizing hormone (LH) controls egg release. LH levels noticeably rise about 24–36 hours
before ovulation. Home ovulation tests usually either measure LH in the urine, or oestrogen
levels in saliva, and help to pinpoint the most fertile days in a woman’s cycle.
Relieve leg cramps Crampeze Pregnancy Leg Cramps Contains magnesium, vitamin B6 and D, and viburnum opulus to assist with the relief of leg
cramps during pregnancy and whilst breastfeeding.
Natural / herbal products /
supplements
[GENERAL SALE]
eg, Mumomega Pregnancy 30 Capsules*, Bio-
Oil, Mustela Stretch Mark Double Action, ginger,
horsetail, Lady's Mantle
eg, Sea-Band Mama
Mumomega capsules contain DHA-rich marine fish oils and evening primrose oil.
Creams or oils applied twice daily from the first trimester of pregnancy may reduce the
development of stretch marks. Ginger has been shown to alleviate nausea in pregnancy.
Horsetail may help tone the uterus and Lady's Mantle may help prevent spot bleeding.
Pressure applied to the Nei-Kuan acupressure point may help relieve morning sickness.
Products with an asterisk have a detailed listing in the Pregnancy section of OTC Products, starting on page 255.
Page 122 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
»»
Diet can affect fertility in the short and long term.
»»
A healthy body mass index (BMI) of between 20 and 25 is required by most
women to sustain ovulation. Obesity affects ovarian function and can lead
to abnormal menstrual cycles.
»»
Weight loss and a significant lack of body fat are related to the cessation
of ovulation.
• Cigarette smoking decreases sperm count in men and increases the risk of
miscarriage, ectopic pregnancy, and premature birth in women.
»»
Smokers are only 60% as likely to conceive each month as non-smokers.
• Alcohol also affects sperm count and if taken during pregnancy can increase
the risk of birth defects in babies.
• Caffeine can detrimentally affect fertility if more then two cups of caffeinated
drinks are drunk per day.
• 60% of couples get pregnant within three months; this increases to 80% by
six months. Most couples with relative infertility eventually conceive and only
5% have complete infertility.
»»
Around 30% of infertility is attributable to a problem with female fertility,
30% to a problem with male infertility, and in 20% there is a problem with
both partners. No clear or definite cause is ever found for the other 20%.
Supplements
Folic acid should be taken at least one month before conception and three
months after to reduce the incidence of neural tube defects in the developing
baby (see Product options on opposite page).
Iodine should be taken throughout pregnancy and while breastfeeding to support
normal brain growth and development in the unborn baby and newborn infant.
Pregnant women should also talk with their doctor or midwife about other
supplements (eg, calcium, iron, vitamin D) that may also be needed during pregnancy.
Pregnancy points
• Breast changes (eg, fullness, tenderness) are often the first signs of pregnancy.
The nipples also enlarge as pregnancy develops.
• Shorter, lighter bleeding may occur during early pregnancy in some women, at
the expected time of their period.
• Certain foods (eg, cold meats, raw eggs, uncooked seafood, unpasteurised
cheese/milk) are not recommended during pregnancy. See www.foodsmart.
govt.nz for a list of safe foods in pregnancy.
• Leg and foot cramps are common in pregnancy. Supplements may help.
Initial assessment
Discuss folic acid and iodine supplementation with any woman coming into the
pharmacy for a pregnancy or ovulation test kit (see Product options opposite
for more details). Women who are planning to conceive should also refrain from
drinking alcohol, smoking cigarettes or other substances, and minimise caffeine
intake. If a woman not been previously vaccinated against rubella (German measles),
she should talk to their doctor about getting vaccinated before conception.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial
assessment may have already provided some answers. Decide if any
further questions still need to be asked and refer any “yes” answers
to a pharmacist.
• Does the woman have any other health conditions (eg, epilepsy,
thyroid problems)?
• Does the woman take any other medication or herbal remedy,
either prescribed by a doctor or bought from a shop or
supermarket?
• Would the woman be worried if she was pregnant?
• Has the woman missed a period but pregnancy tests have been
negative?
• Does the woman usually have irregular periods so is not quite
sure when her next period is/was due?
• Has the woman had a positive pregnancy test but has not yet
seen a doctor?
• Has the woman been having abdominal pain or period problems?
• Does the woman have any allergies to supplements?
Advise women who are pregnant to organise a lead maternity carer (LMC)
as soon as possible – this can be a midwife or specialist doctor. See www.
findyourmidwife.co.nz or ask your doctor for a local list of LMCs.
Advice for customers
• If the woman’s menstrual cycle varies in duration so that period dates cannot
be predicted, test first thing in the morning when HCG concentration is at its
strongest. Use a mid-stream urine sample.
• Retesting after a few days is recommended if a women gets a negative result
after using an early pregnancy test seven days post ovulation.
» » Alternatively, blood tests (from a doctor) are sensitive at detecting HCG
from about six to eight days after ovulation.
• For more information on medications that can be safely taken during
pregnancy see Drugs in Pregnancy, page 210.
Page 123

Preventive Health
There are certain lifestyle choices people can make to increase their chances of
living a long and healthy life. Most are simple and readily available. A summary of
key preventive health topics is given below. For more information about staying
well, see the New Zealand Ministry of Health’s website for New Zealanders,
HealthEd (www.healthed.govt.nz).
Immunisation
Immunisation is one of the most cost-effective ways to prevent disease. It stimulates
the body’s natural immune system to build resistance to specific infections. The
National Immunisation Schedule of New Zealand is the series of vaccines that are
offered free to babies, children, adolescents and adults. For more information on
vaccination and the diseases vaccinated against, see Childhood Diseases and
Immunisations. While many of these diseases are no longer prevalent in New
Zealand, some are endemic overseas and people travelling should ensure their
full childhood course of immunisations has been completed.
Eating and Activity Guidelines
The weight of New Zealanders continues to increase with nearly 32% of adults
reported as obese in the 2015/2016 New Zealand Health Survey, and a further
35% reported as overweight (but not obese). Maori and Pacific adults have
comparatively high rates of obesity (47% and 67% respectively). Obesity rates
in children have remained relatively stable at 11% of children aged two to 14
years; however, Pacific children were more than three times as likely to be obese
as non-Pacific children.
The New Zealand Eating and Activity guidelines recommend to:
• eat a variety of nutritious foods everyday including plenty of vegetables and
fruit; grain foods (mostly wholegrain and high in fibre); some milk and milk
products (mostly low and reduced fat); some legumes, nuts, seeds, fish and
other seafood; poultry and some red meat (with the fat removed)
• choose foods that contain unsaturated fat (rather than saturated fat), that are
low in sodium (salt), with little or no added sugar, that are mostly whole and
less processed
»»
Use salt sparingly and choose iodised salt over uniodised salt.
• make plain water your preferred drink
• keep alcohol intake low if you choose to drink alcohol; avoid alcohol during
pregnancy or when trying to get pregnant
• partake in at least 150 minutes of moderate or 75 minutes of vigorous intensity
physical activity spread throughout the week. Do muscle strengthening exercises
on at least two days per week. Break up long periods of sitting with activity.
Funded screening programmes
Screening aims to identify the presence or risk of a disease before it has fully
developed or become harmful and there is a range of screening activities open to
a person throughout their lifecourse. Not all are government funded and several
lack evidence that screening is in fact beneficial. Five screening programmes and
one quality improvement programme are currently coordinated by the National
Screening Unit of New Zealand. These are:
• Breastscreen Aotearoa: screens women for breast cancer
• National Cervical Screening Programme: screens women for abnormal
changes to cells on the cervix
• Newborn Metabolic Screening Programme: screens newborns for certain
metabolic disorders
• Antenatal HIV Screening Programme: screens pregnant women for HIV to
reduce mother-to-child transmission
• Universal Newborn Hearing Screening Programme: screens newborn babies
for hearing loss
• Antenatal screening for Down syndrome and other conditions (quality
improvement for screening).
See the table next page for further information about some of these
government-funded screening programmes and others.
Eye health
Glaucoma affects 2% of the population over 40 years and is largely symptomless.
Glaucoma NZ recommends all adults have an eye examination for glaucoma by
the time they are 45 and then every five years thereafter if the examination is
normal. In addition, macular degeneration – a condition that affects almost one
in seven older New Zealanders and is the leading cause of blindness – should be
screened for in those over the age of 50.
Maintaining good oral health
Good oral health is essential to overall health, and oral health services are free
for all New Zealanders until their 18th birthday. Despite this, the prevalence and
severity of child dental decay In New Zealand is higher than that seen in the
United States, Australia, or the United Kingdom. Significant differences exist in
the number of children who are dental caries-free by age five associated with
ethnicity, region and water fluoridation status, and these inequalities, particularly
between Maori and non-Maori, are worsening. In some areas of New Zealand
the severity of dental decay in children is at the level of developing Eastern
European countries.
Pharmacy staff are in an ideal position to educate their customers about
good oral hygiene and free dental healthcare for their children (see www.
healthysmiles.org.nz or ask at the child’s school). For more information see
Oral Health or Toothache.
Sexual and reproductive health
Sexually transmitted infections (STIs) are common in New Zealand particularly
in adolescents and adults aged 15–25 years. Chlamydia is New Zealand’s most
commonly diagnosed STI and if left untreated (70% of people who have it have
no symptoms), can lead to pelvic inflammatory disease, ectopic pregnancy,
urethritis and infertility. The New Zealand Ministry of Health recommends
chlamydia testing be considered in all sexually active people under the age of 25.
Although not as prevalent as chlamydia, the number of people diagnosed with
READY, SET, LEARN!
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CONTINUING OTC EDUCATION
Screening in New Zealand
SCREENING
CONDITION
Breast cancer
Cardiovascular
disease (CVD)
SCREENING TESTS
Mammography
Ultrasound
Fasting lipid profile
Fasting plasma
glucose
Blood pressure
COMMENTS
The New Zealand Breast Cancer Foundation recommends annual screening mammograms for women from 40 years on.
Free breast screening every two years is available for women aged 45–69 years through the National Breast screening programme, BreastScreen
Aotearoa (freephone 0800 270 200 to enrol).
See also Heart Health
All men from the age of 45 and women from the age of 55 should have a cardiovascular disease risk assessment, unless they have risk factors
or are Maori, from the Pacific Islands or Indian subcontinent, then a check should be conducted 10 years earlier.
Cervical cancer Pap smear The NZ National Cervical Screening programme (0800 729 729) recommends that any woman who has ever been sexually active should have a
cervical smear test every three years from the time they turn 20 until they turn 70.
Includes all women who have been immunised against HPV.
Colorectal
cancer
Osteoporosis
Colonoscopy
Sigmoidoscopy
Faecal occult blood
test
FRAX tool
Dual energy x-ray
absorptiometry
(DEXA) of the hip
and spine
Ultrasound of the
heel
Bowel cancer is the most frequently diagnosed cancer and the second highest cause of cancer death in New Zealand.
Pilot scheme started in 2011 and extended until the end of 2017 to screen people aged 50–74 years living in the Waitemata District Health
Board area (Auckland) using a faecal occult blood test. No decision has yet been made on implementing a national programme at time of going
to print. For other tests, recommended screening interval is dependent on screening test.
FRAX tool calculates the probability of an osteoporotic fracture occurring based on clinical risk factors. Uses either a body mass index (BMI) or
bone mineral density T-score (available at www.shef.ac.uk/FRAX).
Determining who is at risk of falls may be more important than just DEXA measurement. The Health Quality and Safety Commission of New
Zealand (www.hqsc.govt.nz) recommends health professionals make it routine practice to ask older people about falls.
Access to and funding of bone densitometry scanning varies throughout New Zealand. Bone density usually only measured if result will impact
on decision making. May be considered in women aged >60 years, men aged >70 years, and those with risk factors for osteoporosis (ie,
previous fracture, low body weight, family history of osteoporosis, premature menopause, glucocorticoid or anticonvulsant use, smokers).
Prostate
cancer
Digital rectal
examination (DRE)
Prostate specific
antigen (PSA)
Prostate biopsy
No funded population-based screening in New Zealand. Controversy exists over value of encouraging screening requested by individuals. It is
recommended that every man has the right to decide for himself whether or not to be tested. Practice of prostate screening varies widely in New
Zealand, some doctors screen up until age 75. United States guidelines recommend against prostate cancer screening in asymptomatic men.
Most patients present with potentially curable disease and most do not have symptoms even if the cancer is extensive within the prostate.
PSA test is not specific for prostate cancer. Can be normal in some men with cancer and can elevate with some other conditions (eg, urinary
tract infections, prostatitis, benign prostatic hyperplasia [BPH]).
gonorrhoea, genital herpes, genital warts, or infectious syphilis is increasing. Two
hundred and twenty four people were diagnosed with HIV in 2015. Over 68%
were men infected through having sex with men.
All New Zealand citizens and permanent residents are entitled to free
maternity care (www.findyourmidwife.co.nz). Supplements of folic acid are
recommended for those attempting to conceive and iodine should be taken from
pregnancy confirmation until the end of breastfeeding (see Pregnancy Tests
and Supplements).
Skin cancer
Rates of skin cancer in New Zealand are among the highest in the world. Skin
cancer is largely preventable (see Sun Care), and finding skin cancer as early as
possible is the key to successful treatment. All adults over the age of 20 should
regularly check their skin for changes or abnormal moles, freckles or spots.
Smoking cessation
New Zealand has been at the forefront of tobacco control internationally and the
New Zealand Government is committed to the goal of New Zealand becoming
smokefree by 2025. Despite New Zealand’s progress, smoking remains the single
biggest cause of preventable morbidity, with approximately 5000 deaths each
year attributable to direct smoking or second-hand smoke. For more information
see Smoking Cessation.
TREATMENT OPTIONS
Category Examples Comments
Natural products eg, Turmeric 15800 Complex* Turmeric complex contains turmeric, ginger, and ashwagandha; anti-inflammatory properties
of these natural ingredients may help with joint aches and pains and gastrointestinal health.
Products with an asterisk have a detailed listing in the Preventive Health section of OTC Products, starting on page 256.
Locate this icon throughout the Healthcare Handbook.
Then find the corresponding Pharmacy Today and ELearning articles.
Read all three to unleash learning prizes and giveaways!
Page 125

Probiotics and Prebiotics
Probiotics are live bacteria and yeasts that are good for your health, often
colloquially referred to as “friendly bacteria”. Our bodies are full of bacteria,
and our digestive system alone is home to more than 400 different bacterial and
yeast species. This microbiome helps to maintain the lining of the gut and assists
in digestion and absorption of food. Imbalances in the microbiome, caused by
external factors such as diet, antibiotic use or infection, can result in symptoms
such as bloating, constipation, diarrhoea or pain. Imbalances have also been
linked to more generalised disorders such as eczema, heart disease, obesity, and
several autoimmune conditions. Epidemiologists have noted a higher prevalence
of such conditions in societies with very good hygiene, possibly because our
immune systems are not being properly challenged by pathogenic organisms.
Probiotics may help with many of the ailments listed above; however, research
is still very limited and most evidence supports the role of probiotics in boosting
the immune system.
Common probiotics
Research into the effects and benefits of probiotics is ongoing. It is important to
realise that not all probiotics have the same effect so it is important to make sure
the specific strain you recommend is one appropriate for your customer’s needs
or ask the customer exactly which specific strain they are wanting. Combinations
of different strains or species may work better for certain conditions such as
ulcerative colitis or pouchitis. Most probiotics need to be taken regularly for full
effect.
Lactobacillus species
The lactobacillus species of bacteria is the largest and most well-known
group of probiotic bacteria that inhabit the intestine. Over 18 different
strains exist and all are gram-positive rods that produce lactic acid. They
tend to be well tolerated although mild flatulence that subsides with therapy
is a common side effect.
The following conditions are just some examples of where evidence of an
effect has been documented:
• antibiotic-associated diarrhoea: L. rhamnosus GG
• atopic eczema: L. rhamnosus GG, L. sakei, L. reuteri
• bacterial vaginosis: L. acidophilus
• chemotherapy-induced diarrhoea: L. rhamnosus GG
• hay fever: L. paracasei
• high cholesterol: L. reuteri NCIMB 30242, L. plantarum
• infantile colic: L. reuteri
• irritable bowel syndrome (IBS): L. acidophilus
• mouth sores from chemotherapy: L. brevis
• respiratory tract infections: L. acidophilus, L. rhamnosus GG
• rheumatoid arthritis: L casei
• rotaviral diarrhoea: L. casei, L. reuteri, L. rhamnosus GG.
Bifidobacteria
There are at least seven different strains of bifidobacteria and their main function
is to provide a microbial barrier to infection. They mainly colonise the human
colon and are the predominant intestinal flora of breastfed infants (especially
B. bifidum). Different bifidobacteria strains differ in their effectiveness due to
differences in their ability to adhere to epithelial cells. B. longum is particularly
resistant to gastric acid. Bloating and flatulence may occur initally but this tends
to subside with continued use and they may cause diarrhoea in children. Evidence
of an effect has been documented for (not all inclusive):
• constipation: B. longum BB536 + milk/yoghurt
• irritable bowel syndrome: B. infantis
• respiratory tract infections: B. animalis
• rotaviral diarrhoea: B. bifidum
• ulcerative colitis: B. bifidum, B. breve.
Saccharomyces boulardii
S. boulardii is a yeast that enhances the protective effects of the normal, healthy,
human gut flora. It has a wide range of effects including inhibiting the growth
of bacteria and parasites, neutralising viruses, preventing bacterial adherence,
stimulating antibody production and acting as an immune stimulant. Research
has found it to be beneficial in the prevention and treatment of diarrhoea,
PROBIOTIC AND PREBIOTICS
Category Examples Comments
Digestive health
eg, L. acidophilus and/or B. lactis (eg, Bioglan
Restore, Clinicians, Go Healthy, Inner Health
Plus, Lifestream Bowel, Nutralife)
eg, L. reuteri (Blackmores Digestive Bio Balance)
eg, kiwifruit extract (Phloe Capsules/Chewable
Tablets)
Oral health eg, S. salivarius K12 (eg, BLISS K12 range), S.
salivarius M18 (BLIS M18 Probiotic for Teeth
and Gums)
Contain probiotic bacteria to aid digestive health and other conditions resulting from an
imbalance of bacteria within the gut. Helps restore the balance between beneficial and
harmful bacteria.
Kiwfruit extract contains a combination or prebiotics, enzymes and fibre to aid good digestive
health and help relieve constipation.
Use in conjunction with regular oral hygiene to establish a healthy balance of bacteria in the
mouth.
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CONTINUING OTC EDUCATION
decrease the appearance of acne, and help symptoms of Crohn’s disease or
ulcerative colitis. Flatulence may be an issue and it may not be suitable for people
with a yeast allergy or those who are immunocompromised.
S. cerevisiae is another probiotic yeast with strong antioxidant activity that
may help reduce pain associated with IBS.
Streptococcus salivarius
S. salivarius K12 and M18 are oral cavity probiotics which are have activity
against bacteria implicated in bad breath, gingivitis (see Oral Health), and tooth
decay. K12 also helps stimulate antiviral immune defenses and reduce episodes
of otitis media.
S. thermophiles has been widely used in the dairy industry in the production
of milk, cheese and yoghurt since the 1900s. Live cultures of S. thermophiles can
help people who are lactose-intolerant digest dairy products.
Safety of probiotics
Although probiotics are generally considered safe and cause few side effects,
assessments are ongoing into the safety and toxicity of these substances.
Reassuringly, yoghurt, cheeses, and many other foods that contain live cultures
(probiotics) have been eaten for centuries with few reported ill effects. However,
people with a weakened immune system or a serious illness have a reduced
ability to fight infection and may be vulnerable to infection from probiotics, and
should avoid them.
Probiotics: foods versus supplements?
The form of the probiotic (ie, as a powder, tablet, capsule, or food) generally does
not matter as long as it contains at least 7–9 billion colony forming units (CFU)
per dose, although recommended dosage for different strains varies.
As a general rule, most foods do not contain enough organisms or the content
varies widely from batch to batch as a result of the manufacturing process or
storage. Choose commercially prepared probiotic products from a reputable
company that guarantees a specific number of organisms at the time of purchase,
and ensure storage requirements are adhered to. Products stored for long periods
of time or improperly stored may contain few live and active organisms to start
with.
Prebiotics
Prebiotics are non-digestable food ingredients. They are mostly obtained from
carbohydrate fibres called oligosaccharides. Sources of prebiotics include whole
grains, bananas, onions, garlic, honey and artichokes. Prebiotics can increase
the number of beneficial bacteria in the intestine by stimulating their growth.
A prebiotic combined with a probiotic is called a symbiotic – a substance that
contains both live bacteria and the fuel it needs to survive.
Prebiotics available in New Zealand mostly contain inulin or oligofructose.
Both are effective for the treatment of constipation. Inulin can also lower
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, cancer, is pregnant or breastfeeding)?
• Does the person take any regular medicine that has been
prescribed by a doctor?
• Is the person wanting a probiotic for a very young child or an
elderly person?
• Does the person have any symptoms of concern (eg, blood in the
faeces, unexplained weight loss, inconsistent bowel movements)?
• Has the person recently travelled to a developing country?
• Have probiotics been tried before without success?
• Does the person have any allergies to milk or lactose?
triglycerides and is included in several meal replacement formulae or weight loss
products as it suppresses hunger by making people feel full. A kiwifruit extract is
also available that contains prebiotics, dietary fibre to bulk up and improve the
water-retaining properties of the faecal mass, and enzymes. The main side effect
of prebiotics is bloating and flatulence.
Initial assessment
Ask questions to ensure you select the correct species and strain of probiotic
for your customer's condition. Refer any "yes" answers from the Refer to
Pharmacist questions to a pharmacist.
Advise customers to take probiotics with food to take advantage of the
increased alkalinity of the stomach (and therefore ensure better survival of the
probiotic) and to separate the administration of probiotics and antibiotics by at
least two hours. Discard all products once they are past their expiry date.
• Store probiotics strictly according to the storage requirements on the label.
Now you can complete
your ENHANCE modules on
your phone or tablet
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Page 127

Psoriasis
Psoriasis is a long-term skin condition that can occur on any part of the body. It
affects 2%–4% of New Zealanders and is more common in those with European
ancestry. Psoriasis can occur at any age, but more commonly begins in the late
teens or around the age of 50. Psoriasis affects males and females equally,
although in children it more commonly affects girls.
About 25% of people find their psoriasis is itchy and others may have a
burning feeling on the skin. The appearance of psoriasis depends on what part of
the body is affected. On the back, trunk, arms and legs there may be red patches,
often covered with thick silvery-white scales (“plaque” psoriasis), or there may
be small red spots scattered across the skin (“guttate” psoriasis).
On the scalp it can look like severe dandruff and there can be hair loss.
Psoriasis can affect nails, distorting their shape and making them pitted and
yellow. On the palms of the hands and the soles of the feet, psoriasis can look
like pustules – blisters surrounded by red skin. Psoriasis can also occur in the skin
folds, such as in the groin area, under the breasts or in the armpits. Here, it often
appears as smooth, shiny red patches.
Approximately 5% of people with psoriasis will also have psoriatic arthritis,
which causes pain, stiffness and swelling of the joints and can be very debilitating.
Psoriasis tends to come and go over time, and 80% of people have a mild
form of the disease. Rarely, hospitalisation is necessary if the disease is severe.
Psoriasis may be confused with seborrhoeic dermatitis and other types
of dermatitis (see Dermatitis/Eczema), candida and dermatophyte fungal
infections (see Fungal Infections: Superficial), as well as other skin conditions
Triggers of psoriasis
The cause of psoriasis is not fully understood but it may result from either an
TREATMENT OPTIONS
Category Examples Comments
abnormal activation of cell death pathways (apoptosis) or an overactive immune
system that causes inflammation, proliferation of extra blood vessels and
increased skin cell turnover. Up to 50% of people with psoriasis will know of
another affected family member. Certain triggers seem to precipitate psoriasis or
make it worse and include:
• alcohol
• certain medicines (eg, beta-blockers, lithium, withdrawal from oral or topical
corticosteroids)
• hormonal changes (commonly occurs post-puberty)
• infections (eg, streptococcal throat infections, candida, Malassezia yeasts)
• injury to the skin, including sunburn
• obesity (severity of psoriasis correlates with insulin resistance)
• smoking
• stress, both physical and psychological.
Initial assessment
Psoriasis can significantly impact a person's quality of life so take a supportive
approach and help your customer find non-irritating moisturisers, shampoos and
body washes; offer samples if you can. Refer any customers requiring treatment
for flare-ups of psoriasis to a pharmacist.
Treatment
There is no cure for psoriasis and it can be difficult to treat, although satisfactory
control of the psoriasis can be achieved for most people. Some customers may
have to try several different products before finding one that works for them.
Topical treatment options are available for mild-to-moderate plaque and scalp
Moisturisers [GENERAL SALE]
eg, Dermasoft, Epaderm, Lipobase, Lucas Papaw
ointment, NeoStrata Ultra Moisturising Cream,
QV Skin Lotion*
Products containing
coal tar
Combination coal tar products
[GENERAL SALE]
eg, Pinetarsol*, Egoderm, Egopsoryl TA Gel,
eg, shampoos (Neutrogena T Gel, Sebitar, Scytera
Coal Tar Foam, Polytar)
[GENERAL SALE]
eg, Coco-Scalp*
Topical corticosteroids [PHARMACY ONLY MEDICINE 0.5%]
[PHARMACIST ONLY MEDICINE 1.0%]
eg, hydrocortisone (Dermaid, Skincalm)
Frequently used to help soften and soothe skin, reducing cracking and dryness.
Useful for mild psoriasis. It is best to patch-test products to ensure no skin sensitivity
reactions occur.
Coal tar and coal tar-related products (eg, pine tar, oil of cade or ichthammol) are old but
effective treatments, although it is not known how they work. Tar is most useful for scalp
psoriasis and chronic plaque psoriasis. Can be messy and some people may dislike the smell.
Contains coal tar, sulphur and salicylic acid in a coconut-oil base. It effectively removes
skin scales on the scalp. Apply to the scalp for an hour, then wash off, usually with a tarcontaining
shampoo.
Restrict use to small areas to reduce risk of absorption.
Use for longer than seven days only on medical advice.
May be used in combination with an antifungal agent to combat candida.
Natural / herbal products /
supplements
Aloe, honey, Milk thistle, Vitamin D,
eg, Hopes Relief, Plasmalg Gel, Skybright
Chickweed cream
Some natural extracts may help decrease symptom severity. Topical vitamin D is effective at
treating plaque psoriasis in some patients.
Products with an asterisk have a detailed listing in the Psoriasis section of OTC Products, on page 256.
Significant learning
opportunity: Wound care
Your new Group 3 CPD project
Page 128 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
psoriasis within the community pharmacy setting are limited. More effective
therapies are available through a GP or specialist and phototherapy (ultraviolet
light) can also be prescribed. General measures to help long-term management of
psoraisis include:
• sun exposure, but avoid overexposure and burning
• baths containing bath oil or coal-tar solution which help to soften the psoriasis
and lift the scale
• bland soaps or soap substitutes to avoid further irritation. Products containing
antiseptics are not necessary and may make the psoriasis worse
• moisturising creams or emollients to keep the psoriasis soft and prevent it
from cracking and becoming sore
• occlusive dressings which may help small localised patches of psoriasis
• rest, particularly bedrest for short periods, is beneficial for psoriasis.
Advice for customers
• Stress is one of the main triggers of psoriasis.
»»
Find ways to relax, such as yoga or meditation.
»»
Build a good support network. Contact a local psoriasis support group (see
page 212 for contact details of support groups).
• Follow a healthy diet and limit intake of alcohol, fried or processed foods.
• Try not to scratch or pick psoriatic lesions (it may make them more resistant to
treatment and trigger new lesions).
• Keep skin cool and moisturised to help reduce itching and scratching. Apply
emollients frequently and regularly for relief.
• Warn patients to be careful when getting out of the bath or when using bath
additives that may make the bath slippery.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Are the lesions extensive or severe?
• Have the lesions occurred following recent infection?
• Do the lesions cause moderate-to-severe itching?
• Could the diagnosis be something other than psoriasis?
• Is the person feeling depressed or anxious about their psoriasis?
• Is this the first time the person has experienced psoriasis?
• Are the lesions pustular or do they look red or infected?
• Are the lesions within the nails?
• Have products been tried before without success?
• Is the person the first person in the extended family to develop
psoriasis?
• Does the person have any allergies to topical medicines?
Visit ELearning to start your project
www.pharmacytoday.co.nz
Facilitated by Dr Alesha Smith
Page 129

Scabies
Scabies is a very contagious skin disease caused by the barely visible parasitic
mite Sarcoptes scabiei. These mites are found worldwide but are more common
in places frequented by lots of people, such as prisons, hospitals, rest homes,
refugee camps, university or school dormitories.
Symptoms
A mild rash on the limbs and trunk which is intensely itchy is usually the most
common presenting symptom, which can be easily misdiagnosed as dermatitis.
The rash associated with scabies typically develops several weeks after infestation,
unless the person has been infested before, in which case it may start within a
few hours. The itchiness is the result of the affected person developing an allergic
reaction to the mite’s eggs, faeces and saliva. The itch tends to worsen at night
or after a hot bath or shower.
Scabies may also present with itchy lumps or nodules in the armpits and groin
or along the shaft of the penis. These nodules usually persist for several weeks
after successful eradication of the living mite.
Scabies rarely affects the face and scalp, but is more likely to do so in young
babies and bed-bound elderly patients. Young children are also more likely to
have blisters and pustules on their palms and soles.
Transmission of the mite to others is high during the period of time before
the infected person becomes itchy and realises that they have scabies. The
mite is easily spread through direct skin-to-skin contact for just a few minutes
(eg, holding hands, sexual contact). Transmission can also occur from sharing
clothing, towels and bedding as the mite can live for up to three days off a
human’s skin. Poverty and overcrowding are a factor in transmission although
scabies is not due to poor hygiene, or from contact with animal mites.
Typically, several mites are responsible for the initial infection. After mating,
the male mite dies and the female burrows into the top layer of skin and lays
approximately two to three eggs per day during her lifespan of one to two
months. It takes 10 to 14 days for an egg to hatch and develop into an adult.
Crusted scabies
Crusted scabies (also called Norwegian scabies) is an extremely severe form of
scabies in which there are thousands or even millions of mites, but very little
itch. It is extremely contagious and often responsible for outbreaks of scabies
in hospitals, resthomes or prisons. It is frequently misdiagnosed as psoriasis
because the thickened crusts of skin containing the mites look like psoriasis
plaques. Crusted scabies is more likely to develop in people with a poor immune
system, neurological disease, with mental impairment or who are elderly. Oral
ivermectin prescribed by a doctor may be necessary for effective treatment.
Initial assessment
Wearing gloves, search carefully for burrows in customers complaining of severe
itch, especially if the rash looks mild. Burrows look like a 5–10mm zigzag line
and are most commonly found between the fingers or on the wrists or palms,
although may be present in the armpits, buttocks, on the genitalia, insteps of the
feet or backs of the heels. In some people, it may be difficult to see the burrows
as they may be obscured by scratching, eczema or an infection. Normally the
mite is too small to see with the naked eye (a full-grown mite is about the size
of a pinpoint).
Refer any customer with signs of a secondary bacterial infection of the rash
(such as crusted patches or pus) or cellulitis (an infection of the deeper dermal
layer of the skin that causes painful swelling, intense redness and fever) to a
doctor. Also refer any customers with "yes" answers to the Refer to Pharmacist
questions to a pharmacist. Treat all other customers with a suitable scabicide.
Treatment
Treatment is with a scabicide (eg, permethrin, malathion) which, for adults, is
applied to the entire body from the chin and ears downwards. Most people
will require help to get to hard-to-reach areas, such as their back. Permethrin
products need to be left on for eight to 14 hours, and Malathion for 24 hours
before washing off. Advise customers to use a nailbrush to get the product under
their nails and to pay particular attention to the finger and toe webs. In children
aged six months to two years, the face and scalp may need to be included as well,
but this should only be done under further advice from a pharmacist.
Products are best applied to the body after a bath or shower once the skin
has cooled down. All household members, and anybody with recent direct and
prolonged contact with a person with scabies, should be treated at the same
TREATMENT OPTIONS
Category Examples Comments
Treatment products
[GENERAL SALE]
eg, malathion
[GENERAL SALE]
eg, crotamiton (Eurax Cream, Itch Soothe Cream)
[GENERAL SALE]
eg, permethrin (A-Scabies Lotion, Lyderm)
Effective against scabies, head lice and body lice. Follow packet dosage instructions. This
water-based product may be less irritating to people with asthma or sensitive skin, and less
irritating to sensitive areas such as the genitalia.
This has been used in the past to treat scabies, although it is not as effective as other
products. Best used to treat the itch that persists after scabies treatment (just apply to the
affected areas).
Effective against scabies. Pregnant women and children aged between two months and two
years should be treated under medical supervision.
@PharmacyToday. A part of your everyday.
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Page 130 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
time, even if they are not itchy.
It is important to tell people they may still remain itchy for up to four weeks
after they have treated their scabies, due to the continuing allergic reaction to
the mite’s byproducts until they are cast off by the skin. However, a persistent
itch may also be due to incorrectly applied treatment, reinfestation, or ongoing
dermatitis. In some circumstances the customer may have had an incorrect
diagnosis. Anybody worried about their persisting itch should be re-examined
by a doctor or pharmacist. Crotamiton cream, oral antihistamines, 0.5%
hydrocortisone cream, or emollients may be applied to relieve this itch.
Advice for customers
• Follow the product instructions exactly and ensure product stays on for the
recommended length of time before being washed off.
»»
The whole body needs to be treated, not just the itchy areas
»»
Reapply product to the hands if they are washed within the treatment time.
• A second application may be given after at least seven days if there are no
signs of the original lesions healing or if new burrows have appeared.
• Consider taking oral antihistamines, or using topical crotamiton, moisturisers,
or hydrocortisone cream for help with the itch, which may persist for up to four
weeks after treatment.
• Treat everyone in the house and at the same time, even if they have no signs
of scabies.
»»
Advise family members, friends and babysitters who have been in the house
that they will also need to be treated.
»»
If multiple family members require treatment and cost is an issue, inform
customers that some products are subsidised on a prescription from a
doctor.
• Wash in hot water any bedding, clothing or soft toys that have come into
contact with the infected person. Alternatively, seal objects in a plastic bag
for one to two weeks.
»»
Hang other bedding outside in the sun for a day, and thoroughly vacuum
carpets and furniture.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, lung
problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Is the itch severe or extensive?
• Is the diagnosis uncertain?
• Will the treatment be used on a child under two?
• Is there evidence of crusting or pus from scratching?
• Is the scratching localised in one specific area?
• Does the person also suffer from dermatitis or other skin
conditions?
• Have the symptoms persisted or recurred despite treatment (note
that itch can persist for several weeks)?
• Does the person have any allergies to topical medicines?
Page 131

Shingles
Shingles (herpes zoster) is a reactivation of the varicella zoster virus – also called
herpesvirus 3, the same virus that causes chickenpox (see Childhood Diseases
and Immunisation).
Chickenpox generally occurs in children and young people. However, once an
episode of chickenpox has resolved, the virus is not eliminated from the body
but lies dormant in nerve cells close to the spinal cord. Many years later it can
reactivate to cause shingles, an infection with symptoms vastly different from the
original chickenpox infection. Exactly how the virus remains latent in the body,
and subsequently reactivates, is not understood.
Shingles occurs only in people who have had chickenpox, and people whose
immune systems are impaired due to ill health, medications, or diseases that
lower the immunity (eg, cancer, HIV) are most at risk. Occasionally, trauma (eg, a
surgical scar) may trigger shingles at the site of the injury. Contact with somebody
who currently has varicella or herpes zoster may also cause reactivation. Shingles
can occur at any age but is more common in adults aged over 60. Rarely, shingles
may occur in young children who were either born with chickenpox or had it soon
after birth. Most people get shingles only once in their lifetime.
Symptoms of shingles
Early symptoms may include non-specific complaints, such as headache, fever
and malaise, which may be easily misdiagnosed. After a couple of days, itching,
tingling, numbness or burning, and/or a stabbing pain may develop in the
affected dermatome (an area of skin supplied by one spinal nerve). Usually, after
one or two days (but sometimes as long as three weeks), the initial phase is
followed by the appearance of the characteristic skin rash.
The pain and rash most commonly occur on the areas of skin supplied by
the thoracic (chest), cervical (neck), ophthalmic (forehead), and lumbar (torso)
nerves. The rash usually starts as a crop of red papules and may look like hives
but, since the virus spreads along certain nerves located off the spinal cord, it
typically has a stripe-like and usually unilateral presentation, unlike hives which
are usually widespread. Within a few days, the papules form small, painful,
exudate-filled blisters, which may persist for up to seven to 10 days before they
crust over and heal.
Once the blisters have appeared, and until the rash has developed crusts, a
person is extremely contagious and transmission of the virus can occur to people
without immunity to the virus. These people may then develop chickenpox but
will not immediately develop shingles.
Shingles may be associated with serious complications including postherpetic
neuralgia, bacterial superinfection, infection of internal organs, visual
impairment, hearing loss and death. Sometimes after severe blistering, scarring
and discoloured skin may remain.
Initial assessment
Avoid close contact with somebody with suspected shingles if you have never
TREATMENT OPTIONS
Category Examples Comments
Oral analgesics
Topical pain relievers
Varicella vaccine
Natural / herbal products /
supplements
[GENERAL SALE]
eg, paracetamol (Panadol, Paracare), ibuprofen
up to 25s (Advil, Nurofen)
[PHARMACY ONLY MEDICINE]
eg, paracetamol – greater than 20 tablets,
suspension (Pamol All Ages, Paracare, Panadol),
ibuprofen >25s (Advil, Nurofen), ibuprofen +
paracetamol (Maxigesic, Nuromol)
[GENERAL SALE]
eg, capsaicin cream (Zostrix HP*), lignocaine
preparations (Soov cream/spray)
[PHARMACY ONLY MEDICINE]
eg, lignocaine/prilocaine (Emla), aspirin (

CONTINUING OTC EDUCATION
had chickenpox or been vaccinated against chickenpox. Refer any customers with
suspected shingles to a doctor as prompt treatment with antiviral medicine can
help reduce symptoms and complications.
Treatment
Antiviral drug treatment prescribed by a doctor can reduce the severity of
the attack and incidence of nerve pain that can persist long after the attack
has resolved (post-herpetic neuralgia), if started within 72 hours of the rash
appearing. The treatment options table lists over-the-counter agents that may
also be considered.
Prevention
Vaccination against the herpes zoster virus with the vaccine Zostavax may be
considered in people older than 50 because they are more at risk of severe
complications from shingles. Zostavax is indicated for the:
• prevention of herpes zoster (shingles) and post-herpetic neuralgia
• reduction of acute and chronic zoster-associated pain.
This vaccine reduces the incidence of shingles by 50% and, in people who do
get shingles despite being vaccinated, the symptoms are usually less severe and
post-herpetic neuralgia is less likely to develop. The vaccine is currently unfunded,
but may be administered by registered pharmacists who have successfully
completed an approved vaccinator training course.
Post-herpetic neuralgia
This is defined as pain that persists or recurs more than a month after the onset
of shingles. It is more common in people older than 40 and is more likely in
people with facial shingles infections. The pain may be burning and continuous,
Refer to
PHARMACIST
Customers with suspected shingles should be referred to a doctor.
For people with previously diagnosed shingles, the pharmacist
should ask the following specific questions to help decide whether
the person needs referring back to a doctor:
• has the rash persisted, despite a course of antiviral treatment?
• does the person appear to be getting worse, not better, despite
ongoing treatment?
• is the person still in pain?
• does the person appear depressed or are they having trouble
sleeping?
• has the rash now appeared on the forehead or spread into the eye?
• has the person previously been treated for shingles but is now
having severe post-herpatic neuralgia?
• has the customer had any reactions to products previously
prescribed for shingles?
or spasmodic and shooting, or, rarely, an itchy, crawling variety. The overlying skin
may feel numb or extremely sensitive to touch. Topical pain relievers including
capsaicin cream may help, but some people may require further referral for
ongoing assessment and management with prescription medicines, acupuncture
or transcutaneous electrical nerve stimulation (TENS) therapy.
Advice for customers
• Early treatment from a doctor will reduce the severity and duration of shingles.
• Rest and take pain relief (eg, paracetamol).
• Apply a bland, protective cream to the rash, and wear loose clothing.
• If the pain persists following treatment return to your doctor.
• Warn customers that they are highly contagious until the rash crusts over.
Page 133

Sinus and Nasal Problems
Sinuses are spaces or air cavities found within the skull which connect with the
nose. Their function is to filter and moisten the air that we breathe, give resonance
to our voices, and make the skull lighter. Various sinus-related conditions may
occur.
Persistent allergic rhinitis
Symptoms occur continuously rather than seasonally as in intermittent allergic
rhinitis (see Hay Fever). However, they may worsen during pollen season. Nasal
congestion is more common and sense of smell may be lost. Sneezing is less
than with hay fever, although sinusitis occurs more often. The eyes are usually
unaffected. Persistent allergens, such as house dust mites, moulds and animal
dander are the typical causative agents, and should be avoided if possible. Wooden
flooring should replace carpets and allergen-impermeable bed linen should be
used. Treatment is with OTC antihistamines, corticosteroids and decongestants.
Sinusitis
Sinusitis occurs when the sinuses become inflamed or infected, and the
congestion that results is unable to drain, causing pain. Often associated with a
cold (see Colds), symptoms may also include headache or apparent toothache.
Sinusitis can be acute or chronic, and antibiotics may be needed if the cause is
due to a bacterial infection.
Infective rhinitis
This is often associated with the common cold (see Colds) and is usually viral
in origin. Symptoms such as coloured nasal discharge, cough and/or sore throat
typically resolve within a few days.
Vasomotor rhinitis
Symptoms of vasomotor rhinitis are similar to those of allergic rhinitis, and often
get worse with seasonal changes. Allergy testing will give a negative result.
Certain odours, such as perfume, cigarette smoke and paint fumes, alcohol, spicy
foods, environmental factors (eg, temperature, barometric pressure) and bright
lights may also exacerbate or “trigger” the symptoms.
The nose can be either really runny, or dry and congested. Base choice of
topical nasal treatment product on symptoms.
Nasal foreign body
Anybody with an object trapped up their nose should see a doctor if the object
cannot be dislodged easily. For parents, sometimes the first sign in young children
is a smelly discharge leaking from one nostril. Seek medical advice rather than
attempting self-removal. Keep toys with small parts, or other items (such as
beads) out of reach of young children at all times.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Does the person also have shortness of breath, a cough or wheeze?
• Are there any other symptoms (eg, swollen glands, fever and/or a
persistent headache)?
• Is there any coloured or yellow discharge from the nose or eyes?
• Is only one side of the nose or eye affected?
• Could a foreign body be trapped up the nose that cannot be easily
dislodged?
• Have the nasal symptoms come on soon after beginning a new
medication?
• Are the ears or sinuses painful?
• Have symptoms persisted despite treatment?
• Is the person a child?
• Does the person have any allergies to topical medicines?
or vasomotor rhinitis and refer any customers with "yes" answers to the Refer
to Pharmacist questions. For other customers, base product selection on most
troublesome symptom, for example:
• itchy eyes: an antihistamine eye drop
• blocked nose: an oral decongestant
• runny nose: an oral antihistamine
• sinus pain: an oral analgesic and possible referral to a doctor.
Initial assessment
The time of the year and a person's symptoms should give you some clues as to
their most likely condition. Offer lifestyle advice to people suffering from allergic
ACTS
IN
5MINS
Voltaren Rapid 25 390x45.indd 2
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CONTINUING OTC EDUCATION
TREATMENT OPTIONS
Category Examples Comments
Oral antihistamines
Topical (nasal and ocular)
antihistamines, nasal
corticosteroids
Nasal corticosteroids
Decongestants
Combination products
(contain analgesics)
Non-sedating
[PHARMACY ONLY MEDICINE]
eg, cetirizine (Razene, Allerid-C, Histaclear, Zetop,
Zyrtec), desloratadine (Aerius), fexofenadine
(Hayfex, Fexoclear, Telfast, Xergic), levocetirizine
(Levrix), loratadine (Loraclear, Lorafix)
Sedating
[PHARMACIST ONLY MEDICINE]
eg, dexchlorpheniramine (Polaramine),
promethazine (Phenergan)
[PHARMACY ONLY MEDICINE]
eg, levocabastine (Livostin Eye Drops/Nasal
Spray), naphazoline + pheniramine (Naphcon-A,
Visine Allergy), naphazoline + zinc (Clear eyes-A),
naphazoline + antazoline (Albalon A Allergy),
ketotifen (Zaditen)
[PHARMACY ONLY MEDICINE]
eg, beclomethasone (Alanase, Beconase Allergy
& Hayfever), budesonide (Butacort), fluticasone
(Flixonase Hayfever & Allergy), triamcinolone
acetonide (Telnase)
Topical (nasal)
[PHARMACY ONLY MEDICINE]
eg, oxymetazoline (Drixine No Drip, Sudafed Nasal
Spray*), xylometazoline (Otrivin range)
Oral
[GENERAL SALE] eg, phenylephrine (Sudafed PE
Nasal Decongestant*)
[GENERAL SALE] or [PHARMACY ONLY
MEDICINE]
eg, ibuprofen + phenylephrine (Nurofen Sinus Pain)
eg, paracetamol + phenylephrine (Dimetapp range,
Sudafed PE Sinus + Pain Relief*)
eg, paracetamol + phenylephrine + chlorpheniramine
(Dimetapp PE Sinus Pain + Allergy, Sudafed PE
Night*, Sudafed PE Sinus + Allergy & Pain Relief*,
Sudafed PE Sinus Day + Night Relief*)
Useful for symptoms that persist during the day. Although drowsiness with these products
is rare, it may still occasionally occur in some people. Always caution about driving or
operating machinery if feeling drowsy.
May not be suitable for children of certain ages.
May be useful to aid sleep when symptoms are more problematic at night. Warn about
drowsiness and the risk of driving or operating machinery. Refer to the pharmacist people
on medicines, or with certain health conditions, since these products may not be suitable for
them (see Reference section, OTC Interactions, Precautions). Avoid alcohol. These are
[PRESCRIPTION ONLY MEDICINES] for children under two years old.
Have a localised effect and a rapid onset of action.
Many eye drops may not be suitable for use with contact lenses – check instructions.
Use eye drops combining antihistamines with decongestants short term only (ie, less than
three days). Throw drops away one month after opening.
Stinging and a bitter taste after application have been reported.
Useful for treatment and prevention and as a first-line therapy for moderate-to-severe
allergic rhinitis.
A decongestant or antihistamine may also be required initially on starting a nasal
corticosteroid as relief may be delayed two to three days.
Best reserved for when nasal congestion needs to be treated quickly. Useful for symptom
relief while waiting for nasal corticosteroids to take effect. Rebound congestion can occur
with extended use. Topical decongestants should not be used longer than three days. Do not
use in children aged under two years unless on medical advice.
Decongestants dry up a runny nose. May not be suitable for some people (see Reference
section, OTC Medicines – Precautions). Some products are also not recommended
for children under six, see Colds. Watch for double-dosing if taking more than one product.
May be useful for periods where symptoms are particularly bad.
Watch for double-dosing of decongestant ingredients if taking more than one product.
Some products are not recommended for children under six, see Colds.
Other nasal products
Natural / herbal products /
supplements
[GENERAL SALE]
eg, cellulose and peppermint powder (Nasaleze)
eg, saline (Otrivin Clear Saline Plus, Fess Nasal
range)
eg, Neil Med Naspira Nasal-Oral Aspirator
Cowslip, elderflower, sorrel, verbena, bromelain,
quercetin, Sanderson Sinus & Allergy
Cellulose powder is delivered as a fine mist into the nasal passages where it forms an
impermeable barrier to allergens.
Saline thins nasal mucus and moisturises dry nasal passages. It allows mucus to break
down faster and washes away pollen, animal dander and dust.
Nasal-oral aspirators allow nasal mucus to be removed efficiently.
A combination of cowslip, elderflower, sorrel and verbena reduces symptoms of acute and
chronic sinusitis. Other natural products (eg, bromelain, quercetin) may also help.
Products with an asterisk have a detailed listing in the Sinus & Nasal Problemssection of OTC Products, starting onpage 258.
Otrivin nasal spray (xylometazoline HCl 1 mg/mL).
Pharmacy Medicine. For short-term relief of nasal congestion
caused by colds, flu, sinusitis or allergies. Do not use if
allergic to any ingredient, after operations through the nose
or mouth, with narrow angle glaucoma or in children under
the age of 12. Common side effects: brief stinging sensation
or sneezing. Otrivin is a trademark owned by or licensed to
the GSK group of companies.
GSK Auckland, NZ. TAPS PP9527. CHANZ/CHOTRI/0012/17.
10/04/17 5:17 pm
Page 135

Sleep Problems and Snoring
Sleep is a vital part of our wellbeing. Despite spending almost one-third of our
lives asleep, scientists still have more questions than answers about why we
sleep. Research has associated lack of sleep (insomnia) with attention deficit
hyperactivity disorder (ADHD), Alzheimer's disease, cardiovascular disease,
obesity, type 2 diabetes, mood disorders and depression. Studies have also
shown that production of immature T cells – a type of white blood cell that are
essential for human immunity – peaks during early nocturnal sleep. Chronic poor
sleep increases your risk of dying from any cause by 15%.
Appropriate sleep durations vary depending on age but range from 14 –17
hours for newborns to between seven and eight hours for older adults. One
night's sleep is actually made up of, on average, five sleep cycles. Within each
sleep cycle, there are five stages of sleep – the first four stages are associated
with non-rapid eye movement (NREM) sleep, and the final stage is when
rapid eye movement (REM) sleep occurs. Each sleep cycle takes about 90
minutes and we briefly wake up between cycles, although most of us don't
remember waking.
Many people experience sleep problems at some point in their life. For the
majority, sleeplessness is only temporary, but for others it may persist for months
or even years. Sleep disturbances may be a sign of an underlying problem, such
as stress, depression, pain, or genitourinary disorders; or due to environmental
disturbances (such as an unsupportive bed or high temperatures); jet lag; shift
work; diet; or having a partner who snores. In many cases, no reason for the sleep
disturbance is found.
Initial assessment
Persistent lack of sleep can take a toll on somebody's health, and you may notice
your customer looks tired or has difficulty stringing sentences together. Take any
complaints of sleeplessness seriously, and congratulate the person on actively
doing something about their lack of sleep, as many people just put up with it
for years.
Referring your customer to a doctor for a sleeping pill is not the right approach.
Although sleeping pills do make people sleep, it is uncertain whether they reverse
any of the conditions associated with lack of sleep and most prescription sleeping
tablets are highly addictive. However, some people may need a doctor's referral
for other reasons, particularly if you suspect there may be an underlying medical
reason for their insomnia.
Try to identify any environmental or other factors (such as stress or diet) that
may be contributing to the lack of sleep and suggest ways to improve these
(see Advice for customers). Relaxation and calming exercises or podcasts that
teach deep breathing, meditation or visualisation techniques should be the next
step (see Sleep and relaxation techniques opposite page). People who travel
a lot and suffer from ongoing jet lag may also like to discuss melatonin with their
TREATMENT OPTIONS
Category Examples Comments
Sedating antihistamines
Melatonin
Anti-snoring treatments
Restless legs/muscle
cramps
Natural / herbal products
/ supplements
[PHARMACIST ONLY MEDICINE]
eg, doxylamine 25mg (Dozile*)
[PRESCRIPTION MEDICINE]
eg, melatonin 2mg (Circadin)
eg, Asonor drops (nasal drops to help dry up secretions),
Aveo TSD Anti-Snoring Aid (device holds the tongue
forward to keep airway open during sleep), Breathe
Right nasal strips (adhesive nasal strips to reduce nasal
congestion), Silence (spray which lubricates nasal passages
and throat), Snoreeze (lubricating throat spray, nasal spray
or oral strips), SnoreMed (mouthpiece holds lower jaw
forward during sleep)
[GENERAL SALE]
eg, magnesium + other ingredients (Crampeze Night
Cramps)
Valerian, lemon balm, hops, lavender oil, passionflower,
skullcap, tart cherry, tyrosine
eg, Good health Deep Sleep, Nutralife Sleep Well,
Remifemin Sleep, Swisse Ultiboost Relax & Sleep
Use only for temporary insomnia due to an identifiable cause (eg, jet lag) and restrict use to
five days. Take 20 minutes before going to bed. Tolerance may develop and side effects include
dry mouth, constipation or blurred vision. Avoid drinking alcohol and driving or operating
machinery within eight hours of taking doxylamine. Has the potential to be abused so refer
suspicious requests to a pharmacist. See OTC Reference section, Precautions.
Melatonin is a hormone produced by the pineal gland which is thought to play a role in
maintaining the body’s circadian rhythm (body clock) as it is stimulated by darkness and
suppressed by light. May cause daytime drowsiness and impaired concentration.
These products will only help snoring, not sleep apnoea. Can be effective for mild snoring.
If snoring persists and/or becomes severe despite using these strategies, refer the snorer to their
doctor.
Magnesium products may provide relief from, and help reduce, muscle cramps and spasms,
tired, aching and restless legs.
Evidence supports the use of valerian and lemon balm to improve quality and quantity of
sleep. Many other ingredients (eg, tart cherry – a natural source of melatonin), lavender,
passionflower) are reported to help sleep; however, evidence is often limited.
Products with an asterisk have a detailed listing in the Sleep Problems section of OTC Products, starting on page 260.
Page 136 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Sleep and relaxation techniques
••
Fall asleep in 60 seconds
»»
Breathing technique based on pranayam, an ancient Indian practice
»»
Uses the ratio 4-7-8: First exhale completely through mouth making a whooshing sound.
Close mouth and breathe in through nose for four seconds. Hold breath for a count of
seven. Then exhale for eight seconds making another whooshing sound. Repeat at least
three times.
••
Progressive muscle relaxation
»»
Involves progressive tensing and relaxation of muscles starting from the toes and working
up to the facial muscles. Hold each tension for about five seconds and relax for 10 seconds.
••
Visualisation
»»
With closed eyes, imagine a place or activity that is both calming and peaceful. Concentrate
on how relaxed this place or activity makes you feel.
doctor. Occasional use of over-the-counter medicines or prescription medicines
prescribed by a doctor may be necessary to aid sleep in some people in certain
circumstances.
Snoring and Obstructive Sleep Apnoea
Snoring is a sign that a person’s breathing is being affected by sleep. People are
more likely to snore if they are overweight or have a thick or wide neck, drink
too much alcohol, have a blocked nose, have certain medical conditions (such as
Parkinson’s disease), smoke or take medicines that make them sleepy.
Obstructive sleep apnoea (OSA) is a form of snoring where breathing pauses
or is markedly reduced for short periods of time during sleep. It is more likely to
develop in men who are overweight, aged over 40 years, with diabetes, and/
or who have other relatives with OSA. Women and children with a large neck
circumference, enlarged tonsils or tongue, are also at risk of developing the
condition. People with OSA have a higher risk of heart attack or stroke, high
blood pressure, heart arrhythmias and driving accidents.
People with OSA usually snore very loudly, snort or grunt, or gasp for air when
their breathing pauses during sleep, and complain of daytime fatigue. Refer
anybody with suspected OSA to a doctor or a sleep apnoea clinic.
Advice for customers
• Exercise daily, but not within four hours of going to bed.
• Set a bedtime that is not too early or late, and stick to that time every night.
• Start preparing for bed 30–60 minutes before bedtime. Turn off electronic
devices, shower and brush teeth, and do something relaxing but not
stimulating.
• Try to keep the temperature of the bedroom around 18°C. Make sure the bed
is supportive and comfortable and the room is used only for sleeping in. The
bedroom should be dark once the lights are out (use blackout curtains to
prevent any street lighting from shining in).
• Set your alarm clock and wake up at the same time each morning. Ensure you
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any medicine or complementary medicine,
either prescribed by a doctor or bought from a shop?
• Is the person a child under 12?
• Has the insomnia lasted for more than three weeks?
• Does the person have other symptoms that may suggest a
previously undiagnosed medical condition?
• Does the person appear overly anxious, stressed or depressed?
• Is the person a severe snorer with symptoms suggestive of OSA?
• Have self-help remedies, over-the-counter medications for
insomnia or devices for snoring been tried without success?
• Is the person having to wake often to go to the toilet?
• Could pain be the reason for waking?
• Can some changes be made to the person’s prescription medicines
which may improve sleep?
• Does the person have any allergies to medicines?
expose your face to some natural sunlight as soon as you can, because this
helps maintain a healthy sleep-wake cycle.
• Avoid napping during the day, taking stimulants such as caffeine, nicotine and
alcohol too close to bedtime, eating a meal or large snack just before going to
bed, or going to bed too early (unless you need to wake early).
Page 137

Smoking Cessation
Almost 5000 New Zealanders die annually from smoking-related illnesses,
such as heart disease, lung cancer and stroke. The lifespan of people who
smoke is shortened, on average, by about 15 years, and children exposed to
passive cigarette smoke (second-hand smoke) have a higher incidence of croup,
pneumonia, bronchiolitis and asthma. Smoking also contributes to socioeconomic
and ethnic inequalities in health.
Maori are over-represented in smoking statistics. Research has shown almost 38%
of Maori people aged 15 to 64 years smoke cigarettes, compared with just 15% of
New Zealanders of European ethnicity. The New Zealand Government is committed
to the goal of New Zealand becoming auahi kore (smoke-free) by 2025. Promotion
of the auahi kore message (www.smokefree.org.nz) throughout community and
whanau groups aims to change attitudes towards smoking, encouraging Maori to
either stop smoking or not to start.
There is never a bad time to quit smoking. Within one year of stopping the risk
of a heart attack or stroke significantly decreases, reaching that of a non-smoker
within three to five years. The risk of lung cancer can also be reversed, but this
may take 10–15 years.
Once someone has started smoking, quitting can be challenging because
smoking is so addictive.
Initial assessment
If you suspect a customer smokes, tactfully enquire as to their smoking status.
Pharmacy staff are in an ideal position to deliver personalised, empathic
smoking cessation advice, since there is good evidence that even brief advice
from health professionals has a significant effect on smoking cessation rates.
Success is increased when repeated interventions are delivered from several
different sources over a long period of time. This may be as little as saying the
words “If you ever want to stop smoking, we can help” to a customer who you
know smokes. Smokers cycle through the stages of contemplation, quitting and
relapse an average of 14 times before achieving permanent success. A free online
smoking cessation training course for health professionals (Helping people to
stop smoking e-learning) is available at learnonline.health.nz. The most
important variable determining how smokers will respond to any intervention is
TREATMENT OPTIONS
Category Examples Comments
Nicotine replacement therapy
(NRT)
Natural / herbal products /
supplements
[GENERAL SALE]
eg, Habitrol Gum*, Habitrol Patches*, Habitrol
Lozenges*, Nicorette CoolDrops Lozenge*,
Nicorette Gum*, Nicorette 16hr InvisiPatch
Patch*, Nicorette QuickMist*
[PHARMACY ONLY MEDICINE]
Nicorette Inhalator*
L-tryptophan, Quit Smoke
NRT offers relief against nicotine withdrawal symptoms, including cravings, irritability,
excitability, anxiety, headaches, nausea, dizziness, lethargy, loss of concentration, insomnia,
gastric disturbance and respiratory problems. NRT is the preferred method for smoking
cessation, as recommended by the New Zealand Ministry of Health.
Ensure correct strength. Under-dosing leads to nicotine craving and loss of confidence.
Guidelines recommend staying on the same starting dose for at least eight weeks to allow
time to create new habits and routines. Do not exceed stated doses.
Keep out of reach of children and pets; poisoning has occurred from improperly discarded
patches. Fold sticky ends of the patch together, wrap and place in bin.
Patches may cause skin reactions. Always reapply on a new part of the skin. Use surgical tape
over the patch to hold in place if the patch does not stick well. Patches may be worn while
showering, exercising, or swimming. Remove patches overnight if they disturb sleep.
May help with smoking cessation.
Products with an asterisk have a detailed listing in the Smoking Cessation section of OTC Products, starting on page 260.
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Page 138 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Advice for smokers ready to quit
••
Set a quit date, preferably within two weeks.
••
Contact a local smoking cessation provider.
••
Inform friends, family, and co-workers and ask for support to quit
••
If the urge to smoke is strong then Delay (acting on the urge to smoke), Deep breathe, Drink
water, and Do something else.
••
Remove cigarettes from home, car and workplace and avoid smoking in these places for two
weeks before quitting.
••
Anticipate challenges, particularly during the first few weeks, including nicotine withdrawal.
••
Focus on the benefits and rewards of quitting.
••
Totally stopping is essential – not even a single puff.
••
Drinking alcohol is strongly associated with starting smoking again.
their readiness to change (ie, they have to want to stop).
Smoking cessation advice is based around the mnemonic ABC.
• Ask customers about their smoking status.
• Give specific Brief advice about stopping smoking to all smokers, eg, “making
a quit attempt will make a big difference to your health”.
• Strongly encourage every person who smokes to use Cessation support and
offer to help them access it.
Enquire about a customer's progress or problems when they buy or collect
their smoking cessation products and encourage continued abstinence.
Treatment
There are many effective treatments (some prescription only) that can produce
long-term abstinence, but evidence has shown the success rate is improved fivefold
when treatment is combined with personalised counselling and behaviour
modification. The Quit Group (www.quit.org.nz or 0800 778 778) offers free
smoking cessation advice and generously subsidised Nicotine Replacement
Therapy (NRT). NRT is also subsidised on a prescription and through many other
qualified smoking cessation providers. Some research suggests only 3%–7% of
people stop smoking by going “cold turkey” alone.
Hypnosis, acupuncture, and prescription medicines (eg, bupropion,
nortriptyline, varenicline) are also options for smoking cessation. Electronic
cigarettes mimic the look and feel of conventional cigarettes; however, evidence
does not currently support their use as an aid to stopping smoking.
Advice for customers
• Giving up smoking may take a number of attempts but this is normal.
• Planning a quit attempt, rather than just deciding to stop suddenly, has a
higher chance of success.
»»
Make a chart to identify why and when you smoke (your smoking triggers).
A key factor in quitting is changing your routines and habits.
»»
Register with a smoking cessation provider (eg, www.quit.org.nz) and
discuss coping with cravings before you quit.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Is the person pregnant or breastfeeding or underweight?
• Is the person elderly or do they have diabetes or heart disease?
• Does the person experience skin sensitivity reactions often?
• Is the person reluctant to totally abstain from smoking?
• Does the person have an irregular smoking habit?
• Has the person had a reaction to nicotine products in the past?
» » Review previous quit attempts – what helped, what did not help and any
reasons for relapse. Trying a different type of treatment may help.
» » Apply for subsidised nicotine replacement therapies – an eight-week supply
of nicotine patches costs around $5 compared with over $200 if bought.
• Make your home and car smokefree and get rid of ashtrays. Wash all your
smoky clothes and wash down furnishings.
• Brush your teeth with fresh minty toothpaste and book into a dentist to have
your teeth cleaned.
• Carry a water bottle with you and practise saying "I am a non-smoker" or
"I don't smoke".
• The correct way to use nicotine gum is the “chew and park” method.
» » Bite down slowly on a piece of gum six to 10 times, enough to soften it and
release the nicotine, which may tingle or impart a spicy taste.
» » Park the gum under the tongue or between the cheek and the gum,
allowing the nicotine to be absorbed through the lining of the mouth into
the bloodstream.
» » Avoid over-chewing the gum or drinking while chewing the gum as this
can wash nicotine into the stomach, causing side effects such as heartburn,
abdominal pain or hiccups.
» » An occasional bite will expose a fresh surface of gum and release more
nicotine.
» » Repeat the process around five or six times in 30 minutes if needed, until
the gum loses its effectiveness.
» » Wrap up the gum and dispose of in a rubbish bin.
• If using lozenges, follow the same process as for the gum, except the lozenge
should be sucked, not bitten.
Page 139

Sore Throat
Sore throats are very common and symptoms can vary from a mild scratchiness at
the back of the throat to severe pain. Visually, the throat may look dry and red and
the tonsils inflamed and swollen. Often, lymph nodes in the neck become enlarged
and tender and can be easily felt from the outside of the neck. It may be hard for
the person to swallow and their voice may sound husky or hoarse.
Sore throats can be associated with colds and flu, tonsillitis (inflammation
of the tonsils caused by a bacterial or viral infection), or strep throat. Viruses
account for almost 90% of all infections, with the cold virus the most common
cause. The Epstein-Barr virus, which is responsible for glandular fever and the
measles virus can also cause sore throat. If a cause other than a cold virus is
suspected, the person should be referred to the pharmacist.
Products available for viral sore throats temporarily relieve the pain associated
with the sore throat. Products include oral and topical analgesics, and numbing
sprays or lozenges. Even sucking non-medicated lozenges can provide some relief as
the action of sucking produces saliva, which lubricates and soothes inflamed tissue.
streptococcal (strep) sore throats
Sore throats produced by Group A streptococcal bacteria tend to be more severe
and persistent than other causes of sore throats. Symptoms may include a distinct
pattern of white patches on the back of the throat or a high fever. Occasionally
the person may develop a rash that feels rough to the touch. It may start on the
neck and chest and eventually spread to the whole body. A strep throat infection
accompanied by this distinctive rash is known as scarlet fever. The rash is caused
by toxins produced by the streptococcal bacteria.
Strep throats are more prevalent in people aged three to 45 years, particularly
those under 15, and are highly infectious. If one person in a family develops a
strep throat, then all members of a household should be tested for the presence
of the bacteria. Refer anybody with a suspected strep throat particularly in areas
of high strep throat occurrence to a free sore throat clinic (see www.health.
govt.nz or call Healthline on 0800 611 116 for locations), or a doctor because
untreated infections can result in rheumatic fever (an inflammatory disease that
can permanently damage the heart) or kidney disease. Rheumatic fever is more
common in Maori and Pacific Islanders, especially those in overcrowded living
conditions. Always refer Maori or Pacific children aged four to 19 with a sore
throat.
Initial assessment
Ask your customer for a description of their symptoms, or if appropriate, don a
face mask and gloves and take them to a private area to look at their throat. Try
to assess the degree of redness (ie, mild, moderate or severe) and look for any
unusual features (such as white patches on the back of the throat or pus). Refer
any customers with "yes" answers to the Refer to Pharmacist questions to
a pharmacist.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medicine or complementary
products, either prescribed by a doctor or bought from a shop?
• Is the person a child aged less than 19 years?
• Are the lymph nodes really swollen?
• Is there any sign of pus or ulceration?
• Are there any other symptoms, such as a rash, fever, vomiting, ear
pain, breathlessness or generally feeling unwell?
• Is swallowing extremely difficult, or preventing the person from
drinking anything. Are they showing signs of dehydration?
• Are there any white patches visible on the throat or tonsils?
• Has swallowing been difficult for a long time (eg, weeks)?
• Does the person often get sore throats?
• Has the person taken any new medicine recently?
• Does the person have any allergies to medicines?
chicken soup. Avoid crunchy or spicy foods with severe sore throats. Increase
water and fluid intake to offset dehydration.
• Rest as much as you can. Talk to a doctor if your sore throat does not get
better within a few days.
• Regular sucking of lozenges or pastilles stimulates saliva, which will lubricate
and soothe sore throats. Do not exceed the recommended dosage.
• Avoid smoking – it can make a sore throat feel worse.
• Cough into the crook of your elbow or cover your mouth with a tissue when
you sneeze or cough to avoid spreading your sore throat. Wash your hands or
use a sanitising hand gel immediately if you cough on your hands.
• Wash hands thoroughly before preparing food and before and after tending
to small children.
Advice for customers
• Eat cool, soft food such as smoothies and drink cool or warm liquids such as
MANAGING PAIN
FREE
PROFESSIONAL DEVELOPMENT FOR
Pharmacy assistants, technicians and students
4
Page 140 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
TREATMENT OPTIONS
Category Examples Comments
Soothing products
Antiseptic/antibacterial agents
Antiviral agents
Anti-inflammatories
(locally acting)
eg, Radiance ManukaGuard Honey Lozenges
eg, Weleda Throat Relief Oral Spray
[GENERAL SALE]
eg, Codral Sore Throat Lozenges Antibacterial Honey
& Lemon*, Codral Sore Throat Lozenges Antibacterial
Menthol*, Strepsils Soothing Honey and Lemon
Lozenges*, Strepsils Children 6 + , Strepsils Sore Throat
and Blocked Nose*
[PHARMACY ONLY MEDICINE]
eg, Difflam-C Solution Sugar-Free (+ antiinflammatory),
Difflam Lozenges Sugar Free (+
anti-inflammatory)
[PHARMACY ONLY MEDICINE]
eg, Betadine Sore Throat Gargle*
[PHARMACY ONLY MEDICINE]
eg, benzydamine (Difflam range)
Natural lozenges containing honey can help soothe the throat. Suck regularly but do not
exceed the recommended dosage. Homeopathic ingredients such as arnica, belladonna
and cinnabar can help soothe and maintain the health of the throat.
Relieve the symptoms of sore throat. Also contain an antibacterial agent. Do not exceed
maximum dose. Many contain an artificial sweetening agent that may have a laxative
effect in some people.
May irritate tongue and lips.
May kill viruses and bacteria associated with sore throats but offers little symptom relief.
Effective at relieving pain associated with sore throats. If solution stings, it may be
diluted with water. Benzydamine is not recommended for children aged under six years.
Locally acting anaesthetics
Oral non-steroidal
anti-inflammatory agents
(NSAIDs)
Locally acting non-steroidal
anti-inflammatory agents
(NSAIDs)
Simple analgesics
Treatment and prevention
using natural bacteria
Natural / herbal products /
supplements
[GENERAL SALE]
eg, Codral Sore Throat Lozenges Antibacterial and
Anaesthetic Lime & Lemon*, Difflam Lozenges Plus
Anaesthetic, Strepsils Plus Anaesthetic Throat Spray*,
Strepsils Plus Lozenges*
[GENERAL SALE]
eg, aspirin (Aspro range, Disprin)
eg, ibuprofen 25s (Nurofen range), ibuprofen
suspension (Nurofen for Children, Fenpaed), eg,
ibuprofen + paracetamol (Maxigesic [50, 100],
Nuromol [24, 48])
[PHARMACY ONLY MEDICINE]
eg, flurbiprofen (Strepfen Intensive Honey & Lemon
Lozenges*)
[GENERAL SALE]
eg, paracetamol (Children’s Panadol, Pamol, Panadol,
Paracare range)
[SUPPLEMENT]
eg, Streptococcus salivarius K12 (BLIS K12 Throat
Guard Boost, Blis K12 Throat Guard Daily)
eg, honey, echinacea, eucalyptus, liquorice, slippery
elm
eg, Bosistos range, Comvita Fortacold Lozenges with
Propolis, Kiwiherb Herbal Throat Formula
These contain lignocaine or benzocaine and are effective at soothing and numbing sore
throats.
Warn customer to be careful when eating or drinking hot foods or drinks due to altered
perception of heat.
Not recommended for children aged under six years.
Effective at reducing inflammation, which will help ease sore throat pain.
Ibuprofen is the NSAID least likely to cause stomach irritation.
NSAIDs may not be suitable for people on certain other medications or with some medical
conditions (eg, asthma, kidney disease – see Refer to Pharmacist). Advise customer to
stop taking if stomach upsets, increased bruising or prolonged bleeding occur.
Soluble aspirin may be used as a gargle to treat a sore throat. Avoid aspirin in children
aged under 12 years.
See Reference Section, OTC Medicine Interactions, Precautions.
Effective and well tolerated for the relief of sore throats.
Not recommended for children aged less than 12. Usual precautions for NSAIDs apply.
Effective at relieving pain but these are not anti-inflammatory, so will not relieve swelling
or inflammation in the area. Suitable for people with contraindications to NSAIDs.
Streptococcus salivarius helps replenish naturally occurring beneficial throat bacteria,
providing one month’s protection.
Several natural ingredients have soothing effects on the throat.
Products with an asterisk have a detailed listing in the Sore Throat section of OTC Products, starting on page 262.
To complete the work book assessment
visit pharmacytoday.co.nz
WIN
ONE OF SEVEN
$500
CASH PRIZES
Page 141

Strains and Sprains
Sprains and strains are common injuries, especially in children and people who
play sport. A sprain comes from an immediate injury and pain usually occurs
straight away or the injured person may report a pop, tear, or sudden loss of
power. Pain from strains may not begin until a few hours after exercise. Swelling
is usually greater with sprains and it can be difficult to move or walk on the
injured part. Bruising may occur with either injury.
Sprains
A sprain can be a serious injury and occurs when a ligament is stretched and/
or torn. Ligaments are fibrous bands of connective tissue that join one end of a
bone to another. Ligaments stabilise and support the body’s joints.
Signs of a sprain include pain, swelling, bruising, instability, and loss of the
ability to move and use the joint (called functional ability). Signs and symptoms
can vary in intensity and with a mild sprain, minimal pain and swelling and little
or no loss of functional ability is experienced.
Sprains typically occur through direct or indirect trauma such as a fall, awkward
landing or blow to the body. It knocks the joint out of position, overstretching
and, in severe cases, rupturing the supporting ligaments. Ankles, wrists and knees
sprain easily. If a sprain does not heal fully, there is a good chance the same injury
will recur. Customers with a sprain should follow the RICED regimen for the first
48 hours (see opposite text box). Always refer customers with a moderate or
severe sprain to a doctor or physiotherapist for further evaluation.
Strains
A strain is when the muscle or tendon (fibrous cord of tissue that attaches the
muscle to the bone) has been stretched too far. Strains often happen when too
much pressure is exerted on a muscle or the muscle is pushed too far (eg, when
lifting a heavy object). Strains can happen suddenly or develop over a period of time.
People with strains typically experience pain, limited motion, muscle spasms
and, sometimes, muscle weakness. There may also be swelling around the
affected area, cramping, or inflammation and some loss of muscle function.
Severe strains are often very painful and disabling.
Back, necks and legs can commonly be strained, especially if no proper
warm-up has been done, or when somebody returns to a sport after a period of
absence. Bad work habits (including bad posture and incorrect lifting techniques)
can also lead to strains (see Advice for customers).
Follow the RICED regimen above. If the area strained is not allowed to heal
completely, it can remain painful and weak.
TREATMENT OPTIONS
Category Examples Comments
Topical antiinflammatory
agent
Topical non-steroidal
anti-inflammatory agents
(NSAIDs)
Oral non-steroidal
anti-inflammatory agents
(NSAIDs)
Simple analgesics
Sports taping and
mouthguards
Sports supports
Natural / herbal products
/ supplements
[GENERAL SALE] eg, mucopolysaccharide
polysulfate (eg, Hirudoid)
[GENERAL SALE]
eg, ibuprofen (Nurofen Gel), diclofenac
(Voltaren Emulgel*)
[PHARMACY ONLY MEDICINE]
eg, etofenamate (Rheumon Gel)
[GENERAL SALE]
eg, ibuprofen up to 25s (Advil, Nurofen)
[PHARMACY ONLY MEDICINE]
eg, diclofenac 12.5mg (Voltaren Rapid 12.5),
ibuprofen >25s (Advil, Nurofen), ibuprofen +
paracetamol (Maxigesic, Nuromol)
[PHARMACIST ONLY MEDICINE]
eg, diclofenac 25mg (Voltaren Rapid 25)
[GENERAL SALE]
eg, paracetamol (Panadol, Paracare)
eg, Elastoplast sport, Kinesio Tex Tape, Leuko
tape, USL sports tape and mouthguards
eg, elastic supports, neoprene supports
(Elastastrap, Thermastrap Supports)
eg, arnica, comfrey, menthol
eg, Anti-Flamme Creme, Anti-Flamme Extra,
Tiger balm, Zorub
Use for contusions, sprains, haematomas, bruises and swelling.
These treat the body’s inflammatory reaction to injury and reduce pain, but evidence suggests they may
delay tissue healing if used for longer than three days after the injury. Consult a doctor for advice.
May, rarely, cause the same adverse effects as oral NSAIDs. Similar care and consideration before use is
recommended. Avoid massaging for the first 48 hours after injury – rub in gently.
These treat the body’s inflammatory reaction to injury and reduce pain, but evidence suggests they may
delay tissue healing if used for longer than three days after the injury. Consult a doctor for advice.
Ibuprofen is the NSAID least likely to cause stomach irritation.
NSAIDs may not be suitable for people on certain other medications or with some medical conditions (eg,
asthma, kidney disease – see Refer to pharmacist). Advise customer to stop taking if stomach upsets,
increased bruising or prolonged bleeding occur see Reference Section, OTC Medicine Interactions,
Precautions. Aspirin is not recommended for adolescents or children under 12 years old (see
Childhood Pain and Baby Teething: Treatment options).
May be beneficial as a first-line treatment for sprains and strains. Effective at relieving pain.
Suitable for people with contraindications to NSAIDs.
Strapping tape helps stabilise joints during exercise and should be removed immediately after exercise.
Kinesio tapes have specific stretch, recoil and adhesive properties and can be worn for three to five days.
Mouthguards should always be worn during contact sport.
Elastic supports provide compression and support for wrists, ankles, knees and elbows.
Comfrey and arnica have some pain-relieving properties. Menthol has a cooling effect.
Heat rubs and other topical applications can also relieve pain and swelling (see also Muscular Aches
and Pains: Treatment options).
Products with an asterisk have a detailed listing in the Strains and Sprains section of OTC Products, on page 264.
FIGHT
AT A ROOT CAUSE*
Voltaren ® Rapid 25 (diclofenac potassium 25 mg/tablet). Pharmacist Only Medicine. Indications and dosage: Adults and children 14 years: Temporary relief of acute pain where inflammation is present, such as sprains and strains, back and joint pains, migraine headaches and period pain. Initially 50 mg, then
20–50 mg every 8 hours if necessary (max 150 mg per day). Contraindications: Hypersensitivity to any ingredient; in asthma attacks, urticaria or rhinitis precipitated by aspirin or other NSAIDs; patients with previous myocardial infarction within the last 6–12 months; severe cardiac failure; hepatic failure; renal failure;
active gastric or intestinal ulcer, bleeding or perforation; last trimester of pregnancy; children under 14 years. Interactions: Lithium/digoxin, other NSAIDs, corticosteroids, anticoagulants and antiplatelet agents, methotrexate, cyclosporin, glucocorticoids, voriconazole, phenytoin, diuretics and antihypertensive agents, drugs
known to cause hyperkalaemia, oral antidiabetic agents, quinolone antibacterials. Adverse reactions (common): headache, dizziness, vertigo, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence, decreased appetite, transaminases increased, rash. For less common adverse reactions see full Data Sheet.
Voltaren is a registered trade mark of the GSK group of companies or its licensor. GSK Auckland, NZ. TAPS NA 9036. CHANZ/CHVOLT/0090/17.
Voltaren Rapid 25 390x45.indd 1
Page 142 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
RICED regimen
••
Rest – No further exercise for at least 48 hours.
••
Ice – Apply ice (bags of frozen peas are ideal) for 20 minutes every two hours for the first 48
hours. Wrap ice in a moist towel to protect the skin from ice burn.
••
Compression – Apply a crepe bandage that extends above and below the area to help limit
bleeding and swelling.
••
Elevation – Ideally raise the injury above the heart to help fluid drain away from the injury
and limit swelling.
••
Diagnosis – Consult a medical professional or sports physiotherapist for a precise diagnosis,
ongoing care and treatment. A full recovery is then more likely.
Initial assessment
If a customer presents with an acute injury, apply ice to the affected area then
run through the Refer to Pharmacist questions and refer any "yes" answers
to a pharmacist. Any injury accompanied by severe pain, significant swelling or
bruising, or restricted movement may indicate tendon or ligament damage and
needs to be investigated by a doctor or physiotherapist.
Strains may be treated with oral or topical analgesics. Offer advice about
warming up before and after exercise in addition to stretching and strengthening
exercises once the pain has gone.
Advice for customers
• Sprains, strains and other soft tissue injuries are best treated by the RICED
regimen for the first 48 hours.
»»
Controlled mobilisation of the joint usually begins after 48 hours.
»»
Avoid HARMful activities (Heat, Alcohol, Running, Massage) for 48–72
hours after a sprain or strain.
»»
Allow enough time for the injury to heal properly. If surgery is needed, it
may take at least six months before a person can return to sport.
• Supports such as shoes with good ankle support, tape for ankle strapping,
knee braces, etc, are important once activity is resumed.
• With more severe injuries, non-weight-bearing exercise may be preferred
initially (eg, swimming, cycling).
• Organise work areas to make them more comfortable and avoid awkward
working postures.
• Practise correct lifting techniques and use two-person lifts.
• Warm up, stretch and take regular breaks from intensive activities.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have health conditions (eg, diabetes, is pregnant
or breast feeding), or is taking other medication, and is wanting
oral or topical pain relief?
• Has the pain persisted for five to seven days after the injury or got
worse?
• Is the pain or swelling very severe?
• Is there a loss of normal range of movement or is there any
numbness?
• Is the pain affecting a person’s ability to function (eg, feeling
dizzy)?
• Is the strain or sprain in a child?
• Does the injured area look crooked or have lumps and bumps
(other than swelling) that are not seen on the uninjured joint?
• Is the person unable to move the injured joint or walk more than
four steps without significant pain?
• Is there any redness or red streaks spreading out from the injury?
• Has the area been injured several times before?
• Is there pain, swelling, or redness over a bony part of the foot?
• Does the person have any allergies to medicines?
*TREAT THE
INFLAMMATION
PROVEN
BACK PAIN
RELIEF
10/04/17 5:16 pm
Page 143

Sun Care
Sunburn
Sunburn occurs from overexposure to ultraviolet (UV) radiation, most commonly
from the sun but also from sunbeds. Symptoms of mild sunburn include reddened
skin that is painful and hot to touch, and tiredness and a headache from
dehydration caused by prolonged exposure to the sun. With severe sunburn the
skin blisters, and chills and fever result. Severe sunburn also causes dehydration
which can lead to electrolyte imbalances, shock or even death. Four to seven days
after exposure, sunburnt skin usually starts to peel and flake off.
Sunburn causes microscopic changes in the skin, and weakens the skin’s immune
defence system. One blistering sunburn is thought to double the likelihood of that
person developing skin cancer. Premature ageing (wrinkling, sagging, age spots),
brown spots and freckles, development of premalignant lesions (solar keratoses)
and eye damage (see Sun Care: Eye Protection) also occur with long-term sun
exposure, not necessarily just with sunburn.
Sunburn and skin cancer
The two most common types of skin cancer are basal cell carcinoma and
squamous cell carcinoma. Adults of fair complexion who have had a lot of
previous sun exposure, or repeated episodes of sunburn (especially during their
childhood years) are more at risk. Melanoma is the deadliest form of skin cancer,
killing more than 300 New Zealanders each year.
UV index and the Sun Protection Alert
UV radiation is not something that can be seen or felt. The UV index (UVI) is a
standardised way of measuring the intensity of UV radiation on a particular day
in a particular place. It takes into account the sun elevation angle, ozone amount,
cloud cover, sun-earth separation, altitude, pollution and surface reflections (eg,
snow cover). A UVI greater than 10 is considered extreme and a UVI of less than
3, low. Daily UV indices are available at www.niwa.co.nz
The Sun Protection Alert is a simpler tool which tells people what to do
when the sun is at its strongest (ie, seek shade, reapply sunscreen, wear a hat)
and indicates the period of time during the day when people should protect
themselves from the sun. A daily Sun Protection Alert is published in many New
Zealand newspapers during summer and can also be found with town-specific
predictions on several websites (eg, sunsmart.org.nz, www.metservice.
com) and on the MetService weather App. In New Zealand, sun protection is
generally required daily, even on cloudy and cooler days, from September through
to April. Sun protection may also be required during winter, especially at high
altitude and in snow.
Sun protection and sunscreen
Sun protection involves the use of protective clothing, sunglasses, avoidance of
the sun around the hottest period of the day (solar noon: NZ 1pm) and use of
sunscreen on exposed parts of the skin.
Sunscreens either work chemically, by absorbing UV energy, or physically,
by reflecting it off. In the UV spectrum, both UVA and UVB rays contribute to
sunburn, skin cancer and wrinkling. Broad-spectrum sunscreens block out
both UVA and UVB rays and usually contain various combinations of chemical
TREATMENT OPTIONS
Category Examples Comments
Sunscreens (contain chemical
with or without physical
agents)
Physical sunscreens
Lip balms
Sunburn treatment products
Natural / herbal products /
supplements
[GENERAL SALE]
eg, Hamilton Sunscreen* (SPF 50 + ), Banana
Boat, Cancer Society range Neutrogena range,
SunSense range
[GENERAL SALE]
eg, zinc oxide (Sunsense Sensitive Invisible*)
[GENERAL SALE] eg, Nivea range, Sunsense Lip
Balm SPF 50+
[GENERAL SALE] eg, moisturising products
(Cancer Society After Sun Gel, Lucas Papaw)
eg, cooling gel + vitamins (Sunsense After Sun)
eg, MEBO Burn Repair
eg, local anaesthetics (Soov Cream/Spray)
Aloe vera gel
Vitamin C with vitamin E
Organic Children Sun Lotion
Products with an asterisk have a detailed listing in the Sun Care section of OTC Products, starting on page 265.
Chemical sunscreens absorb harmful ultraviolet light to protect the skin against sunburn.
Some also contain physical agents such as titanium or zinc which deflect UV radiation.
Deflect UV radiation from the skin rather than absorbing it. Both zinc oxide and titanium
dioxide provide UVA and UVB protection and are formulated as ultra-fine particles so as not
to leave a sheen on the skin. Less likely to cause allergies.
Protect lips with special lip sunscreens – lips burn easily and sunburn can reactivate a cold
sore on the lips. Reapply lip balm frequently as it gets “licked off”.
A moisturiser will not prevent peeling or damage but will help relieve irritation of dry, flaky
skin. Cooling gels can be kept in the fridge and applied when the skin is hot.
MEBO Burn Repair promotes faster healing after suburn by encouraging stem cell
regeneration. Also helps cool the skin and relieves discomfort.
Local anaesthetics (eg, lignocaine) offer pain relief after sunburn. Avoid broken skin.
Aloe vera has a soothing, cooling action on skin that has been exposed to the sun.
Combinations of vitamin C and E taken orally or applied topically prior to sun exposure can
reduce risk of sunburn. They can also help heal sunburn when applied afterwards.
Organic Children Sun Lotion contains a naturally occurring UV filter which may be used on
young babies.
SENSITIVE
INVISIBLE
ZINC
OXIDE
DEFENCE
• Dries clear
• 4 hours water
resistance
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CONTINUING OTC EDUCATION
Sun Protection Advice
Slip, Slop, Slap and Wrap!
••
Slip on a shirt and slip into the shade in summer
»»
Put on standard-approved sun-protective clothing or wear dark, tightly woven clothes.
Seek shade between 10am and 4pm.
••
Slop on sunscreen
»»
Use an SPF 50+ broad spectrum sunscreen (that meets the revised AUS/NZS 2604:2012)
»»
Apply thickly (use at least seven teaspoonsful or 35ml) 15–20 minutes before going
outside
»»
Reapply every two hours as well as after swimming or sweating.
••
Slap on a hat
»»
Choose a hat with a wide brim or a cap with flaps.
••
Wrap on a pair of sunglasses.
»»
Choose standard-approved wrap-around sunglasses.
Sunscreen should not be used as a way of staying out in the sun longer, but as a way of reducing
risk of UV exposure.
ingredients (eg, oxybenzone, octyl methoxy cinnamate, octocrylene) and physical
sunscreens, such as zinc and titanium oxide.
Sensible sun protection is unlikely to make people vitamin D deficient as vitamin
D is still made by the skin in the shade with sunscreen on. Sunscreens that allow for
vitamin D production allow one specific wavelength of UVB light to penetrate the skin
in order to make vitamin D. Therefore the benefits of allowing vitamin D penetration
need to be weighed against the risks of unlimited penetration of that UVB wavelength
all day. Sunsmart NZ and the NZ Ministry of Health recommend 30 minutes of sun
exposure without sunblock every day before 10am and after 4pm from September
to April. From May to August, 30 minutes of sunblock-free sun exposure should take
place around the middle of the day.
Initial assessment
Despite New Zealand having higher levels of UV radiation than most of the rest of the
world, we are not generally very good at applying sunscreen. For customers buying
sunscreen, take note of their skin type and stress the importance of never getting
sunburnt, especially to those with fair skin. Explain the different types of sunscreen
and encourage proper and regular application (see text box Sun Protection Advice
above). Educate visitors from overseas about the dangers of our sun and that
protection is often required for most of the day (ie, 9.30am – 5pm) during summer.
Sell customers presenting with mild sunburn a topical cooling preparation (eg,
aloe vera) and an SPF 50+ sunscreen for future use. Refer anybody with "yes"
answers to the Refer to Pharmacist questions to a pharmacist.
Refer to
PHARMACIST
The following questions aim to identify customers who would benefit
from further input from a pharmacist. Your initial assessment may
have already provided some answers. Decide if any further questions
still need to be asked and refer any “yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, cancer)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications) that may affect how long they should
stay in the sun?
• Does the person have severe sunburn and blisters?
• Is the person in extreme pain, feeling unwell or have a headache?
• Is the person complaining of burning more easily than before,
especially if sun exposure has been minimal?
• Is the person a young child with moderate to severe sunburn?
• Does the person have any other symptoms, apart from sunburn?
• Does the sunburn appear to be a recurring problem?
• Does the person have any suspicious-looking moles?
• Is the person allergic to any topical ingredients?
»»
ALL sunscreens need to be reapplied after immersion in water or after
sweating.
• Warn people taking phototoxic medications (eg, doxycycline) to limit sun
exposure and use a broad-spectrum sunscreen when outside.
• Avoid sunbeds since the risk of skin cancer is increased. Artificial tanning lotions
may be used to create a tanned look without exposure to the sun.
• Store sunscreen away from heat and discard once expired.
Advice for customers
• Sunscreen is considered safe to use on full-term babies over six months of
age; however, it is still best to keep them out of the sun as much as possible.
• Water-resistant sunscreen products retain sun protection properties for at
least 40 minutes in water.
SunSense is a premium sunscreen range,
scientifically formulated for individual
skin types. SunSense provides very high
UVA and UVB broad spectrum protection.
SunSense is fragrance free,
non-comedogenic and contains added
moisturisers to hydrate skin
Always read the label,
use only as directed
NZ’s #1 Sunscreen brand in Pharmacy *
*Iri Market Data, NZ National Pharmacy 13 wks to 22/01/17
Page 145

Sun Care: Eye Protection
Protecting eyes against the sun is just as important as protecting skin. While most
people are aware of the link between ultraviolet (UV) radiation and skin cancer
(see also Sun Care), few realise the connection between UV radiation (UVR)
exposure and eye damage.
Particles in the atmosphere scatter UVR so even staying out of direct sunlight
does not eliminate this hazard. UV damage to the surface tissues and internal
structures of the eye (such as the cornea and lens) can occur from either natural
sunlight or artificial UV rays.
In the short term, excessive exposure to UV radiation from daily activities can burn
the surface of the eye, similar to a sunburn on the skin. Exposure is exacerbated by
reflections off snow, concrete, water, or other shiny or white surfaces.
Acute effects
Acute effects of UV radiation on the eye include inflammation of the cornea and
the iris, photoconjunctivitis (an inflammation of the conjunctiva, the membrane
that lines the inside of the eyelids), and photokeratitis (snow blindness: a
temporary but painful burn to the cornea).
Long term risks
Long-term exposure to UV radiation can lead to, or increase the risk of:
• age-related macular degeneration: a deterioration in macular tissue that
causes loss of central vision
• cataracts: a clouding of the eye’s lens that can blur vision
• pterygiums: a white or creamy opaque growth attached to the cornea (white
of the eye). These are usually non-cancerous, but may grow over the cornea,
partially blocking vision, and may require surgery to be removed
• skin cancer around the eyelids: basal cell carcinoma is the most common.
In order to reduce the risk of eye damage, sunglasses should always be worn
outside, particularly when it's sunny, at the beach or near water, when driving or
outside at high elevations or participating in snow sports. Anybody with an eye
disease, who has had cataract surgery, or is taking photosensitising medicines
should always wear sunglasses outside.
Choosing sunglasses
While more expensive sunglasses may use slightly dearer materials for both the
frame and the lens, sunglass cost has more to do with the brand name than a
reflection of UVR protection. Pharmacies should choose to only stock sunglasses
that comply with the Australian/NZ standard (AS/NZS)1067:2003, or another
internationally recognised standard. Note that this standard is only voluntary in
New Zealand, although it is mandatory in Australia.
Initial assessment
Help customers select sunglasses that best suit the main activity for which they
will be worn. For example, polarised sunglasses are best for fishing and driving;
nylon blended frames are resistant to hot and cold, and easily moulded into
wrap-around styles so are ideal for high-intensity sports; and purple or rose tints
offer the best contrast of objects against a green or blue background so are
perfect for hunting or water-skiing. Importantly, the customer likes and feels
comfortable in the sunglasses, which makes them more likely to be worn.
People who wear corrective lenses may consider having a UV protective coating
added to their prescription lenses, investing in a pair of prescription sunglasses or
buying protective shades that can be worn over their vision-correcting glasses.
About the Australian/NZ standards (AS/NZS)
The AS/NZS: 1067:2003 sets limits on the allowed transmittances of fashion
spectacles and sunglasses for adults and children. Sunglasses that are allowed to
be worn while driving must comply with the colouration limits of AS/NZS 1067.
Colours, in particular traffic signals, must still be recognisable when viewed
through the lenses. The standard defines five categories of lenses – see below.
LENS
DESCRIPTION
CATEGORY
0 Fashion spectacles with very low sunglare
reduction. Some UVR protection
1 Fashion spectacles – not sunglasses. Limited
sunglare reduction. Some UVR protection
2 Sunglasses – medium sunglare reduction
and good UV protection
3 Sunglasses – high sunglare reduction and
good UV protection
4 Special purpose sunglasses – very high
sunglare reduction. Good UV protection
ADDITIONAL
ENDORSEMENTS
None
Not suitable for
driving at night
None
None
Must not be used
when driving
Several other markings may be found on sunglasses including the Eye
Protection Factor (EPF) rating. This takes into account the frame coverage, UV
protection, blue light and infrared protection (ability to shield the eyes from
heat). Sunglasses labelled EPF 10 actually exceed the requirements of AS/NZS
1067:2003. Sunglasses may also be labelled “Absorbs 100% UVR”. According
to the New Zealand Association of Optometrists, the claim "UV400" is little more
than a marketing spin as there is no accepted definition.
TREATMENT OPTIONS
Category Examples Comments
Sunglasses eg, Bill Bass, North Beach, Zoya sunglasses Sunglass suppliers offer a wide range of popular branded sunglasses of varying specifications.
READY, SET, LEARN!
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CONTINUING OTC EDUCATION
COMPONENT MATERIALS INFORMATION
Frame Moulded plastic polymer Plastic injected into a desired mould. Cost-effective but frames cannot be reheated or generally take a prescription lens.
Cellulose acetate
Nylon
Metal (eg, titanium,
beryllium, stainless steel,
aluminium)/monel
Frames are cut from solid sheets of acetate. Retain their shape and do not shrink. Hypoallergenic and easily coloured.
Nylon blends make superior sports and performance frames and are resistant to hot and cold, flexible and readily moulded into wraparound
styles.
Lighter than plastic and easy to adjust. Less obtrusive to the field of vision. More expensive and less durable than other types and not
for high-impact activities. Can get hot.
Titanium is a hypoallergenic metal that is lightweight, strong, durable and corrosion resistant. Produced in a variety of colours.
Beryllium is less expensive than titanium. Resists corrosion and tarnish – good for people with high skin acidity or around salt water.
Stainless steel is light weight and strong and provides excellent resistance to corrosion, abrasion and heat. Usually hypoallergenic.
Aluminium is lightweight and corrosion resistant and usually combined with silicon and iron to increase strength.
Monel is a rust-proof metal alloy, composed of nickel and copper with some traces of iron. Good malleability.
Lens Polycarbonate Expensive, virtually unbreakable thermoplastic that is 1/3rd the weight of acrylic and 1/6th as heavy as glass. Usually made from bisphenol
A. Excellent transparency, durability, and high refractive index. Can be made thinner than glass or conventional plastic. Polarising
filters can be incorporated. High impact resistance. Easily shaped but more likely to scratch. Can discolour over time.
CR39
Patented plastic polymer. Reasonably cheap. Same optical qualities and visual acuity as glass but more lightweight and impact resistant.
Optically superior to polycarbonate. High glossy surface finish.
Plastic
Light and impact resistant. Naturally UVR resistant.
Acrylic
Synthetic cast lens. Same optical qualities and visual acuity as glass but more lightweight and 20 times more impact resistant. Can crack
when exposed to extreme temperatures. More easily scratched than other lenses since softer. Good optical qualities at a low price.
Glass
Excellent optical quality and scratch resistant. Heavy. Can shatter on impact. No UVR protection unless coated.
Lens effects Mirrored Reduce glare by reflecting light off the lens surface. Scratch easily as coating applied last.
Photochromatic/
photochromic
Polarised
Tinted
Become darker when exposed to UV radiation. Can take up to two minutes for adjustment to happen, and may not darken inside
vehicles with glass that blocks UV light.
Block polarised light reflected off horizontal surfaces and reduce light intensity. Enhance visual acuity. Recommended for water sports
and driving but not as effective against snow glare as snow reflects light equally in all directions, rather than just horizontally.Test
if truly polarised by holding lens up to a reflective surface (eg, car bonnet) and slowly rotating 90 degrees. Polarised sunglasses will
show a significant diminishing of glare. Cost and optical quality depends on polarising method used and includes external film coating
(cheapest), sandwiching polarising filter between layers of the lens (more durable and expensive), combining the polarising filter with
the lens material while in liquid form (best optical quality).
Tint reduces visible light but does not provide protection from UVR. May affect ability to drive at night. Various tints are available:
–grey, grey-green, smoke: good all-purpose tint. Reduces brightness while preserving 100% colour recognition. SPORTS: all outdoor
sports in bright light conditions.
–green: heightens contrast (mildly) while preserving colour balance. SPORTS: golf, baseball.
–dark amber, copper, brown: good for blocking blue light (ie, on a cloudy day). Contains a red element to enhance depth perception.
Useful to improve contrast on grass and against blue skies. SPORTS: fishing, cycling, golf, hunting, skiing, watersports.
–yellow, orange: less glare protection but perfect for moderate-to-low level light conditions. Excellent depth perception and contrast
enhancement in flat-light conditions. SPORTS: skiing, snowboarding, hunting, indoor sports.
–amber, rose, red: heightens contrast in partly cloudy and sunny conditions but causes significant colour imbalances. SPORTS: cycling,
fishing, hunting, skiing, snowboarding, water sports.
Hydrophobic coatings repel water. Anti-scratch coatings improve durability. Anti-fog coatings good for high-energy activities.
Other
Other Reduce fogging “Air dams” direct the flow of air over the inside of the lenses. Small ventilator holes can also reduce fogging.
Hinges
Metal are more durable than plastic.
Grips
Rubber nose or ear pieces help keep sunglasses from sliding down nose.
Side protection Wide plastic temples and wraparound lenses give more protection from dust, snow, wind, rain and glare that may come in from the side.
Stock display and marketing
• Keep a good selection of each brand on display and ensure the eyewear and
display cabinet is thoroughly dusted, clean and tidy.
• Keep the best selling styles at eye level.
• Know your product and be aware of different features and benefits.
»»
Ask your supplier for more information if you need it.
• Ask customers what style they prefer (ie, large, rimless, metal, plastic)
»»
Allow them to try on several pairs and listen to their feedback.
Locate this icon throughout the Healthcare Handbook.
Then find the corresponding Pharmacy Today and ELearning articles.
Read all three to unleash learning prizes and giveaways!
Page 147

Sweating: Excessive (Hyperhidrosis)
Although everybody sweats to a certain extent, some people have a problem
with excessive or uncontrollable sweating, known medically as hyperhidrosis. The
condition mainly affects the underarms, but may also affect the palms or feet.
Although hyperhidrosis is not life-threatening, it can cause significant
embarrassment and discomfort to the person involved and impact on work,
school and social relationships. The excessive sweating can stain clothing,
chafing can occur leading to dermatitis and infections, and damp feet can begin
to smell or damage footwear.
Sweat glands
There are two types of glands located in the skin that contribute to sweat
production. These are the apocrine and eccrine glands.
Apocrine glands are present from birth but only mature at puberty and start
manufacturing sweat at that time. They are mainly found in the armpits, round
the belly button, and in the genital area and produce a milky type of sweat
that exits the body along the hair follicle. Sweat production is increased during
periods of heightened emotional state (eg, stress, fear). In animals, apocrine
glands produce body odours that attract sexual partners. There is no conclusive
evidence to indicate that these glands perform this same function in humans.
Eccrine glands secrete a watery salty solution in response to heat, exercise,
or emotional stress and have their own duct system to move the sweat to the
surface of the skin. Evaporation of this solution (sweat) from the surface of the
skin provides a cooling effect, helping to control body temperature. The skin
contains between two million and three million eccrine sweat glands and these
are more concentrated in the soles of the feet, palms, armpits and forehead.
Body odour from sweating occurs when bacteria, that are normal inhabitants
on the surface of the skin, feed off the sweat and break it down. It is the bacteria’s
waste products that smell, and bacteria proliferate quickly in the presence of
sweat, especially if the pH balance of the skin is disrupted (such as with using
alkaline soap), or if the sweat is allowed to remain on the skin for a prolonged
period of time. Shaving can also contribute to bacteria growth as the absence of
hair does not allow the sweat to wick away from the surface of the skin.
Hyperhidrosis is classified either as primary or secondary hyperhidrosis,
depending on whether there is an underlying medical condition or not.
Primary focal hyperhidrosis (PFHH)
This is the most common form of hyperhidrosis and most frequently affects the
underarms, hands, feet or face/scalp, with normal sweat production occurring on
other parts of the body.
Sweat production can occur without the effects of heat or physical activity,
and the severity can vary from time to time. Sometimes, certain “triggers” such as
anxiety, emotion, spicy foods, heat, and even being anxious about sweating can
make it worse. At other times, no obvious factor can be pinpointed that will have
triggered the sweating. PFHH tends to be a long-term condition, but in some
cases symptoms can improve over time.
The condition affects around 2%–3% of the population, and typically first
occurs in adolescence, although can also begin in childhood or even in infancy.
Although the exact cause is unknown, it appears to be due to overactivity of the
hypothalamus (the area of the brain that maintains body temperature) which
stimulates the sympathetic nervous system to release sweat from the eccrine
sweat glands.
Secondary hyperhidrosis
Secondary hyperhidrosis refers to excessive sweating that is due to an underlying
medical condition. Secondary hyperhidrosis can either be generalised, in that it
affects the whole body versus, less commonly, localised (focal), which means it
just affects one particular part (for example, after a spinal injury sweating may
occur in only one leg). Usually a cause is found or suspected. Some conditions
that have been associated with secondary hyperhidrosis include:
• anxiety
• diabetes, heart problems or stroke
• menopause
• nerve damage
• obesity
• Parkinson’s disease
• respiratory failure
• some medicines (eg, nortriptyline, paracetamol, zinc)
• some tumours (rarely)
• thyroid gland overactivity
TREATMENT OPTIONS
Category Examples Comments
Aluminium-containing
antiperspirants for
hyperhidrosis
Other products
[PHARMACY ONLY]
eg, contains aluminium chloride hexahydrate
20% (Driclor), aluminium zirconium (Rexona
Clinical Protection)
[GENERAL SALE]
eg, contains diphemanil 2% (Prantal powder)
eg, aluminium chlorohydrate (Neat 3B Action
Cream)
Do not shave 24 hours before applying product. Use pH neutral soap. Apply at night to
clean, dry underarms and wash off the next morning. Use normal deodorants during the day.
Reduce frequency of application once sweating has stopped. May damage clothing.
May be useful for mild hyperhidrosis. Can be applied to affected body part (eg, hands,
amputated stumps, between the toes, under the breasts, on the groin area, skin folds).
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CONTINUING OTC EDUCATION
• tuberculosis or other infections.
Initial assessment
Offer customers suffering from hyperhidrosis some practical advice (see Advice
for customers) and discuss the difference between antiperspirants and
deodorants. Antiperspirants reduce the release of sweat, deodorants only contain
a fragrance to mask unpleasant smells. Deodorant crystals which have natural
antibacterial or antifungal properties to limit odour-causing bacteria may also be
considered as a “natural” alternative to chemical products; however, they will not
decrease sweating.
Explain that strong antiperspirants are usually applied at night and washed
off the next morning. Warn customers that aluminium antiperspirants can stain
clothing.
Treatment
Antiperspirants usually contain an aluminium salt such as aluminium chloride,
aluminium chlorohydrate, or aluminium zirconium. Aluminium zirconium tends to
be better tolerated by the skin and less likely to cause irritation or aggravation
after razor use. In low concentrations, aluminium ions cause a temporary closure
of the sweat glands, reducing the amount of sweat produced, but reapplication
is often needed.
In the higher concentrations used for hyperhidrosis, aluminium can cause a
more long-lasting closure and ultimately shrink the sweat gland, decreasing the
amount of sweat it can produce. Ensure strong aluminium chloride or zirconiumbased
antiperspirants are used exactly as directed. Most recommend to apply the
product once at night for a set period of time, then to decrease the frequency
of use. Sometimes aluminium salts are combined with salicyclic acid to enhance
penetration.
Customers who have tried strong antiperspirants with limited success may
need referral to a doctor for tests to exclude secondary causes or to try other
types of therapy which may include:
anticholinergic medication (eg, glycopyrrolate, oxybutynin) which helps
prevent the stimulation of sweat glands
beta-blockers for stress-induced sweating
botox (Botulinum toxin type A) – used for severe underarm sweating,
temporarily blocks the nerves that stimulate sweating
endoscopic thoracic sympathectomy – involves cutting of the nerve that
stimulates sweat production. More effective for palm sweating
iontophoresis – a procedure that uses a gentle current of electricity to
temporarily turn off the sweat gland (most effective for sweating of the hands
and feet)
removal of the sweat glands by liposuction, curettage, microwave thermolysis
or surgery.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, immunosuppression, diabetes, is pregnant or
breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Does the sweating most often occur during sleep?
• Is the sweating accompanied by other symptoms such as fever,
weight loss, chest pain, shortness of breath, or a rapid heartbeat?
• Is the sweating occurring in a child without the effects of heat or
physical exercise?
• Is the excessive sweating a new occurrence in an adult?
• Is the person allergic to any topical ingredients?
Advice for customers
• Avoid clothes that show up sweat marks more easily.
• Wear loose-fitting clothing, made of natural fibres (avoid Lycra or nylon).
• Use a soap-free cleanser.
• Dress shields (also known as armpit or sweat shields) can help absorb excess
sweat and protect delicate or expensive clothing.
• Look up the International Hyperhidrosis Society’s website for more information,
support, or to purchase products (www.sweathelp.org).
• See Foot Care for advice for people with excessively sweaty feet.
Now you can complete
your ENHANCE modules on
your phone or tablet
www.pharmacytoday.co.nz
Page 149

Toothache
Toothache is the term used for pain that occurs in and around the teeth and
jaws. The pain usually starts suddenly and it can vary from mild discomfort to a
severe throbbing, which is often worse at night and may be exacerbated by hot
or cold food or drinks.
A tooth has two main anatomical parts. The crown of the tooth is covered
with enamel and is visible in our mouths. The root is the part embedded in the
jaw that anchors the tooth into its bony socket. It is normally not visible. Beneath
the enamel lies a layer of dentine. Dentine is much softer than enamel, forms the
bulk of the tooth, and becomes sensitive if the protection of the enamel is lost.
The pulp is the innermost part of the tooth. It is made up of soft, sensitive tissue
that contains the blood and nerve supply to the tooth. The pulp extends from the
crown to the tip of the root.
Toothache happens when the innermost layer of the tooth – the pulp –
becomes inflamed. The most common reason for dental pulp inflammation is
tooth decay (dental caries). Tooth decay is caused by the action of acids on the
enamel surface. The acid is produced when sugars (ie, fructose, glucose, sucrose)
in foods or drinks react with bacteria present in the plaque on the tooth surface.
The acid produced leads to a loss of calcium and phosphate from the enamel by
a process called demineralisation. Saliva acts to dilute and neutralise the acid
that causes demineralisation and is an important natural defence against caries.
Saliva also has the ability to remineralise areas of destroyed enamel once the
acids have been neutralised. However, if the process of demineralisation exceeds
remineralisation, the caries progresses and a breakdown in the enamel surface
occurs leading to a cavity. Other causes of tooth pain include:
• a cracked tooth, loose or broken fillings, or a recently restored tooth
• a periapical abscess – pus which collects in the root as a result of an untreated
cavity, injury or prior dental work
• alveolar osteitis (dry socket) – pain that occurs in the tooth socket three to
four days following dental extraction. OTC analgesics will help relieve the pain
• pericoronitis – an infection of the soft tissue covering impacted wisdom teeth,
common in adolescents, which requires immediate referral to a dentist
• receding gums – contraction of the gums exposes dentine in the tooth root.
• Many people also suffer from “sensitive teeth”, when the teeth are exposed to
temperature extremes. The reason for the pain is unknown.
People at higher risk of dental decay
People considered at high risk of tooth decay (dental caries) include those:
• currently undergoing orthodontic treatment
• with a history of dental decay or precavitated lesion in the past three years
• with decreased salivary flow causing a dry mouth
TREATMENT OPTIONS
Category Examples Comments
Simple analgesics
[GENERAL SALE] eg, paracetamol (Panadol,
Paracare, Pamol suspension)
Effective at relieving pain but are not anti-inflammatory so will not relieve swelling or
inflammation in the area. Suitable for people with contraindications to NSAIDs.
Oral non-steroidal
anti-inflammatory agents
(NSAIDs)
Oral hygiene products
Natural / herbal products /
supplements
[GENERAL SALE] eg, aspirin (Disprin range),
ibuprofen 25s (Nurofen range), ibuprofen
suspension (Fenpaed, Nurofen for Children)
eg, ibuprofen + paracetamol (Maxigesic,
Nuromol)
[PHARMACIST ONLY MEDICINE]
eg, diclofenac 25mg (Voltaren Rapid 25)
eg, ibuprofen + codeine (Ibucode Plus, Nurofen
Plus), paracetamol + codeine (Panadeine,
Panadeine Extra)
eg, interdental brushes, dental floss,
mouthwashes, personal water jets, toothbrushes,
toothpastes, xylitol or fluoride-containing
products, sugar-free gum
Clove oil, S. salivarius K12 and M18
Ibuprofen is the NSAID least likely to cause stomach irritation.
NSAIDs may not be suitable for people on certain other medications or with some medical
conditions (eg, asthma, kidney disease – see Refer to Pharmacist). Advise customer to
stop taking if stomach upsets, increased bruising or prolonged bleeding occur.
Aspirin is not recommended for adolescents or children under 12 years old (see Childhood
Pain and Baby Teething: Treatment options). Avoid aspirin following dental surgery
(may prolong bleeding time). See Reference Section, OTC Medicines – Precautions.
Combination NSAIDs are effective for moderate pain. Warn customers that codeine is an
addictive substance and should not be used for more than three days at a time. Constipation
or drowsiness may also occur. Monitor sales and be alert for any customers who may be
misusing codeine-containing preparations.
Interdental brushes help remove plaque from between teeth and are an alternative to dental
floss. Both can help reduce tooth decay by removing food and plaque from the spaces
between teeth. Products containg xylitol or fluoride can decrease the risk of dental caries.
Mouthwashes (antiseptics) temporarily lower the number of bacteria in the saliva but are not
a substitute for regular teeth brushing.
Chewing sugar-free gum stimulates saliva production which is important for buffering food
acids, supplying minerals for remineralisation, and diluting and increasing clearance of food
debris from around the teeth. See Oral Health: Treatment options, for product details.
Clove oil applied directly to tooth with a cotton bud may act as a local anaesthetic until the
person can see a dentist. Can be fatal if swallowed. Keep out of reach of children.
S. salivarius K12 and M18 are oral cavity probiotics which are have activity against bacteria
implicated in bad breath, gingivitis, and tooth decay.
MANAGING PAIN
FREE
PROFESSIONAL DEVELOPMENT FOR
Pharmacy assistants, technicians and students
4
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CONTINUING OTC EDUCATION
Caring for children’s teeth
••
Always supervise and assist children aged less than eight to brush their teeth.
••
Begin caring for your child’s teeth as soon as they have erupted.
••
Use just a smear of normal-strength fluoride toothpaste either on a cloth (very young children) or
a child-size toothbrush, up until age six.
••
For children older than six years, use a pea-sized amount of toothpaste.
••
Brush twice a day, morning and last thing before going to bed, for two minutes. Spit out extra
toothpaste, but avoid rinsing with large amounts of water as this will wash away protective fluoride.
••
Help children to floss their teeth when two teeth touch (usually when the back teeth appear).
••
Replace a toothbrush when worn, or at least every three months.
••
Breast milk is best for babies. Never give infants sweet drinks in their bottle and never dip
dummies in sweetened substances.
••
Use a training cup instead of a bottle as soon as the child can drink from one.
••
Parents should avoid sharing spoons with their children or putting their child’s dummy in their
own mouth to avoid the transfer of dental caries-causing bacteria.
• with eating disorders
• with enamel defects
• without exposure to fluoride, either through a drinking source or supplements
• with poor oral hygiene or who smoke
• who eat a high sugar or high carbohydrate diet
• who are unable to afford dental treatment, or who seek it rarely
• who consume sugar-laden sports gels or drinks during prolonged exercise.
Good oral hygiene is important for everyone, not just those at risk (see Oral
Health). Regular dental check-ups (six monthly to yearly) may help prevent major
dental surgery later on (eg, root canals) or gum problems such as gingivitis (see
Oral Health). OTC analgesics may partially or temporarily alleviate toothache or
other types of dental pain until the person is able to see a dentist.
Fluoride helps prevent tooth decay and many town water supplies in New
Zealand are fluoridated. Refer anybody wanting information on fluoride
supplements to a pharmacist.
Children’s teeth
Taking good care of children’s teeth while they are young helps to prevent dental
problems later in life. Early childhood caries (ECC) is the form of tooth decay that
affects the teeth of infants and young children and has been identified as an
important health problem in New Zealand. It can cause problems with low selfesteem
and speech development and have lifelong implications. ECC is caused
by long and frequent exposure of a child’s teeth to sugar.
Encourage parents to regularly inspect their child’s mouth for signs of dental
decay, and to take them to a dental clinic if they have any obvious cavities or are
complaining of pain. Free basic oral health services are available to New Zealand
children from birth until their 18th birthday (see www.healthysmiles.org.nz
or ask at the child’s school). For baby teething advice see Childhood Pain and
Baby Teething.
To complete the work book assessment
visit pharmacytoday.co.nz
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication, either prescribed by a
doctor or bought from a shop or supermarket (including herbal/
complementary medications)?
• Is the person a child?
• Does the person have a cold or fever, obvious inflammation or
abscess?
• Is there any swelling around the tooth, jaw or face?
• Has the person sustained a facial injury (eg, mouth trauma)?
• Has the person had any dental extractions previously?
• Does the person drink unfluoridated water?
• Does the person have any allergies to medicines?
Initial assessment
Visually, there are not usually any outward signs of a toothache, and a good
history from your customer or a child's caregiver plus the answers to the Refer
to Pharmacist questions will help you decide if the condition is treatable
in a pharmacy. Most toothaches are not; however, analgesics may be sold to
temporarily relieve the pain until a person can see a dentist.
For people prone to cavities or with concerns about their teeth, offer advice
about good oral hygiene (see Oral Health), and consider the use of probiotics
(see Probiotics) such as S. salivarius K12 and M18. Mouthwashes may also
help, but these should not be used as a substitute for good teeth brushing.
WIN
ONE OF SEVEN
$500
CASH PRIZES
Page 151

Travel Health (including Vaccinations)
With some forward planning and sensible precautions, New Zealanders can
reduce their risk of getting sick while overseas.
Medicines
Medicines should only be taken overseas if they are for a customer’s personal
use, or the personal use of someone travelling with them. All medicines should
be left in their original packaging, and a note from the prescriber explaining what
the medicine is for, together with a copy of the prescription (if applicable) should
be carried. Since some medicines may not be legal in certain countries, customers
should check with the Embassy or High Commission of that country before departing.
Customers should also be wary of purchasing prescription medicines over the counter
overseas since counterfeit or substandard products are rife.
Mosquito-borne illnesses
Several life-threatening illnesses are transmitted by mosquitoes and travellers
need to be aware of which ones they may be at risk from during their trip.
Malaria is more common in Central and South America, Africa, Asia, Indonesia
and Eastern Europe. Symptoms occur anywhere from seven days to one year after
infection and include fever and flu-like illness, chills, headache, muscle aches and
tiredness. Customers should consult with a doctor aware of current, country-specific,
anti-malarial recommendations, as these are always changing. If anti-malarial tablets
are prescribed, these need to be taken exactly as directed, and precautions also taken to
avoid getting bitten (see also Bites and Stings).
Dengue fever is a mosquito-borne viral illness that has seen a dramatic rise in
incidence in tropical and subtropical parts of the world in the past few decades.
Outbreaks have been reported in Burkina Faso, Egypt, Fiji, Hawaii, Queensland,
Samoa, Tonga, and Uruguay in the past three years. Symptoms of dengue fever
are usually mild and flu-like and include a high temperature, headache, pain
behind the eyes, joint pain, muscle and bone pain, rash and mild bleeding such
as nose bleeds. Some people are at risk of developing severe dengue which
can be fatal without immediate medical attention. Symptoms of severe dengue
include a decrease in temperature (below 38°C), severe abdominal pain and
persistent vomiting, rapid breathing, bleeding gums and blood in vomit, fatigue,
and restlessness. Several dengue fever vaccines are in development. The first,
Dengvaxia is approved for use in Brazil, Mexico and the Philippines but has
limited availability elsewhere. Travellers must still protect themselves from
mosquito bites during the day and night as the vaccine is only 60% effective
against dengue; however, it does prevent more than 80%–90% of severe cases.
Zika is another mosquito-borne viral illness that is becoming more prevalent.
The 2016 outbreak that started in Brazil rapidly spread to other tropical and
sub-tropical countries. Zika is typically a mild disease; four out of five people
experience no symptoms. The remainder develop a low-grade fever, headache,
a rash, joint pain and conjunctivitis. Hospitalisation is uncommon and symptoms
usually resolve within a week. Significantly, outbreaks have been associated with
an increase in the number of cases of Guillain-Barré syndrome, and a twentytimes
higher rate of microcephaly (abnormally small head, incomplete brain
development) in babies born to mothers infected with Zika. Other mosquitoborne
illnesses include chikungunya and Japanese encephalitis.
Vaccinations
Advise customers to see their doctor or travel vaccination clinic ideally eight to 12
weeks before departure to discuss what vaccines they will need and to allow time
to begin the course before their departure. Whether vaccinations are required or
not depends on age and:
• duration of visit and planned activities (eg, cycling, caving, trekking)
• how the person plans to travel (eg, car, bus, safari truck, on foot)
• if they are a woman who is pregnant or breastfeeding
• long-term health conditions (eg, asthma, diabetes) or regular medicines
• possible contact with animals and type of accommodation
• previous vaccinations (including completion of childhood immunisations).
Most travel vaccinations are not free and can cost from $20 to over $250 per
dose. Yellow fever vaccinations can only be given by an approved vaccination
centre which will issue an International Certificate of Vaccination, which certain
countries require before entry is granted. Commonly encountered diseases for
which vaccinations are available, are summarised in the table. Because no vaccine
guarantees complete immunity, good hygiene and self-protection measures (eg,
applying insect repellent, safe-sex) should still be practised.
Traveller’s diarrhoea
Diarrhoea affects over half of all travellers. Causes are numerous including
changes in food or drinking water, bacteria, viruses or other microbes (eg, E. coli,
rotavirus, Giardia). Treat with electrolyte solutions to replace fluids lost through
PHARMACY TRAVEL ESSENTIALS
Category Examples Comments
Vaccines
Other products
[PRESCRIPTION MEDICINE] – except in the
form of an oral liquid when sold in a pharmacy
by a registered pharmacist eg, Dukoral
eg, MicroCleanz
eg, 1Above, No Jet Lag
eg, Blis K12 Travel Guard, Colloidal Silver
Oral vaccine. Provides approximately 85% protection against Vibrio cholerae and at least
50% protection against enterotoxigenic E. coli. Follow recommended algorithm to assess
customer suitability.
Hand sanitisers may be used if hygienic hand washing facilities are unavailable.
Products are available that may help alleviate the symptoms associated with jet lag.
Other products may help support our body's natural immune defence system.
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CONTINUING OTC EDUCATION
Vaccinations to Consider for Travellers
Disease Transmission Illness effects
Protective
effect
Countries where prevalent
(not all inclusive)
Chickenpox (varicella) a Virus transmitted through airborne droplets Generally mild, with a rash. Serious complications rare 10–20+ years Common in countries with low vaccination rates
Cholera
Bacteria transmitted through contaminated Acute, profuse, watery diarrhoea and dehydration 6 months–2 years Endemic in much of the developing world
water and food
Dengue b Mosquito-borne virus Generally mild and flu-like but severe dengue can be fatal Unknown (2+ years) Common throughout tropical and subtropical countries
Influenza
Virus transmitted through infectious airborne
droplets
Flu symptoms which can be fatal in certain groups of people 1 year (since virus
changes)
Worldwide
Hepatitis A
Hepatitis B a
Japanese B
encephalitis
Measles, Mumps,
Rubella a
Exposure to sewerage-contaminated water,
ice, shellfish, or uncooked, unpeelable fruits,
vegetables or other foods
Contact with blood or blood-derived fluids,
contaminated needles, unprotected sex
Viral infection of the liver – fever, anorexia, abdominal discomfort,
jaundice. Not associated with chronic or long-term infection
Viral infection of the liver – fever, anorexia, abdominal discomfort,
jaundice. Can become chronic
Vaccine: 20+ years
Lifelong
Common throughout the developing world
South-East Asia, Africa, Carribean
Mosquito-borne virus Only 1:250 infected people develop encephalitis symptoms 2–3 years Most of Asia especially rural agricultural regions where
flooding irrigation is used
Direct contact with infectious droplets,
sometimes airborne
Measles: Rash, fever, cough, sometimes severe complications
Mumps: Swelling of salivary glands, sometimes severe
complications and infertility
Rubella: Can cause birth defects in pregnant women
15+ years Common in countries with low vaccination rates
Meningococcal disease Direct contact Fever, headache, nausea, vomiting. Can be fatal 2–3 years Sub-Saharan Africa, Haj pilgrims
Epidemic in New Zealand 1991–2004
Poliomyelitis a Virus transmitted by faecal–oral or oral route Most infections asymptomatic, but in some people acute paralysis,
respiratory failure, and rarely death can result
10+ years Low incidence worldwide due to vaccination
Rabies Animal bite that inoculates virus into wound Incubation period of 1–3 months after which no treatment is
effective. Delirium and convulsions followed by coma and death
Tetanus/Diphtheria/
Pertussis a
Tuberculosis (BCG)
Traveller’s diarrhoea
Tetanus: Bacteria transmitted usually through
contaminated wounds though has occurred
during clean surgical procedures
Diphtheria: Raw milk or dairy products
Pertussis: Contact with respiratory droplets
Usually airborne spread of bacilli through
coughing or prolonged sharing of same
air space. Can be transmitted through
unpasteurised milk from infected cattle
Can be due to changes in food or water or
microbes (eg, bacteria, virus, protozoa)
Tetanus: Muscle rigidity and painful spasms, sometimes fatal
Diphtheria: Bacteria causes membrane to form over mucous
membranes. Can be fatal
Pertussis: Severe cough, sometimes serious complications
Latent TB is asymptomatic. Active pulmonary TB causes cough,
fever and weight loss
Dehydration caused by excessive diarrhoea and vomiting can be
very debilitating and even fatal
1–10+ years Found in many parts of the world. Risk highest with
unprotected outdoor exposure
10–20+ years Common in countries with low vaccination rates
Long for miliary and
meningeal forms.
Variable for pulmonary
disease
Vaccination unreliable in adults. Not generally recommended
since treatment is usually effective
3+ months Although traveller’s diarrhoea is common, routine
vaccination is not considered necessary unless under the
advice of a health professional
Typhoid
Bacteria transmitted through unboiled water, or Persistent very high fever, sometimes rash, can be fatal 2–3 years South-Asia, Central America
uncooked or poorly reheated foods
Yellow fever c Virus transmitted through mosquito bites Can cause severe hepatitis and haemorrhagic fever 10 years Parts of Sub-Saharan Africa (eg, Guinea, Kenya) and South
America (eg, Columbia, Brazil). Some countries require
International Certificate of Vaccination for entry
Protective effect of vaccination varies according to information source. a. Included in NZ immunisation schedule; b. Limited availability internationally (not currently New Zealand); c. Must be given at an authorised yellow fever vaccination centre.
diarrhoea and vomiting; with antidiarrhoeal medicines (eg, loperamide); and if
necessary, antibiotics (but only under medical supervision). See Diarrhoea for
OTC product information.
Initial assessment
If you know or suspect a customer may be travelling overseas, offer to help them
put together a first-aid kit and recommend other OTC travel-related essentials
(such as flight pillows, sunscreen and insect repellent). Check they have had
a recent dental check-up and sought advice about which vaccines they may
need. Encourage travellers going to less developed parts of the world to use
self-purified or properly sealed bottled water for drinking and cleaning teeth, and
to avoid ice. Hands should also be washed thoroughly before eating and after
toileting or hand sanitiser used if washing facilities are unavailable or suspect.
Foods should be cooked thoroughly and served piping hot. Avoid vegetables or
fruits that cannot be peeled and raw seafood and shellfish.
Customers should also be directed to the New Zealand Government’s official
source of advice for New Zealanders travelling or living overseas (www.
safetravel.govt.nz) which contains information on everything from passports
and visas to weather warnings and recommendations about what countries NOT
to visit. Travellers can also register their travel plans on the site.
Information about the association between venous thromboembolism
(blood clots) and air travel can be found in the Varicose Veins and Support
Stockings chapter).
Page 153

Travel Sickness
Travel, or motion, sickness is a common problem, especially in young and elderly
people. Prevalence varies according to mode of travel but has been estimated at
around 50% of children aged two to 12 years travelling in cars or planes, and
close to 100% of boat passengers in very rough seas.
Although the exact cause is not fully understood, most experts believe that
motion sickness arises from either conflicts occurring between the various
sensory inputs to the brain, or an overstimulation of balance mechanisms
located within the inner ear. Sensory systems involved in monitoring balance
include the:
• inner ears – semicircular canals within the inner ears contain a fluid which can
tell the brain the direction of motion (up, down, side to side, round and round,
forward, backward)
• eyes – these also help let the brain know if a person is moving and in what
direction
• skin receptors – these let the brain know what parts of the body are touching
the ground
• muscles and joint sensors – these tell the brain if a person’s muscles are
moving and what position their body is in.
When a person is moving, either under their own steam or with the aid of a
vehicle, boat or plane, the brain receives a report from these sensory systems and
attempts to make sense of what the person is doing.
Of the four systems mentioned above, the sensory apparatus in the inner ear
seems to be most critical in the development of motion sickness. If this becomes
overstimulated or if any of the other sensory reports do not fit together, the brain
gets confused and travel sickness occurs.
TREATMENT OPTIONS
Category Examples Comments
Antihistamines
Hyoscine (scopolamine)
Other products
Natural / herbal products /
supplements
[PHARMACY ONLY MEDICINE]
eg, meclozine (Sea-Legs), promethazine
(Avomine*)
[PHARMACIST ONLY MEDICINE]
eg, promethazine (Allersoothe, Phenergan
Tablet/Elixir*)
[PHARMACY ONLY MEDICINE]
eg, hyoscine/scopolamine (Scopoderm TTS
Patches)
eg, @-ease, 1-Above, No Jet Lag, Trip Ease
eg, Nei-Kuan pressure point bands (eg, Sea
Band Nausea Relief Adult/Child, Travacalm
Travel Band*)
eg, Blis K12 Travel Guard
eg, ginger (Blackmores Travel Calm Ginger,
Lifestream Ginger, Seaband Ginger), pycnogenol
(1Above)
Sea-Legs are not for use in children under six years. Avomine are not for use in children
under 10 years. Ensure packet instructions are followed for the correct dose according to
age. Meclozine is generally less sedating than promethazine (although sedation may be
an advantage for some people). Warn about the risk of drowsiness and to avoid driving
or operating machinery if affected. Refer to the pharmacist people on medications or with
certain health conditions since these products may not be suitable for them (see Reference
section, OTC Medicines – Precautions). Avoid alcohol. Be wary of the potential for
abuse of these medicines and refer any suspicious requests to the pharmacist. Non-sedating
antihistamines are ineffective.
Not for use in children under 10 years. Apply to the hairless area behind the ear at least four
hours before travel (eight hours is best for maximal effect). Remove or replace with a new
patch after 72 hours. Do not cut patch in half (although a half patch can be obtained by
covering half the patch with an occlusive dressing).
Dispose of the patch carefully after use and wash hands after applying to prevent inadvertent
transfer to the eye. Warn about the risk of drowsiness and to avoid driving or operating
machinery if affected. Avoid alcohol.
Homeopathic remedies may help alleviate symptoms associated with travel.
Bands that apply constant pressure to the Nei-Kuan pressure points in the wrists may help
reduce feelings of nausea. Apply in the middle of the inner wrist, about three finger widths
from the crease where the wrist joins the hand.
Other products support the body’s natural immune defence system.
Ginger may help relieve symptoms such as nausea associated with travel sickness.
Pycnogenol may help reduce both the severity and duration of jet lag.
Products with an asterisk have a detailed listing in the Travel Sickness section of OTC Products, on page 265.
For DRUG-FREE relief of nausea
Page 154 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
For example, if a person is travelling in a car, reading a book with their head
down, the inner ears and skin receptors tell their brain that their body is moving
forward. However, their eyes are looking at a book that isn’t moving and the
muscle and joint sensors are telling their brain that they are sitting still.
During the early stages of travel sickness, most people start to feel a little tired
and dizzy, a bit nauseous, and may begin to salivate. Many people never progress
to vomiting, while others are more severely affected and may have to seek
medical help at the time. Other symptoms may include yawning, hyperventilation
(rapid, deep breathing), sweating and looking pale.
Women who are pregnant or menstruating, people who are feeling scared or
anxious or who suffer from migraine headaches or conditions that interfere with
sensory input are more at risk of motion sickness.
In some people, smells, such as those of food or petrol, coupled with the
anticipation of travel can also bring it on.
People who are subjected to repeated exposure of the same motion develop
a tolerance for it after a period of time – often referred to as “gaining your sea
legs” if on a boat. Once the motion stops, the feeling of still moving persists for
several hours until the body readapts to the lack of movement.
Initial assessment
Most people buy products in anticipation of future motion sickness. Try to
establish what their symptoms are when it happens and run through the Refer
to Pharmacist questions and refer anybody with "yes" answers to a pharmacist.
Treatment
A number of different medicines are effective in treating motion sickness. Most
are more successful at alleviating symptoms if taken before the motion occurs,
rather than waiting until it has happened.
Sedating antihistamines (eg, meclozine, promethazine) and anticholinergics
(eg, scopolamine) are most commonly used before travel while antiemetics (antinausea)
medicines may be used to control nausea and vomiting after motion
sickness has developed. Several of these medicines can cause drowsiness.
Natural remedies, such as ginger or peppermint and pressure bracelets that
act on the Nei-Kuan pressure point on the anterior wrist may also be effective.
Advice for customers
• Keep food light and avoid heavy, fatty or spicy meals and alcohol before
travelling. Peppermint or ginger taken before travel may help.
• Take the recommended medicine at least one to two hours before travelling
(or even the night before).
• Reduce symptoms by choosing seats with the smoothest ride (eg, front seat of
a car, front carriages of a train, seats between the wheels of a bus, centre of a
boat and seats over the aircraft wing).
• Focus on distant objects or the horizon, do something distracting (eg, listen to
music) or keep eyes closed.
• Avoid activities, eg, reading, that encourage looking down and require close
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication or herbal remedy,
either prescribed by a doctor or bought from a shop?
• Does the person have any pain or oozing from one ear (may
indicate an ear infection)?
• Is there severe anxiety associated with travelling?
• Have travel sickness symptoms become worse over time, not
better?
• Does the person suffer from prolonged vomiting when they are
travelling?
• Is the medication intended for:
»»
a child aged less than six years?
»»
an elderly person? (Can be sensitive to the side effects of
medication.)
»»
a woman who is pregnant or breastfeeding?
• Does the person appear suspicious and may possibly be drug
seeking?
• Does the person have any allergies to medicines?
visual concentration.
• Minimise head movement with a head support, or try lying down.
• Get plenty of fresh air (open personal air vents on planes).
• If a person is feeling car sick, stop in a safe spot and allow them to get out
and walk around a bit.
» » If it is unsafe to pull over, make sure they have a plastic bag in the car – just
in case!
Relieves nausea due to motion, pregnancy,
anesthesia and chemotherapy
Drug-free - Uses the science of acupressure
No drowsiness
Perfect for both kids and adults
Always read the label & follow the instructions. TAPS NA 6962
Page 155

Urinary Incontinence
Urinary incontinence, or loss of bladder control, is when urine accidentally leaks
from the bladder. In some people, just laughing, coughing or sneezing can cause
leakage. The amount of urine that leaks can range from just a few drops up to
the entire contents of the bladder.
More than 1.1 million (25%) of New Zealanders experience bladder or bowel
control problems. Urinary incontinence has been identified by the World Health
Organization as a major health issue in developed and developing nations.
Stress incontinence
This is when the bladder leaks due to physical pressure, usually from lifting,
exercising, coughing, sneezing or laughing. It happens when a person has weak
pelvic floor muscles or a weak urethral sphincter.
Pelvic floor muscles hold all the pelvic organs in their correct positions, and
also help keep the urethra closed, preventing leakage. The urethral sphincter is
a band of muscles around the urethra that, for the majority of the day, remain
tightly squeezed, keeping urine in the bladder. Nerve endings in the bladder
send a message to the spinal cord and brain for urination to occur once a certain
amount of urine has accumulated in the bladder. This results in relaxation of both the
sphincter and pelvic floor muscles. In people with stress incontinence, these muscles
are not strong enough to withstand the extra pressure lifting, exercising, coughing or
sneezing places on them. They involuntarily relax, allowing urine to escape.
Causes of stress incontinence include pregnancy and childbirth, menopause,
constant coughing, lots of heavy lifting, being overweight, straining to empty the
bladder or bowel, ageing, a lack of fitness or extreme exercise.
Urge incontinence
This is when there is a sudden, strong urge to pass urine and the person is unable to
hold on until they reach the toilet. People with urge incontinence may also feel the
need to urinate more often, including at night, even though their bladder is not full.
Urge incontinence occurs as a result of inappropriate contraction of the
urethral sphincter muscle, or the detrusor muscle of the bladder wall. Often these
contractions occur regardless of the amount of urine that is in the bladder.
Causes include urine infections, stroke, Alzheimer’s disease, Parkinson’s disease,
diabetes, certain medications and prostate problems. A "Can't Wait" toilet card is
available free from www.continence.org.nz for people with a medical condition
who need to let strangers discreetly know that they need a toilet quickly.
Overflow incontinence
This happens when the bladder is unable to fully empty itself. It becomes too
full, causing it to overflow and regularly leak or dribble small amounts of urine.
Causes include prostate problems, diabetes and certain medications.
Incontinence due to physical/neurologic abnormalities
Anatomic or neurologic abnormalities may affect the urinary system and cause
incontinence, such as fistulas (an abnormal opening between the bladder and
another structure).
Damage to the nervous system that regulates bladder control can also occur
due to trauma, disease or injury. This may cause the bladder to be underactive
(unable to contract and empty completely) or overactive (contracting too quickly
or frequently).
Other causes
Incontinence can also be a result of surgical procedures such as prostate or rectal
surgery and caesarean surgery. Some people (mostly women) can experience
both stress incontinence and urge incontinence simultaneously.
Incontinence can also occur simply due to a person’s inability to physically get
to a toilet, or to communicate this need to a caregiver.
Overactive Bladder Syndrome
Overactive bladder (OAB) syndrome is a general term used to describe the
symptoms of urinary urgency with or without urge incontinence, including the
frequent need to go to the toilet, and having to urinate more than once at night.
In summary, OAB is the condition, and urinary incontinence is a symptom of OAB.
TREATMENT OPTIONS
Category Examples Comments
Incontinence pads/pants
Furniture liners
eg, Attends range, Comforts Pads,
Confitex, D-Brief range, Depend range,
Molicare range, MoliMed, Poise Pad
Rrange, Tena range
eg, DryLife Absorbent Bedliner, DryLife
Seatliner
Minimise contact between urine and skin. May be reusable or disposable. Useful for temporary incontinence,
before seeing a doctor, or if medical options have been unsuccessful or are not appropriate. Most provide high
absorbent capacity with little bulk. Menstrual pads are not suitable for urinary incontinence since their absorption
capacity is limited and they become lumpy and leak when sodden. Consider the customer’s needs (light, moderate
or heavy) and whether assistance is needed to use and change the product.
Draws in and traps moisture, protecting bedding or furniture and minimising wetness. Absorbs 2.5L over eight hours.
Machine washable.
Barrier products
eg, dimethicone (Silic 15), zinc
(Sudocrem), zinc and castor oil, vitamin A
and calamine (Ungvita Cream)
Silicone or zinc-containing barrier creams protect the skin from the irritating effects of urine. Wash urine off
the skin with a mild cleanser and water before applying.
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CONTINUING OTC EDUCATION
Initial assessment
Bladder training, surgery and other procedures can help many people with
urinary incontinence so politely enquire if a customer has talked to a doctor
about their incontinence when selling incontinence pads or pants.
Skin irritation can also occur, and customers should be advised to use a barrier
cream to protect their skin, and to keep underwear clean and dry.
More information can be found on the NZ Continence Association’s website at
www.continence.org.nz. A related site, pelvicfloor.co.nz provides detailed
information and advice about maintaining a strong pelvic floor.
Treatment
In most cases, people with incontinence will need to be referred for further
investigations to establish a cause. Products available in a pharmacy for
incontinence include absorbent pads and underwear, which may be used as a
temporary measure before the customer sees a doctor, or for use in people when
the cause has been established but urinary leakage still occurs.
Urinary incontinence in children
The age at which children achieve dryness varies. Wetting in very young children
is common and is not considered incontinence. The term enuresis is often used to
describe inability to control urination in those old enough to exercise such control.
Daytime enuresis affects around 3%–4% of children between the ages of four
and 12 with girls being more commonly affected than boys. Children experiencing
daytime enuresis should initially be assessed by a doctor to rule out a urinary
tract infection and also constipation, which can also adversely affect bladder
function. Some children may also need an ultrasound if structural abnormalities
are suspected. In most cases a cause is not identified.
Nocturnal enuresis (wetting the bed at night) is not usually diagnosed until
age seven and typically resolves with age, with only 1%–2% of 18-year-olds
still being affected. It occurs slightly more in boys than girls and tends to run in
families with most children having at least one relative who also wet the bed.
Information about toilet training and the management of both daytime
and nocturnal enuresis for parents and caregivers can be found at www.
continence.org.nz. Daytime enuresis may resolve once fluid intake is increased
(makes it easier for the child to recognise a full bladder) and bladder retraining
techniques are put in place. Alarm systems that wake a child at night have proven
to be a good long-term treatment for nocturnal enuresis with a 70% success rate.
Refer to a
PHARMACIST/DOCTOR
If the person suddenly CANNOT pass urine, then they should
see their doctor immediately as this may be a medical emergency.
Refer all customers presenting with urinary incontinence for
the first time to a pharmacist. The pharmacist should then direct
them to a doctor to establish a cause.
For customers with previously diagnosed urinary incontinence
who are purchasing pads or incontinence pants refer any of the
following “yes” answers to the pharmacist.
• Is the urine leakage interfering with the person’s lifestyle?
• Are there any signs of a bladder infection, such as pain in
passing urine (see Cystitis).
• Is there any blood in the urine?
» » advice about toileting outside of the home situation.
• Some exercise regimens are not pelvic floor friendly. See pelvicfloor.co.nz for
pelvic floor safe exercises.
• Customers with incontinence of recent onset should keep a bladder diary
before seeing their doctor.
» » Record when and how much leakage occurs, how strong the urge is to
urinate, what activity was being done when the urge to urinate occurred,
medicines taken (prescription, over the counter) and daily fluid intake.
• Avoid foods and drinks that can irritate the bladder, eg, spicy foods, caffeine,
alcohol, fizzy drinks, chocolate, citrus fruits and juices.
• Weight loss may help in people who are overweight.
• Community incontinence nurse educators provide education and advice.
Advice for customers
• Ensure the customer has discussed an incontinence management plan with
their doctor which usually consists of several of the following options:
»»
ensuring an adequate, but moderate, fluid intake (eg, 1000 –1500ml/day)
»»
a pelvic floor muscle exercise programme
»»
a bladder retraining and toileting programme
»»
medicines for incontinence
»»
incontinence aids (eg, pads, condom drainage, catheters)
Page 157

Urticaria (Hives)
Urticaria refers to a group of skin disorders characterised by weals (also
called hives) or angiodema, or both weals and angiodema forming on the
skin. There are several different types of urticaria. Weals (also spelt wheal)
may last from a few minutes to several hours and are pale or skin-coloured
superficial swellings, usually surrounded by erythema (redness). Weals are
generally itchy, 1–2cm in width, and may merge together to form a map-like
pattern or one giant patch. The term urticaria is derived from the Latin word
for stinging nettle, Urtica dioica.
Occasionally, the surface weals may be accompanied by angioedema – which
is a swelling beneath the skin that usually occurs around the facial area (ie, eyes
and lips) but may also be present on the hands, feet, and throat. Angiodema may
progress to anaphylaxis; symptoms include breathing and swallowing difficulty
and shock (see Allergies). Urgent medical advice must be sought. Angioedema
may also occur without weals.
Urticaria can occur anywhere on the body but is mainly found on the trunk,
arms and legs. Sometimes the rash can change shape and disappear from one
place, only to reappear a few hours later somewhere else. The underlying chemical
responsible for urticaria is histamine. Most cases of urticaria resolve within a few
days although, occasionally, a person will have hives for many months or years.
Acute urticaria
Acute urticaria refers to a rash that lasts for less than six weeks. The rash may be
triggered by an allergy or another non-allergic cause. Mast cells and white blood
cells in the skin release histamine, which causes small blood vessels to leak fluid
which pools to form weals.
In acute urticaria due to an allergic cause, the substance responsible is usually
ingested, inoculated, or inhaled, though in some people skin contact with the
allergen may be enough to set off the urticaria (eg, latex). The most common
allergic causes of urticaria are:
• bee or wasp stings
• foods – particularly nuts, fish or shellfish, eggs, tomatoes, eggs, berries, milk,
strawberries and kiwifruit
• latex
• medicines – almost any type of medicine, either prescription or over the
counter, although antibiotics are the most commonly implicated.
Most cases of urticaria are NOT due to allergy, and can occur without previous
exposure. Non-allergic causes of acute urticaria include:
• contact with irritating plants (eg, thistles, stinging nettle) or stinging jellyfish
• infections – such as viral upper respiratory tract infections (eg, colds, sinusitis),
Candida infections, dental abscesses, Helicobacter pylori, viral hepatitis
• non-allergic food reactions – common examples include salicylates in fruits,
azo-dye food-colouring agents, benzoate preservatives, and histamine due to
bacterial decomposition in fish (eg, scombroid fish poisoning)
• non-allergic release of mast-cell granules, which can occur with opiates (eg,
morphine, codeine) and radio-contrast agents
• serum sickness – as a result of a blood transfusion, viral infection or medicines.
TREATMENT OPTIONS
Category Examples Comments
Oral antihistamines
Topical anti-itch products
Natural / herbal products /
supplements
Non-sedating
[PHARMACY ONLY MEDICINE]
eg, cetirizine (Razene, Allerid-C, Histaclear,
Zetop, Zyrtec tablets & liquid), desloratadine
(Aerius Tablets), fexofenadine (Arrowcare
Fexofast*, Hayfexo, Fexoclear, Telfast
180*, Telfast Oral Liquid For Kids, Xergic),
levocetirizine (Levrix), loratadine (Loraclear,
Lorafix)
Sedating
[PHARMACIST ONLY MEDICINE]
eg, dexchlorpheniramine (Polaramine),
promethazine (Phenergan, Allersoothe)
[PHARMACY ONLY MEDICINE]
eg, Anthisan Cream
Vitamin C
Aloe vera gel
These help to control total body itch and wheals. Try and eliminate the underlying cause (eg,
food, medication).
Oral antihistamines are more convenient than topical antihistamines when itch affects the
whole body area.
Generally non-sedating medicines do not cause drowsiness; however, some people may be
more sensitive than others. Warn about the risks of driving or operating machinery if they do
get drowsy.
Similar to non-sedating antihistamines (above); however, these medicines can be quite
sedating. May be useful when taken at night to improve sleep quality if itching is severe.
Warn about the sedating effects and risks of driving or operating machinery while
taking these medicines and to avoid alcohol (see Reference Section, OTC Medicine
Precautions). Sedating antihistamines are [PRESCRIPTION ONLY MEDICINES] for children
under two.
Relieves localised itch and inflammation. Good for short-term use (two to three days) on
small localised areas. Some people with sensitive skin may react to excipients in the cream
and develop a contact dermatitis.
Higher doses of vitamin C (ie, 1000mg) may help reduce histamine levels.
Aloe vera has a cooling, soothing action.
Products with an asterisk have a detailed listing in the Itchy Rash and Urticaria section of OTC Products, on page 266.
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Acute urticaria can also be caused by sunlight, heat, cold, water, pressure,
vibration, or exercise. The trigger is not known or identified in about half of all cases.
Chronic urticaria
Chronic urticaria lasts more than six weeks and is often due to an
autoinflammatory disease such as systemic lupus erythematosus. Referral to a
doctor for an extensive review of the customer’s medical history, diagnostic tests
and a thorough physical examination is necessary.
Initial assessment
Put on a pair of gloves and have a good look at the customer's urticaria. Ask
about extent of spread and run through the Refer to Pharmacist questions
and refer any "yes" answers to a pharmacist.
Treatment
The best treatment for urticaria is to identify and eliminate the cause if possible.
Oral antihistamines are effective at relieving the itch and work best if taken on
a regular schedule. Oral corticosteroids or other medicines (eg, antileukotriene
agents) prescribed by a doctor may also provide relief and in severe cases an
injection of adrenaline may be needed.
Advice for customers
• Avoid triggers for urticaria if known and if possible.
• Dietary changes may help. Some urticaria is aggravated by salicyclates in
certain fruits, or additives including amines, tartrazine (102), benzoates (210-
220) and other food chemicals.
• Seek medical advice if certain medications appear to precipitate urticaria.
Similar classes of medications may do the same thing.
• Customers with urticaria should:
»»
avoid alcohol (it causes the surface blood vessels to dilate)
»»
avoid tight clothes as sweating and pressure may worsen symptoms
»»
cool the affected area with a fan, cold flannel, ice pack, or cream containing
menthol; alternatively a tepid or cold shower may be soothing
»»
treat any pain with paracetamol
»»
see a doctor if the urticaria does not respond to an antihistamine, or persists
more than a few days.
Refer to
PHARMACIST
Seek urgent medical help if the person has any signs of facial swelling,
or difficulty swallowing or breathing.
In other cases of urticaria, ask the following questions to identify
customers who would benefit from further input from a pharmacist.
Your initial assessment may have already provided some answers.
Decide if any further questions still need to be asked and refer any
“yes” answers to a pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any other medication or herbal remedy,
either prescribed by a doctor or bought from a shop?
• Has the urticaria lasted longer than 24–48 hours?
• Are there any blisters, crusting or pus associated with the urticaria?
• Does the urticaria occur more often than just occasionally?
• Does the urticaria cover a large area of the body?
• Does the person have a fever or feel generally unwell?
• Is the person a child under 12 years?
• Have oral antihistamines been tried but the itch still persists?
• Does the person have any allergies to medicines?
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Page 159

Vaginal Health
The vagina is a closed muscular canal that is naturally acidic and contains rich
quantities of beneficial bacteria and yeasts. Changes to the natural environment
or structure of the vagina, as a result of endometriosis, hormonal contraceptives,
feminine hygiene products, infection, menopause, pregnancy and childbirth,
psychological distress, or trauma can upset its proper functioning, leading
to abnormal discharge, genital sores, infertility, sexual discomfort, urinary
incontinence, or vaginitis. Good vaginal health is an important contributor to a
woman's overall state of health.
Symptoms of poor vaginal health
A healthy vagina secretes a small amount of discharge to keep itself clean, and
a change in this discharge (colour, smell, or consistency) is often the first sign
that something is wrong. Other symptoms of concern include abdominal pain; a
noticeable lump or bulge inside the vagina; bleeding between periods, after sex, or
after menopause; and vaginal redness, itching or irritation. Discussions on vaginal
health are best conducted in a private area and by a pharmacist since most vaginal
conditions either require a pharmacist to sell the treatment (such as vaginal thrush) or
refer the customer to a doctor. The exception is vaginal dryness, common in women
going through menopause, for which a vaginal lubricant or gel can be sold.
Pharmacists should also not assume any abnormal discharge is vaginal thrush
as many other conditions (such as bacterial vaginosis, trichomoniasis) present in
a similar way.
Vaginal thrush
Vaginal thrush (vaginal candidiasis) is a common fungal infection caused by
overgrowth of the yeast, Candida albicans. Although not considered a sexually
transmitted infection, occasionally the yeast can be transferred to a male partner
causing redness, itching and soreness around the foreskin and head of the penis.
Only symptomatic males need treatment with a topical antifungal cream; studies
have shown treating non-symptomatic males does not reduce the number of
episodes of candidiasis in their female partner.
Symptoms of vaginal thrush in women include itching, irritation or a burning
sensation in the genital area. Vulval soreness may occur and there may be a thick,
white or creamy vaginal discharge.
If itching is the main presenting complaint and there is no thick discharge,
consider other causes such as cystitis or a rash due to sensitivity (eg, toiletries,
synthetic underwear). If a "fishy" or malodorous smell is present, consider
bacterial vaginosis (refer to a doctor).
Occasional recurrent episodes of vaginal thrush may be treated with over-thecounter
vaginal antifungal agents sold by a pharmacist, particularly if there is a
readily identifiable cause, eg, a course of antibiotics.
Customers with symptoms that show no improvement after four days must
be reviewed by a doctor. There may be an underlying medical condition (eg,
diabetes or an autoimmune condition), an atypical yeast infection (eg, Candida
glabrata) or a non-fungal cause (bacteria, trichomoniasis, chlamydia, gonorrhoea,
TREATMENT OPTIONS
Category Examples Comments
Imidazole antifungal vaginal
products
Triazole antifungal vaginal
products
Combination antifungal
vaginal products
Vaginal lubricants and gels
Natural / herbal products /
supplements
[PHARMACIST ONLY MEDICINE]
eg, clotrimazole (Canesten range), miconazole
(Micreme Vaginal Cream, Resolve Thrush)
eg, clotrimazole + hydrocortisone (Canesten
Plus)
[PHARMACIST ONLY MEDICINE]
eg, fluconazole (Canesten Oral Capsule, Diflucan
One, Flucazole 150)
[PHARMACIST ONLY MEDICINE]
eg, clotrimazole cream + oral fluconazole
capsule (Canesten Duo)
[GENERAL SALE]
eg, Aci-jel, Kolorex Intimate Care cream,
Lactigel*, Rephresh Vaginal gel, Replens Vaginal
Moisturiser
Horopito extract (eg, Kolorex Candida
Care), Lactobacillus acidophilus, L. casei
GG, Bifidobacteria, echinacea, Naturopharm
Thrushmed Relief Gel
Vaginal antifungal products are available as creams, pessaries or ovules for intravaginal use in
single-dose, three and six-day treatments. Single-dose treatments are more convenient; however,
longer therapy may be required in some circumstances (eg, if the woman is still on antibiotics).
Disposable applicators are supplied in the packet and treatment is best used at night.
The combination cream containing hydrocortisone can be used to treat the external symptoms of
thrush only. Hydrocortisone is very effective at relieving the itch.
Only one capsule needs to be taken, once.
Similar in efficacy to imidazole vaginal antifungals.
Avoid use if the patient has previously had liver disease with fluconazole (rare). Note possible
drug interactions (see OTC Medicines Interactions). Pharmacist is not able to sell OTC in
females aged under 18 or in pregnancy or breastfeeding.
A combination pack, see above for selling notes related to individual products.
Vaginal gels and creams maintain a healthy vaginal pH to reduce the risk of vaginal
infections.
Lactigel restores vaginal pH and may help suppress bacterial vaginosis-associated bacteria.
Most are usually safe to use with condoms but check manufacturers’ recommendations.
Horopito is an effective antifungal agent. Several probiotics are effective at returning gut
yeast populations back to normal. Echinacea stimulates the immune system and the body’s
ability to overcome Candida overgrowth.
Products with an asterisk have a detailed listing in the Vaginal Health section of OTC Products, starting on page 266.
READY, SET, LEARN!
Page 160 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
herpes, vaginal dermatitis, malignancy and certain other conditions which may
masquerade as vaginal thrush).
Thrush triggers
Many things can affect the delicate pH balance of the vagina, triggering an
overgrowth of Candida albicans and an episode of thrush. The most common
triggers include a course of broad-spectrum antibiotics (eg, tetracycline,
amoxicillin with clavulanic acid), higher-dose combined oral contraceptive pills
or oestrogen-based hormone replacement therapy, immunodeficiency (eg, HIV),
iron-deficiency anaemia, hot and humid weather, emotional or physical stress,
poorly controlled diabetes or pregnancy.
Women with higher levels of oestrogen are more likely to get thrush because
oestrogen causes the lining of the vagina to mature and produce glycogen, a
substance on which Candida albicans thrives. Lack of oestrogen in young girls
and older women makes vaginal thrush less common.
Treatment
Both oral and vaginal antifungal preparations which stop the growth of Candida
yeast without affecting the “helpful” bacteria in the vagina are available for
customers to purchase through a pharmacist.
Guide to recommending topical versus oral thrush treatments
Topical
Oral
Breastfeeding
Cost
Customer preference
Interacting medicines
Liver disease
Pregnancy *
Younger customers ( ⩾16 but

Varicose Veins and Support Stockings
Varicose veins are large dilated blood vessels that have a red or bluish colour
and protrude above the surface of the skin. Most people use the term varicose
veins to describe veins in the legs but they can occur elsewhere on the body.
When situated in the leg they can ache or throb, and cause cramp or leg swelling.
Very small veins in the skin are called thread veins or spider veins and,
although they cause fewer other symptoms, they may be more difficult to treat
(see Bruises, Scars and Spider Veins).
Varicose veins are usually caused by an incompetent valve system allowing
blood to return into the superficial layers just beneath the skin. The resultant
increase in pressure in these thin-walled skin veins can then cause vein
enlargement and further valve failure. Varicose veins are usually hereditary and
occur more often as people age. The risk is also higher in people who stand all
day on hard surfaces, in pregnant women and in people who are obese.
Initial assessment
Varicose veins are best diagnosed by a doctor, as they may signal other circulatory
problems or harbour blood clots. A doctor will conduct a physical exam and use
other tests, such as an ultrasound, to determine valve functioning.
For customers wanting flight socks, check they do not have any circulatory
problems (such as diabetes), and that they have the physical capability to pull on
the socks. Refer any customers with "yes" answers to the Refer to Pharmacist
questions to a pharmacist.
Treatment of varicose veins
Support stockings (also called compression stockings) remain an important
treatment for varicose veins. These stockings provide a graduated compression,
which helps direct blood flow back from the lower leg to the heart. Compression
is firmest at the ankle and gradually reduces as the distance from the ankle
increases.
Long-term use of support stockings is recommended, even after leg vein
surgery, to prevent varicose veins from returning. Graduated compression
stockings cannot cure varicose veins but can prevent further vein deterioration.
Compression hosiery/stockings can be used:
• after leg liposuction
• after treatment of spider or varicose veins
»»
Treatments for varicose veins include Endovenous Laser Ablation (EVLA),
Ultrasound Guided Sclerotherapy (UGS) and surgery.
• as flight socks (grade 1 compression only) to help prevent deep vein thrombosis
(DVT) on long-haul flights or prolonged car travel
• to help symptoms of varicose veins.
Advice for customers
• Measurements may be required to fit the person with the correct size of
stocking. Class 1 stockings do not require fitting, while classes 2 to 4 must
have measurements taken for a correct fit, and can be sold only on the
TREATMENT OPTIONS
Category Examples Comments
Graduated compression
hosiery
Other products
Natural / herbal products /
supplements
eg, Encircle Merino, Jobst range, Mediven range,
Scholl Flight Socks, TGX Socks, Venosan
[GENERAL SALE]
eg, mucopolysaccharide polysulfate (eg,
Hirudoid)
Butcher’s broom, horse chestnut (Venotrex),
gotu kola, grape, nattokinase, pycnogenol, sweet
clover
Support hosiery is classified into four different grades of compression: Class 1 may be sold in
pharmacies and without a doctor’s recommendation. Classes 2 to 4 may be sold only on the
recommendation of a doctor.
Grade/class 1 compression is recommended for people with tired, aching legs, mild varicose
veins, mild ankle swelling and to prevent ankles and feet swelling during long flights, eg,
Scholl Flight Socks.
Grade/class 2 compression is used for people with moderate-to-severe varicose veins,
pronounced ankle swelling after vein surgery, and to prevent recurrence of venous leg ulcers.
Grade/classes 3 and 4 compression hosiery is used for people with severe varicose veins or
ankle swelling, active leg ulcers and to prevent leg ulcers recurring. These would probably be
recommended by a specialist.
Full-length hosiery – stockings or pantyhose – are usually preferred for people with varicose
veins in the thigh, and for pregnant women.
Knee-high support stockings provide enough support for people with lower leg problems, eg,
varicose veins, swollen ankles and ulcers.
It is important to fit people with the correct size, according to the properly taken
measurement.
Contains enzymes that help disperse excess fluid in swollen areas. They reduce swelling and
bruising. Can also be used as a treatment following sclerotherapy.
There is some evidence for the benefits of horse chestnut, butcher’s broom, grape,
pycnogenol, and sweet clover in chronic venous insufficiency and for the improvement in
symptoms of varcose veins. Gotu kola, nattokinase or pycnogenol may decrease the risk of
DVT related to long-distance travel.
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Traveller ’s thrombosis
Traveller’s thrombosis is the term used to describe the formation of a blood clot within a vein
soon after travel. A deep vein thrombosis (DVT) is a blood clot that forms within major veins (ie, in
the legs or pelvis). Life-threatening complications occur if these clots dislodge (embolise) or parts
break off and lodge in other veins or arteries in the lungs, heart or brain. The risk of developing a
blood clot after any form of travel (not just air travel) is generally low but is more likely to occur
in people aged over 40 or who:
••
are immobile for long periods of time
••
are obese
••
are taking the contraceptive pill or HRT
••
are dehydrated (increases blood viscosity)
••
have cancer or a chronic medical illness (eg, inflammatory bowel disease)
••
have had previous venous disease or a stroke
••
have had recent major surgery or trauma (particularly involving the lower limbs or hip)
••
have thrombophilia or with a genetic predisposition to clotting
••
who are pregnant or who have recently given birth
••
with a central venous catheter or pacemaker
••
with congestive heart failure, chronic obstructive pulmonary disease, pneumonia
••
with a personal or family history of a DVT.
Symptoms
Symptoms vary depending on the area affected but the most common symptom of a blood clot or
DVT is a cramping, aching pain that does not subside with rest. Other symptoms include swelling
or tenderness and a localised redness or warmth. If a pulmonary embolism (PE) has occurred, the
person may complain of chest pain and breathlessness. A DVT does not always cause symptoms.
Recommendations:
••
Maintain some activity during long-haul flights or long-distance car travel – wiggle ankles up
and down, stretch, go for occasional cabin walk or stop the car and walk around for 20 minutes.
••
Ask for an aisle seat on planes and avoid sedative medicines.
••
Consider compression stockings for people identified as being at increased risk. Compression
stockings are synergistic (work with) aspirin or heparin.
••
Maintain fluid intake and limit alcohol to remain hydrated.
••
People at high risk should see their doctor before travelling who may prescribe prophylactic
treatment.
Refer to
PHARMACIST
People with symptoms suggestive of a DVT or pulmonary embolism
should seek urgent medical attention. Also refer all customers
without a formal diagnosis of varicose veins to a pharmacist, who
should refer them to a doctor.
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg, heart or
lung problems, diabetes, is pregnant or breastfeeding)?
• Does the person take any medication or herbal remedy, either
prescribed by a doctor or bought from a shop that may be causing
fluid retention?
• Does the leg look swollen or does the foot look pale or dark?
• Are the varicose veins very large?
• Are there leg ulcers or broken, weepy skin visible, or is there a deep
raspberry stain colour over the lower calf area?
• Is the person complaining of deep calf pain?
• Does the person have eczema or dermatitis?
and jewellery snagging the stockings. Rubber gloves also help the person to
move the stocking up the leg. Trim rough nails on hands and feet.
• When worn for treatment, compression hosiery is usually worn for 24 hours
a day under medical advice, including while sleeping and showering for the
first week.
»»
A hairdryer may be needed to dry stockings after showering or the hosiery
may be covered with a large plastic bag.
recommendation of a doctor.
• Measurements are best taken as early as possible in the morning. If the person
has walked to the pharmacy, rest the legs horizontally for as long as possible
before taking measurements.
• Graduated compression stockings are designed to be firm and supportive.
Moving up or down a size is not recommended as the amount of compression
applied to the lower leg will not be correct.
• After washing, do not dry stockings in a clothes dryer – refer to manufacturer’s
information for laundry details.
• Wear rubber gloves when putting on support stockings to prevent fingernails
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Page 163

Vitamins and Dietary Supplements
Vitamins and dietary supplements are intended to provide essential nutrients,
such as vitamins, minerals, fatty acids or amino acids, which are missing or not
consumed in sufficient quantities in a person’s diet.
Dietary intake of these nutrients may be reduced due to poor food intake,
sickness, “fad” diets, pregnancy or lactation, or chronic medical, psychological,
or physical reasons. Being aware of the recommended dietary intakes (RDI) or
upper intake limits of different types of nutrients, according to age and energy
expenditure, helps determine what (if any) supplement a person needs to take.
Many people take supplements they do not actually need, usually through lack
of knowledge, and for this reason it is advisable to seek dietary counselling from
a dietitian. This is especially true for people who choose to restrict their diet (eg,
vegetarians, vegans) or intolerant of certain food groups (eg, lactose, gluten).
Nutrient reference values (NRVs)
NRVs refer to the levels of recommended intakes of essential nutrients, such
as vitamins and minerals. In 2006, New Zealand and Australia developed joint
recommendations for nutrient intakes necessary to keep people healthy and
to reduce their risk of chronic disease. A revision of these recommendations
TREATMENT OPTIONS
Category Examples Comments
Calcium
Omega-3/omega-6 fatty
acid supplements
Probiotics
Folic acid supplements
Iron supplements
Vitamin D with
or without other
supplements
Vitamins for Age-Related
Macular Degeneration
Iodine
[GENERAL SALE]
eg, calcium (Caltrate, GO Calcium) calcium
+ vitamin D (Ostelin) calcium + minerals +
vitamin D (Caltrate Plus)
eg, Bioglan Kids Smart, Eye Q Fish Oil,
Eye Q Baby
eg, Bioglan Restore Daily Probiotic,
Clinicians Antibiotic Support
[GENERAL SALE]
eg, folic acid (Apo-Folic 0.8)
eg, folic acid with iodine, iron and other
vitamins and minerals (FabFol Plus)
eg, folic acid with iron (Ferrograd F)
eg, Fab Iron, Fab Iron Liquid Iron (10mL
=10mg elemental iron + B vitamins)
[PHARMACY ONLY MEDICINE]
eg, Ferrograd (=105mg elemental iron)
eg, Ferrograd C (=105mg elemental iron +
vitamin C 500mg)
eg, vitamin D (Go Healthy D3, Sanderson
Premium D3)
eg, vitamin D + other vitamins (Mvite,
Vitabdeck, Vitadol C
eg, Macu-Vision Blackmores* (contains
ascorbic acid, cupric oxide, zinc oxide,
vitamin E)
[PHARMACY ONLY MEDICINE]
eg, NeuroTabs (potassium iodate 268mcg
[= iodine 150mcg]), Elevit + iodine
(potassium iodine 250mcg)
Actual recommended daily intake is controversial (ranges from 500–1000mg). Calcium from dietary sources
is preferred over supplemental calcium (see Osteoporosis). Supplements taken at too high a dose may cause
kidney stones or affect the heart.
Omega-3 and omega-6 fatty acids are essential for optimum growth and development, including brain
development.
Probiotic bacteria aid digestive health and can restore imbalances between beneficial and harmful bacteria,
especially following antibiotic therapy (see Probiotics and Prebiotics).
Folate is an essential B vitamin and is found naturally in leafy vegetables, citrus fruits, wholemeal bread,
yeast, liver and legumes, and is important for cell growth and reproduction. Folic acid is the synthetic
form of folate. For more information about use of folic acid during pregnancy see Pregnancy Tests and
Supplements.
For more information about iron supplements see Iron Deficiency.
Be aware that iron is dangerous in overdose and tablets must be taken as directed for the recommended
course. Keep all iron products out of reach of children.
Fortification of milk and margarine products with vitamin D is voluntary in New Zealand. Vitamin D helps
maintain bone strength by regulating the amount of calcium in the blood, and is obtained from the
action of sunlight on skin (produces D3 or cholecalciferol) or from a limited range of foods (contain D2 or
ergocalciferol), although it is almost impossible to obtain sufficient vitamin D from the diet alone. Since too
much vitamin D is toxic, people at risk of vitamin D deficiency should discuss their status with their doctor
before taking supplements.
The types and quantities of antioxidants included in Macu-Vision are based on the AREDS (Age-Related Eye
Disease Study) research. May help protect the macular region of the eye and protect against Age-Related
Macular Degeneration (see Eye Conditions).
New Zealand’s Ministry of Health recommends healthy pregnant and breastfeeding women take a daily
150mcg iodine-only tablet from confirmation of pregnancy until the discontinuation of breastfeeding in
addition to eating iodine-containing foods such as low-fat milk products, eggs, seafood, and commercially
prepared bread. Women with pre-existing thyroid disease or with currently high iodine intakes should be
referred for further medical advice.
Foods eg, Go Superfood, Whole Live Nutrients Several whole-food supplements are now available that can be used to boost diets that are deficient in
certain nutrients.
Products with an asterisk have a detailed listing in the Vitamins and Dietary Supplements section of OTC Products, starting on page 267.
Join us on the path to better health with Blackmores.
Blackmores, Auckland.
blackmore
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CONTINUING OTC EDUCATION
is currently under way. NRVs are also used by the Food Safety Authority
of New Zealand for guidance on food labelling requirements. A link to the
recommendations – known as the Nutrient Reference Values for Australia and
New Zealand – is available from the Ministry of Health website at: www.health.
govt.nz. The NZ Nutrition Foundation (www.nutritionfoundation.org.nz)
also provides summarised information on nutrients, vitamins and minerals.
The Nutrient Reference Values document also outlines suggested dietary
targets to reduce chronic disease risk. Some of these include:
• reducing sodium intakes to less than 2 grams/day (equivalent to less than 5
grams of salt per day)
• a dietary fibre intake of 38g/day (men) and 28g/day (women) to reduce
cardiovascular disease risk
• increasing dietary intake of omega-3 fatty acids (DHA/EPA/DPA) to 610mg/day
(men) and 430mg/day (women).
Research has shown it is possible to achieve recommended daily intakes (RDIs)
of all nutrients by consuming commonly eaten foods, although in Australia and
New Zealand, intake of folate (folic acid), calcium and iron for women, as well as
iodine and selenium in all people, are generally borderline. Diets should be varied
and rich in vegetables and fruits (including some nuts and seeds), wholegrain
cereals, reduced-fat dairy foods and lean meats, fish (particularly those rich in
omega-3 fats) and poultry as well as small amounts of poly or monounsaturated
fats and oils. Probiotics may also be considered to restore the balance of natural
bacteria in the gut and help relieve common digestive complaints or maintain good
oral health (see Probiotics and Prebiotics).
Being physically active allows more flexibility of food choice and this is a key
component in maintaining a healthy lifestyle. Although vitamin and mineral
supplements are not considered necessary in healthy people eating a wellbalanced
varied diet, they may help some people, including:
• strict vegetarians who consume no animal foods (may need supplements of
vitamin B12, omega-3 fatty acids, iron and zinc)
• elderly people, babies of vitamin D deficient mothers, housebound or
institutionalised people, people with darker skin or those who cover their skin
for religious or cultural reasons may require vitamin D
• pregnant and lactating women (folic acid required during early pregnancy,
iodine supplementation recommended throughout, iron and calcium
supplementation may also be needed; see Pregnancy Tests and
Supplements)
• older adults with poor nutritional intake, such as those with dementia, or living
alone (may benefit from protein-rich supplement drinks or meal replacement
powders).
People with chronic diseases or premature infants require specialist advice
about supplements.
• vitamin C can help iron absorption if consumed at the same time
• high intakes of iron may interfere with the absorption of zinc (both use the
same absorption pathway)
• vitamin K contained in some supplements may interact with warfarin.
If an interaction is not desirable, taking the nutrients or medication two or
three hours apart may be advised (although this would not stop the vitamin K/
warfarin interaction).
Eating and Activity Guidelines
The Eating and Activity Guidelines developed by the New Zealand Ministry of
Health recommend adults:
• eat a variety of nutritious foods everyday including plenty of vegetables and
fruit; grain foods (mostly wholegrain and high in fibre); some milk and milk
products (mostly low and reduced fat); some legumes, nuts, seeds, fish and
other seafood; poultry and some red meat (with the fat removed)
• choose whole foods that contain unsaturated fat (rather than saturated
fat), that are low in sodium, with little or no added sugar, and are mostly
unprocessed
»»
Use salt sparingly and choose iodised salt over uniodised salt.
• make plain water their preferred drink
• keep alcohol intake low; avoid alcohol if pregnant or when trying to conceive
• partake in at least 150 minutes of moderate or 75 minutes of vigorous intensity
physical activity spread throughout the week. Do muscle strengthening
exercises on at least two days per week. Break up long periods of sitting with
regular activity.
Initial assessment
Supplements can't and shouldn't take the place of a well-balanced diet, so
it is important that you encourage people looking for supplements to first
improve how they eat (see the information provided above under Eating and
Activity Guidelines). Epidemiological studies have shown that use of dietary
supplements is not generally associated with an increased life span, in fact
associations with higher mortality have been found with certain supplements
such as iron.
Always refer people currently taking medications, with chronic illnesses, or who
are pregnant or breastfeeding to the pharmacist. Also refer if your knowledge of
supplements is limited as you may be doing your customer more harm than good
by recommending supplements they don't need.
Interactions and when to refer
Some nutrients can interact with other nutrients, supplements, or medications in
either a good or a bad way. Examples include:
5% of Eye Care sales
goes to support
proudly supported by
Always read the label. Use only as directed. If symptoms persist see your healthcare professional.
Vitamin supplements should not replace a balanced diet. Blackmores, Auckland. TAPSPP6714
blackmore
Page 165

Warts
Warts are benign (non-cancerous) growths of skin caused by the human
papillomavirus (HPV). More than 100 different subtypes of the HPV virus are
known. The HPV virus causes the top layer of skin to grow rapidly forming a wart.
The HPV virus is transmitted by direct skin-to-skin contact with other people
with warts. Warts can also be spread to other parts of the body if they are picked
or scratched and the viral particles are able to gain entry through a break in the
skin barrier – this is called autoinoculation. Warts have a long incubation period
and it may take up to 12 months after infection for the first wart to appear.
Common warts typically occur on the backs of fingers or toes, less commonly
on the elbows and knees. They may occur singly or in crops and are usually
painless. Warts located around the nail bed may also distort nail growth. Some
take on a cauliflower-like appearance with tiny black dots visible within the wart
(these are thrombosed capillary blood vessels); these are known as butcher's
warts. Plane warts tend to have a flat surface and may appear in a line since they
are commonly inoculated by shaving or scratching. Filiform warts have a long
stalk and more commonly occur on the face. Warts can also affect the oral cavity,
particularly the tongue, inside surface of the cheeks, and lips. These are called oral
squamous cell papillomas and are typically caused by virus types HPV-6 and HPV-
11. These subtypes are not usually cancerous but may be surgically removed for
cosmetic reasons. Refer all customers presenting with oral cavity or anogenital
warts to a doctor or dermatologist. For information on verrucae (warts on the
soles of the feet – also called plantar warts) see Foot Care.
Warts are common in children, with a peak incidence occurring in adolescents
aged 12–16 years. Fifty per cent of cutaneous warts in children dissappear by
themselves within six months without any treatment. More than 90% are gone
in two years. Warts in adults tend to be more persistent, although most clear up
eventually. People with Human Immunodeficiency virus (HIV) infection, or who
take the immunosuppressant medicines azathioprine and cyclosporin are more
likely to suffer from numerous warts that are difficult to treat.
Initial assessment
In a private area of the pharmacy, put on gloves and inspect the wart if it is on
an exposed part of the body. If there are multiple warts, are they in a defined
area or widespread? Refer the customer to a pharmacist if the lesion does not
look typically wart-like, the patient appears to have a poor overall general health,
or if they answer "yes" to any Refer to
Pharmacist questions.
Treatment
Many people seek treatment either
because the wart is painful or
for cosmetic reasons if the
wart is unsightly.
Treatment options
include chemical treatments
containing salicylic acid or
similar compounds which
remove the dead surface skin
cells and are effective in around
70% of cases although they may
take up to 12 weeks to work. Even
if the wart doesn’t go completely,
products usually make the wart smaller and
less uncomfortable. Podophyllotoxin is a cytotoxic
TREATMENT OPTIONS
Category Examples Comments
Salicyclic/lactic acid
Volatile hydrocarbons (home
cryotherapy)
Other products
Natural / herbal products /
supplements
[PHARMACY ONLY]
eg, Duofilm Wart Remover, Scholl Wart Remover
system (fabric/washproof)
[GENERAL SALE]
eg, Wartie Wart Remover*, Warteze, Wartner
Wart Remover, Scholl Freeze Verruca & Wart
Remover
[GENERAL SALE]
eg, Wartfree Wart Remover Pen
Homeopathic Thuja wart paint, Naturo Pharm
Wartoff Paint/Tablets/Spray
Garlic, green tea extract
Products with an asterisk have a detailed listing in the Warts section of OTC Products, starting on page 267.
Soak affected area in warm water and towel dry before applying product. Effectiveness may
be improved by rubbing the surface with pumice stone or emery board to remove any hard
skin. Daily treatment is necessary except for fabric-based systems which are changed every
48 hours.
Contain ingredients that freeze the wart, such as dimethyl ether and propane. Usually just a
one-off application of 20 seconds is needed; however, it may be repeated after 15 days. May
be uncomfortable for a few minutes and may result in blistering. May take several repeat
attempts over several months to completely get rid of the wart. There is no evidence to
suggest this treatment is any more beneficial than other wart treatments; however, it may be
more convenient.
Typically contain corrosive ingredients that induce peeling of the surface of the wart.
Homeopathic remedies aim to stimulate the immune system to attack the virus responsible
for warts. Topical garlic has some effectiveness for warts. Effectiveness for a green tea extract
ointment against genital and perianal warts has been reported.
Page 166 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
agent which is a prescription medicine. It is more commonly used for anogenital
warts and should not be used by pregnant or breastfeeding women.
Cryotherapy is the process by which a wart is frozen repeatedly, at one to three
week intervals with liquid nitrogen by a doctor or with over-the-counter products
bought for use at home. The process may be uncomfortable for a few minutes
and blistering of the area may occur. It also has around a 70% success rate.
Other options include:
• keeping the wart covered for 24 hours of the day (ie, with duct tape)
• electrosurgery – performed for particularly large and annoying warts under
local anaesthetic, although 20% of warts may recur
• laser treatments.
Advice for customers
• Do not pick, bite or scratch warts since this may encourage spread to other
parts of the body, and to other people.
»»
Never share razors as these can aid in the spread of warts.
• If using a chemical wart paint, first, soften the skin in a bath or bowl of hot
soapy water.
»»
Rub the hard skin away from the wart surface with a piece of pumice stone
or emery board
»»
Cut a hole in a plaster or surround the wart with vaseline. Apply the wart
paint or gel only to the wart and allow it to dry completely
»»
Cover the wart with plaster or duct tape (particularly recommended when
the wart is on the foot)
»»
Stop treatment for a few days if the skin becomes sore, then recommence,
paying particular attention to not getting the paint on unaffected areas of
skin.
• In general, keeping warts covered (ie, with duct tape) may help prevent spread.
• Encourage patient compliance and persistence with regimens, since most
warts take up to 12 weeks to treat.
• Wear jandals when using public showers or walking around swimming pools
since warts can be spread indirectly through wet surfaces particularly through
scratches or cuts when barefoot.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes, is pregnant or breastfeeding)?
• Is the customer aged over 50 years?
• Are the warts located on other parts of the body (eg, feet, face,
genital region, oral cavity)?
• Are there multiple or widespread warts?
• Is the wart larger than 7mm in diameter?
• Is there any itching or bleeding associated with the wart?
• Does the wart have an irregular border?
• Does the wart have pigmentation or a reddish colour or has it
changed colour?
• Does the wart look smooth or have a central dimple?
• Has the wart grown recently?
• Does the person have any allergies to topical medicines?
• Are you or the customer unsure of the diagnosis?
Read the label and follow the instructions. Wilson Consumer Products, Auckland
TAPS NA8914
Page 167

Weight Loss
Obesity has reached epidemic proportions globally. Historically more prevalent in
high-income countries, obesity is now common in low-to-middle income countries
with nearly one-third of the world's population now obese or overweight.
According to the World Health Organization (WHO), 44% of diabetes, 23% of
heart disease, and 7%–41% of certain cancers are attributable to excessive
weight.
Obesity is typically the result of an increased consumption of high-calorie
foods without a corresponding increase in physical activity. Environments that
promote healthy eating and exercise typically contain fewer individuals who are
overweight.
The risk of heart disease, indigestion or heartburn, gallstones, sleep apnoea
(see Sleep Problems), type 2 diabetes and certain cancers increases in people
who are overweight. Reducing weight to within the healthy range reduces most
of these risks and may also benefit customers with osteoarthritis or those having
issues with reproductive health.
Maintaining a healthy weight makes exercise and movement easier and
increases life expectancy. More information is available through the NZ Ministry
of Health’s HealthEd website (www.healthed.govt.nz).
mass index (BMI) as medically obese (BMI more than 30). Weight loss is also
recommended for people with a BMI of more than 25.
»»
BMI is calculated as body weight divided by height squared, ie, kg/m 2 .
Calculate this by obtaining a person’s weight (in kilos), dividing by their height
(in metres), and then dividing by their height again. A BMI of 18.5–25 is a
healthy body weight. People should aim for a BMI of 25 or less.
»»
For people of Asian or Indian descent, a lower BMI may be desirable.
• Waist circumference should also be measured as this gives an indication of
truncal or abdominal obesity.
»»
Weight carried mainly around the middle part of the body is associated
with a higher risk of metabolic complications (ie, high blood pressure,
dyslipidemia, insulin resistance) which can lead to heart disease, diabetes,
stroke, and gall-bladder disease.
• People with a high muscle mass (eg, body builders) may have a higher BMI
but may not be overweight. Waist circumference may be a more accurate
measure of body fat in very muscular adults, in ethnic groups with a smaller
body size (eg, South Asian populations) and in older people.
When is weight loss important?
• Weight loss is extremely important when a person is defined by their body
TREATMENT OPTIONS
Category Examples Comments
Weight loss programmes eg, System: Slim Personal, trained consultants are available on site at specific pharmacies. Consultants
provide weight management advice and eating plans to develop good eating habits using
normal grocery items. Dietary supplements are also available but meal replacement formulas
are not used. Weekly visits to consultants are encouraged (www.systemslim.co.nz).
Meal replacements eg, Optifast VLCD (Very Low Calorie Diet) VLCDs are intended for people with a BMI greater than or equal to 30 or greater than 27
with obesity-related medical complications. People should see a health professional twice
a month while on the programme, and people with type 2 diabetes and hypertension need
careful monitoring. See www.optifast.com.au
Oral medication for weight
loss
Other products
Natural / herbal products /
supplements
eg, Kate Morgan Weight Management
Programme
[PHARMACIST ONLY MEDICINE]
eg, Orlistat (Xenical)
eg, IsoWhey Weight Management, Radiance
WellTrim, XL-S Medical Direct Oral Powder
Whey protein powder
Hoodia (eg, Go Healthy Slim Hoodia)
Caralluma fimbriata, garconia cambogia, green
coffee bean
eg, Synetrim Slim*
5-way weight management programme. Replace two meals per day with Kate Morgan meal
replacement, which also contains essential vitamins and minerals. Guidance on low GI foods,
low fat meals and physical activity provided (www.katemorgan.co.nz).
Xenical can be sold only to people with an initial BMI of greater than or equal to 30 or
greater than 27 with additional risk factors (eg, high BP, raised cholesterol, diabetes). It
blocks approximately 30% of dietary fat from being absorbed. The recommended dose is one
capsule taken three times daily with each main meal (breakfast, lunch and dinner), or up to
one hour after a meal. Use with well-balanced, low-fat meals and regular physical activity.
May contain ingredients that bind fat or create a feeling of fullness.
Whey protein may help reduce body weight and increase insulin sensitivity.
Hoodia is used by Kalahari bushmen to prevent hunger during long journeys. Growing and
extracting the active ingredient out of the plant is difficult and evidence of a benefit for
weight loss is limited. Evidence for a benefit for caralluma fimbriata or garconia cambogia is
also limited. Small studies have been favourable towards green coffee bean extract.
Synetrim Slim is a multi-action formula containing Cissus quadrangularis, green tea, green
coffee bean seed and chromium for weight management.
Products with an asterisk have a detailed listing in the Weight Loss section of OTC Products, starting on page 267.
Significant learning
opportunity: Wound care
Your new Group 3 CPD project
Page 168 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION
Waist Circumference Measurement and Health Risk
Risk Men Women
Average 88cm
Heart Foundation. Measurements apply to Caucasian men and women and Asian women, and are yet to be
determined for other ethnic groups
• While children should eat healthy food, they are not small adults. A growing
child’s diet requires a different proportion of fats, carbohydrates and fibre,
compared with an adult diet.
Initial assessment
Losing weight is hard and specific training in selling weight-loss regimens is
recommended since correct consultation techniques, coupled with an empathic
approach, will help you to engage the customer. Know what products your
pharmacy stocks for weight loss and any extra support they may offer. All regimens
need to be combined with a reduced-calorie diet and exercise programme.
Encourage customers to maintain a healthy weight and to increase their
consumption of vegetables and fruit; choose unsaturated fats instead of saturated
or trans fats; and to limit their intake of salt and sugar. Even a small weight loss
(ie, 5%–10% of current weight) will lower the risk of obesity-related diseases.
Treatment
A wide range of products for weight loss (many marketed with online, phone, or
face-to-face support programmes) are available through pharmacies.
Options range from meal replacement regimens to pharmacist-only products
(eg, orlistat) that reduce the amount of fat absorbed. Prescription medicines are
also available and bariatric surgery may be considered for some people after
specialist referral.
Advice for customers
• Have a realistic weight loss target. A weekly weight loss of 0.5–1kg is healthy
and achievable.
• Research has shown that people who weigh themselves daily are more
successful at keeping weight off as they use it as an early warning system for
preventing weight regain.
• Waist measurement is important for measuring fat loss.
• Targeting weight loss from just one spot, eg, the hips, generally does not
work, but overall weight loss will eventually result in reduction of the size
of the problem spot.
• Beware of products which advertise “no effort or exercise required”, “burn
fat”, and other fad diets. They rarely work. Starvation diets (ie, 5:2) may cause
excessive muscle loss in addition to fat loss and should be used with caution.
• A change in lifestyle is usually necessary to maintain weight loss
– this involves increased activity and different eating habits.
Refer to
DOCTOR
Refer the following people to a doctor:
• people with signs of obesity who also have other medical
conditions (such as heart disease). The doctor can assess the
person’s ability to cope with any increase in physical activity
• anyone who appears to be losing weight quickly or appears to be
losing too much weight
• anyone regularly buying laxatives, which may be an indication of
unhealthy weight loss methods
• anyone with persistent complaints of faintness or dizziness
• people showing signs of bulimia (self-induced vomiting after
food), bingeing until sick, or anorexia nervosa
• children with weight problems.
• Choose healthier foods and make use of wristband activity monitors. Download
the FoodSwitch App to identify what's in packaged foods which allows you
to make simple switches to healthier options.
• Eat a bit less of most things (except vegetables and fruit). See Vitamins and
Dietary Supplements: Eating and Activity Guidelines.
• Take every opportunity to move and be active, eg, get rid of the TV remote,
park on the far side of the supermarket car park, walk up and down stairs, get
off the bus one stop early, and do housework energetically.
• Smoking should not be used to lose weight. Smoking increases the risk of
heart and lung disease. It also reduces circulation and ages skin, increasing
wrinkles.
• Some medicines, eg, for blood pressure and diabetes, may need adjusting as
weight loss continues.
Visit ELearning to start your project
www.pharmacytoday.co.nz
Facilitated by Dr Alesha Smith
Page 169

Worms
Pinworms (Enterobius vermicularis) are small worms that live in the lower
digestive tract. Pinworms may also be called threadworms, enterobiasis or
oxyuriasis. They are white and thin and look like a small piece of white cotton
about the size of a staple (5–10mm). Occasionally they can be spotted in the
stool (poo) or around the anus, but are usually difficult to see. A "sticky tape"
test involves sticking and then quickly removing a piece of sticky tape to the
anus in an attempt to catch any pinworm eggs. This is best done late at night or
early morning as the female pinworm deposits her eggs outside the anus during
the night. The tape is then viewed under a microscope for the presence of eggs.
Generally, it is not considered necessary to confirm the diagnosis by actually
observing either pinworms or their eggs; the suspicion of an infection is usually
enough for treatment.
Humans are considered the only hosts of pinworms, so this type of worm
cannot be caught from pets. Pets carry other sorts of worms, such as roundworm,
tapeworm and hookworm which can be transmitted very occasionally to people.
Children and individuals who are immunocompromised are more vulnerable to
infection with animal worms than adults.
Pinworm is the most common worm infection occurring in New Zealand and
it is estimated that every child is infected with this parasite at least once before
reaching secondary school.
Symptoms of worms
Many people infested with worms have no symptoms at all. Some people,
particularly children, are more likely to complain of:
• itching around the bottom, typically at night – this is caused by a reaction to
the glue used by the pinworm to attach its eggs to the skin
• sleep disturbance from scratching, which may result in daytime tiredness or
irritability
• teeth grinding or bed-wetting
• broken, infected skin around the bottom from persistent scratching (refer to
pharmacist)
• abdominal pain, nausea or vomiting with severe infestations.
Sometimes in females, the adult worms migrate to the vagina instead of
returning to the bowel. Itchiness in the vaginal region along with a mucous or
blood-stained discharge may be reported.
Symptoms of either hookworm or tapeworm infections are usually nonspecific.
Infection may cause inflammation in the intestines which may then
cause abdominal discomfort and loss of appetite leading to weight loss and
malnutrition. Roundworms tend to migrate around the body to the lungs, liver
and eyes and, while most mild infections are asymptomatic, some people may
have a swollen liver, rash, or complain of lung or eye problems.
Transmission of worms
Pinworm eggs are able to survive outside of their human host for up to two
weeks and the eggs are easily picked up through contact with infected surfaces
(such as bed sheets, toys, taps) and then swallowed if hands are not washed
properly before eating. Airborne eggs carried in dust or released into the air after
making the bed may also be inhaled.
Larvae hatch out of the pinworm eggs and live in the lower bowel, migrating
out of the infected person’s bottom (usually at night) to lay their eggs. If children
scratch their bottom, the eggs can get under their fingernails. The eggs can then
be transferred to objects or other people and be swallowed, starting the cycle
again. Children are more likely to become infected because they sometimes
forget to wash their hands after playing, going to the toilet, or before eating
food and are often putting their hands in their mouth.
People get roundworm and hookworm infections through direct contact
with infected pet faeces. Tapeworms are transmitted by fleas and also through
undercooked meat from infected animals. Pets should be wormed and deflead
monthly, and dog faeces should be bagged and disposed off promptly.
Eggs and larvae of roundworm and hookworm are very resilient and can
survive for a long time in areas such as parks, playgrounds, backyards, and
even inside homes.
Initial assessment
In a quiet area of the pharmacy, talk with the caregiver or person with suspected
worms about their symptoms (it is not necessary to actually visualise a worm).
TREATMENT OPTIONS
Category Examples Comments
Mebendazole
Pyrantel
Sanitising products
[PHARMACY ONLY MEDICINE]
eg, Combantrin-1, de-Worm, Vermox
[PHARMACY ONLY MEDICINE]
eg, Combantrin
[GENERAL SALE]
eg, Dermasoft Alcohol Free Foaming Hand
Sanitiser, Germ-X range
The dose is the same for everybody aged over two years. Repeat dose in two to four weeks.
Chewable tablets, squares or suspension are available. The tablet can also be crushed and
given to children mixed with honey, food or fruit juice.
The dose is 10mg/kg (consult guide on back of packet). Recommended for children aged
one year or older. Treatment of children aged less than one year should be under medical
advice. Repeat the dose in two to four weeks. Chewable squares, suspension and tablets are
available. Take as a single dose, after food.
Encourage children and adults to wash their hands or use sanitising gels or wipes before
eating and after going to the toilet. This can help stop the spread of worms.
@PharmacyToday. A part of your everyday.
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CONTINUING OTC EDUCATION
Reassure the customer that pinworms occur across the social strata and do not
imply a lack of hygiene. Many people also periodically treat their children for
worms every six months or so, regardless of whether or not they have symptoms,
and this is acceptable practice.
Run through the Refer to Pharmacist questions and refer any people with
"yes" answers to a Pharmacist. For all other customers, show them the treatment
products available, discuss the dosage, and ways to prevent reinfection.
Treatment
Anti-worm products (anthelmintics) sold through New Zealand pharmacies
contain either mebendazole or pyrantel (see Treatment Options). Both are
effective at treating pinworm, roundworm and hookworm infections. People with
suspected tapeworm infection or with persisting symptoms despite treatment
with either mebendazole or pyrantel should be referred to a doctor.
Advice for customers
• Treat the whole family, even if some family members have no symptoms.
• To prevent reinfection:
» » wash hands thoroughly before eating food and after toileting (encourage
use of gel hand-sanitisers and personal hand towels at school or work)
» » scrub underneath fingernails and keep them short, as eggs may lodge under
nails
» » while undergoing treatment for worms, shower at night and again the next
morning to remove eggs
» » undress children in the shower so eggs are washed away
» » change underwear daily
» » disinfect the toilet seat daily for one week after treatment
» » wash bed linen and towels in hot water, separate from other washing, daily
until worms have been eradicated. Do not shake before washing
» » vacuum carpet and furniture to remove eggs.
• If children scratch themselves in their sleep it may be necessary for them to
wear cotton mitts and tight-fitting underpants at night. This prevents anusto-mouth
transfer.
• Worm and de-flea dogs and cats monthly.
» » Dogs and cats of any age may get roundworms and hookworms but they
are most vulnerable when they are very young. Most pets show no sign of
infection, although heavy infestations may be fatal.
» » Puppies are often born with a significant number of worms which are often
passed to them from their mother before or shortly after birth.
» » Teach children to always wash their hands after coming into contact with
animals. Keep play areas, lawns and gardens free of animal waste. Cover
sandpits when not in use.
Refer to
PHARMACIST
The following questions aim to identify customers who would
benefit from further input from a pharmacist. Your initial assessment
may have already provided some answers. Decide if any further
questions still need to be asked and refer any “yes” answers to a
pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, cancer, is pregnant or breastfeeding)?
• Is the person concerned about a child aged less than two years?
• Has the person been overseas to a developing or remote country
within the past year?
• Is there blood in the faeces?
• Is there any accompanying diarrhoea?
• Has there been a marked weight loss?
• Is the skin around the anal area broken due to scratching?
• Has treatment been tried before without success?
• Do the worms keep coming back?
• Does the person have any allergies to medicines?
Page 171

Wound Care
Our skin acts as a barrier to the outside world, protecting us from infection,
temperature extremes and UV radiation; and internal organs and other structures
from damage. A wound is a break in the skin which may be caused by cuts
or abrasions (see also Cuts, Abrasions and Blisters), surgery, cancer, burns,
trauma to fragile skin, penetrating objects, pressure sores, skin ulcers, and many
other things. Some people are more prone to wounds, such as elderly people,
people with diabetes, and people taking corticosteroids.
Most wounds heal faster and with less scarring if the wound is kept moist.
Modern dressings containing hydrogels and other substances prevent wounds
from drying out and absorb fluid (exudate) from weeping wounds.
Serious wounds often need long-term treatment and patients are usually
under the ongoing care of a nurse and/or doctor. However, patients may wish to
buy dressings at the pharmacy.
Initial assessment
If a customer presents to your pharmacy with an acute wound, get them to stem
TREATMENT OPTIONS
Category Examples Comments
Sanitising products eg, MicroCleanz Eliminates most common harmful germs and bacteria. Convenient alternative to
hand washing.
Saline for cleansing
[GENERAL SALE]
eg, saline 0.9% (GP Wound Wash Saline)
Normal saline (saline 0.9%) or tap water have similar outcomes when used to clean
wounds.
Antiseptic wound care
applications
Products to stop bleeding
Wound healing products
Dressings
Topical anaesthetics
[GENERAL SALE]
benzalkonium chloride (eg, Bepanthen, Dettol Antiseptic
Wound Wash Spray)
bufexamac + chlorhexidine + lignocaine (eg, Ethics 4
Way Antiseptic Soothing Cream)
chlorhexidine ± cetrimide (eg, Medipulv Antiseptic
Powder (with allantoin), Savlon*, Soov Cream* [with
lignocaine])
chloroxylenol (eg, Dettol Antiseptic)
honey, medical grade topical (eg, Manuka Health Wound
Gel, Medihoney Antibacterial Medical Honey)
polyhexanide with betaine (eg, Prontosan)
povidone iodine (eg, Betadine Antiseptic liquid/ointment/
spray*)
silver (eg, Skybright Colloidal Silver)
stabilised hydrogen peroxide (eg, Crystaderm*)
super-oxidising solutions (eg, Microdacyn Wound Care
solution/hydrogel*)
[PHARMACY ONLY]
eg, chlorhexidine, cetrimide, lignocaine (eg, Medicreme
Antiseptic cream)
eg, Celox Nose Bleed dressings, Celox Granules, Celox
Gauze Pad
[GENERAL SALE]
eg, Mebo Wound repair
eg, Manuka Health Wound Dressings, Nexcare Sensitive
Skin range, Nexcare Waterproof Bandages
[PHARMACY ONLY MEDICINE]
eg, lignocaine/prilocaine (Emla cream)
Topical antiseptic agents may help reduce the risk of future infection when applied
to an acute wound. They are preferred over topical antibiotic agents because they
are broader in their spectrum of activity, less likely to cause allergic reactions, and
rarely associated with bacterial resistance. Ensure correct dilutions are used.
Super-oxidising solutions, polyhexanide, diluted bleach, chlorhexidine, silver and
cadexomer iodine cause less rejuvenating tissue damage than unstabilised hydrogen
peroxide and povidone iodine.
Super-oxidising solutions and solutions that contain betaine also possess antibiofilm
activity.
No clinically important resistance has been noted to super-oxidising solutions,
polyhexanide, diluted bleach, silver, iodine, hydrogen peroxide and honey. Gram
negative bacilli resistance has been reported with chlorhexidine and benzalkonium.
Some strains of Staphylococcus aureus (including methicillin-resistant S. aureus
[MRSA]) are resistant to chlorhexidine, cetrimide or benzalkonium.
Honey has antibacterial properties and provides a moist environment for healing
minor wounds. Diabetics may need to monitor blood sugars (refer to pharmacist).
Hydrogels donate moisture to a dry wound, improving healing.
Contain chitosan obtained from shrimp shells that clots blood within 30 seconds.
Effective even for people who take anticoagulants such as warfarin. Does not affect
long-term wound healing. No adverse reactions reported even in patients with a
known hypersensitivity to shrimp or crab.
Supports the body’s immune response to fight infection, and promotes natural skin
healing, minimising scarring.
Wound dressings containing medical grade manuka honey have natural antibacterial
properties and help maintain a moist wound surface. For more information about
other dressings see Treatment options in Cuts, Abrasions and Blisters.
Lignocaine/prilocaine creams can be used before cleaning painful wounds, such as
leg ulcers. Apply to the skin 45–60 minutes before the procedure.
Natural / herbal products /
supplements
Honey, St John’s wort, trypsin, calendula ointment, zinc
cream, vitamin A ointment
Products with an asterisk have a detailed listing in the Wound Care section of OTC Products, starting on page 267.
Topical honey-impregnated dressings or creams appear to improve wound healing,
reduce odours, help clean the wound and decrease risk of infection. Topical St John’s
wort, trypsin, calendula, vitamin A and zinc also have skin healing properties.
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CONTINUING OTC EDUCATION
any bleeding with a gauze pad, while you quickly assess the wound to determine
if it is appropriate to deal with in a pharmacy setting. Some wounds are best
referred straight away to the nearest accident and emergency or medical centre.
If the wound is relatively minor and you are comfortable treating it, put on
gloves and apply first aid. Otherwise refer the customer to a pharmacist. Also
refer any customers with "yes" answers to the Refer to Pharmacist questions.
Treatment of acute wounds
Proper wound care aims to minimise the risk of infection and scarring. See table,
next page, for treatment advice for different types of wounds. Generally:
• Stop any bleeding.
»»
Using a clean bandage apply pressure to the area for 10 minutes.
»»
If bleeding is brisk and does not stop or spurts out with the heartbeat seek
urgent medical attention.
• Clean the wound.
»»
Use water, saline, or a low-toxicity antiseptic solution to gently clean the
wound. Pay particular attention to removing any small pieces of foreign
material (such as wood, soil and clay) or non-viable tissue; moist gauze,
gentle scrubbing with a brush, or tweezers may aid removal. If the wound
cannot be cleaned thoroughly, refer the customer to a doctor.
»»
Apply a topical antiseptic agent to reduce the risk of infection. Superoxidising
solutions, polyhexanide, diluted bleach, chlorhexidine, silver and
cadexomer iodine cause less rejuvenating tissue damage than unstabilised
hydrogen peroxide and povidone iodine. Ensure product instructions for
correct dilution are followed.
• Apply a dressing to protect against further trauma. The dressing should
keep the wound moist, but not wet; have the capacity to absorb discharging
fluid or blood; and be shower-proof (eg, island dressings). Change regularly
depending on dressing type.
• A booster tetanus shot may be needed if it is more than five years since the
person’s last tetanus vaccination.
Advice for customers
• Watch for signs of infection (eg, redness spreading out from the wound or
yellow drainage from the area) and seek medical advice if this occurs.
• Topical antibiotics are usually not necessary. Overuse of these medicines can
lead to bacterial resistance and oral antibiotics are usually more effective if a
wound infection is present.
• Do not pick scabs off as the wound heals – this can cause scarring.
• Correct any nutritional deficiencies. Deficiencies of vitamins A, C, and zinc and
poor dietary protein intake impair normal wound-healing mechanisms.
• People with diabetes should seek medical advice with any wound, especially
wounds on the lower extremities (ie, feet, lower leg). People with diabetes:
»»
have a reduced blood flow to their extremities (delays healing)
»»
commonly have peripheral neuropathy, a reduced sensation in the hands
and feet, which means an injury may not be noticed straight away.
Refer to
PHARMACIST
If there is copious bleeding call for an ambulance immediately. Seek
medical advice if the wound is extensive or it has been difficult to
completely clean.
For all other customers, aim to identify those who would benefit
from further input from a pharmacist. Your initial assessment may
have already provided some answers. Decide if any further questions
still need to be asked and refer any “yes” answers to a pharmacist.
• Does the person have any other health conditions (eg,
immunosuppression, diabetes)?
• Is the person elderly, frail, on immunosuppressing medicines (such
as prednisone) or have a chronic illness?
• Does the person have a chronic wound, eg, leg ulcers, varicose
ulcers or bleeding moles, that is not being managed by a doctor?
• Is there copious bleeding?
• Is the wound extensive, deep or very dirty, or contain pus?
• Does the wound contain a foreign object which is embedded or
unable to be easily removed?
• Is the wound and surrounding area painful and warm?
• Does the person also have a fever or flu-like symptoms?
• Has it been more than five years since the person had a tetanus
vaccination?
• Does the person have known allergies, especially to topical agents
(eg, antiseptics, plasters containing resins) or eczema?
• For elderly people at risk of skin tears:
» » keep skin moisturised and use sheepskin boots and elbow pads to reduce
friction
» » self-adhesive bandages are less likely to damage the skin than adhesive
tapes and dressings
» » assist those at risk of falling, and pad furniture and equipment to prevent
bruising from collisions.
Page 173

Wound Care (continued)
Wound type Management Dressings Dressing features
Surgical wounds
Puncture wounds
eg, splinters or
nail puncture
Household
burns
Skin tears
Skin ulcers
• For surgical wounds, keep wound edges
together and follow surgeon's instructions
for wound care.
• For small puncture wounds clean the
wound with saline, tap water, or a lowtoxicity
antiseptic cleansing solution, and
apply an antiseptic. Refer to a doctor more
serious puncture wounds, or if it has been
more than five years since a person's last
tetanus shot.
• If a protective dressing is needed, use an
island adhesive dressing and change daily.
• Remove heat source from the patient.
• Immediately cool the area for up to 20
minutes with cool running water from a
tap or shower. In the absence of water, any
cool clean fluid can be used.
• Remove any affected clothing if it is wet
with hot liquid or affected by a chemical
splash. Remove tight rings or jewellery
from the injured area before swelling
occurs. Do not try to remove fabric stuck
to skin.
• Call 111 for patients with serious burns or
refer them to their doctor.
• After cooling the area for 20 minutes,
remove any non-viable tissue and apply
an antiseptic if the burn has compromised
the skin integrity. Apply a sterile dressing.
Improved outcome results have been
reported for sustained-release silver
dressings and honey dressings.
• Skin tears often occur in fragile skin of the
elderly. Salvage the skin flap if possible.
Keep the flap moist and stop any bleeding
by using impregnated gauze. Realign the
skin using wound closure strips.
• Cover skin tear with a moist, healing
wound dressing.
• Skin ulcers should be correctly diagnosed
by a doctor before commencing treatment.
• Provide a moist healing environment.
• Use dressings which absorb exudate from
the wound.
• Dressings keep the wound at body
temperature – optimum for new skin
growth.
• Wound closure strips eg, Elastoplast,
Steristrip, Nexcare Butterfly/Steri-strip
Closures
• Wound pad non-stick dressings eg,
Elastoplast, Melolin, Telfa
• Film dressing eg, Elastoplast, Opsite,
Tegaderm
• Dressings impregnated with honey
eg, Manuka Health Wound Dressings,
ApiNate dressing
• Island dressings eg, Elastoplast, Opsite
Post-Op, Nexcare, Telfa, Tegaderm with
pad.
• Silver dressings eg, Acticoat, Allevyn
Ag
• Dressings impregnated with honey
eg, Manuka Health Wound Dressings,
ApiNate dressing
• Hydrocolloid dressings eg, Elastoplast
• Island dressings eg, Elastoplast, Opsite
Post-Op, Nexcare, Telfa, Tegaderm with
pad.
• Silver dressings eg, Acticoat, Allevyn
Ag
• Impregnated gauze eg, Jelonet
• Wound closure strips eg, Elastoplast,
Steristrip, Nexcare Butterfly/Steri-strip
Closures
• Film dressing eg, Elastoplast, Opsite,
Tegaderm
• Follow doctor's advice regarding choice
of wound dressing. Dressings are usually
occlusive as ulcers heal better in a moist
environment. Honey dressings may be
helpful.
• Hydrocolloid/Hydroactive dressings
eg, Elastoplast, Allevyn and Duoderm
• Dressings impregnated with honey
eg, Manuka Health Wound Dressings,
ApiNate dressing
• Wound closure strips hold wound edges together,
are flexible, help reduce scarring and have
hypoallergenic adhesive.
• Non-stick wound pad dressings absorb fluid but
won’t stick to the wound.
• Film dressings are water and bacteria-proof moist
dressings, which do not absorb exudate.
• Self-adhesive island dressings have two types:
– non-waterproof, with non-adherent wound pad,
which absorbs wound exudate without sticking
to the wound.
– waterproof and bacteria-proof dressings which
are covered by a special film. This waterproofs
and protects the wound against bacteria.
The transparent film allows the wound to be
monitored.
• Island dressings – see above.
• Hydrocolloid dressings are highly absorbent,
binding exudate and preventing skin maceration
and breakdown.
• Dressings impregnated with honey help absorb fluid
exudate, keep the wound moist, will not stick to
the wound and have antibacterial properties. Cover
with waterproof dressing, or if moderate to heavy
exudate use a dry dressing with tape and bandage.
Caution: Diabetics may need to monitor blood
sugars (refer to pharmacist).
• Impregnated gauze keeps the area moist.
• Wound closure strips hold wound edges together,
are flexible, help reduce scarring and have
hypoallergenic adhesive.
• Film dressings are water and bacteria-proof moist
dressings, which do not absorb exudate.
• Hydrocolloid dressings are highly absorbent,
binding exudate and preventing skin maceration
and breakdown
• Dressings impregnated with honey help absorb fluid
exudate, keep the wound moist, will not stick to
the wound and have antibacterial properties. Cover
with waterproof dressing, or if moderate to heavy
exudate use a dry dressing with tape and bandage.
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Glossary
WHAT DOES THAT WORD MEAN?
Acute New, immediate, sudden
Absorption Transfer of a substance into another area, eg, into the body through skin or mouth
ACE inhibitor Medicine used to treat heart and blood pressure problems
Adsorption The accumulation of gases, liquids, or solutes on the surface of a solid or liquid
Analgesic Pain-relieving medicine
Angioedema Rapid swelling of the dermis, subcutaneous, mucosa and submucosal tissues. Airway obstruction and suffocation
may result
Antipyretic Medicine which reduces fever
Antitussive Medicine which helps stop coughing
Candidiasis Fungal infection commonly called thrush
Cardiac Relating to the heart
Chronic Long-term medical condition
Congenital anomalies Disease or disorder that is present at birth
Congestion Nose, sinuses or chest blocked with mucus; swollen tissue
Contraindicated Treatment is inadvisable
Emetic A medicine which causes vomiting
Expectorant A medicine which loosens chest congestion
Diabetes mellitus Chronic high blood glucose, now referred to as type 2 diabetes
First-line therapy First choice of medicine for treatment
Gastro-oesophageal reflux Acid stomach contents rising up to cause heartburn
Haematuria Presence of blood in the urine
Heart failure Heart disease
Hepatic Relating to the liver
Humectant Adds moisture or dampness
Hypertension High blood pressure
Hyperthyroidism Overactive thyroid gland causing weight loss and nervousness
Immunosuppression Loss of the normal immune protection
Keratolytic Skin-peeling agent
Malaise Feeling of being unwell or not healthy
Nocturia Frequent need to arise during the night in order to urinate
NSAID Non-steroidal anti-inflammatory drug, used for relief of pain, fever and inflammation
Occlusive Sealed, eg, an occlusive dressing
Opiate/Opioid Originating from or similar to morphine
Papules Red bumps on skin
Pharynx Throat area containing openings to both the trachea and the oesophagus
Pustules Red bumps with pus, on skin
Renal Relating to the kidneys
Rhinitis Inflamed, swollen lining of the nose, common when you have a cold
Secondary infection Infection which develops from an earlier condition
Stools Bowel motion, faeces
Subarachnoid haemorrhage Bleeding into the space between the two membranes that surround the brain
Topical agent Product applied to the skin
Urinary retention Unable to pass urine properly
Vesicles Little pimples with clear fluid
Welt Raised, pink, itchy patch on skin
Page 176 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

Chapter References
Acne
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Dermatology and Allergology 2016;33(2):81-86. doi:10.5114/ada.2016.59146.
Kumari R, Thappa DM. Role of insulin resistance and diet in acne. Indian J Derm Venereol Leprol 2013;79:291-9
Krader C. Energy-based treatment advantages for acne. May 09, 2016. Dermatology Times. http://dermatologytimes.
modernmedicine.com/dermatology-times/news/energy-based-treatment-advantages-acne?page=0,1&Page=0,1
Oakley A. Acne management. Feb 2014. Dermnet. http://www.dermnetnz.org/topics/acne-management/
Tan J. Current Measures for the Evaluation of Acne Severity. Expert review of Dermatology 2008;3(5):595-603.
Medscape http://www.medscape.com/viewarticle/582896
Allergy
Allergy and anaphylaxis guidelines for early childhood services and schools. Allergy NZ. www.allergy.org.nz/site/
allergynz/files//Allergy%20and%20anaphylaxis%20guidelines%20-%20green.pdf
Allergy Overview. Auckland Allergy Clinic. 2016. http://www.allergyclinic.co.nz/allergy_overview.aspx
Anaphylaxis. Allergy New Zealand. http://www.allergy.org.nz/A-Z+Allergies/Anaphylaxis.html
Dust mite allergy. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/dust-mites/basics/lifestyle-homeremedies/con-20028330
The Australasian Society of Clinical Immunology and Allergy (ASCIA). www.allergy.org.au
Asthma and COPD
Asthma. NZ Formulary. http://nzf.org.nz/nzf_1675
COPD. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/copd/basics/treatment/con
Living with Asthma. Asthma and Respiratory Foundation of New Zealand 2016 https://www.asthmafoundation.
org.nz/your-health/living-with-asthma
National Respiratory Strategy. Asthma and Respiratory Foundation of New Zealand 2016 https://www.
asthmafoundation.org.nz/about-us/advocacy/national-respiratory-strategy
Online Pharmaceutical Schedule. http://www.pharmac.govt.nz/healthpros
What is COPD. http://www.copdfoundation.org/What-is-COPD/Understanding-COPD/What-is-COPD.aspx
Yarovah Pl et al. Calcium-sensing receptor antagonists abrogate airway hyperresponsiveness and inflammation in
allergic asthma. Science Translational Medicine, 22 April 2015, doi:10.1126/scitranslmed.aaa0282
Baby Feeding
Feeding Your Baby. July 2015. Ministry of Health. http://www.health.govt.nz/your-health/pregnancy-and-kids/firstyear/6-12-months/feeding-your-baby
Gastric reflux. Symptoms. Crying over spilt milk. https://www.cryingoverspiltmilk.co.nz/reflux/symptoms/
Keeping baby safe in bed: The first 6 weeks http://www.health.govt.nz/your-health/pregnancy-and-kids/first-year/
first-6-weeks/keeping-baby-safe-bed-first-6-weeks
Low Milk Supply. Baby Center.com http://www.babycenter.com/0_low-milk-supply_8487.bc
Pregnancy Nutrition and Baby Feeding Advice. ForBaby http://www.forbaby.co.nz/
Thrush when breastfeeding. Ministry of Health. http://www.health.govt.nz/your-health/conditions-and-treatments/
diseases-and-illnesses/thrush-when-breastfeeding
Bites and Stings
Bites and Stings. St Johns. http://www.stjohn.org.nz/First-Aid/First-Aid-Library/Bites-and-Stings/
Insect bites and stings. http://umm.edu/health/medical/ency/articles/insect-bites-and-stings
Jellyfish stings NZ MOH http://www.health.govt.nz/your-health/conditions-and-treatments/accidents-and-injuries/
bites-and-stings/jellyfish-stings
Jellyfish stings Auckland Regional Public Health Service. http://www.arphs.govt.nz/Portals/0/Health%20
Information/HealthyEnvironments/Factsheets/Recreational%20Water/Jellyfish%20stings/Jellyfish_Stings_Fact_
Sheet.pdf
Lions mane jellyfish fact file. www.arkive.org/lions-mane-jellyfish/cyanea-capillata/
Marine wounds and stings. Dermnet NZ. http://www.dermnetnz.org/arthropods/spider-bites.html
Spider Bites. Dermnet NZ. www.dermnetnz.org/arthropods/spiderbites.html
Bruises, Scars, Spider Veins
Keloids & hypertrophic scars http://www.dermnetnz.org/dermal-infiltrative/keloids.html
Scars. www.nlm.nih.gov/medlineplus/scars.html
Sclerotherapy. http://dermnetnz.org/procedures/sclerotherapy.html
The Northern Clinic Vein centre. http://vein.co.nz/?gclid=CMOs-ubs1qcCFQkMbAodN1ep8A
Varicose veins and spider veins. emedicine. http://emedicine.medscape.com/article/1085530-overview
What are bruises. Nov 2016. NHS Choices. http://www.nhs.uk/chq/Pages/1057.aspx?CategoryID=72
Childhood Diseases and Immunisations
Changes to the National Immunisation Schedule. 28 July 2016. Pharmac https://www.pharmac.govt.nz/news/
notification-2016-07-28-immunisation-schedule/
Chapter 12: Meningococcal disease. Immunisation handbook. Ministry of Health. http://immunisation.book.health.
govt.nz/12+Meningococcal+disease/12.4+Vaccines
Chickenpox (varicella). DermNet NZ. www.dermnetnz.org/viral/varicella.html
Fever in children www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/fever/feverchildren
Hepatitis B. Immunisation advisory center www.immune.org.nz/diseases/hepatitis-b
HPV Vaccination for boys HPV. The New Zealand HPV Project http://www.hpv.org.nz/hpv-vaccination-boys
Immunisation Advisory Centre. Arainga mate. University of Auckland www.immune.org.nz
Genital HPV Infection - Fact Sheet www.cdc.gov/std/hpv/stdfact-hpv.htm
Meningococcal disease. Causes & Transmission. Centers for Disease Control and Prevention. http://www.cdc.gov/
meningococcal/about/causes-transmission.html
New Zealand Immunisation Schedule. http://www.health.govt.nz/our-work/preventative-health-wellness/
immunisation/new-zealand-immunisation-schedule
Position Statement on the Use of Paracetamol Around the Time of Immunisation. July 2015. Immunisation
Advisory Center. University of Auckland. http://www.immune.org.nz/sites/default/files/resources/
AdministrationParacetamolImac20150701V02_0.pdf
Reclassification of vaccines. Published: 14 January 2016 Committees. Medsafe. http://www.medsafe.govt.nz/profs/
class/ReclassificationOfVaccines.asp
The Core Health Checks. Well Child provider visit.Well Child http://www.wellchild.org.nz/wcto-programme/wellchild-provider-visit
Vaccinations. Meningococcal (groups A, C, Y and W-135) congugate. Dec 2016. Online Pharmaceutical Schedule.
http://www.pharmac.govt.nz/Schedule?osq=mening
Vaccines for Meningococcal Disease. The Meningitis Foundation. http://www.meningitis.org.nz/vaccines_for_
meningococcal_disease
Childhood Pain and Baby Teething
Pain in Childhood Special Interest Group The Australian Pain Society. https://www.apsoc.org.au/pain-in-childhood
Reducing and eliminating procedural pain related to needles: The Four essential (non-negotiable) components
Australian Pain Society https://blog.apsoc.org.au/2014/08/21/reducing-and-eliminating-procedural-pain-relatedto-needles-the-four-essential-non-negotiable-components/
Understanding pain and what s to be done about it in 10 minutes Australian pain Society. https://blog.apsoc.org.
au/2014/05/22/understanding-pain-and-whats-to-be-done-about-it-in-10-minutes/
Cold Sores
Herpes Simplex. DermNetNZ. http://dermnetnz.org/viral/herpes-simplex.html
Herpes simplex virus. http://umm.edu/health/medical/altmed/condition/herpes-simplex-virus
Colds
Colds. Ministry of Health. Manatu Hauora. http://www.health.govt.nz/your-health/conditions-and-treatments/
diseases-and-illnesses/colds
Constipation
Constipation. Ministry of Health. Manatu Hauora. http://www.health.govt.nz/your-health/conditions-andtreatments/diseases-and-illnesses/constipation
Contraception and Erectile Dysfunction
Combined oral contraceptive pill. New Zealand family planning. http://www.familyplanning.org.nz/advice/
contraception/combined-oral-contraceptive-pill
Erectile Dysfunction. Selected topics in Men’s health. BPAC Sep 2010 http://www.bpac.org.nz/BT/2010/September/
mens-health.aspx
Erectile Dysfunction. Mayo Clinic May 2016 http://www.mayoclinic.org/diseases-conditions/erectile-dysfunction/
basics/definition/con-20034244
Estrogen and Progestin. Medline Plus. https://www.nlm.nih.gov/medlineplus/druginfo/meds/a601050.html
Oral Contraceptives. New Zealand women to have access to regular repeat supplies of oral contraceptives directly
from their community pharmacist. https://www.psnz.org.nz/Story?Action=View&Story_id=12
Online Pharmaceutical Schedule. http://www.pharmac.govt.nz/healthpros
Contraception: Emergency
Emergency contraception. http://www.health.govt.nz/your-health/healthy-living/sexual-health/emergencycontraception
Emergency Contraception. NZ Family Planning. www.familyplanning.org.nz
Emergency Contraception accreditation training. College Education and Training. PSNZ
Coughs: Dry
Your child’s cough. Kidshealth. http://www.kidshealth.org/parent/general/eyes/childs-cough.html
Cough-symptoms. NHS choices. www.nhs.uk/Conditions/Cough/Pages/Symptoms.aspx
Coughs: Productive
Alerts/Letters. Use of cough and cold medicines in children – updated advice. Medsafe NZ. www.medsafe.govt.nz/
hot/alerts/CoughandCold/InfoOct2009.asp
Your child’s cough. Kidshealth. www.kidshealth.org/parent/general/eyes/childs-cough.html
Cough-symptoms. NHS choices. www.nhs.uk/Conditions/Cough/Pages/Symptoms.aspx
Cuts, Abrasions and Blisters
Abrasions, Cuts, Lacerations. World of Sports Science. www.faqs.org/sports-science/A-Ba-and-timeline/Abrasions-
Cuts-Lacerations.html
Wound care. Family Health Diary. https://www.familyhealthdiary.co.nz/conditions/wound-care-cuts-and-grazes/
Cystitis [Bladder Infection]
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Older Women in Nursing Homes. A Randomized Clinical Trial. JAMA. 2016;316(18):1879-1887. doi:10.1001/
jama.2016.16141
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women. Cochrane Database of Systematic Reviews 2016, Issue 4. Art. No.: CD010745. DOI: 10.1002/14651858.
CD010745.pub2
Trimethoprim accreditation training. College Education and Training. PSNZ
Urinary Tract Infection. Health Navigator New Zealand. https://www.healthnavigator.org.nz/health-a-z/u/urinarytract-infection-uti/
Dandruff
Dandruff Mayo Clinic. www.mayoclinic.com/health/dandruff/DS00456/DSECTION=treatments-and-drugs
Dandruff: How to treat. American Academy of Dermatology. https://www.aad.org/public/diseases/hair-and-scalpproblems/dandruff-how-to-treat
DE Angelis YM, Gemmer CM, Kaczvinsky JR, et al. Three etiologic facets of dandruff and seborrheic dermatitis:
Malassezia fungi, sebaceous lipids, and individual sensitivity. Journal of Investigative Dermatology. Symposium
Proceedings. 2005. 10(3):295–57.
Seborrhoeic dermatitis and eczema. DermNetNZ. http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html
Dermatitis/Eczema
Allergic Contact Dermatitis. DermNet NZ. http://www.dermnetnz.org/dermatitis/contact-allergy.html
Atopic dermatitis. DermNet NZ. http://dermnetnz.org/dermatitis/atopic.html
Cradle cap (infantile seborrhoeic dermatitis) DermNetNZ http://dermnetnz.mobify.me/dermatitis/cradle-cap.html
Dermatitis (Eczema) DermNet NZ www.dermnetnz.org/dermatitis/dermatitis.html
Dry skin. DermNet NZ. http://dermnetnz.org/dermatitis/dry-skin.html
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MediaLibrary/PDF%20Documents/Practice%20and%20Parameters/Contact-dermatitis-2015.pdf
Seborrhoeic dermatitis and eczema. DermNet NZ. http://dermnetnz.org/dermatitis/seborrhoeic-dermatitis.html
The causes of atopic eczema. DermNet NZ. http://dermnetnz.org/dermatitis/atopic-causes.html
Diabetes
Diabetes NZ. https://www.diabetes.org.nz/home
Classification and Diagnosis of Diabetes. American Diabetes Association. http://care.diabetesjournals.org/
content/38/Supplement_1/S8.full
Risk factors. Diabetes. Mayo Clinic. http://www.mayoclinic.org/diseases-conditions/diabetes/basics/risk-factors/
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Diarrhoea and Vomiting
Diarrhoea. Ministry of Health. http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-andillnesses/diarrhoea
Viral gastroenteritis KidsHealth http://www.kidshealth.org.nz/gastroenteritis
Dry Skin
Dry skin. Dermnet NZ. http://www.dermnetnz.org/dermatitis/dry-skin.html
Dry Skin. Mayo Skin Clinic. www.mayoclinic.com/health/dry-skin/DS00560/DSECTION=causes
Icthyosis. Dermnet NZ. http://dermnetnz.org/scaly/ichthyosis.html
Kang BC, Kim YE, Kim YJ, et al. Optimizing EEMCO guidance for the assessment of dry skin (xerosis) for pharmacies.
Skin Res Technol. 2014 Feb;20(1):87-91. doi: 10.1111/srt.12089. Epub 2013 Jul 2.
Ear Conditions
Earache. Ministry of Health. http://www.health.govt.nz/your-health/conditions-and-treatments/diseases-andillnesses/earache
Hall, F (Dr). Otitis Externa - A patient's guide. Family Doctor. www.familydoctor.co.nz
Hearing problems in children. Kids Health NZ www.kidshealth.org.nz/hearing-problems-children#block_2205
Swimmer’s Ear. Mayo Clinic. www.mayoclinic.com
The Good, the Bad and the Eww of Earwax Removal. http://online.wsj.com/news/articles/SB1000087239639044
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Treating ear infections. Deafness Research UK www.deafnessresearch.org.uk
Eye Conditions
Blepharitis www.eyenz.co.nz/patient_info/Blepharitis.htm
Eye Problems and Diseases. www.allaboutvision.com/conditions/
Facts About Age-Related Macular Degeneration. National Eye Institute (NEI). www.nei.nih.gov/health/
maculardegen/armd_facts
Eyes: Contact Lenses
Contact lens subsidy www.health.govt.nz/new-zealand-health-system/claims-provider-payments-andentitlements/contact-lens-subsidy
Cornea & Contact Lens Society of NZ Inc. www.contactlens.org.nz/
Consumer guide to contact lenses www.allaboutvision.com/contacts/
Contact lens council. www.mycontactlenses.org
Laser eye surgery (PRK and Lasix) https://www.southerncross.co.nz/AboutTheGroup/HealthResources/
MedicalLibrary/tabid/178/vw/1/ItemID/146/Laser-eye-surgery-PRK-and-LASIK.aspx
Fever
2017 Revised Classification of Seizures. Febrile seizures. Epilepsy Foundation. http://www.epilepsy.com/learn/
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Athletes foot symptoms www.webmd.com/skin-problems-and-treatments/tc/athletes-foot-symptoms
Cracked Heels. DermNet NZ. http://dermnetnz.org/scaly/cracked-heels.html
Foot corns and callus. DermNet NZ. www.epodiatry.com/corns-callus.htm
Fungal nail infections. DermNet NZ http://dermnetnz.org/fungal/onychomycosis.html
Paronychia. DermNet NZ. http://dermnetnz.org/fungal/paronychia.html
Vurrucae www.scpod.org/foot-health/common-foot-problems/verrucae/
Viral warts. DermNet NZ. http://dermnetnz.org/viral/viral-warts.html
Fungal Infections, superficial
Definition of dermatophytes www.cdc.gov/fungal/dermatophytes/definition.html
Fungal infections. Dermnet NZ. www.dermnetnz.org/fungal/
Mycology of dermatophyte infections www.dermnetnz.org/fungal/mycology.html
Nappy Rash. Dermnet NZ www.dermnetnz.org/dermatitis/napkin-dermatitis
Paronychia DermNet NZ http://dermnetnz.org/fungal/paronychia.html
Pityriasis versicolour. DermNet NZ http://www.dermnetnz.org/fungal/pityriasis-versicolor.html
Ringworm. Vet info. www.vetinfo.com/zringwrm.html
Tinea capitis http://dermnetnz.org/fungal/tinea-capitis.html
Tinea corporis www.dermnetnz.org/fungal/tinea-corporis.html
Tinea cruris www.dermnetnz.org/fungal/tinea-cruris.html
Fungal Nail Infections (Onychomycosis)
Ameen M, Lear JT, Madan V et al. British Association of Dermatologists’ guidelines for the management of
onychomycosis 2014. British Journal of Dermatology 2014;171:937-958 DOI 10.1111/bjd.13358
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onychomycosis. J Eur Acad Dermatol Venerol 2005;19:17–9. doi: 10.1111/j.1468-3083.2005.01283.x
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Gupta AK, Daigle D, Foley KA. Topical therapy for toenail onychomycosis: an evidence-based review. Am J Clin
Dermatol 2014;15(6):489-502. doi: 10.1007/s40257-014-0096-2.
Gupta AK, Simpson FC New pharmacotherapy for the treatment of onychomycosis: an update. Expert Opin
Pharmacother. 2015 Feb;16(2):227-36. doi: 10.1517/14656566.2015.993380. Epub 2014 Dec 19.
How nails grow. American Academy of Dermatology. https://www.aad.org/dermatology-a-to-z/for-kids/aboutnails/how-nails-grow
Lauharanta J. Comparative efficacy and safety of amorolfine nail lacquer 2% versus 5% once weekly. Clin Exp
Dermatol 1992;17: 41–3. doi: 10.1111/j.1365-2230.1992.tb00277.x
Tietz HJ, Hay R, Querner S, et al. Efficacy of 4 weeks topical bifonazole treatment for onychomycosis after
nail ablation with 40% urea: a double-blind, randomized, placebo-controlled multicenter study. Mycoses
2013;56(4):414-21. doi: 10.1111/myc.12037
Gout
Batt C Phipps-Green A, Black M. Sugar-sweetened beverage consumption: a risk factor for prevalent gout with
SLC2A9 genotype-specific effects on serum urate and risk of gout http://ard.bmj.com/content/early/2013/09/10/
annrheumdis-2013-203600.full.pdf
Choi HK, Atkinson K, Karlson EW, et al. Purine-rich foods, dairy and protein intake, and the risk of gout in men. New
England Journal of Medicine 2004;350(11):1093–103.
Choi HK. Diet, alcohol, and gout: how do we advise patients given recent developments. Current Rheumatology
Reports 2005;7(3):220–26.
Gout. Department of Biochemistry. University of Otago. http://biochem.otago.ac.nz/our-people/academic-teachingstaff/tony-merriman/gout/
Gout-symptoms diagnosis treatment. www.southerncross.co.nz/aboutthegroup/healthresources/medicallibrary/
tabid/178/vw/1/itemid/171/gout-symptoms-diagnosis-treatment.aspx
Long term Control Of Gout. NZ Formulary http://nzf.org.nz/nzf_5676?searchterm=gout
Neogi T et al. 2015 Gout Classification Criteria. An American College of Rheumatology/European League Against
Rheumatism Collaborative Initiative. J Arthritis and Rheumatology; 67(10):2557-68. DOI 10.1002/art.39254
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NZRA Consensus Statement on the use of colchicine in the Treatment of Gout. NZ Rheumatology Association www.
rheumatology.org.nz/position_statement.cfm
Haemorrhoids
Hemorrhoids.org www.hemorrhoids.org/
Hemorrhoids and what to do about them. Updated January 27th, 2016. Harvard Health Publications. http://www.
health.harvard.edu/diseases-and-conditions/hemorrhoids_and_what_to_do_about_them
Piles and Haemorrhoids. Unity Health Care. www.ntuchealth.com.sg/articles/detail.php?ID=245
Hair Loss
Clive Hair Clinics. www.cliveclinics.co.nz/?page_id=106
Finasteride. Dermnet NZ http://dermnetnz.org/treatments/finasteride.html
Hair Loss. Dermnet NZ. http://dermnetnz.org/hair-nails-sweat/hair-loss.html
Telogen effluvium. Dermnet NZ http://dermnetnz.org/hair-nails-sweat/telogen-effluvium.html
Hay Fever
Allergic rhinitis (hay fever) Allergy New Zealand. http://www.allergy.org.nz/A-Z+Allergies/
allergic+rhinitis+hay+fever.html
Hay Fever site. Allergy and fungal spores. www.hayfeversite.com/allergy-and-fungal-spores
St Aubyn Crump, Vincent. Pollen allergies and cross reaction in New Zealand. www.allergyclinic.co.nz/guides/26.
html
Waitemata Allergy Clinic www.waitemataallergy.co.nz/
Head Lice
Abdel-Ghaffar F et al. Efficacy of a single treatment of head lice with a neem seed extract: an in vivo and in vitro
study on nits and motile stages. Parasitol Res. 2012 Jan;110(1):277-80. doi: 10.1007/s00436-011-2484-3
Headlicewww.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/headlice
Head lice www.kiwifamilies.co.nz/articles/head-lice/
Head lice. Dermnet NZ. http://dermnetnz.org/arthropods/headlice.html
Head lice advice www.scdhb.health.nz/a-healthy-community/public-health-nursing-service/headlice-advice.html
Head lice and Nits Guide for school communities www.minedu.govt.nz/NZEducation/EducationPolicies/Schools/
SchoolOperations/HealthAndSafety/HeadliceAndNitsGuideForSchoolCommunities.aspx
Management of head lice in primary care. National Prescribing Center www.npc.nhs.uk/merec/therap/infest/
resources/merec_bulletin_vol18_no4_head_lice.pdf
Pediculosis. Emedicine http://emedicine.medscape.com/article/225013-overview
Headache
Headaches www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/headache
Headaches. Danger signs. Medline Plus. US National Library of Medicine. https://www.nlm.nih.gov/medlineplus/
ency/patientinstructions/000424.htm
Migraine. Headache. Neurological Foundation of New Zealand. www.neurological.org.nz
National Headache Foundation. www.headaches.org/
Pray WS. Patients With Headaches: The Pharmacist's Role https://www.uspharmacist.com/article/patients-withheadaches-the-pharmacists-role
Heart Health
Assessment and management of cardiovascular risk. NZ Guidelines Group. www.nzgg.org.nz/guidelines/0035/
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Coronary artery disease. Mayo Clinic. www.mayoclinic.com/health/coronary-artery-disease/DS00064/
DSECTION=risk-factors
Eating and Activity Guidelines. NZ Ministry of Health 2015 http://www.health.govt.nz/our-work/eating-andactivity-guidelines
Heart Foundation of New Zealand www.heartfoundation.org.nz/healthy-living
Scientific report of the 2015 Dietary guidelines Advisory Committee. USDA. http://health.gov/dietaryguidelines/2015-
scientific-report/PDFs/Scientific-Report-of-the-2015-Dietary-Guidelines-Advisory-Committee.pdf
Statistics. General heart statistics in New Zealand. Heart Foundation NZ. http://www.heartfoundation.org.nz/
statistics/
Hyperhidrosis
Excessive sweating – hyperhidrosis www.patient.co.uk/health/Excessive-Sweating.htm
Hyperhidrosis www.dermnetnz.org/hair-nails-sweat/hyperhidrosis.html
Hyperhidrosis www.ncbi.nlm.nih.gov/pubmedhealth/PMH0004518
Indigestion, Heartburn, Gastritis
Diagnosis and Management of Gastroesophageal Reflux Disease. American College of Gastroenterology 2013
Heartburn and Indigestion. http://quickcare.org/gast/heartburn.html
Managing dyspepsia and heartburn in general practice-an update. BPAC NZ www.bpac.org.nz/magazine/2011/
february/dyspepsia.asp
Wyeth J. Reflux and dyspepsia. Pharmacy Today. March 2014
Influenza
Committees. Reclassification of vaccines. http://www.medsafe.govt.nz/profs/class/ReclassificationOfVaccines.asp
Dobson J et al. Oseltamivir treatment for influenza in adults: a meta-analysis of randomised controlled trials. The
Lancet 2015;385(9979):1729-37 http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(14)62449-1/
Immunisation Advisory Centre. Arainga mate. The University of Auckland. www.immune.org.nz
Influenza (flu). Centers for Disease Control and Prevention http://www.cdc.gov/flu/
Influenza. Ministry of Health. www.health.govt.nz/yourhealth-topics/diseases-and-illnesses/influenza
Influenza vaccine composition. www.medsafe.govt.nz/regulatory/flu.asp
Iron Deficiency
A patient’s guide to oral iron supplements. Anemia.org. www.anemia.org/patients/feature-articles/content.
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Bermejo F et al. A guide to diagnosis of iron deficiency and iron deficiency anemia in digestive diseases. World J
Gastroenterol 2009; 15(37): 4638–43. PMCID: PMC2754511
Iron www.nutritionfoundation.org.nz/nutrition-facts/minerals/iron
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Iron. The vegan society. https://www.vegansociety.com/sites/default/files/Iron.pdf
Iron deficiency anemia. PubMed Health. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001610/
Iron deficiency anemia www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/
vw/1/ItemID/150/Iron-deficiency-anaemia.aspx
Iron in the vegan diet. www.vrg.org/nutrition/iron.php
Irritable Bowel Syndrome
Food, FODMAPS and IBS: What to eat and what to avoid. www.healthyfood.co.nz/articles/2011/november/foodfodmaps-and-ibs-what-to-eat-and-what-to-avoid
Fraser A. Irritable Bowel. Gastro-info http://www.gastro-info.co.nz/gastro-information.aspx?pid=5
IBS Diet: What to Do and What to Avoid International Foundation for Functional Gastrointestinal Disorders. http://
www.aboutibs.org/ibs-diet/ibs-diet-what-to-do-and-what-to-avoid.html
Irritable bowel syndrome. Ministry of Health NZ. www.health.govt.nz/yourhealth-topics/diseases-and-illnesses/
irritable-bowel-syndrome
Irritable bowel syndrome. PubMed Health. www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001292/
Irritable bowel syndrome: a patients guide. www.familydoctor.co.nz/index.asp?U=conditions&A=341
Probiotic therapy for IBS. www.ncbi.nlm.nih.gov/pmc/articles/PMC2886445/
Menopause
Breastscreen Aotearoa www.nsu.govt.nz/Current-NSU-Programmes/559.asp?gclid=CKXt0Kr9zqUCFQYHbAodIC
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2012, doi: 10.3109/13697137.2012.707385
Menopause and hot flashes www.webmd.com/menopause/guide/hot-flashes
Menopause - signs, symptoms, diagnosis, treatment www.southerncross.co.nz/AboutTheGroup/HealthResources/
MedicalLibrary/tabid/178/vw/1/ItemID/142/Menopause-signs-symptoms-diagnosis-treatment.aspx
Migraine
Buse DC, Rupnow MFT, Lipton RB. Assessing and Managing All Aspects of Migraine: Migraine Attacks,
Migraine-Related Functional Impairment, Common Comorbidities, and Quality of Life. Mayo Clinic Proceedings.
2009;84(5):422-435.
Migraine. www.neurological.org.nz/disorders/migraine
Migraine and Headaches. Neurological Foundation of New Zealand. www.neurological.org.nz/News/General-
Articles/Article/Migraine+and+headaches/
Migraine headache. A Patients guide. Family doctor. www.familydoctor.co.nz/index.asp?U=conditions&A=29530
Migraine headaches http://umm.edu/health/medical/reports/articles/migraine-headaches
National Headache Foundation. www.headaches.org/
Ravishankar K. The art of history-taking in a headache patient. Annals of Indian Academy of Neurology.
2012;15(Suppl 1):S7-S14. doi:10.4103/0972-2327.99989.
The Migraine Trust www.migrainetrust.org/faqs
Muscular Aches and Pains
Muscle Aches. Medline Plus. www.nlm.nih.gov
Muscle Pain. Mayo Clinic. http://www.mayoclinic.org/symptoms/muscle-pain/basics/causes/sym-20050866
Nappy Rash
Diaper rash. E-Medicine.www.emedicinehealth.com/diaper_rash/page2_em.htm
Diaper rash pictures. Desitin. https://www.desitin.com/identifying-diaper-rash/pictures-of-diaper-rash
Napkin dermatitis http://dermnetnz.org/dermatitis/napkin-dermatitis.html
Nappy rash. The Royal Children’s Hospital Melbourne. www.rch.org.au/clinicalguide/guideline_index/Nappy_Rash/
Oral Health
Common issues in paediatric oral health. Best Practice Update. Issue 27. April 2010. www.bpac.org.nz/
magazine/2010/april/oral.asp
Teeth and gums. NZ MOH http://www.health.govt.nz/your-health/healthy-living/teeth-and-gums
Types of gum disease. American Academy of Periodontology www.perio.org/consumer/2a.html
Osteoarthritis
Osteoarthritis www.mayoclinic.org/diseases-conditions/osteoarthritis/basics/definition/CON-20014749
Osteoarthritis NZ Arthritis Foundation www.arthritis.org.nz/index.php/Osteoarthritis.html
Osteoporosis
Better bones fewer fractures. Osteoporosis New Zealand. http://osteoporosis.org.nz/
Calcium. Nutrition Foundation. www.nutritionfoundation.org.nz/nutrition-facts/minerals/calcium
Osteoporosis. https://www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/tabid/178/vw/1/
ItemID/131/Osteoporosis-symptoms-treatment-prevention.aspx
National Osteoporosis Foundation www.nof.org
NZ Nutrition Foundation www.nutritionfoundation.org.nz/nutrition-facts/minerals/calcium
Period Pain and Endometriosis
Endometriosis centre, Ascot Hospital www.endometriosis-ascot.co.nz/
Endometriosis NZ www.nzendo.co.nz
Premenstrual syndrome Pub med health www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002474/
Premenstrual syndrome - a patients guide. Family Doctor NZ. www.familydoctor.co.nz/index.
asp?U=conditions&A=32701
Poisonings
Facts about childhood poisoning www.poisons.co.nz/fact.php?f=22&c=23
National Poisons and Hazardous Chemical Information Centre www.poisons.co.nz
National Poisons Centre continues to deliver. Poisonsline 25/06/2015 http://www.poisons.co.nz/news.php?n=99
Peiris-John, R., Kool, B. and Ameratunga, S. (2014), Fatalities and hospitalisations due to acute poisoning among
New Zealand adults. Intern Med J, 44: 273 281. doi:10.1111/imj.12364
Poisonous plants. Landcare research. http://www.landcareresearch.co.nz/publications/factsheets/poisonous-plants
Poisoning. Safe Kids Aotearoa http://www.safekids.nz/Safety-Topics/Details/Type/View/ID/10/Poisoning
Poisonous plants. www.landcareresearch.co.nz/publications/factsheets/poisonous-plants
TOXINZ Poisons information. www.toxinz.com/
Understanding suicide in New Zealand. Ministry of Health. http://www.health.govt.nz/our-work/mental-healthand-addictions/working-prevent-suicide/understanding-suicide-new-zealand
Pregnancy Tests and Supplements
Choosing Your Midwife. Find Your Midwife https://www.findyourmidwife.co.nz/howichoose
Folic acid and Spina Bifida/iodine and Iodine deficiency. www.healthed.govt.nz/resource/folic-acid-and-spinabifidaiodine-and-iodine-deficiency
How long it takes to conceive. Baby Center.com http://www.babycenter.com/how-long-does-it-take-to-getpregnant
List of safe food in pregnancy. www.foodsmart.govt.nz/information-for/pregnant-women/list-of-safe-food.htm
Maternity. Supplement (tablet) to take when pregnant or breastfeeding. MOH. www.moh.govt.nz/moh.nsf/
indexmh/pregnancy-supplement
Understanding your fertility. www.fertilityassociates.co.nz/Understanding-your-fertility.aspx
Vitamin D and your pregnancy. www.health.govt.nz/your-health/healthy-living/pregnancy/nutrition-duringpregnancy/vitamin-d-and-your-pregnancy
Preventive Health
2016/17 guideline update for cardiovascular disease risk assessment. Ministry of Health http://www.health.govt.
nz/our-work/diseases-and-conditions/cardiovascular-disease/2016-17-guideline-update-cardiovascular-diseaserisk-assessment
About skin cancer. Cancer society NZ https://auckland-northland.cancernz.org.nz/en/reducing-cancer-risk/whatyou-can-do/sunsmart/about-skin-cancer/
Antenatal screening and testing for Down syndrome and other conditions. Health Ed. www.healthed.govt.nz/
resource/antenatal-screening-and-testing-down-syndrome-and-other-conditions
Bowel cancer programme www.health.govt.nz/our-work/diseases-and-conditions/cancer-programme/bowelcancer-programme
Eating and Activity Guidelines. NZ Ministry of Health 2015. http://www.health.govt.nz/our-work/eating-andactivity-guidelines
Gabriel K. Age Specific Screening and Preventative Medicine – New Zealand General Practice https://www.rnzcgp.
org.nz/assets/documents/Training-and-Beyond/Dr-Kevin-Gabriel-Age-Specific-Screening.pdf
High level of HIV diagnoses in New Zealand persists in 2015 University of Otago Newsletter May 2016. http://
www.otago.ac.nz/news/news/otago612512.html
HIV/Aids. NZ Ministry of Health. www.health.govt.nz/your-health/conditions-and-treatments/diseases-andillnesses/hiv-aids
National Screening Unit. Current NSU programmes. www.nsu.govt.nz/current-nsu-programmes/index.asp
NZ Breast Cancer Foundation www.nzbcf.org.nz
Obesity data and stats. NZ Ministry of Health. http://www.health.govt.nz/nz-health-statistics/health-statistics-anddata-sets/obesity-data-and-stats
Physical activity NZ Ministry of Health www.health.govt.nz/our-work/preventative-health-wellness/physical-activity
Preventive health/wellness. NZ Ministry of Health. www.health.govt.nz/our-work/preventative-health-wellness
Prostate cancer http://prostate.org.nz/prostate-cancer/
Prostate cancer screening. USPSTF. http://www.uspreventiveservicestaskforce.org/Page/Document/
UpdateSummaryFinal/prostate-cancer-screening
Reducing harm from falls www.hqsc.govt.nz/our-programmes/reducing-harm-from-falls/
The smokefree coalition. www.sfc.org.nz/infohealtheffects.php
Tobacco control. NZ Ministry of Health. www.health.govt.nz/our-work/preventative-health-wellness/tobaccocontrol
Probiotics
Bifidobacteria. Medline Plus. https://medlineplus.gov/druginfo/natural/891.html
Cayzeele-Decherf A, P lerin F, Leuillet S, et al. Saccharomyces cerevisiae CNCM I-3856 in irritable bowel syndrome:
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Dosage. Probiotic Advisor. https://www.probioticadvisor.com/probiotic-essentials-2/dosage/
Fakruddin M, Hossain MN, Ahmed MM, et al.Antimicrobial and antioxidant activities of Saccharomyces cerevisiae
IFST062013, a potential probiotic. BMC Complement Altern Med. 2017 Jan 21;17(1):64. doi: 10.1186/s12906-
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Immune System. National Institute of Allergy and Infectious Diseases. www.niaid.nih.gov/topics/immuneSystem/
Pages/immunity.aspx
Kelesidis, T. Efficacy and safety of the probiotic Saccharomyces boulardii for the prevention and therapy of
gastrointestinal disorders. David Geffen School of Medicine, UCLA, Los Angeles, CA. http://www.ncbi.nlm.nih.gov/
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Lactobacillus. Medline Plus. https://medlineplus.gov/druginfo/natural/790.html
Mouton G. The use of prebiotics www.optibacprobiotics.co.uk/about-probiotics/the-uses-of-prebiotics.html
Probiotics. Therap Adv Gastroenterol. 2012 March; 5(2): 111–25.
Probiotics: In Depth. National Center for Complementary and Integrative Health https://nccih.nih.gov/health/
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Psoriasis
Psoriasis. Dermnet NZ. http://dermnetnz.org/scaly/psoriasis-general.html
Psoriasis. www.blackmoresnz.co.nz/health-topics/psoriasis
Psoriasis - a patient's guide. Skin problems.Family Doctor. http://www.familydoctor.co.nz/categories/skin-problems/
psoriasis-a-patients-guide/
Scabies
Oakley A. Scabies. Dermnet NZ. http://www.dermnetnz.org/topics/scabies/
Scabies. Diagnosis and management. BPAC NZ. www.bpac.org.nz/magazine/2009/february/docs/bpj19_scabies_
pages_12-16.pdf
Scabies www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/scabies
Scabies leaflet www.healthed.govt.nz/uploads/docs/HE4191.pdf
Shingles
Herpes Zoster. Dermnet NZ. http://www.dermnetnz.org/topics/herpes-zoster/
Mikaeloff Y, Kezouh A, Suissa S. Nonsteroidal anti-inflammatory drug use and the risk of severe skin and soft tissue
complications in patients with varicella or zoster disease. www.ncbi.nlm.nih.gov/pubmed/18251759
Post-herpetic neuralgia - Treatment. www.nhs.uk/Conditions/postherpetic-neuralgia/Pages/Treatment.aspx
ZOSTAVAX® Zoster Vaccine Live (Oka/Merck). April 2016. http://www.medsafe.govt.nz/profs/Datasheet/z/
Zostavaxinj.pdf
Shingles. DermNet NZ http://dermnetnz.org/viral/herpes-zoster.html
Sinus and Nasal Problems
Acute sinusitis. www.patient.co.uk/health/acute-sinusitis
Sinusitis and Allergy. www.allergy.org.au/patients/allergic-rhinitis-hay-fever-and-sinusitis-and-allergy
What are the symptoms of sinusitis. www.niaid.nih.gov/topics/sinusitis/pages/symptoms.aspx
Sleep Problems and Snoring
Breathing technique claims to send you to sleep in 60 seconds. NZ Herald. http://www.nzherald.co.nz/lifestyle/
news/article.cfm?c_id=6&objectid=11444015
Page 179

Chapter References (continued)
Gordon A. Your Sleep Cycle Revealed. https://www.psychologytoday.com/blog/between-you-and-me/201307/yoursleep-cycle-revealed
Melatonin - Don't lose sleep over it. www.saferx.co.nz/full/melatonin.pdf
Sleep hygiene. sleepfoundation.org
Tips for Getting a Good Night’s Sleep. HelpGuide.org http://www.helpguide.org/articles/sleep/how-to-sleep-better.
htm
Smoking Cessation
Heart foundation NZ www.heartfoundation.org.nz/healthy-living/quitting-smoking
Ministry of Health. (2015). Annual Update of Key Results 2014/15: New Zealand Health Survey. Wellington:
Ministry of Health.
Tips for quitting. Quitline. https://www.quit.org.nz/46/staying-quit/tips-for-quitting
Pacific People and Tobacco Smoking In New Zealand. www.heartfoundation.org.nz/programmes-resources/pacificsmoke-free
Smokefree Aotearoa NZ 2025 http://smokefree.org.nz/
Sore Throats
Sore Throat in Adults. Health Navigator New Zealand http://www.healthnavigator.org.nz/health-a-z/s/sore-throat/
Sore throats. Medicine Net www.medicinenet.com/sore_throat/page3.htm
Strep throat: Causes. Symptoms. www.southerncross.co.nz/AboutTheGroup/HealthResources/MedicalLibrary/
tabid/178/vw/1/ItemID/533/Strep-throat-causes-symptoms-treatment.aspx
Sore throat www.health.govt.nz/your-health/conditions-and-treatments/diseases-and-illnesses/sore-throat
Sore Throat Clinics. Ministry of Health. Revised 03/2016 http://www.health.govt.nz/your-health/conditions-andtreatments/diseases-and-illnesses/sore-throat/sore-throat-clinics#listofclinics
Strains and Sprains
Knee Ligament Injuries. www.patient.co.uk/health/knee-ligament-injuries-leaflet
Management of acute soft tissue injuries. The “RICED” regimen http://sportsphysiotherapy.org.nz/documents/
SPNZ%20RICED.pdf
Non Steroidal Anti-Inflammatory Drugs in the Treatment of Sports Injury. www.physioroom.com/injuries/
supplements/nsaids.php
R.I.C.E.D. ACC http://www.acc.co.nz/preventing-injuries/playing-sport/common-sports-injuries/pi00110
Sprains and strains NIAMS www.niams.nih.gov/Health_Info/Sprains_Strains/default.asp
Sprains and Strains. www.patient.co.uk/health/Sprains-and-Strains.htm
Sprains, strains and bruises. www.stjohn.org.nz
Suncare
Cancer Society of NZ www.cancernz.org.nz
Melanoma. DermNet NZ. www.dermnetnz.org/lesions/melanoma.html
Melanoma Research Foundation www.melanoma.org
Metservice www.metservice.com/national/home
Sunburn. DermNet NZ. www.dermnetnz.org/reactions/sunburn.htmlSun protection
Sunsmart NZ www.sunsmart.org.nz
Suncare: Eye Protection
A Guide to Sports & Activity Tints. www.vsp.com/lens-tints.html
Cheap sunglasses protect and meet the standard. Standards NZ http://www.standards.co.nz/touchstone/
consumer-safety/2015/dec/cheap-sunglasses-can-provide-good-uv-protection/
How to chose sunglasses www.rei.com/expertadvice/articles/sunglasses.html
Prevent eye damage: protect yourself from UV radiation. National Eye Institute, National Institute of Health, U.S.
Department of Health and Human Services www.epa.gov/sunwise/doc/eyedamage.pdf
Protecting people and the environment from the harmful effects of radiation. Australian Government Australian
radiation protection and Nuclear Safety Agency. www.arpansa.gov.au
Eye protection from ultraviolet radiation. The Cancer Council Australia. www.cancer.org.au/file/policypublications/
pseyeprotectionaug06.pdf
What is age-related macular degeneration. Eye smart. AAO http://www.geteyesmart.org/eyesmart/diseases/agerelated-macular-degeneration/
Your Guide to Sport Sunglass Lens Tints www.allaboutvision.com/sportsvision/lens-tints-chart.htm
Sweating: Excessive (Hyperhidrosis)
Excessive sweating. Palm clinic. http://www.palmclinic.co.nz/botox-fillers/botox-fillers-treatments-by-concern/
botox-for-excessive-sweating?gclid=Cj0KEQiAw_DEBRChnYiQ_562gsEBEiQA4LcsspYduBc9SicR3CyHLAz-
AmG0ehuhyRbT5HXe3-15lawaAnNN8P8HAQ
Hyperhidrosis www.dermnetnz.org/hair-nails-sweat/hyperhidrosis.html
Hyperhidrosis www.nlm.nih.gov/medlineplus/ency/article/007259.htm
Toothache
Dental caries (tooth decay) www.dentalhealth.ie/dentalhealth/causes/dentalcaries.html
Guidelines for the Use of Fluorides NZ Guidelines Group www.moh.govt.nz/moh.nsf/pagesmh/9664/$File/
guidelines-for-the-use-of-fluoride-nov09.pdf
Healthy Smiles. www.healthysmiles.org.nz
Structure and function of teeth www.dentalhealth.ie/children/structure.html
Types of gum disease. American Academy of Periodontology www.perio.org/consumer/2a.html
Travel Health
Dengue and severe dengue. www.who.int/mediacentre/factsheets/fs117/en/
Dengue Fever. World Health Organization. http://www.who.int/csr/don/archive/disease/dengue_fever/en/
Dengue Fever, Zika & Chikungunya www.arphs.govt.nz/health-information/communicable-disease/dengue-feverzika-chikungunya#.VLgkqlp4rGs
Dengue vaccine initiative http://www.denguevaccines.org/sites/default/files/Statement%20by%20the%20
Dengue%20Vaccine%20Initiative%20on%20Philippines'%20FDA%20Regulatory%20Approval%20of%20
Dengvaxia.pdf
Immunization Advisory Centre (NZ Childhood Immunization Schedule) www.immune.org.nz
Mexican safety agency approves first use of dengue vaccine. Dec 10 2015. http://www.nzherald.co.nz/business/
news/article.cfm?c_id=3&objectid=11558750
Reyes N, et al. The Pre-Travel Consultation. Deep Vein Thrombosis & Pulmonary Embolism Yellow Book http://
wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travel-consultation/deep-vein-thrombosis-pulmonary-embolism
Safe Travel NZ www.safetravel.govt.nz
WHO – World Health Organization International Travel and Travel Health Advice www.who.int/ith/
Zika virus. CDC. http://www.cdc.gov/zika/
Travel Sickness
Hicks, R.Travel Sickness. BBC Health. www.bbc.co.uk/health/physical_health/conditions/travelsickness1.shtml
Motion sickness - causes. www.nhs.uk/Conditions/Motion-sickness/Pages/Causes.aspx
Motion sickness overview. E-medicine health www.emedicinehealth.com/motion_sickness/article_em.htm
Urinary Incontinence
Nocturnal Enuresis in Children www.patient.co.uk/doctor/nocturnal-enuresis-in-children
NZ Continence Association www.continence.org.nz/
Srikrishna S. Management of overactive bladder syndrome. Postgrad Med J. 2007; 83(981): 481–6. doi: 10.1136/
pgmj.2007.057232 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2600101/
The Kiwi Enuresis Encopresis Association KEEA www.keea.org.nz/
Urinary incontinence Mayo clinic www.mayoclinic.org/urinary-incontinence/types.html
Urinary incontinence in children. National Kidney and Urologic Diseases Information Clearinghouse (NKUDIC)
http://kidney.niddk.nih.gov/kudiseases/pubs/uichildren/
Urticaria
Acute urticaria www.patient.co.uk/health/acute-urticaria-hives
Burning & Stinging Nettles www.ipm.ucdavis.edu/PMG/PESTNOTES/pn74146.html
Hives www.healthline.com/health/hives
Urticaria (hives, nettlerash) www.users.globalnet.co.uk/~aair/urticaria.htm
Urticaria – Hives. American Academy of Dermatology www.aad.org/public/publications/pamphlets/skin_urticaria.
html
Urticaria. DermNet NZ http://dermnetnz.org/reactions/urticaria.html
Vaginal Thrush
Best probiotics for treating candida. www.livestrong.com/article/485722-best-probiotics-for-candida-cure/
Women's Health. Mayo Clinic. http://www.mayoclinic.org/healthy-lifestyle/womens-health/in-depth/vagina/art-
20046562?p=1
Vaginal thrush. Pharmacy self-care column. http://psnz.www0-w2k3.net24.net.nz/public/selfcare/self_care_fact_
cards/columns/vaginal%20thrush.aspx
Vulvovaginal candidiasis DermNet NZ http://dermnetnz.org/fungal/vaginal-candidiasis.html
Varicose Veins and Support Stockings
Compression stockings for varicose veins. VariStop. http://www.varistop.com/compression-stockings-varicoseveins/
Deep vein thrombosis and pulmonary embolism http://wwwnc.cdc.gov/travel/yellowbook/2016/the-pre-travelconsultation/deep-vein-thrombosis-pulmonary-embolism
Sclerotherapy. http://dermnetnz.org/procedures/sclerotherapy.html
The Northern Clinic Vein centre. http://vein.co.nz/?gclid=CMOs-ubs1qcCFQkMbAodN1ep8A
Travellers’ Thrombosis www.medsafe.govt.nz/profs/PUarticles/travthromb.htm
Varicose veins and spider veins. emedicine. http://emedicine.medscape.com/article/1085530-overview
Vein Treatments and Symptoms. Skin Institute. http://www.skininstitute.co.nz/
Vitamins and Dietary Supplements
Eating and Activity Guidelines. NZ Ministry of Health 2015 http://www.health.govt.nz/our-work/eating-andactivity-guidelines
Kamangar F, Emadi A. Vitamin and Mineral Supplements: Do We Really Need Them? International Journal of
Preventive Medicine. 2012;3(3):221-226.
Maternity. Supplement (tablet) to take when pregnant or breastfeeding. MOH. www.moh.govt.nz/moh.nsf/
indexmh/pregnancy-supplement
Mursu J, Robien K, Harnack LJ, et al. Dietary supplements and mortality rate in older women: the Iowa Women's
Health Study. Arch Intern Med. 2011 Oct 10;171(18):1625-33. doi: 10.1001/archinternmed.2011.445.
Nutrition: Iodine status in NZ. MOH. www.moh.govt.nz/moh.nsf/indexmh/nutrition-iodine#importance
Warts
Akram S and Zaman H. Warts and verrucas: assessment and treatment. The Pharmaceutical Journal 9 JUN
2015 http://www.pharmaceutical-journal.com/learning/learning-article/warts-and-verrucas-assessment-andtreatment/20068680.article
Viral warts. Dermnet NZ http://dermnetnz.mobify.me/viral/viral-warts.html
Warts. KidsHealth. www.kidshealth.org.nz/index.php/ps_pagename/contentpage/pi_id/195
Weight Loss
Body Mass Index www.nutritionfoundation.org.nz/nutrition-facts/nutrition-a-z/BMIHealthy weight for Adults.
Health Ed. MOH NZ www.healthed.govt.nz/uploads/docs/HE1324.pdf
Childhood obesity 'an exploding nightmare', says health expert. The Guardian. http://www.theguardian.com/
society/2016/jan/25/childhood-obesity-commission-world-health-organisation
Nearly one-third of the world s population is obese or overweight, new data show. Institue for Health metrics and
Evaluation (IHME). http://www.healthdata.org/news-release/nearly-one-third-world%E2%80%99s-populationobese-or-overweight-new-data-show
Onakpoya I, Hung S, Perry R, et al. The use of garcinia extract (hydroxycitric acid) as a weight loss supplement: a
systematic review and meta-analysis of randomised clinical trials. Journal of Obesity 2011: 509038
Worms
Flea and worm. Pets at home. www.petsathome.com/webapp/wcs/stores/servlet/Info_10601_cat-flea-andworm_-1_10551
Parasites – Enterobiasis (also known as pinworm infection) CDC www.cdc.gov/parasites/pinworm/gen_info/faqs.
html
Pinworms. www.dermnetnz.org/arthropods/pinworm.html
Pinworms. E-Medicine Health. www.emedicinehealth.com/pinworms/article_em.htm
Pinworms. Kidshealth. http://kidshealth.org/parent/infections/stomach/pinworm.html
Pinworms. medline Plus. www.nlm.nih.gov/medlineplus/ency/article/001152.htm
What every pet owner should know about roundworms and hookworms. www.cdc.gov/healthypets/Merial_
CDCBroch_rsgWEB.pdf
Vet care www.vetfirst.co.nz/vetcare/PageID/12/ViewPage/Worm-treatments/
Wound Care
Leg ulcers. www.dermnetnz.org/site-age-specific/leg-ulcers.html
St John. www.stjohn.org.nz/First-Aid/First-Aid-Library/Burns/
The NZ Wound Care Society. www.nzwcs.org.nz/
Wound Care. E-Medicine Health. www.emedicinehealth.com/wound_care/article_em.htm
Wound infection in clinical practice. International Wound Infection Institute. 2016. http://www.woundinfectioninstitute.com/wp-content/uploads/2017/03/IWII-Wound-infection-in-clinical-practice.pdf
Page 180 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

NUROMOL. A PAIN RELIEVER
COMBINATION TO RECOMMEND FOR
4 VERY GOOD REASONS
1 STRONGER PAIN RELIEF *1,2
3 CODEINE FREE
2 LONGER LASTING 4 *1,2
REASONS TO RECOMMEND NUROMOL
UNIQUE SYNCHRO-TECH
TECHNOLOGY
Mean pain relief and intensity differences shown at each time point
Mean pain relief (intention and intensity to treat population) differences shown at each time point (intention to treat population)
Sum of the pain intensity difference and the pain relief score
2 x ibuprofen 200mg/
codeine 12.8mg
2 x ibuprofen 200mg/
paracetamol 500mg
(NUROMOL)
2 x paracetamol 500mg/
codeine 15mg
Time (hours)
Adapted from Fig. 2 Daniels et al Pain 152 (2011) 632-642.
Adapted from Fig. 2 Daniels et al Pain 152 (2011) 632-642.
STRONGER
FOR LONGER
PAIN RELIEF *
*vs. Paracetamol & Paracetamol + Codeine in dental pain studies.
References: 1. Mehlisch D et al. Clinical Therapeutics 2010;32(6):1033-49 2. Daniels S et al. Pain 2011;152:632-42
Each tablet contains: Ibuprofen 200mg, Paracetamol 500mg. Contra: stomach ulcer, pregnancy 3rd trimester, renal, cardiac or stomach ulcers. Prec: previous history of peptic
ulcer, GI bleeds, asthma, cardiovascular disease. Adverse: GI ulcer, bleeding, fluid retention, increased risk of CV event. Use lowest possible dose for shortest period of time.
Do not exceed 1200mg ibuprofen/24 hrs. Nuromol maximum of 6 tablets/24hrs. Read pack for dosing details. Reckitt Benckiser, Auckland. 0508 731 234. TAPS DA1628JD

Significant learning
opportunity: Wound care
Your new Group 3 CPD project
www.pharmacytoday.co.nz
Click on the ELearning link to start your project
A word from the facilitator
My name is Dr Alesha Smith.
I have a PhD in pharmacy and public health and I have worked as an academic
and research consultant in healthcare for more than 10 years, both in New
Zealand and overseas. My research and work focuses on improving patient
outcomes through quality use of medicines, guideline development, the use
of innovative health IT solutions and extending pharmacy services.
From working in the education sector for many years I know that learning
to reflect on your practice is new to many experienced pharmacists and
it can be difficult and rewarding in equal, or unequal, measure.
In conjunction with the Pharmacy Today ELearning team, we are pleased
to offer a course that will guide you through the fundamentals of reflective
practice and provide you with the tools and material to complete some
learning that will help you meet the requirements of a Group 3 CPD project.
Our first topic is skin infections. This topic has been chosen to
support ACC in their goal of reducing preventable skin infections
over the next five years and they need pharmacists help!
Group 3 projects require you to undertake activities where an assessment of existing
practice (as an individual or within a pharmacy practice), and the needs and barriers
to changes in this practice is undertaken prior to the development of a particular
activity. As a result, the activity addresses identified learning needs with a reflection
post activity to evaluate practice change or outcomes resulting from the activity.
This course will give you online tools to assess your areas for learning through
the documentation and reflection of patient encounters matched against best
practice recommendations. We will then provide you with resources for enhancing
your knowledge and activities to help you upskill in a particular area related to
preventable skin infections. Following this, we will provide a tool to help you assess
and reflect on your learning and document how this has impacted your practice.
You will also have the opportunity to find a learning partner or connect with likeminded
pharmacists through the use of our online discussion boards and forums.
I am looking forward to working with pharmacists from across New Zealand to help
you complete a successful and meaningful Group 3 project.
Dr Alesha Smith
GROUP 3
Project
guideline
ONE TWO THREE FOUR
Assess your areas
for learning using
patient encounter
reflection forms.
Advertise for a
learning peer
Access resources
for enhancing your
knowledge based
on your knowledge
gaps
Undertake
activities
to upskill
Assess and
reflect on your
learning and print
your learning log

2017-2018 Healthcare Handbook
Reference
Charts
Medicines Safety-----------------------------------------------------183
OTC Medicines: Interactions--------------------------------------184
OTC Medicines: Precautions--------------------------------------191
OTC Medicines: Adverse Effects---------------------------------195
Herbal Supplements: Interactions------------------------------197
Drugs in Sport--------------------------------------------------------206
Drugs in Aviation----------------------------------------------------208
Drugs in Diving-------------------------------------------------------209
Drugs in Pregnancy-------------------------------------------------210
Drugs in Driving -----------------------------------------------------211
NZ Support Groups-------------------------------------------------212
Page 181

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Medicines Safety
The New Zealand Pharmacovigilance Centre (NZPhvC) is the main body in
New Zealand responsible for monitoring the safety of medicines and related
products in New Zealand through voluntary reporting of adverse events. The
NZPhvC oversees the Centre for Adverse Reactions Monitoring (CARM), the
Medication Error Reporting Programme (MERP) and the Psychoactive Substances,
Recreational Substances & Legal Highs reporting programme.
Adverse Reactions Monitoring
CARM collects and evaluates spontaneous reports of adverse reactions to
medicines, vaccines, herbal products and dietary supplements sent in by health
professionals, patients and pharmaceutical companies throughout New Zealand.
These reports are routinely shared with Medsafe. Over 110,000 reports are
currently held by the CARM database providing New Zealand-specific information
that can help contribute to knowledge already known about the adverse reaction
profiles of certain medicines or complementary therapies. This knowledge can
help support clinical decision making.
CARM also undertakes regular analysis of the database to identify any
significant patterns of adverse reactions. These results may be considered by
the Medicines Adverse Reactions Committee who may suggest to Medsafe that
relevant prescribing advice for a particular product be emphasised or changed.
This should result in the safer use of the medicine concerned.
Information collected by CARM and other international monitoring centres
is fed into the World Health Organization’s International Drug Monitoring
Programme database, based in Uppsala, Sweden. This allows New Zealand and
other countries to keep abreast of the latest concerns around drug safety as
they emerge. New Zealand is the third highest reporting country globally, behind
Singapore and the United States of America.
What to report
It is important to report any suspect reactions of clinical concern. This includes
adverse reactions or interactions to all:
••
medicines
••
vaccines
••
over the counter remedies or medicines
••
herbal, traditional and alternative remedies.
Reactions and interactions that are serious and medically significant should
always be reported; however, if you are unsure of its significance, report it!
It is also important to report ANY serious allergic reactions so that a danger
warning can be entered against the patient’s name in the national health
database, so re-exposure can be avoided for that individual.
How to report
Anybody can report an adverse event. An online reporting form is available on the
NZ Pharmacovigilance Centre website (nzphvc.otago.ac.nz). A link to this site
is also available through Medsafe (www.medsafe.govt.nz/profs/adverse/
reactions.asp). Alternatively, reports can be made to CARM by telephone
(03 479 7247) or by downloading the ADR Reporting Card from nzphvc.
otago.ac.nz/reporting-forms. Once completed, these can be either faxed
(03 479 7150), emailed (nzphvc@otago.ac.nz), or posted back to:
NZPhvC
University of Otago Medical School
PO Box 913
Dunedin 9054
NEW ZEALAND
Medication Error Reporting Programme (MERP)
MERP collects and analyses voluntary reports from healthcare professionals of
actual and ‘near miss’ medication errors occurring in primary care. Its aim is to
enhance the safety of medication use for New Zealanders by sharing information
about medication errors to reduce and prevent other harmful medication errors.
An online reporting form for MERP is available on the NZ Pharmacovigilance
Centre website (nzphvc.otago.ac.nz/merp/report/).
Psychoactive Substances, Recreational
Substances & Legal Highs
This programme aims to provide a way for health professionals and members of
the public to report reactions to psychoactive substances. The programme was
developed by CARM in response to a request by the Psychoactive Substances
team at the Ministry of Health. Each individual report is anonymised for both
patient and reporter and findings are used by the Ministry of Health as part
of their ongoing safety review of products that are under review in terms of
the Psychoactive Substances Act. An online reporting form is available on the
NZ Pharmacovigilance Centre website (nzphvc.otago.ac.nz/substance/). The
online form also links to a gallery of images of currently known psychoactive
substances, which can be used to help identify the substance of concern.
M 2 Medicines monitoring scheme
M 2 is a medicines monitoring scheme which aims to:
• • highlight safety concerns identified from reports of suspected adverse
medicine reactions sent to CARM
• • encourage further reports and increase the information on these potential
safety concerns.
This helps CARM and Medsafe to investigate these safety concerns and decide
if any action needs to be taken. It is important to note that the appearance of a
possible safety issue to a medicine does not mean that Medsafe and CARM have
concluded that this medicine causes the reaction.
Current medicines with safety concerns on the M 2 list at the time of going to
print were:
• • Viekira Pak and Viekira Pak-RBV – possible effects on blood glucose control
when used in people with type 2 diabetes
• • iodine-containing contrast agents – possible risk of hypothyroidism in infants
exposed to these agents
• • rivaroxaban, dabigatran, apixaban – possible risk of alopecia (hair loss).
Medicines remain on the M 2 list for approximately six months and the list of
medicines being monitored changes regularly. For more information see www.
medsafe.govt.nz/safety/EWS/monitoring-communications.asp
Page 183

OTC Medicines: Interactions
When selling off-the-shelf medicines, Pharmacy, or Pharmacist Only medicines it
is important that the pharmacist checks the product being sold does not interact
with any other medicines the customer is already taking.
Interactions in this table are generally clinically relevant in the community
pharmacy environment. This table is NOT ALL INCLUSIVE, and does not
include isolated reports of interactions, theoretical interactions, undocumented
interactions, or interactions with uncommonly prescribed medications.
When considering a potential interaction, consider the importance of stable
blood levels of the concomitant medication, especially for those products with a
narrow therapeutic index (eg, warfarin, digoxin).
Base product choice on effectiveness and likelihood of interaction.
Take into consideration dose and frequency of administration of the pharmacy-
sourced medication in determining how clinically relevant the interaction will be
(eg, short-term infrequent dosing of a NSAID will usually have clinically irrelevant
effects on blood pressure).
Always recommend antacids be taken at least two hours apart from other
medications, since they can affect the absorption of many drugs.
Customers prescribed colestipol and cholestyramine should be reminded these
medications can cause reduced or delayed absorption of most medicines and to
administer separately, at least one hour before or 4–6 hours after cholestyramine
or colestipol.
See the New Zealand Formulary (nzf.org.nz) or individual drug datasheets
(www.medsafe.govt.nz) for more information.
OTC Medicines: Interactions
Drug/drug group Interacting substance Details
Analgesics – aspirin
(moderate-high dose)
(Interactions are usually not
clinically relevant with low
dose aspirin
eg, 75–100mg/day)
ACE inhibitors and angiotensin II
receptor blockers
Acetazolamide
Increased risk of renal impairment
Reduced antihypertensive effect. Low dose aspirin combination acceptable
Both acetazolamide and salicylate toxicity possible with high dose aspirin
Risk higher in elderly or those with renal impairment
Risk of gastric bleeding and ulceration increases as alcohol consumption increases
Increased excretion of aspirin in alkaline urine
Bleeding time is prolonged and risk of major bleeding episode increased. Avoid combination (only use low
dose aspirin only on medical advice)
Increased hypoglycaemic effect (excludes metformin). Monitor blood glucose and adjust dosage of oral
hypoglycaemics if necessary (unlikely to apply to low dose aspirin)
Reduces renal tubular reabsorption of salicylates. May reduce analgesic effects
Reduced antihypertensive effect. Low dose aspirin combination acceptable
Alcohol
Antacids and urinary alkalinisers
Anticoagulants (eg, dabigatran, heparin,
warfarin)
Antidiabetic agents (oral hypoglycaemic
agents and insulin)
Calcium
Calcium channel blockers (eg,
amlodipine)
Clopidogrel
Increased risk of bleeding (low dose aspirin only on medical advice)
Corticosteroids
Reduced plasma salicylate concentrations resulting in reduced aspirin effect. Increased risk of GI bleed and
ulceration
Gold compounds
Increased risk of hepatotoxicity
Loop diuretics (eg, furosemide) Analgesic doses may blunt diuretic and natriuretic response to loop diuretics. Monitor
Methotrexate
Reduced renal clearance of methotrexate resulting in increased risk of toxicity. Less likely to occur with
weekly low dose methotrexate therapy
Metoclopramide
Increased rate of aspirin absorption and higher peak plasma salicyclate levels. Combination may be
beneficial for migraine attacks
NSAIDs
Additive GI toxicity including increased risk of GI ulceration. Possible prolonged bleeding time. Possible
reduction of cardioprotective effect of low dose aspirin
Omeprazole, lansoprazole
Possibly may decrease absorption of aspirin. May also cause premature dissolution of enteric coated
formulations
Phenytoin
Aspirin may increase pharmacologic and toxic effects of phenytoin. Monitor combination
Sodium valproate
Increased risk of toxicity. Monitor or avoid high dose aspirin combination
SSRI
Higher incidence of upper GI bleeding reported (even with low dose aspirin)
Uricosurics (eg, benzbromarone, Aspirin, at analgesic doses antagonises the effects of uricosuric drugs. Consider an alternative analgesic/
probenecid)
anti-inflammatory.
Vaccinations
Avoid aspirin use for six weeks after immunisation due to Reye’s syndrome being reported after natural
varicella and wild-type influenza infection. Risk is greater in children (avoid aspirin in children

OTC Medicines: Interactions
Drug/drug group Interacting substance Details
Analgesics – NSAIDs
ACE inhibitors and angiotensin II
receptor blockers (ARBs)
Alcohol
Alendronate
Anticoagulants (eg, warfarin, heparin)
Antidiabetic agents (oral hypoglycaemic
agents)
Antihypertensives
Aspirin (analgesic doses)
Aspirin (low dose)
Clopidogrel
Corticosteroids
Increased risk of renal impairment. Elderly people or people with, poor renal perfusion, dehydration, heart
failure, or also on diuretics at higher risk. Reduced antihypertensive effect
Increased risk of gastric bleeding and ulceration proportional to amount of alcohol consumed
Possible increased risk of GI damage (controversial)
Bleeding time is prolonged and risk of major bleeding episode increased. Avoid combination
Increased hypoglycaemic effect (excludes metformin). Monitor blood glucose and adjust dosage of oral
hypoglycaemic agent if necessary
Possible reduced hypotensive effect. Monitor BP
Additive GI toxicity including increased risk of GI ulceration. Possible prolonged bleeding time. Avoid
analgesic/anti-inflammatory doses of aspirin
Increased risk of GI bleed. Possible reduction of cardioprotective effect of low dose aspirin
Increased risk of bleeding (low dose aspirin only on medical advice)
Increased risk of GI bleed and ulceration
Cyclosporin Increased risk of nephrotoxicity, increased diclofenac blood levels (reduce diclofenac dose by 50%).
Possible increased cyclosporin blood levels with some NSAIDs
Digoxin
Possible decrease in renal excretion of digoxin resulting in increased digoxin levels with some NSAIDs.
Monitor digoxin level
Lithium
Reduced renal excretion of lithium may result in increased lithium level and toxic effects. Avoid
combination unless close monitoring possible
Diuretics (eg, furosemide,
bendrofluazide)
Methotrexate
Other NSAIDs
Potassium-sparing diuretics and
aldosterone antagonists
Probenecid
Quinolones (eg, ciprofloxacin,
norfloxacin)
Spironolactone
SSRI antidepressants
Warfarin
Reduced diuretic and antihypertensive effect, possibly due to salt and water retention. Congestive heart
failure may be exacerbated. Increased risk of nephrotoxicity, especially with ACE inhibitor or angiotensin II
receptor antagonist combination
Reduced renal clearance of methotrexate resulting in increased risk of toxicity. Less likely to occur with
weekly low dose methotrexate therapy
Additive GI toxicity including increased risk of GI ulceration. Increased bleeding time. Avoid
Reduced diuretic and antihypertensive effect. Increased risk of nephrotoxicity and hyperkalaemia
Increased plasma levels of NSAIDs. Reduce dose of NSAID if using combination
Increased risk of CNS stimulation and convulsions. Monitor for CNS adverse effects (eg, seizures, tremors)
and avoid combination in patients with epilepsy
May reduce diuretic and antihypertensive effect. May increase risk of hyper kalaemia and renal impairment. Risk
increased further with ACE inhibitor or ARB, especially if elderly
Higher incidence of upper GI bleeding reported
See anticoagulants
Analgesics – paracetamol Alcohol Risk of severe and sometimes fatal liver damage in people who drink excessively and take even moderate doses
of paracetamol. Reduce dose or avoid paracetamol
Anticonvulsants (eg, carbamazepine,
phenytoin)
Metoclopramide
Warfarin
Efficacy of paracetamol may be reduced due to increased clearance. Increase in toxic metabolites of
paracetamol may increase risk of hepatotoxicity. Avoid prolonged use
Increased rate of paracetamol absorption. Combination may be beneficial for migraine
Possible increased INR with sustained high dose administration of paracetamol. Monitor
Antacids Acetazolamide Increased risk of renal calculi if administered with sodium bicarbonate. Avoid regular dosing
Digoxin
Bioavailability may be decreased. Mechanism unknown. Separate administration by 2–3 hours
Enteric coated and delayed release
medications
H2-antagonists (eg, ranitidine)
Early dissolution of formulation may result in dose-dumping in stomach.
Separate administration by 2–3 hours
Reduced gastric absorption and bioavailability reported. Separate administration
Hexamine
Sodium bicarbonate alkalinises the urine. Hexamine requires a urinary pH of 5.5 or lower to be active so
alkalinisation of urine reduces antibacterial effect. Avoid
Iron supplements Some studies show significant reductions in amount of iron absorbed. Separate administration by 2–3
hours
Isoniazid
Aluminium salts may decrease absorption. Separate administration
Lithium
Sodium-containing antacids increase lithium excretion (reduce plasma lithium concentrations). Avoid
regular dosing
Tetracyclines Antacids may decrease plasma tetracycline concentrations by chelation. Separate administration by 2–3
hours
Other medications
Potential for decreased absorption. Separate administration by 2–3 hours
Phenylephrine
Sodium bicarbonate alkalinises the urine so renal excretion of phenylephrine may be reduced, increasing
risk of side effects (eg, tremors, anxiety, insomnia and/or tachycardia). Monitor for signs of toxicity and
adjust dosage as necessary
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OTC Medicines: Interactions
OTC Medicines: Interactions
Drug/drug group Interacting substance Details
Antacids
cont…
Antidiarrhoeals
– loperamide
Antifungals
– clotrimazole vaginal
cream
Antifungals – fluconazole
(Fluconazole inhibits CYP2C9
and 3A4 but to a lesser
extent than ketoconazole)
Antifungals
– miconazole oral gel
Antihistamines
– sedating
(eg, brompheniramine,
chlorpheniramine,
cyclizine, diphenhydramine,
promethazine, triprolidine,
meclozine)
Antihistamines
– non-sedating
(eg, cetirizine, loratadine)
Quinolone antibiotics (eg, ciprofloxacin,
norfloxacin)
Zinc supplements
Clozapine
Desmopressin
Ergotamine or related compounds
Latex condoms
Warfarin
Benzodiazepines (eg, midazolam,
triazolam)
Carbamazepine
Celecoxib
Cyclosporin
Ergotamine or related compounds
Phenytoin
Quetiapine
QT-interval prolonging drugs (eg,
quinolones, salmeterol, tricyclic
antidepressants)
SSRI antidepressants
Statins
Sulphonylureas and possibly
thiazolidinediones
Warfarin
Zidovudine
Warfarin
Antihypertensive medicines
CNS depressants (eg, anxiolytics,
hypnotics, sedatives, alcohol, opiate
analgesics, antipsychotics)
Other agents with anticholinergic/
antimuscarinic effects (eg, amantadine,
benztropine, bromocriptine, disopyramide,
levodopa, selegiline, pergolide,
procyclidine, sedating antihistamines,
phenothiazines, tricyclic antidepressants,
orphenadrine)
Phenytoin
Topiramate
Amiodarone
Nefazodone
May decrease the solubility of fluoroquinolones in the urine and increase the risk of crystalluria
Reduction in the amount of zinc absorbed with calcium containing antacids. Separate administration by
2–3 hours
One fatal report. Possible increased risk of toxic megacolon
Increased GI absorption of desmopressin caused by reduction in GI motility caused by loperamide. Monitor
for increased adverse effects (eg, hyponatraemia)
Although systemic absorption is limited, azole antifungals may inhibit the metabolism of ergot derivatives
resulting in increased adverse effects. Avoid if possible
Some intravaginal clotrimazole products may damage latex condoms causing contraceptive failure
Potential to interact (rare reports)
Inhibits metabolism of benzodiazepines metabolised by CYP3A4 (eg, midazolam, triazolam) resulting in
increased risk of toxicity. Use lowest dose or change to benzodiazepine metabolised by glucuronidation
(eg, temazepam, lorazepam)
Decreases carbamazepine metabolism causing a possible increase in carbamazepine levels. Monitor
Inhibits celecoxib metabolism and can increase celecoxib levels up to two-fold. Initiate celecoxib at lowest
recommended dose
Inhibits cyclosporin metabolism, increasing cyclosporin levels and risk of toxicity. Avoid combination or
closely monitor
Inhibits metabolism resulting in increased adverse effects of ergot alkaloids (risk of vasospasm and serious/
life-threatening ischaemia increased). Avoid
Inhibits metabolism resulting in increased phenytoin levels and possible toxicity. Avoid combination or
closely monitor
Possible increased levels quetiapine through inhibition of metabolism
Increased risk of QT prolongation although combination may often be used. Monitor
Fluconazole also inhibits CYP2C19 so may increase serum concentrations of citalopram and escitalopram.
Increased risk of serotonin syndrome
Some reports of serious or life-threatening musculoskeletal toxicity associated with increased plasma levels
of statins. Generally avoid with atorvastatin or simvastatin. Pravastatin may be safer as not metabolised by
CYP450 3A4
Inhibits metabolism resulting in increased serum concentrations and possible hypoglycaemia. Monitor and
reduce dosage of oral hypoglycaemic agent if necessary
Inhibits metabolism resulting in increased prothrombin time/INRs and increased risk of bleeding events.
Single doses of fluconazole may also potentiate warfarin effects
Increased serum concentrations and half-life of zidovudine. Increased risk of adverse effects
Inhibits metabolism resulting in increased prothrombin time/INRs and increased risk of bleeding events
May potentiate hypotensive effect. Monitor closely
Additive CNS depressant effects may occur (eg, sedation)
Additive cholinergic adverse effects (eg, dry mouth, urine retention, constipation, confusion in elderly)
Some reports of increased phenytoin levels. Monitor
May potentiate the risk of oligohydrosis and hyperthermia associated occasionally with topiramate,
especially in pediatric patients or those exposed to hot weather
Possible increased risk of QT prolongation
Possible increased risk of QT prolongation with higher doses of loratadine (20mg/day)
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OTC Medicines: Interactions
Drug/drug group Interacting substance Details
Antimuscarinics
(eg, hyoscine [scopolamine],
atropine.
Alcohol, other CNS depressants
Metoclopramide
Nitrates
Other agents with antimuscarinic
effects (eg, amantadine, benztropine,
bromocriptine, disopyramide, levodopa,
selegiline, pergolide, procyclidine,
sedating antihistamines, phenothiazines,
tricyclic antidepressants, orphenadrine)
Potassium salts (solid-dose
formulations)
Additive sedative effects
Possible reduction in prokinetic effect of metoclopramide
Possible reduced effect of sublingual nitrates (failure to dissolve under tongue due to dry mouth)
Increased adverse effects (eg, dry mouth, urine retention, constipation, confusion in elderly)
Antimuscarinic action may slow transit time. Severe GI injury reported due to high localised concentration
of potassium salts. Avoid if possible
Chloramphenicol (ocular) Bone marrow depressant medications Although concerns around aplastic anaemia occurring with ocular chloramphenicol have been largely
discounted, literature recommends avoiding concomittant use
Phenytoin
Theoretically may increase plasma phenytoin levels. Avoid or monitor closely
Warfarin
Some case reports available which document an increased INR with concomitant warfarin and ocular
chloramphenicol use. Monitor
Dextromethorphan
(Dextromethorphan is
primarily metabolised by
CYP2D6 and also has
serotonergic effects)
Diptheria/ tetanus/
pertussis (Tdap)
CNS depressants (eg, alcohol, sedatives)
CYP2D6 inhibitors (eg, amiodarone,
bupropion, fluoxetine, quinidine)
SSRIs (eg, fluoxetine, paroxetine),
venlafaxine
MAOIs – irreversible (eg, phenelzine,
tranylcypromine)
MAOIs – reversible (eg, moclobemide)
Selegiline
Other injectable vaccines or
immunoglobulin
Possible enhanced sedative and hypotensive effect
Increased adverse effects of dextromethorphan (eg, GI upset, sedation)
Some reports of serotonin syndrome. Monitor
Many reports of serotonin syndrome, including fatalities. Avoid concurrent use
Significantly reduced metabolism of dextromethorphan. Adverse effects increased. Avoid combination
Reports of serotonin syndrome. Avoid combination if possible
Administer at different sites
Dukoral Food/ drink Vaccine is acid labile so separate administration from food or drink by one hour as food and drink may
increase acid production in stomach
Typhoid vaccine (oral)
Take at least eight hours apart
Probenecid
Probenecid may increase the serum concentrations of famciclovir and its active metabolite, penciclovir,
through competitive inhibition of renal tubular secretion. Monitor
H2-antagonists
(Ranitidine)
Iodine supplements
(oral)
Antacids
Antifungals
Atazanavir
Cefuroxime axetil (oral)
Enteric-coated formulations
Amiodarone
Anti-thyroid medicines (eg,
propylthiouracil, iodide)
Lithium
Potassium-sparing medicines (eg, ACE
inhibitors, angiotensin II receptor
antagonists, spironolactone)
Warfarin
Antacids
Antibacterials – quinolones (eg,
ciprofloxacin, norfloxacin)
Antibacterials – tetracyclines (eg,
doxycycline, minocycline)
Biphosphonates (eg, alendronate,
etidronate)
Significant reductions in ranitidine bioavailability demonstrated with co-administration of aluminium or
magnesium containing antacids. Administer 1–2 hours apart
Reduced absorption of itraconazole and ketoconazole. Avoid concomitant use
Reduced absorption of atazanavir since H2- antagonists reduce gastric pH. Separate administration (give
either 2 hours before or 10 hours after H2-receptor agonists)
Bioavailability may be reduced resulting in lower cefuroxime concentrations
May increase dissolution rate of enteric-coated formulations. Generally avoid or separate administration by
2–3 hours
Additive effect as amiodarone contains iodine. Avoid combination except on medical advice
Potentiation of hypothyroid effect. Avoid combination unless under medical advice
Combination can cause hypothyroidism
Most iodine supplements contain potassium.Some medicines reduce the excretion of potassium by the
kidneys and the combination can increase potassium levels in the body. Avoid combination unless under
medical advice
Anticoagulant effect of warfarin may be decreased
Some studies show significant reductions in amount of iron absorbed. Separate administration by 2–3 hours
Decreases absorption and may reduce plasma concentrations of quinolone antibiotics to subtherapeutic
levels. Separate administration by at least 2–3 hours. Monitor response
Insoluble chelate formed which decreases absorption of tetracyclines. Separate administration by at least
2–3 hours. Monitor patient for reduced response
Reduced absorption of bisphosphonates. Separate administration by at least 30 minutes to 2 hours
depending on biphosphonate used
Carbidopa and levodopa Reduced absorption may be clinically significant in some patients. Separate administration by at least 2–3
hours. Monitor patient for reduced response
Cholestyramine
Reduced absorption of iron
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OTC Medicines: Interactions
OTC Medicines: Interactions
Drug/drug group Interacting substance Details
Iron supplements (oral) Levothyroxine Poorly soluble chelate formed which reduces absorption of levothyroxine
Separate administration by at least 2–3 hours. Monitor patient for reduced response
Methyldopa
Reduced absorption of methyldopa may reduce antihypertensive effect. Separate administration by at least
2–3 hours
Penicillamine
Reduced absorption of penicillamine. Separate administration by at least 2–3 hours
Vitamin E
May reduce absorption of vitamin E. Separate administration by at least 2–3 hours
Zinc
Reduced absorption of iron and zinc. Separate administration by at least 2–3 hours
Laxatives
– bulk laxatives
Levonorgestrol
(emergency and oral
contraceptive pill)
Digoxin
Lithium
Enzyme inducers (eg, barbiturates,
carbamazepine, primidone, phenytoin,
topiramate, St John’s wort (Hypericum
perforatum), rifampicin, ritonavir,
griseofulvin)
May decrease digoxin absorption resulting in decreased digoxin levels
Reports of reduced lithium absorption resulting in reduced plasma levels. Monitor lithium levels, separate
administration by at least 2 hours, or use alternative laxative
Increased hepatic metabolism of levonorgestrol and possible reduction in effectiveness if used as
emergency contraception. Consider increasing dose of levonorgestrol
Meningococcal vaccine Immunosuppressive therapies May reduce the immune response to the vaccine
Metoclopramide Alcohol Additive CNS effects (eg, sedation)
Aspirin, paracetamol
Increased rate of aspirin and paracetamol absorption. Combination may be beneficial for migraine attacks
Bromocriptine
Antagonises hypoprolactinaemic effect of bromocriptine
Cyclosporin
Increased absorption of cyclosporin resulting in increased plasma levels. Monitor
Codeine, other opioid analgesics Possible reduction in prokinetic effect of metoclopramide
Dantrolene
Increased absorption of dantrolene resulting in increased plasma levels. Monitor for signs of dantrolene
toxicity (eg, CNS disturbances, diarrhoea)
Digoxin
Absorption of digoxin decreased possibly by increased gut motility. Plasma levels of digoxin may be
reduced. Monitor
Lithium
Risk of extrapyramidal adverse effects or severe neurotoxicity increased.
Avoid combination if possible or carefully monitor for signs of neurotoxicity
MAOIs (irreversible eg, phenelzine, Possible additive hypertensive effects. Avoid combination if possible, or monitor
tranylcypromine)
Medicines with antidopaminergic
actions (eg, antipsychotics,
tetrabenazine)
Increased risk of extrapyramidal adverse effects
Parkinson’s drugs (eg, cabergoline,
levodopa, lisuride)
Medications with antimuscarinic
effects (eg, amantadine, benztropine,
bromocriptine, levodopa, selegiline,
pergolide, procyclidine, sedating
antihistamines, phenothiazines, tricyclic
antidepressants, orphenadrine)
Morphine
SSRIs
Metoclopramide is a dopamine antagonist and antagonises action of medications used to treat Parkinson’s
disease. Avoid combination
Possible reduction in prokinetic effect of metoclopramide
Additive CNS effects (eg, sedation) possible. Increased rate of morphine absorption (faster onset of action)
Possible increase in metoclopramide absorption with increased risk of adverse effects (eg,extrapyramidal
effects)
Methyl salicylate
Warfarin
Topical use of methyl salicylate has been shown to increase INR/PT and result in bleeding and bruising.
(topical)
Present in many OTC analgesic liniments, creams or medicated oils. Use alternative topical analgesics if
possible, or use with great caution and monitoring
Nasal corticosteroids Other corticosteroid use, eg, inhaled Additive systemic effects of corticosteroids
Omeprazole,
Antifungals
Reduces absorption of itraconazole and ketoconazole
lansoprazole
Antiretroviral medications (eg,
atazanavir, nelfinavir, saquinavir)
Clopidogrel
Clozapine
Digoxin
Medications metabolised by CYP 2C19
(eg, citalopram, diazepam, phenytoin,
warfarin, other vitamin K antagonists)
Other CYP 2C19 or CYP 3A4 inhibitors
(eg, clarithromycin, voriconazole)
Decreases serum levels of atazanavir, nelfinavir (avoid combination). Increases levels of saquinavir (contact
prescriber)
Reduces efficacy of clopidogrel (approximately 30% less inhibition of platelet aggregation)
Three reports of elevated clozapine levels documented (two resulted in seizures). Monitor
Reduces absorption of digoxin. Monitor
Theoretically may inhibit the metabolism of these agents, but few clinical reports documented. Monitor
May increase serum levels of omeprazole or lansoprazole, although dosage adjustment not usually
required
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OTC Medicines: Interactions
Drug/drug group Interacting substance Details
Oral contraceptives
Antibiotics or other medicines (eg,
orlistat) that cause diarrhoea or
vomiting
Enzyme inducers (eg, aprepitant,
bosentan, carbamazepine, efavirenz,
modafinil, nelfinavir, nevirapine,
oxcarbazepine, perampanel,
phenobarbital, phenytoin, primidone,
rifabutin, rufinamide, rifampicin,
ritonavir, St John’s Wort, topiramate)
May reduce the absorption of oral contraceptives. However, generally antibiotics that are not enzymeinducing
do not interact with oral contraceptives
Increase the metabolism of combinined oral contraceptives and may reduce ovulation suppression
Orlistat Amiodarone Decreased absorption of amiodarone. Plasma levels of amiodarone may be reduced. Monitor
Cyclosporin
Markedly decreased cyclosporin levels. Avoid combination
Povidone iodine (see
also iodine supplements
[oral])
Fat-soluble vitamins (eg, vitamin A, D,
E, K)
Oral contraceptives
Warfarin
Lithium
Decreased absorption of fat-soluble vitamins. Separate administration by at least 2 hours or take vitamins
at bed time
Absorption of oral contraceptives may be compromised by any diarrhoea caused by orlistat. Possible failure
of contraceptive action
Isolated report of INR increase, possibly due to reduction in vitamin K absorption. Monitor INR
Additive hypothyroid effect possible with long term topical povidone iodine administration
Prochlorperazine Antihypertensives Possible additive hypotensive effect
CNS depressants (including alcohol, Additive CNS depressant effects (eg, sedation)
opiods)
Drugs causing QT prolongation (eg, Possible increased risk QT prolongation (rare reports)
erythromycin, haloperidol, sotalol)
Lithium
Possible increased risk of neurological adverse effects
Other agents with anticholinergic/ Additive cholinergic adverse effects (eg, dry mouth, urinary retention, constipation, confusion in the elderly)
antimuscarinic effects (eg, amantadine,
benztropine, bromocriptine, disopyramide,
levodopa, selegiline, pergolide,
procyclidine, sedating antihistamines,
phenothiazines, tricyclic antidepressants,
orphenadrine)
Phenytoin
Alteration in phenytoin metabolism. Plasma levels may be increased or decreased. Monitor.Phenothiazines
may also reduce seizure threshold
Parkinson’s drugs (eg, cabergoline,
levodopa, lisuride)
SSRI and tricyclic antidepressants
Effects of Parkinson’s disease drugs may be antagonised since prochlorperazine has some dopamine
antagonist activity
Metabolism may be inhibited increasing risk of adverse effects (eg, extrapyramidal reactions, sedation,
possibly QT prolongation)
Sildenafil Alpha blockers (eg, doxazosin) May reduce both standing and supine blood pressure. Dizziness reported
CYP 3A4 (eg, cimetidine, erythromycin, Drugs that inhibit these enzymes may increase sildenafil concentrations
saquinavir)
Nitrates (eg, glyceryl trinitrate,
Contraindicated. Potentiates hypotensive effects
isosorbide dinitrate)
Sumatriptan,
zolmitriptan
Ergotamine or related compounds Additive vasoconstriction may result in fatal reactions (eg, MI). Avoid combination
MAOIs – irreversible (eg, phenelzine,
tranylcypromine)
MAOIs – reversible (eg, moclobemide)
Medications that increase serotonin
levels (eg, SSRIs, venlafaxine, tricyclic
antidepressants sibutramine, St John’s
wort)
Medications that lower the seizure
threshold (eg, neuroleptics,
antidepressants)
MAOIs can inhibit metabolism of sumatriptan increasing risk of serotonin syndrome. Avoid for 2 weeks
after stopping MAOI
Moclobemide inhibits metabolism of sumatriptan. Increased risk of serotonin syndrome. Avoid
Increased risk of serotonin syndrome. Avoid combination or careful monitoring required
Sumatriptan can also lower seizure threshold so additive effects possible
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OTC Medicines: Interactions
OTC Medicines: Interactions
Drug/drug group Interacting substance Details
Sympathomimetics Cardiac glycosides, quinidine, tricyclic Possible increased risk of arrhythmias (rare reports)
(eg, phenylephrine – note antidepressants
also systemic absorption Ergotamine or related compounds Additive vasopressor effects. Combination not recommended
of nasal and ocular
MAOIs – irreversible (eg, phenelzine, Significant risk of hypertensive crisis (up to 2 weeks after stopping MAOI). Avoid combination (includes all
sympathomimetics may be
tranylcypromine)
oral, nasal and ocular products with pseudoephedrine or phenylephedrine)
significant)
MAOIs – reversible (eg, moclobemide) Possible increase risk of hypertension. Best avoided
Methyldopa
Isolated report of hypertension. Monitor blood pressure
Other sympathomimetics
Additive effects, increased toxicity
Selegiline
Increased risk of hypertension with higher dosages
Tricyclic antidepressants
May enhance the pressor response causing hypertension, headache, or tremor
Trimethoprim Cyclosporin Reversible deterioration of renal function observed if combination used following renal transplantation
Digoxin
May increase plasma levels of digoxin in elderly people
Diuretics - amiloride
Excessively low serum sodium levels seen. May theorectically cause hyperkalaemia. Monitor electrolytes
Methotrexate
Consider folate supplementation if combination used
Phenytoin
May prolong half-life. Watch for phenytoin toxicity. Monitor
Warfarin
May potentiate anticoagulant activity of warfarin. Monitor
Urinary alkalinisers Aspirin Increased clearance of salicyclates, possible reduced levels
Flecainide
Alkalinisation of the urine reduces the renal excretion of flecainide. Risk of flecainide toxicity increased.
Monitor
Fluroquinolones (eg, ciprofloxacin, May decrease the solubility of fluoroquinolones in the urine and increase the risk of crystalluria
norfloxacin)
Hexamine
Requires urinary pH of 5.5 or lower to be active so alkalinisation of urine reduces antibacterial effect.
Avoid
Laxatives
Additive laxative effect possible
Lithium
Often contain substantial amounts of sodium, which increases the urinary excretion of lithium, reducing
plasma lithium levels. Avoid if possible or monitor
Methadone
Alkalinisation of the urine reduces clearance of methadone. Increased risk of toxicity
Methotrexate
Alkalinisation of the urine increases renal clearance of methotrexate. Therapeutic efficacy of methotrexate
may be reduced
Mexiletine
Possibly reduced clearance of mexiletine
REFERENCE SOURCES FOR TABLE MIMS online www.mims.co.nz/MIMSGATEWAY.aspx Medsafe data sheets www.medsafe.govt.nz
Page 190 HEALTHCARE HANDBOOK 2017-2018 References Charts

OTC Medicines: Precautions
Please note this list is NOT ALL INCLUSIVE. Only the more commonly reported or
important precautions and contraindications are included. When selling any OTC
medicine, consider the patient as a whole, including comorbid conditions, general
health, age and frailty and weigh up risks versus benefits. Always use caution when
selling medications to pregnant or breastfeeding women and check most recent
literature sources.
OTC Medicines: Precautions
Drug/drug group Condition Details
Analgesics – aspirin
(usually less important with
low-dose aspirin, eg, 75–100mg)
Analgesics – NSAIDs
Allergy including rash, anaphylaxis,
Allergic symptoms, cross-sensitivity with NSAIDs
rhinitis or asthma from aspirin, other NSAIDs or food dyes
Asthma Asthma attack/worsening of asthma, rhinitis or sinusitis in asthmatics (occurs in 3-5%
of population and up to 20% of asthmatics)
Cardiovascular disease
Sodium and water retention
Children/adolescents with viral illness
Reye's syndrome risk. Do not use in children aged less than 16 years with a viral
illness
Dehydration
Risk of renal failure
Elderly
Increased risk of adverse effects
Gastric irritation (indigestion, reflux, nausea, vomiting) Aggravates pre-existing symptoms
Gastric ulcer
Risk of bleed. Avoid in active gastric ulcer. Caution, preferably avoid, in history of
gastric ulcer
Gout
Increases serum uric acid concentrations
G6PD deficiency
High doses can precipitate haemolytic anaemia
Haemorrhagic disorders
Increased risk of bleeding
Hearing difficulties
Analgesic/anti-inflammatory doses may aggravate and/or cause tinnitus
Hepatic impairment
Avoid in severe hepatic impairment
High blood pressure
Sodium and water retention
History of asthma, rhinitis, atopy, nasal polyps
Increased risk of allergy to aspirin and exacerbation of existing asthma, rhinitis, atopy
or nasal polyps
Infection
May mask fever and inflammation
Renal impairment
Sodium and water retention, worsening of renal impairment
Surgery or dental work (1 week prior, or just after) Prolongs bleeding
Allergy including rash, anaphylaxis, rhinitis or asthma from Allergic symptoms, cross-sensitivity with NSAIDs
aspirin or NSAIDs
Asthma
Asthma attack/worsening of asthma, rhinitis or sinusitis in asthmatics (occurs in
3–5% of population and up to 20% of asthmatics)
Cardiovascular disease
Sodium and water retention, increased blood pressure
Dehydration
Risk of renal failure
Elderly
Increased risk of adverse effects
Gastric irritation
Aggravates pre-existing symptoms
Gastric ulcer
Risk of bleed. Avoid in active gastric ulcer. Caution, preferably avoid, in history of
gastric ulcer
Haemorrhagic disorders
Increased risk of bleeding
Hepatic impairment
Avoid in severe hepatic impairment
High blood pressure
Sodium and water retention
History of asthma, rhinitis, atopy, nasal polyps
Increased risk of allergy to aspirin and exacerbation of existing asthma, rhinitis, atopy
or nasal polyps
Infection
May mask fever and inflammation
Renal impairment
Sodium and water retention
Analgesics – paracetamol Alcohol dependence Use with caution. Avoid high or prolonged dosing
Renal or hepatic impairment
Use with caution. Avoid high or prolonged dosing
Antacids Calcium kidney stones (or history of) Avoid calcium containing antacids
Constipation
Aluminium hydroxide can exacerbate
Low phosphate diets (aluminium hydroxide)
Phosphate depletion, increased bone resorption, hypercalciuria, risk of osteomalacia
Low sodium diet, eg, heart failure, hypertension, renal failure,
cirrhosis
Porphyria
Renal impairment
Consider sodium content (sodium bicarbonate, sodium alginate). Preferably avoid
sodium-containing antacids
Avoid aluminium hydroxide
Possible accumulation of some elements, eg, magnesium, aluminium, calcium
Page 191

OTC Medicines: Precautions
OTC Medicines: Precautions
Drug/drug group Condition Details
Antidiarrhoeals Abdominal distension Avoid antidiarrhoeals
Acute inflammatory bowel disease, ileus development, when May cause intestinal obstruction or toxic megacolon
inhibition of peristalsis is to be avoided
Antibiotic-associated pseudomembranous colitis
Avoid antidiarrhoeals
Diarrhoea associated with enterotoxin producing bacteria Avoid antidiarrhoeals
Dysentery
Do not use antidiarrhoeals alone
Hepatic disease
Increased levels loperamide
Infants, young children
Not generally recommended, have been associated with paralytic ileus
Intestinal obstruction
Avoid antidiarrhoeals
Antifungals (eg, fluconazole) Impaired renal function Caution
Previous liver disease with fluconazole, existing liver disease/ Liver disease may occur (fluconazole). Avoid miconazole oral gel
dysfunction in hepatic impairment
Potentially proarrhythmic conditions
Rare cases of QT prolongation and torsade de pointes with fluconazole
Antihistamines – sedating Broken skin
Avoid topical antihistamines
(eg, promethazine,
Epilepsy
Occasional reports of convulsions
brompheniramine,
azatadine, chlorpheniramine,
Hepatic impairment
Caution advised. Dose reduction may be necessary
diphenydramine, triprolidine, Narrow angle glaucoma, prostate problems, constipation, Anticholinergic effects may aggravate these conditions
cyclizine, dimenhydrinate,
meclozine)
urinary retention
Porphyria
Possible acute attacks of porphyria with some antihistamines (eg, diphenhydramine,
promethazine)
Productive cough
Thickens respiratory tract secretions
Renal impairment
Dose reduction may be needed
Significant renal impairment
Increased levocabastine blood levels likely after nasal usage
The very old, the very young
Increased risk of side effects, including paradoxical stimulation. Avoid in young
children
Antihistamines –
Hepatic or renal impairment
Possible accumulation of drug, may need dose reduction
non-sedating
Antimuscarinics
Children, elderly
Increased risk of side effects
(eg, scopolamine, hyoscine butyl Epilepsy
Seizures possible (rare)
bromide)
Impaired metabolism, liver or kidney function
Increased CNS effects (scopolamine)
Narrow angle glaucoma, prostate hypertrophy, constipation, Antimuscarinic effects aggravate these conditions
urinary retention
Porphyria (hyoscine butylbromide)
Association with acute attacks of porphyria
Antitussives
Abuse
Codeine or dextromethorphan abuse has been reported
(eg, codeine, pholcodine,
Asthma
Avoid in acute attack, caution if history of asthma
dextromethorphan)
Children
Caution, avoid in infants
Constipation
Codeine mainly (opiate effects slow GIT motility)
Risk of respiratory failure
Increased risk of respiratory failure
Bromhexine Asthma Care advised with bromhexine
History of peptic ulcer disease
May disrupt the gastric mucosal barrier
Severe hepatic or renal impairment
Reduced clearance bromhexine or metabolites
Chloramphenicol (ocular) Blurred vision, eye pain, or photophobia Refer to the doctor or TPA-endorsed optometrist
Contact lens wearers
Refer to the doctor or TPA-endorsed optometrist
Unsure of diagnosis
Refer to the doctor or TPA-endorsed optometrist
Diptheria/ tetanus/ Acute illness
Postpone vaccination
pertussis (Tdap)
Prior reaction to Tdap
Dependant on reaction. Refer to doctor
Dukoral Acute illness Postpone vaccination
Ear wax softeners Inflamed ear/perforated ear drum Avoid use
Head lice products Skin disease Caution with some treatments
Young children
Caution with most chemical treatments
H2 antagonists Renal impairment Reduce dose
Porphyria
Avoid
Iodine supplements (oral) Excessive use Higher intakes than recommended can cause adverse effects such as thyroid problems
Thyroid disorders (eg, hypothyroidism, goitre, thyroid
tumours)
Can worsen these conditions
Page 192 HEALTHCARE HANDBOOK 2017-2018 References Charts

OTC Medicines: Precautions
Drug/drug group Condition Details
Influenza vaccine Acute illness Postpone vaccination
Iron
Gastrointestinal diseases, eg, inflammatory bowel disease, Use only under medical advice
diverticulae
Iron storage/iron absorption diseases, eg,
Use only under medical advice
haemochromatosis
Repeated blood transfusions, anaemia without iron Do not give iron
deficiency
Laxatives Abusers Electrolyte disturbances, especially potassium loss, diarrhoea. Excessive weight loss
Acute abdominal conditions, undiagnosed abdominal pain Possible complications if laxatives used
(eg, possible appendicitis)
Colonic atony, immobile patients, insufficient fluid/ Bulk-forming laxatives may cause intestinal obstruction or faecal impaction
dehydration
Dehydration (severe)
Further dehydration and electrolyte imbalance with stimulant laxatives
Diabetes
Can affect blood sugars in poorly controlled diabetes
Difficulty swallowing
Avoid bulk-forming laxatives
Faecal impaction or obstruction
Avoid oral laxatives, risk of colonic perforation
Galactose or lactose intolerance
Lactulose contains galactose and lactose. Avoid
Haemorrhoids, anal fissures, proctitis
Avoid laxative suppositories
Inflammatory bowel disease
Increased adverse effects with stimulant laxatives
Regular use
Avoid regular use of stimulant laxatives due to changes in rectal epithelium and risk
of atonic colon
Levonorgestrel Breast cancer Relative contraindication (but levonorgestrel less risk than pregnancy)
Severe malabsorption syndrome, eg, Crohn's disease Impaired efficacy of levonorgestrel; increased dose may be required
Severe liver disease
Interferes with metabolism of levonorgestrel
Meningococcal vaccine Acute illness Postpone vaccination
Methyl salicylate Extensive topical application, exercise, heat occlusion Increased absorption of salicyclic acid into bloodstream (can be toxic)
Metoclopramide Children, young patients and elderly Increased risk of extrapyramidal reactions. Use lower dosages especially if

OTC Medicines: Precautions
OTC Medicines: Precautions
Drug/drug group Condition Details
Orlistat Chronic malabsorption syndrome Avoid
Cholestasis (reduced/halted bile flow)
High fat intake
History of calcium oxalate kidney stones
Type 2 diabetes
Avoid
Increased risk of adverse GI effects
Caution
May need hypoglycaemic dose adjusted
Oseltamivir Renal impairment Moderate renal impairment reduce dose, avoid in severe renal impairment
Povidone iodine (see also Severe burns/extensive areas
Increased sytemic effects iodine – avoid
iodine supplements [oral]) Thyroid disorders
Regular or prolonged use may aggravate thyroid disorders
Prochlorperazine Dehydration Hypotension
Elderly, debilitated
Increased risk of side effects
Impaired kidney, cardiovascular, cerebrovascular,
Increased risk of side effects, avoid
respiratory function
Narrow angle glaucoma, parkinsonism, paralytic ileus, Contraindicated
urinary retention, prostatic hypertrophy, epilepsy, blood
dyscrasias, impaired liver, myasthenia gravis
Phaeochromocytoma
Hypertensive crisis
Sildenafil
Diabetes, smokers, self-reported high cholesterol, previous Refer to doctor
coronary intervention, cardiovascular disease, unusually
high or low blood pressure
Under 35 years and over 70 years
Refer to dcotor
Sumatriptan, zolmitriptan Heart disease or symptoms of heart disease, peripheral Do not use – sumatriptan causes vasoconstriction
vascular disease, history of heart attack, stroke or transient
ischaemic attack (TIA)
Hemiplegic, basilar or ophthalmoplegic migraine
Avoid
History of seizures or conditions predisposing to seizures Seizures have occurred in some patients with history or predisposing factors
Hypertension, including controlled hypertension
Transient increases in blood pressure and peripheral vascular resistance sometimes
occur – do not use OTC
Increased risk of heart disease
Refer to doctor
No previous history of migraine
OTC sumatriptan not allowed
Prinzmetal’s angina (pain at rest rather than during Avoid
activity)
Renal or hepatic disease
Avoid OTC use
Sulphonamide allergy
Possible cross-sensitivity (sumatriptan only)
Unclear migraine diagnosis
Use only with a clear migraine diagnosis
Under 18 years or over 65 years
OTC sumatriptan or zolmitriptan not indicated
Sympathomimetics Cardiovascular disease, high blood pressure
May increases heart rate and blood pressure
(eg, phenylephrine – note also Diabetes (poorly controlled)
May alter blood glucose control
systematic absorption of nasal
Hyperthyroidism
Possible additive tachycardia
and ocular sympathomimetics
may be significant)
Infants and young children
Increased risk
Narrow angle glaucoma
Aggravated by sympathomimetics
Renal impairment
Caution advised
Trimethoprim Antibiotic use (within 6 months) Avoid
Pregnancy
Avoid in first trimester of pregnancy (folate antagonist)
Renal impairment or abnormality, catheterisation, history
of renal stones etc
Refer to a doctor
Page 194 HEALTHCARE HANDBOOK 2017-2018 References Charts

OTC Medicines: Adverse Effects
Commonly reported adverse effects that do not require laboratory tests to detect
are listed below. These tables are not ALL INCLUSIVE and do not list medicines
or supplements know to cause renal or hepatic impairment or blood dyscrasias.
OTC Medicines: Adverse Effects
Adverse effect
Anorexia
Anxiety
Asthma
(exacerbation of)
Black stools
Constipation
Dependence
Diarrhoea
Dizziness
Dry eyes
Dry mouth
Fever
Flushing
Gastric Irritation
Caused by
Diptheria/ tetanus/ pertussis (Tdap)
Possibly phenylephrine
Aspirin and salicylates
Benzoates, Sulphites (preservatives)
NSAIDs
Propolis, Royal jelly
Tartrazine (colouring agent)
Iron
Aluminium hydroxide (in antacids)
Antihistamines (sedating only)
Bulk-forming laxatives (if taken with too little fluid, or in
people with dehydration)
Calcium (supplements or in antacids)
Codeine (decreases gut motility)
Iron salts
Laxatives (overuse, abuse)
Omeprazole, lansoprazole
Codeine
Nicotine nasal spray, nicotine gum
Oxymetazoline, xylometazoline (overuse of nasal products)
Stimulant laxatives (eg, prolonged use of sennosides)
Aloes
Cascara
Fluconazole
H2 antagonists
Iron salts
Isphaghula
Laxatives (overuse or abuse)
Magnesium (supplements or in antacids)
NSAIDs
Omeprazole
Orlistat
Psyllium husk (bulk-forming laxative)
Senna
Oseltamivir
Sumatriptan
Antihistamines (sedating only)
Prochlorperazine
Scopolamine
Antihistamines (sedating)
Hyoscine
Prochlorperazine
Phenylephrine
Diptheria/ tetanus/ pertussis (Tdap)
Influenza vaccine
Meningococcal vaccine
Sildenafil
Sumatriptan
Aspirin
Bromhexine
Bulk-forming laxatives (flatulence, bloating)
OTC Medicines: Adverse Effects
Adverse effect
Gastric irritation
Cont…
Headache
Increased bleeding
Caused by
Caffeine
Calcium (flatulence)
Diptheria/ tetanus/ pertussis (Tdap)
Dukoral (GI upset and rarely cramping)
Eucalyptus
Fish oils
Fluconazole (abdominal pain, flatulence, nausea, vomiting)
Garlic
Iodine (oral)
Iron salts
Lactulose (cramps, flatulence)
Levonorgestrel (nausea)
Loperamide
Magnesium, Potassium, Zinc salts
Mebendazole
Meningococcal vaccine
NSAIDs
Omeprazole
Orlistat (flatulence, faecal urgency, fatty stools, discharge)
Oseltamivir (nausea, vomiting, abdominal pain)
Parsley
Pyrantel
Sildenafil
Sodium bicarbonate (stomach cramps)
Squill
Stimulant laxatives (colic, cramps)
Sumatriptan (nausea, vomiting)
Turmeric
Antihistamines (sedating)
Analgesics (overuse)
Black cohosh
Diptheria/ tetanus/ pertussis (Tdap)
Fluconazole
Influenza vaccine
Levocabastine eye drops and nose spray
Meningococcal vaccine
Nicotine replacement
NSAIDs (including overuse)
Omeprazole
Oseltamivir
Sildenafil
Aspirin
Bilberry
Bromelain
Clove
Coleus
Docosahexaenoic acid (DHA)
Dong quai
Feverfew
Fish oils
Garlic
Ginger
Ginkgo
Page 195

OTC Medicines: Adverse Effects
OTC Medicines: Adverse Effects
Adverse effect
Increased bleeding
cont...
Increased blood
pressure
Increased risk of blood
clots
Injection site reactions
(pain, redness, swelling)
Insomnia
Irritability/ fatigue
Local irritation
Menstrual bleeding
changes
Metallic taste
Mouth ulcers/irritation
Nasal bleeds
Nasal stuffiness
Rebound acid secretion
Sedation
Caused by
Ginseng
Guggul
Horse chestnut
NSAIDs
Turmeric
Aspirin (possibly)
Liquorice (large doses)
NSAIDs
Phenylephrine
Sumatriptan (transient)
Combined oral contraceptives (risk depends on dosage
and specific hormone)
All injectable vaccinations
Caffeine
Ginseng, guarana
Nicotine
Oseltamivir
Sympathomimetics (eg, possibly phenylephrine)
All injectable vaccinations
Chloramphenicol
Nasal or ocular antihistamines
Nasal corticosteroids
Nasal decongestants
Nicotine, nasal spray, inhalation
Povidone iodine
Rectal bisacodyl
Tea-tree oil (Melaleuca alternifolia)
Oral contraceptives (amenorrhoea, breakthrough
bleeding, short-cycles)
Iodine (oral)
Aspirin
Feverfew
Iodine (oral)
Nicotine lozenges, gum
Nasal corticosteroids
Nasal nicotine
Decongestant nasal drops and sprays (prolonged use)
Sildenafil
Calcium carbonate (after long-term use)
Antihistamines (sedating)
Azelastine nasal spray
Chamomile
Codeine
Diptheria/ tetanus/ pertussis (Tdap)
Hops
Hyoscine butylbromide
Kava
L-5-HTP
Levocabastine eye drops and nose spray
Loperamide
Metoclopramide
Passionflower
Pholcodine
Prochlorperazine
OTC Medicines: Adverse Effects
Adverse effect
Sedation
cont...
Skin reactions
Stimulation
Tachycardia (fast heart
beat) or palpitations
Teeth staining
Urinary retention
Caused by
Scopolamine
Skullcap
Sumatriptan
Valerian
Aciclovir, penciclovir (transient stinging, burning)
Aluminium chloride topical (irritation)
Aniseed (furanocoumarins, photosensitivity, contact
allergy)
Antifungals (burning, irritation)
Antihistamines (topical)
Aspirin and salicylates (hypersensitivity reactions)
Benzyl benzoate (irritation)
Benzoyl peroxide (irritation)
Bergamot oil (photosensitivity)
Capsaicin (stinging, burning)
Celery (photosensitivity)
Chamomile (contact allergy)
Cinnamon (contact allergy)
Coal tar and derivatives (photosensitivity, irritant
dermatitis)
Dandelion (contact allergy)
Dong quai (photosensitivity)
Feverfew (hypersensitivity reactions)
Garlic (sulphur allergy)
Gotu kola (contact dermatitis)
Head lice and scabies treatments
Idoxuridine (irritation, hypersensitivity)
Menthol (contact dermatitis)
Nicotine transdermal patches (irritation, allergy)
NSAIDs (hypersensitivity reactions)
Omeprazole
Paracetamol (rarely serious skin reactions)
Povidone iodine (hypersensitivity, irritation)
Promethazine (photosensitivity)
St John’s wort (sensory nerve hypersensitivity)
Salicylic acid (irritation)
Tea-tree oil (allergic dermatitis)
Trimethoprim (rash, pruritis, dermatitis)
Wood tars (irritation)
Sedating antihistamines (paradoxical)
Caffeine
Ginseng
Nicotine replacement therapy
Phenylephrine (possibly)
Prochlorperazine
Chlorhexidine
Liquid iron (dilute with water and use straw)
Tannin-rich agents (eg, green tea)
Antihistamines (sedating only)
Hyoscine
Prochlorperazine
Phenylephrine
Scopolamine
Page 196 HEALTHCARE HANDBOOK 2017-2018 References Charts

Herbal Supplements: Interactions
POTENTIAL INTERACTIONS BETWEEN DRUGS AND PHYTOMEDICINES
Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
Aloe vera gel and juice
American ginseng
(Panax quinqefolium)
Andrographis
(Andrographis paniculata)
Oral hypoglycaemic drugs
(eg, glibenclamide)
Increased hypoglycaemic effects possible
Vitamin C and E Increased absorption possible 1
Antipsychotics
Possible potentiation of antipsychotic properties suggested
Improvement in working memory & reduced extrapyramidal effects
Oral hypoglycaemics Possible enhancement of hypoglycaemic effect 242
Warfarin
Reduced plasma levels in healthy males after two weeks ginseng
administration
Cisplatin Potentiation of in vitro antitumour action by andrographolide 217
Etoricoxib
Reduced etoricoxib bioavailability with large doses of Andrographis or 248
andrographolide reported in rats
Nabumetone
Reduced Cmax and AUC of nabumetone, and compromised its antiarthritic 257
activity in rats
Naproxen
Reduced oral bioavailability of naproxen in rats, but increased anti-arthritic 258
activity
Theophylline Drug bioavailability reduced in studies on rats 216
Aniseed essential oil Paracetamol Reduced paracetamol bioavailability reported in mice 259
Anthraquinone laxatives Cisplatin Reduced anti-cancer activity implicated by in vitro study involving aloe emodin 2
Anxiolytics (eg, valerian,
kava, passionflower, hops)
Anti-platelet agents
(eg, ginger, garlic, clove,
feverfew)
Digoxin and other cardioactive glycosides Potassium depletion (hypokalaemia) leading to increased risk of cardiac 3, 4
toxicity, if large doses used
Thiazide diuretics Potassium depletion 3, 4
Hypnotics, tranquillisers, opiates
and some analgesics acting as CNS
depressants
Anticoagulants (eg, warfarin, heparin)
223
243
Additive CNS depressant effects, particularly with large doses 5, 6
Potentiation of anticoagulant effect and bleeding theoretically possible with
large doses
Bacopa monnieri Thyroxine Possible potentiation of thyroid hormone effects 8
Baical skullcap
(Scutellaria baicalensis)
Cyclosporin
Possible reduction in bioavailability of oral cyclosporin if co-administered with 9
large doses Baical skullcap
Grape seed Potentiated antioxidant effects 10
Etoposide Possible potentiation of antitumour action, by wogonin 218
Mefenamic acid
Potentiation of anti-inflammatory effects & reduction in gastric ulcer adverse 249
effects in rats
Methotrexate Large doses increased methotrexate bioavailability in rats 260
Rosuvastatin Reduced plasma oncentrations of rosuvastatin possible 11
Barberry
Antihypertensives Possible enhanced hypotensive effect, with large doses of fruit extract 12
(Berberis vulgaris)
Berberis vulgaris Losartan Berberine increased Cmax and AUC of losartan in rats (inhibition of CYP3A4 261
proposed)
Betel nut
Antipsychotic drugs Increased parkinsonian side effects reported with flupenthixol and fluphenazine 13
(Areca catechu)
Bilberry Warfarin Possible potentiation of anticoagulant activity, with high doses 14
Bitter melon
(Momordica charantia)
Blackseed
(Nigella sativa)
Bladderwrack
(Fucus vesiculosus)
Oral hypoglycaemic drugs Increased hypoglycaemic effects possible, if large doses taken 15, 16
Vinblastine Reversal of multidrug resistance reported in vitro 17
Amoxycillin Enhanced parenteral and oral bioavailability reported in rats 225
Ciprofloxacin Possibly reduces potential epileptogenic activity of ciprofloxacin 234
Amiodarone Reduced oral drug bioavailability reported in rats 224
Antithyroid agents (carbimazole, Possible antagonism of antithyroid hormone activity 18, 19
propylthiouracil, etc)
Thyroxine Possible potentiation of thyroid hormone activity 18, 19
2
7
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Herbal Supplements: Interactions
Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
Broom
(Cytisus scoparius)
Buckthorn
(Rhamnus frangula)
Bugleweed
(Lycopus virginicus; Lycopus
europaeus)
Antihypertensive drugs Possible interference with hypotensive activity 20
Cardiac glycosides + antiarrhythmic
agents
Use of large doses may product hypokalaemia, which potentiates drug toxicity 3, 4
Antithyroid agents (carbimazole, Possible potentiation of anti-thyroid effects 21, 22
propylthiouracil, etc)
Thyroxine Possible antagonism of thyroxine activity 21, 22
Bupleurum spp. Corticosteroids (eg, prednisone) Theoretical potentiation of anti-inflammatory action of corticosteroids 23
Butterbur
Corticosteroids Enhanced anti-inflammatory effects in asthma 24
(Petasites hybridus)
Carica papaya Amiodarone Increased bioavailability reported in rats 244
Cascara
(and other anthraquinone
laxatives)
Digoxin, quinidine and other
antiarrhythmic drugs
Possible hypokalaemia with long-term laxative use, possibly potentiating
cardiac glycoside and antiarrhythmic toxicity
Cassia auriculata Carbamazepine Increased bioavailability likely 25
Capsicum / cayenne
pepper
Theophylline Increased bioavailability likely 26
Antacids
Possible antagonism of gastroprotective action
Aspirin Reduced salicylic acid bioavailability in rats following large doses of chilli 27
Theophylline Increased bioavailability possible 28
Chamomile Antihistamines Potentiation of antipruritic effects 29
Chaste tree
(Vitex agnus castus)
Cinchona bark
(contains quinine)
Haloperidol, chlorpromazine,
metoclopramide and other dopamine
receptor antagonists
Progesterone drugs, oral contraceptives,
HRT, clomiphene
Possible antagonism of antipsychotic or anti-emetic effects, due to possible
dopaminergic action of Chaste Tree
Possible interference with activity of hormonal drugs, by as yet unknown
mechanisms
Antiarrhythmics Plasma concentration of flecainide increased 32
Antihistamines Ventricular arrhythmias with astemizole and terfenadine 33
Cardioactive glycosides Plasma concentration of digoxin increased 34
Cimetidine Increased plasma levels quinine due to inhibition of metabolism by cimetidine 35
Cinnamon Insulin Possible potentiation of hypoglycaemic effect 36
Oral hypoglycaemic drugs
Possible potentiation of hypoglycaemic effect
Cochinchina momordica Foot and mouth disease vaccine Enhancement of immune response to vaccine shown in pigs 37
Influenza vaccination (H5N1) Enhancement of immune responses shown in chickens 38
Coleus
Anticoagulants and antiplatelet agents Potentiation of anticoagulant or antiplatelet effect theoretically possible 39
(Coleus forskohlii)
Cola Caffeine Enhanced stimulant effects possible with large doses 40
Phenytoin Increased bioavailability of phenytoin reported in rabbits 41
Cordyceps sinensis Gentamicin and other aminoglycosides Protection against nephrotoxicity in rats 42
Cranberry Warfarin Several case reports of increased anticoagulant effects; similar effects in one
out of three studies on healthy volunteers; avoid ingestion of large amounts
Cumin (Cuminum cyminum) Rifampicin Enhancement of plasma levels by aqueous extract reported 55
Curcumin (from turmeric) Ethanol Possible protection against alcohol-induced neurological disorders 57
Gliclazide
Multiple doses of curcumin enhanced the hypoglycaemic effects of gliclazide in 262
rats and rabbits
Vinblastine and other cytotoxics Possible enhanced cytotoxic effects due to reversal of multidrug resistance 56
Dandelion leaf Diuretics Theoretical potentiation of diuretic effects with large doses
Da-Cheng-Qi
(Rheum tanguticum, Citrus
aurantium)
Dan shen
(Salvia miltiorrhiza)
Ranitidine Increased drug bioavailability reported in rats 58
Anticoagulants Potentiation of anticoagulant effects likely 59
Cyclosporin Protection against nephrotoxicity from parenteral Salvia in rats 60
3, 4
30
31
43, 44, 45, 46,
47–54
Page 198 HEALTHCARE HANDBOOK 2017-2018 References Charts

Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
Diuretics
(eg, Apium graveolens)
Dong quai
(Angelica sinensis)
Echinacea
Corticosteroids Increased risk adverse effects due to increased potassium loss (theoretical only) 61
Anticoagulants Theoretical risk of enhanced anticoagulant effects 62
Immunosuppressive drugs (eg,
Theoretical reduction in immunosuppressive effects, though no cases reported 63
cyclosporin, tacrolimus)
Marijuana Increased sensitivity to pharyngeal irritant effects of alkamide-rich liquids 64
Ephedra sinica Antihypertensive agents Possible antagonism of antihypertensive effect
CNS stimulants
Digoxin and cardioactive glycosides
Ergotamine and oxytocin
Halothane
Monoamine oxidase inhibitors (MAOIs)
SSRI antidepressants
Sympathomimetic effects; hypertension
Arrhythmias possible
Hypertension possible
Arrhythmias possible
Life-threatening acute hypertensive response + hyperpyrexia and coma
possible
Potentiation of serotonergic effects possible
Eugenol Gemcitabine Enhanced cytotoxicity reported in vitro 235
Eurycoma longifolia Propranolol Decreased drug bioavailability reported in healthy volunteers 215
(Tongkat ali; Pasak bumi)
Evodia rutaecarpa Theophylline Reduction in drug effects possible 65, 66
Fenugreek Antidiabetic agents Possible potentiation of hypoglycaemic activity (large doses) 67
Hypolipidaemic agents Possible potentiation of lipid-lowering effects (large doses) 68
Theophylline Reduced oral drug bioavailability reported in dogs following large doses 245
Feverfew Anticoagulants Theoretical potentiation of anticoagulant effects 69
Flaxseed
Many drugs Theoretical delay in absorption of drugs taken simultaneously 70
(Linum usitatissimum)
Garlic Adriamycin Protection against cardiotoxicity from large doses 71
Gentian (and other
bitters)
Ginger
Anticoagulants (warfarin,
Possible mild potentiation of anticoagulant effect 72, 73
phenprocoumon)
Gentamycin Protection against nephrotoxicity 74
Glibenclamide Large garlic doses increased hypoglycaemic activity in rats 236
Platelet inhibitors (dipyridamole, aspirin, Theoretical potentiation of platelet inhibitory effects, with large doses garlic 75
indomethacin, etc)
Saquinavir Reduced plasma levels reported, with large doses garlic 76
Anti peptic-ulcer agents
Anticoagulants (warfarin,
phenprocoumon)
Antiplatelet agents (eg, aspirin,
dipyridamole)
Possible antagonism of anti-ulcer effects
Theoretical potentiation of anticoagulant effect, when high doses ginger taken,
though little clinical evidence
Theoretical potentiation of antiplatelet effect, when high doses ginger taken,
though little clinical evidence and no effect in healthy volunteers
Cyclosporin Large doses ginger may reduce bioavailability of oral cyclosporin 78
Diclofenac
Reduced plasma levels seen in rabbits from a combined ginger and pepper 79
preparation
Ginkgo (Ginkgo biloba) Amlodipine Increased oral drug bioavailability reported in rats 250
Anticoagulants and antiplatelet agents Theoretical potentiation of anticoagulant or antiplatelet effects, though no 74, 77, 80
effect in healthy volunteers
Cilostazol Enhanced antiatherogenic effect suggested in mice 226
Clopidogrel
Pretreatment decreased Cmax and AUC of clopidogrel, but high dose ginko 26
increased Cmax and AUC of the clopidogrel active metabolite
Doxorubicin Reduction in cardiotoxicity in animal studies 81, 82
Efavirenz Two cases of virological breakthrough reported 219
Gentamycin Protection against ototoxicity reported in guinea pigs and rats 214
Haloperidol Improves efficacy of haloperidol and reduces adverse effects 83
77
77
Page 199

Herbal Supplements: Interactions
Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
Ginkgo (Ginkgo biloba)
cont.
Ginseng
(Panax ginseng)
Metformin Some potentiation of hypoglycaemic action suggested 84, 85
Midazolam Possible enhancement in drug bioavailability 86
Simvastatin Bioavailability of oral simvastatin but not simvastatin acid PK reduced 227
Tamoxifen No pharmacokinetic interactions in women; slight efficacy increase in rats 237, 238
Tolbutamide Slight attenuation of hypoglycaemic effect possible 86
Albendazole Increased excretion from GIT reported following IV ginseng 87
Caffeine Increased stimulant effects possible 88
Digoxin Interference with certain laboratory plasma measurements reported 89, 90
Hypoglycaemic drugs
MAOI antidepressants
Theoretical potentiation of hypoglycaemic effects, and improved insulin
resistance
Possible potentiation of MAOI effects, causing headache, mania
Globe artichoke Cholesterol-lowering drugs Theoretically additive effects with large doses 68
Goji
Warfarin Three case reports of potentiated anticoagulant effects 92, 93, 228
(Lycium barbarum – fruit)
Golden Seal Debrisoquine Increased drug levels possible 94
Gotu kola Adriamycin Possible protection against cardiac toxicity 95
Grapefruit juice Terfenadine Increased plasma levels reported 96
Calcium channel blockers Increased plasma concentration and thus cardiovascular effects 97
Chloroquine Increased plasma concentrations 98
Fexofenadine Reduced oral bioavailability reported 99
Immunosuppressants (eg cyclosporin, Increased plasma concentrations 97
tacrolimus, sirolimus)
Many other drugs Possible increased plasma concentration and thus effects 100
Statins Increased plasma levels reported 101
Green tea Bortezomib Reduced anticancer effects of bortezomib reported in vitro 102
Guar gum and other Antibiotics Absorption of phenoxymethypenicillin reduced 103
bulking agents
Guarana
Amiodarone Reduced drug plasma levels reported in rats 229
(Paullinia cupana)
Gymnema sylvestre Glimepiride Potentially beneficial antidiabetic effects 252
Hypoglycaemic drugs, including insulin Possible potentiation of hypoglycaemic effects 104
Hawthorn Digoxin and other cardiac glycosides Increased inotropic/cardiovascular activity; consider dosage reduction 105
Hypotensive drugs Increased hypotensive effect possible, with large doses of hawthorn 105
Hemidesmus indicus Gentamicin Protection against nephrotoxicity shown in animal studies 106
Honey Carbamazepine Reduced plasma levels of carbamazepine reported following large doses honey 107
in rabbits
Diltiazem
Reduced plasma levels diltiazem reported following large doses honey to 108
rabbits
Phenytoin Increased plasma levels of phenytoin reported in rabbits 109
Hops
Horse chestnut
Horseradish
Benzodiazepines, hypnotics, opioid
analgesics, tricyclic antidepressants
Anticoagulants and antiplatelet agents
such as warfarin and aspirin
5-fluorouracil
Propylthiouracil, methimazole and other
antithyroid agents
Potentiation of sedative effects 110
Potentiation of anticoagulant effects reported 111
In vitro potentiation of activity against hepatocellular carcinoma reported for 213
aescin, a key constituent
Increased thyrotoxic activity possible with large doses 112
Thyroxine Possible antagonism of thyroxine activity, with large doses 112
Jia-Wei-xiao-yao-san 5-fluorouracil Increased bioavailability of IV 5-FU in rats, with large doses of TJ-24 253
(Kami-shoyo-san; TJ-24)
Kaempferia parviflora Sildenafil Reduced drug bioavailability in rats, after large doses of KP 254
91
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Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
Karela
(Momordica charantia)
Kava
Kelp
Kyushin
(Japanese preparation)
Laxative herbs
(containing anthraquinone)
Insulin, sulphonylureas, biguanides Potentiation of hypoglycaemic effects possible 113
Dopamine antagonists (eg antipsychotics, Increased risk of parkinsonian side effects theoretically possible 114
metoclopramide)
Drugs with a risk of hepatotoxicity Possible increased risk of hepatotoxicity 115
Ethanol Additive CNS depressant effects possible, especially with large doses 116
Levo-dopa & other dopaminergic agents Possible reduction of efficacy of Leva-dopa in Parkinson’s disease. 114
Sedatives (eg, hypnotics,
benzodiazepines, opiates, some
analgesics)
Additive CNS depressant effects possible, especially with large doses 117
Antithyroid agents (carbimazole, Possible interference with antithyroid activity 18, 19
propylthiouracil etc)
Thyroxine Possible potentiation of thyroid hormone activity 18, 19
Digoxin
Possible interference with digoxin plasma assay
Antiarrhythmic drugs
Possible interference with drug activity if hypokalaemia following long-term 3, 4
laxative abuse
Digoxin Possible digoxin toxicity due to hypokalaemia if long-term laxative abuse 3, 4
Lemon Chloroquine Possible reduction in bioavailability and thus antimalarial effects 118
Liquorice
(Chinese; Glycyrrhiza
uralensis, European;
Glycyrrhiza glabra)
Alprazolam Potentiation of anxiolytic effect suggested from animal studies 246
Antihypertensives Interference with hypotensive effects, with prolonged use of large doses 119
Azathioprine Lowered risk of hepatotoxicity possible 120
Corticosteroids
Theoretical potentiation of steroidal effects
Digoxin Hypokalaemia leading to adverse cardiovascular effects, if large doses taken 119
Lignocaine Drug clearance increased after pre-treatment with large doses in rats 121
Ribavarin Reduced drug plasma levels reported with concurrent glycyrrhizin in rats 251
Thiazide and loop diuretics
Hypokalaemia with adverse effects especially likely when combined with 122
digoxin as above
Milk (St Mary’s) thistle Doxorubicin Protection against myocardial adverse effects shown in rats 123
Glibenclamide, metformin Improved diabetic control possible 124
Metronidazole
Reduced antibiotic effects possible – Silymarin shown to increase clearance of 125
metronidazole
Raloxifene
Silybin A and silybin B may increase raloxifene systemic exposure by inhibiting 255
intestinal raloxifene glucuronidation
Ribavarin Reduced drug plasma levels reported with concurrent silymarin in rats 256
Risperidone Increased oral drug bioavailability reported in rats 230
Myrrh Warfarin Case report of reduced anticoagulant effects 126
Ocimum gratissimum
(African Basil)
Orange juice
Paeony (Paeonia lactiflora)
Passionflower
Pepper
Piper nigrum (black)
Piper longum (long)
Ampicillin Enhanced activity against E. coli & Proteus mirabilis suggested 127
Cotrimoxazole Enhanced activity against E. coli suggested 127
Nystatin Enhanced anti-candidal activity suggested 127
Ketoconazole Enhanced anti-candidal activity suggested 127
Atenolol, celiprolol and possibly other
beta-blockers
Reduced bioavailability following 200ml orange juice 3 times daily 128, 129
Sodium picosulphate and other stimulant Reduced plasma levels of paeony active metabolite possible 130-132
laxatives; amoxicillin and metronidazole
Benzodiazepines, hypnotics, opioid Theoretical potentiation of sedative effects 6
analgesics, tricyclic antidepressants
Amoxycillin, cefotaxime and other betalactam
Increased plasma levels possible 133
antibiotics
Diclofenac and other NSAID drugs Combined pepper and ginger products reduced plasma levels in rabbits 134
Phenytoin, rifampicin Increased bioavailability shown with piperine 134
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Herbal Supplements: Interactions
Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
Pomegranate
(Punica granatum)
Pomelo juice
(Citrus maxima)
Psyllium seed
Metformin Reduced metformin Tmax reported in rats 264
Cyclosporin Increased bioavailability reported in healthy volunteers 135
Tacrolimus Case report of increased plasma levels 136
Digoxin, warfarin, lithium, carbamazepine
and possibly other drugs
Decreased absorption from GIT possible, with simultaneously administered
drugs, though controversial
Quercetin Irinotecan Enhanced drug bioavailability suggested by studies on rats 139
Reishi mushroom Benzodiazepines and other sedatives Potentiated hypnotic effects shown in rats 140
(Ganoderma lucidum)
Resveratrol Diclofenac Increased diclofenac bioavailability 266
Rhodiola rosea Losartan Increased oral drug bioavailability reported in rabbits 231
Rhubarb
(Rheum palmatum)
(Rheum officinale)
Cyclosporin Reduced cyclosporin bioavailability reported in rats 265
Digoxin and other cardiac glycosides Potassium loss and thus increased risk of cardiovascular toxicity, with 3, 4
prolonged use or abuse
Methotrexate Increased drug plasma levels reported in rats 239
Rosemary Azathioprine Protection against azathioprine-induced liver toxicity 141
Safflower flowers
(Carthamus tinctorius)
Chemotherapy drugs
Metoprolol
Enhanced intracellular accumulation of doxorubicin and vinblastine reported
in vitro
Reduced metabolism and possible enhanced bioavailability reported in rodent
studies
Sage Azathioprine Protection against azathioprine-induced liver toxicity 141
Salboku-to
(Asian herbal mixture;
contains same herbs as Shosaiko-to,
plus xiao chai hu
tang, poria cocos, Magnolia
officinalis, Perillae frutescens)
Schisandra
(Schisandra chinensis and S.
sphenanthera)
Sedatives
(eg, valerian, hops, kava,
passionflower)
Senna
(Cassia spp)
Senega
(Polygala senega)
Shankhapushpi
(Ayurvedic preparation)
Sho-saiko-to
(Minor bupleurum)
Siberian ginseng
(Eleutherococcus senticosus)
Prednisolone or prednisone Increased steroidal effects possible 143
Ciclosporin A Enhanced oral drug bioavailability at low but not high drug dosages in rats 232
137, 138
Cytotoxics
Possible enhanced cytotoxic effects by large doses due to reversal of multi-drug 144, 145, 146
resistance by gomisin A and schisandrol A
Paclitaxel Enhanced oral drug bioavailability in rats 221
Rapamycin Enhanced oral drug bioavailability in healthy volunteers 233
Tacrolimus
Sedative drugs (eg, benzodiazepines,
clonidine, opioid analgesics,
phenobarbitone)
Cardiac glycosides and antiarrhythmics
(eg, quinidine)
Enhanced oral bioavailability in healthy volunteers. Reduced schisandra lignin 147, 240
plasma levels in rats
Potentiation of sedative effects 6, 117
Hypokalaemia leading to increased risk of cardiac toxicity 3, 4
Hypoglycaemic drugs Possible enhancement of hypoglycaemic effects 148
Phenytoin Decreased phenytoin concentrations, loss of seizure control 149
Carbamazepine Reduced plasma levels measured in rats after large doses 150
Digoxin Interference with certain laboratory serum digoxin measurements reported 151
Slippery elm Various drugs Theoretical reduction in absorption and thus clinical effects
Sophora flavescens Various drugs Theoretical enhancement of effects through inhibition of CYP450 3A4 152
(Kushen)
St John’s wort Amitriptyline and nortriptyline Possible reduction in plasma levels and antidepressant effects 153
Atorvastatin Reduced hypocholesterolaemic effects possible 154
Carbamazepine Theoretical reduction in plasma levels although no effects reported clinically 155
Cisplatin
Possible protection against cisplatin nephrotoxicity by pre-treatment with large
doses
142
212
156
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Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
St John’s wort
cont.
Clopidogrel Enhanced antiplatelet effects reported in hyporesponders 247
Clozapine Case report of reduced plasma drug levels and clinical deterioration 220
Cyclosporin, tacrolimus and other
immunosuppressants
Possible reduction in plasma immunosuppressant levels and thus compromised
treatment/ transplant rejection
Daunorubicin Possible reduction in plasma levels and thus failure of cytotoxic effect 158
Digoxin Possible reduction in plasma digoxin levels, and thus therapeutic failure 159
Docetaxel Possible reduced plasma levels and thus failure of cytotoxic effect 153
Fexofenadine Reduction of plasma levels and thus antihistaminic effects 160
Gliclazide Reduced plasma levels possible 161
Imatinib mesylate Possible reduced plasma levels and thus failure of cytotoxic effects 162
Indinavir, saquinavir, ritonavir and other Possible reduction in plasma levels, and thus failure of antiviral effect 135
protease inhibitor antivirals
Irinotecan Reduced plasma levels of active metabolite SN-38 in cancer patients reported 164, 165
Ivabradine Reduced plasma levels possible 166
MAOIs
Theoretical possibility of serious serotonin syndrome, though no cases reported
Methadone Case reports of reduced plasma levels in two methadone patients 167
Midazolam Reduced plasma levels in volunteer study 168
Morphine Potentiated antinociceptive effects reported in mice 169
Nevirapine Reduced plasma levels reported 170
Nifedipine Reduced plasma levels possible 171
Omeprazole Reduced plasma levels reported 172
Oral contraceptives
Increased breakthrough bleeding possible; case reports of unwanted
173, 174, 175
pregnancies though no evidence of reduced efficacy from 3 controlled studies
Oxycodone Possible reduction in plasma levels and thus analgesic effect 211
Phenprocoumon Reduced plasma levels and thus anticoagulant effects 176
Phenytoin Theoretical reduction in plasma levels 177
Phenobarbitone Theoretical reduction in plasma levels 177
Procainamide Single dose of SJW increases procainamide plasma levels in mice 178
Quazepam Reduced plasma levels possible 179
Simvastatin Reduced plasma concentrations and thus hypocholesterolaemic effects 180
SSRI antidepressants (eg, fluoxetine,
sertraline, paroxetine)
Theoretical possibility of serious serotonin syndrome, though few case reports
to date
Talinolol Reduced plasma levels possible 181
Tacrolimus Reduced plasma levels reported in renal transplant patients 182, 183
Tolbutamide Increased incidence of hypoglycaemia 176
Triptans (sumatriptan, naratriptan, Theoretical possibility of serotonin syndrome, though no case reports to date
rizatriptan, zolmitriptan)
Verapamil Reduced bioavailability reported in healthy volunteers 184
Warfarin Possible reduction in anticoagulant effect 185, 186
Zolpidem Reduced plasma drug levels reported 210
St Mary’s thistle – see milk thistle
Sutherlandia frutescens Nevirapine Reduced drug bioavailability in rats 222
Sympathomimetics ACE inhibitors Severe hypertension 187
(eg, ephedrine and
pseudoephedrine from
Anaesthetics Arrhythmia 188
Ephedra spp.)
Antidepressants Hypertensive crises with MAOIs; hypertension, arrhythmias with tricyclics 189, 190
Antihypertensives, antipsychotics, betablockers
Antagonism, hypertension (possibly severe) 191, 187
157
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Herbal Supplements: Interactions
Herbal Supplements – Interactions
Herb/herb group Possible interacting drugs Possible interaction(s) References
Sympathomimetics
cont…
Tamarind
(Tamarindus indica)
Tannin-rich agents
Thyme
Trikatu
(Ayurvedic preparation
containing ginger, black
pepper, and Piper longum)
Turmeric
Uzara root
(Ayurvedic preparation)
Valerian
Vasoconstrictors
(eg, broom)
Bronchodilators Potentiation 192
Diuretics Increased risk of hypokalaemia 187
Dopaminergics Increased risk of toxicity with bromocriptine 193
Sympathomimetics Potentiation and hypertension 191
Vasoconstrictor Increased vasopressor effects 191
Choroquine Reduced chloroquine bioavailability shown in healthy volunteers 194
Ibuprofen Increased ibuprofen bioavailability shown in healthy volunteers 195
Iron, zinc, calcium and mineral
preparations
Many drugs
Protein-rich preparations
Possible reduced mineral absorption from GIT 196
Theoretical reduction in absorption from GIT, although virtually no evidence to
date
Possible reduced protein absorption from GIT
Tetracycline-based and possibly betalactam-based
Potentiation of antibiotic effects against MRSA possible with large doses 197
antibiotics
Ibuprofen Reduced bioavailability reported in rabbits 134
Rifampicin Rate but not extent of bioavailability reduced in rabbits 198
Platelet inhibitors (eg, aspirin,
dipyridamole)/ anticoagulants (warfarin)
Possible potentiation of antiplatelet effect with high doses of turmeric or
curcumin
Digoxin Interference with digoxin plasma assay 200
Benzodiazepines, hypnotics, tricyclic
antidepressants, opioid analgesics,
anaesthetics
Potentiation of sedative effects and prolongation of anaesthesia 201
Antihypertensives Antagonism 20
Sympathomimetics
Hypertension
Vasodilators
Antihypertensives
Additive effects
(eg, hawthorn)
Vitamins Anticoagulants Vitamin K antagonises
Anticonvulsants
Folic acid occasionally reduces plasma concentration, vitamin D requirements 202
increased
Diuretics Hypercalcaemia with thiazides and vitamin D supplementation 203
Dopaminergics Levodopa antagonised with pyridoxine 204
Wormwood
Warfarin Case report of GI bleeding and increased INR after wormwood 241
(Artemisia absinthium)
Willow bark Anticoagulants Theoretical potentiation of anticoagulant effects with large doses
Withania (Ashwagandha) Digoxin Interference with serum digoxin assay reported 205
Wolfberry or Goji
(Lycium barbarum)
Xanthine-rich remedies
(eg, cola, guarana, mate)
Yohimbe
(Pausinystalia yohimbe)
Warfarin Potentiated anticoagulant effects possible 206
Antidepressants, selective serotonin Plasma concentration of xanthines increased 207
reuptake inhibitors (SSRIs)
Antihypertensives Antagonism of hypotensive effect possible 208
Antihypertensives Antagonism of hypotensive effect possible 209
199
NOTE: While the author has made every effort to ensure that the information
given in this table is accurate and up-to-date, no responsibility can be held for
the clinical safety of any of the above combinations or contraindications, or
any future information that may become available on this constantly changing
subject. (March 2016)
Entire contents Copyright, Phil Rasmussen, 2017
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Page 205

Drugs in Sport
Treating Athletes
Medical professionals need to exercise caution when treating athletes because
many medications are not permitted for use in sport.
Athletes at any level may be subject to drug testing. Testing may be conducted
at a competition or event or out-of-competition when an athlete is training, travelling
or at home. Athletes have a responsibility to inform every doctor or specialist
treating them that they are subject to drug testing in sport. Drug Free Sport NZ
(DFSNZ) provides up-to-date information regarding medications to athletes so
that they can alert medical professionals to their special needs.
The Prohibited List
Medications which are not permitted in sport are listed in the World Anti-Doping
Agency’s Prohibited List which is published on January 1st each year. It is important
to keep up-to-date with what’s included on this list. The list is available at www.
drugfreesport.org.nz
Checking Medications
Medical professionals should always check the status of a medication before
prescribing to an athlete. This can be done by:
••
checking the New Zealand Formulary database (www.nzformulary.org.nz)
for possible restrictions in sport
••
visiting www.drugfreesport.org.nz/medication-check
••
calling Drug Free Sport NZ on 0800 DRUGFREE (0800378437)
••
texting the medication name or active ingredient to 4365 (texts cost 20c).
Common Conditions
If an athlete has one or more of the following conditions it is likely that prohibited
substances will be part of the recommended treatment:
••
ADHD
••
asthma
••
cardiovascular disease
••
diabetes
••
severe acne and other severe skin conditions
••
severe hay fever or other allergic reactions.
Athletes who require anaesthesia, surgery or dental work are also likely to
require medication which is prohibited in sport.
supporting the diagnosis in the event an adverse analytical finding results from
testing. Please call Drug Free Sport NZ on 0800 DRUGFREE (0800 378 437) for
further information.
Supplements
Drug Free Sport NZ advises athletes that they take supplements at their own risk.
It warns athletes to be wary of supplements for the following reasons:
••
supplements are not manufactured to the same rigorous standards as
pharmaceuticals
••
some supplements may be cross-contaminated with prohibited substances
••
labelling laws are not the same in all countries meaning that some ingredients
may not be listed
••
manufacturing standards vary greatly around the world and some supplement
manufacturers use phrases such as “pharmaceutical standards” or “approved by
XXX sports league”. This does not mean they are safe for use in sports.
Drug Free Sport NZ cannot determine the status of any supplement in
sport, but can provide advice about the level of risk associated with particular
brands or ingredients. Athletes should contact Drug Free Sport NZ for advice
on supplements (0800 DRUGFREE) or use the organisation’s online supplement
enquiry form at www.drugfreesport.org.nz/supplement-check
Quick Reminders
••
Ensure you check the status of all medications before administering them to
athletes.
••
If the medication is prohibited, check to see if there is an alternative that is
permitted. If not, check that the athlete is aware a TUE may be required.
••
If you have any queries, call 0800 DRUGFREE (378 437) for assistance
••
Check Drug Free Sport NZ’s website for further information and advice on
treating athletes: www.drugfreesport.org.nz
Reviewed by Drug Free Sport NZ, March 2017.
Therapeutic Use Exemptions (TUEs)
If international or national level athletes (as determined by DFSNZ) are prescribed
a prohibited substance they must obtain a TUE before using the medication. This
form must be submitted to Drug Free Sport NZ (or the athlete’s International Federation
if applicable). The athlete has to wait for TUE approval before using the
medication unless the situation is deemed an emergency whereby the athlete’s
health is at great risk. In these circumstances a TUE application should be submitted
as soon as possible once the situation is resolved. TUE forms are available at
www.drugfreesport.org.nz
Note: Athletes who are not competing at a national or international level
can apply for a TUE retrospectively; however, they will require a full medical file
Page 206 HEALTHCARE HANDBOOK 2017-2018 References Charts

Common permitted and prohibited OTC medicines
Cough, cold, flu,
sore throat
Diarrhoea or
vomiting
Hay fever
Pain/inflammation/
headache
Permitted
Anaesthetic throat sprays
Antihistamines (see hay fever below)
Aspirin, benzydamine, or oral anti-inflammatories
Cough medicines, eg: bromhexine, dextromethorphan, guaiphenesin,
pholcodine
Phenylephrine
Electrolyte replacement therapies (eg, Enerlyte, Gastrolyte, Hydralyte)
Loperamide (eg, Diamide, Imodium, Nodia)
Prochlorperazine (eg, Antinaus), promethazine (Avomine), meclozine
(Sea-Legs), scopolamine (Scopoderm TTS)
All antihistamines (eg, Fexofast, Hayfexo, Levrix, Phenergan,
Polaramine, Zyrtec)
Glucocorticoid nasal sprays (eg, Beconase, Flixonase, Telnase)
Oxymetazoline, xylometazoline (eg, Dimetapp, Otrivin)
All non-steroidal anti-inflammatories (eg, aspirin, ibuprofen, diclofenac,
naproxen)
Paracetamol
Tramadol
Combination analgesics that include codeine with other permitted
medicines (eg, Mersyndol, Nurofen Plus, Panadeine)
Products containing caffeine (eg, Panadol Extra, Parafast Extra)
Examples of prohibited medicines
All pseudoephedrine products are prohibited in competition. DFSNZ recommends
athletes consider using products that contain phenylephrine as a permitted
alternative
Products containing MORPHINE (eg, Gees Linctus)
Alcohol is prohibited in-competition in certain sports – see Drug Free Sport NZ
website for details
All pseudoephedrine products are prohibited in competition
Oral prednisone
In-competition, all medicines containing morphine, pethidine, fentanyl, oxycodone,
etc are prohibited
Skin conditions Topical hydrocortisone preparations (eg, Derm-Aid) Oral glucocorticoids (eg, prednisone) are prohibited in-competition
Note: Call 0800 DRUGFREE (378 437) for a full list of prescription medicines, or if unsure.
A Guide To Commonly Prescribed Medicines And Their Status In Sport
MEDICINE International athlete National athlete Other athletes
Salbutamol by inhalation (eg, Respigen, Salamol, Ventolin)* Permitted Permitted Permitted
Salmeterol by inhalation (eg, Meterol, Serevent)* Permitted Permitted Permitted
eFormoterol by inhalation (eg, Oxis, Foradil, Symbicort,
Vannair)*
Glucocorticoids by inhalation (eg, Beclazone, Flixotide,
Pulmicort)
Permitted Permitted Permitted
Permitted Permitted Permitted
Terbutaline (eg, Bricanyl) TUE required from IF TUE required from DFSNZ TUE required retrospectively if a positive test occurs
Systemic salbutamol (eg, Ventolin elixir) TUE required from IF TUE required from DFSNZ TUE required retrospectively if a positive test occurs
Systemic glucocorticoids (eg, prednisone – oral, parenteral,
intramuscular, rectal)
TUE required from IF TUE required from DFSNZ TUE required retrospectively if a positive test occurs
Nasal/eye/ear/topical corticosteroids Permitted Permitted Permitted
Note: IF stands for the athletes’ International Federation – we advise International Level athletes to call 0800 DRUGFREE (378 437) for assistance when a TUE is required.
*Thresholds exist for certain inhalers (for example, salbutamol has a threshold of 1600mcg per 24 hours or 800mcg per 12 hours. Once this threshold is exceeded, a positive test will be reported).
Essentially, if inhalers are used as prescribed at standard prescription dosages, the threshold should not be exceeded.
Page 207

Drugs in Aviation
AVIATION – PRECAUTIONS FOR OTC MEDICINES USE
The aviation environment is complex and demanding on human performance.
Everyone who works in aviation needs “a clear head”, good mental alertness,
unimpaired vision and balance, the ability to concentrate (often for long
periods), the ability to respond quickly and appropriately to emergencies, and
good coordination and motor skills. Medicines which interfere with these safety
requirements must not be taken prior to, or while on, duty. These include products
which cause:
••
behaviour problems, including excitement or agitation
••
sedation
••
memory, concentration, vigilance impairment
••
locomotor impairment, tremor
••
disturbances of the special senses, particularly vision and balance.
Some nonprescription medicine ingredients such as antihistamines, even some
labelled as non-sedating, can have significant side effects which may compromise
safety in the aviation workplace.
Treatments that may not be safe
Many common products may not be safe to use. These include products used
to treat:
••
abdominal pain
••
colds
••
diarrhoea
••
hay fever
••
itchy eyes
••
motion sickness
••
pain or inflammation
••
smoking addiction (specifically varenicline).
All over the counter medication or health preparations should be regarded
with caution, including preparations used for body-building, which may contain
anabolic steroids. Complementary remedies, including Chinese herbals and even
homeopathic remedies may be unsafe as their content is not subject to the same
stringent requirements as registered medicines, or they may cause side effects
such as drowsiness, or interfere with other medicines the person may be taking.
Medicine side effects can be further aggravated in the flight environment
when combined with other environmental stressors such as hypoxia, reduced
barometric pressure, accelerations, noise, and reduced humidity and temperature.
There are other aggravating factors to consider, such as working at night, jet lag
and fatigue. Interactions with prescription medicines should also be considered.
An important factor is the condition being treated. A pilot requiring treatment
may be unable to safely exercise the privileges of any licence held.
It is essential that anyone involved in prescribing or recommending medicines
for aviation workers ensures patients/purchasers are cautioned about possible
adverse side effects and safety implications in the workplace.
Individuals are ultimately responsible to establish the safety of the medicines
they are taking. It is best to seek medical opinion, preferably from a medical
examiner designated by the Civil Aviation Authority, and inform their operations
manager. It may be necessary to declare that they are unfit for flying or Air Traffic
Control duties. The safety of the individual, co-workers and passengers depends
on responsible and informed users of non-prescription and medically prescribed
drugs or complementary remedies.
Licence holders should be aware of their obligation under Section 27C of the
Civil Aviation Act – see www.caa.govt.nz. In particular, licence holders are
reminded of their duty to report any change of medical condition to the Director
of Civil Aviation (preferably via their Medical Examiner), unless it is a temporary
condition specifically exempted by the Director of Civil Aviation in a General
Direction (GD); there is currently no GD defining temporary medical conditions
that do not need to be reported.
Civil Aviation Authority of NZ central medical unit help desk: 04 560 9466 or
med@caa.govt.nz
REVIEWED BY Dr CLAUDE PREITNER, Senior Medical Officer, Civil
Aviation Authority of New Zealand, March 2017.
Page 208 HEALTHCARE HANDBOOK 2017-2018 References Charts

Drugs in Diving
DIVING – PRECAUTIONS FOR OTC MEDICINES USE
Any drug which acts on a physiological or psychological parameter of an individual
may well impact on diving and diving safety. If a person has a condition which
is a contraindication to diving, it is better not to dive than to take a medicine to
ameliorate the symptoms.
The following classes of drugs may be unsafe to use while
diving.
Analgesics
Analgesics may contain a combination of products including codeine or sedating
antihistamines such as doxylamine. These ingredients may cause drowsiness
or contribute to the deterioration in mental function associated with nitrogen
narcosis.
Bronchodilators
Theophylline may be associated with cardiac arrhythmias and central nervous
system effects such as anxiety and restlessness. Salbutamol is short-acting and
may stop working during diving. Diving should be avoided if a bronchodilator is
considered necessary.
Decongestants (short acting)
Short-acting decongestants such as phenylephrine may wear off during the
dive, and cause a reverse block. Although their use by divers is widespread,
decongestant use may encourage diving with underlying conditions that are
contraindicated, for example, upper respiratory tract infections or allergies.
Decongestants can cause tachycardia, and vertigo or disorientation have also been
reported during diving.
Ear wax softening drops
Although the use of ear wax softening drops is not contraindicated for diving, ear
wax should be removed before diving.
Nicotine/smoking
Nicotine increases production of carboxyhaemoglobin, which lowers the oxygencarrying
capacity of the blood, and causes an overall decrease in cardiovascular
fitness. The acute effect of nicotine is to increase heart rate and blood pressure.
Smoking also increases mucus production and reduces the ability for the lungs
to clear secretions, which could increase the risk of air trapping and pulmonary
barotrauma.
Recreational drugs
All recreational drugs such as alcohol, marijuana, cocaine, opiates, etc., are
strongly advised against when diving.
Sedating drugs
Antihistamines used for allergy or as an antiemetic could cause drowsiness
or contribute to the deterioration in mental function associated with nitrogen
narcosis.
Herbal remedies
Herbal remedies should be avoided in combination with diving, as many of these
are inadequately labelled as to their contents. Some “herbal” remedies have
been found to contain steroids, opiates and even Viagra.
Anyone intending to dive after having taken ANY kind of medicine should first
seek a medical opinion, preferably from a Dive Doctor.
REVIEWED BY Dr Chris Sames, Senior Medical Officer, Slark Hyperbaric
Unit, Waitemata DHB, March 2017.
Page 209

Drugs in Pregnancy
Drug use in pregnancy
Some medicines taken during pregnancy have been documented to cause birth
defects so expectant mums should always discuss safety in pregnancy of any
prescription medicine, OTC or herbal remedy with their doctor or pharmacist first.
Currently up to 4 per cent of babies are born with birth defects but only about
10 per cent of problems seen at birth can be traced to a specific medication, drug,
exposure to an environmental toxin, or nutritional deficiency or supplementation.
Agents that can cause malformations are called teratogens and some over-thecounter
medicines, vitamins and herbal preparations, fall into this category. Many
other medicines may also cause problems but there may be too little research on
the expected level of risk.
The level of risk is usually dependent on when the foetus is exposed to the
substance. Two or three weeks after conception, the embryo is connected to
the mother’s blood supply so that anything she ingests can cross over to the
growing baby. The first trimester is a critical time for foetal development and,
where possible, all drugs should be avoided.
The risk of malformation drops after this period but some drugs can still pose
risks in the second and third trimesters, which is why pregnant women seeking
advice at the pharmacy should always be referred to the pharmacist.
General points about drug use in pregnancy
••
Avoid drugs whenever possible and attempt non-drug treatments first.
••
Avoid all drugs in the first trimester wherever possible. Note, however, that
some medicines may be unsafe at another time, eg, NSAIDs such as ibuprofen
should be avoided in the third trimester. Paracetamol is the recommended choice
for pain relief.
••
Drugs should be given at the lowest effective dose for the shortest possible
time.
••
Select drugs that have an established safety profile and avoid those that have
not been used extensively in pregnant women.
••
Use topical preparations, if available, to minimise systemic exposure, but be
aware that absorption for some may be significant, particularly if used on a large
area, eg, methyl salicylate.
••
In general, herbal and complementary medicines are not recommended in
pregnancy due to lack of safety information. Avoid multivitamin preparations
containing vitamin A.
••
For guidance on Prescribing in Pregnancy, see the New Zealand Formulary:
Prescribing in pregnancy (nzf.org.nz/nzf_151). Hospital Medicines Information
Departments also usually have a good database of previously answered questions
about specific drug use during pregnancy.
••
Refer any pregnant woman who requests a medicine, herbal or complementary
medicine to the pharmacist.
Useful websites:
••
New Zealand Formulary: nzf.org.nz
••
Christchurch Drug Information Centre: www.druginformation.co.nz/
pregnancy.htm
••
Prescribing medicines in pregnancy, on-line database, TGA Australia:
www.tga.gov.au/prescribing-medicines-pregnancy-database
REVIEWED BY: Carmen Fookes, Clinical Pharmacist, March 2017
Page 210 HEALTHCARE HANDBOOK 2017-2018 References Charts

Drugs in Driving
Drugs in driving – legislation
Many medicines can affect driving, and it is an offence to drive a motor vehicle
while impaired as a result of taking a prescription medicine or specified controlled
drug. Specific medicines mentioned in the Land Transport Act legislation include
all illicit controlled drugs (eg, cannabis, methamphetamine), other controlled
drugs (eg, morphine, methadone, oxycodone, fentanyl, benzodiazepines) and
all prescription medicines. Prescription medicines most likely to impair driving
include those that may cause sedation, those that may affect eyesight, and those
that may cause hypotension, hypoglycaemia or dizziness.
Pharmacists should use the PSNZ Cautionary and Advisory Label number 1,
rather than the shortened computer-generated message, on all medicines likely
to cause sedation. This written warning that “This medicine may make you sleepy
and make it dangerous to drive or operate machinery” should also be supported
by clear, verbal advice to ensure patients understand the significance of the
information.
Pharmacists should advise patients not to drive until they are aware of how
the medicine will affect them and for how long after a dose is taken that medicine
affects their ability to drive safely. Usually this will become evident during the
first seven to 10 days of treatment and for three to four days after any dose
increase. If impaired, the person must not drive. Note that it is not an offence to
ingest a medicine that may impair driving. An offence is only created if driving is
impaired to such an extent that it comes to the attention of the police.
The purpose of this legislation is road safety. It empowers police to stop a
person from driving if they have good cause to suspect that person is impaired.
Police then have the right to conduct a roadside impairment test (walk a straight
line, stand on one leg, pupil reaction etc). If the person fails the test, they can be
forbidden to drive until no longer impaired, and a blood sample may be taken.
If any medicines listed in the legislation are detected, prosecution may result.
ORIGINAL AUTHOR: Euan Galloway
REVIEWED BY: Carmen Fookes, Clinical Pharmacist, March 2017
Page 211

NZ Support Groups
ADHD Association
Phone: (09) 625 1754
Email: adhd@clear.net.nz
www.adhd.org.nz
Age Concern New Zealand
Phone: (04) 801 9338
Email: eo@acwellington.org.nz
www.ageconcern.org.nz
Alcoholics Anonymous New Zealand
Phone: (04) 472 4250 or 0800 AA WORKS (0800 229 6757)
Email: nzgso@aa.org.nz
www.aa.org.nz
Allergy NZ
Auckland: Phone: (09) 623 3912 or 0800 34 0800
Email: allergy@allergy.org.nz
www.allergy.org.nz
Alzheimers NZ
Freephone: 0800 004 001
Phone: (04) 387 8264
Email: admin@alzheimers.org.nz
www.alzheimers.org.nz
Arthritis NZ
Freephone: 0800 663 463
Email: info@arthritis.org.nz
www.arthritis.org.nz
Asthma New Zealand
Phone: (09) 623 2293
Email: auckland@asthma.org.nz
www.asthma.org.nz
Asthma and Respiratory Foundation of NZ (Inc)
Phone: (04) 499 4592
Email: info@asthmaandrespiratory.org.nz
www.asthmafoundation.org.nz
Autism NZ Inc
Freephone: 0800 AUTISM (0800 288 476)
Phone: (04) 803 3501
Email: info@autismnz.org.nz
www.autismnz.org.nz
Barnardos NZ (National Office)
Freephone: 0800 BARNADOS (0800 227 627)
Phone: (04) 385 7560
www.barnardos.org.nz
Blind Foundation
Freephone: 0800 24 33 33
Email: generalenquiries@blindfoundation.org.nz
www.blindfoundation.org.nz
Cancer Society of NZ
Cancer Information Helpline: 0800 CANCER (226 237)
Email: info@cancersoc.org.nz
www.cancernz.org.nz
Continence – NZ Continence Association
Bladder Helpline: 0800 650 659
Email: info@continence.org.nz
www.continence.org.nz
Crohn’s and Colitis New Zealand
Freephone: 0800 ASK IBD (0800 275 423)
Email: info@crohnsandcolitis.org.nz
www.crohnsandcolitis.org.nz
Cystic Fibrosis New Zealand (CFNZ)
Freephone: 0800 651 122
Phone: (09) 308 9161
Email: admin@cfnz.org.nz
www.cfnz.org.nz
Cure Kids
Phone: (09) 370 0222
Email: admin@curekids.org.nz
www.curekids.org.nz
Diabetes NZ
Freephone: 0800 DIABETES (0800 342 238)
Email: admin@diabetes.org.nz
www.diabetes.org.nz
Endometriosis New Zealand
Phone: (03) 379 7959
Email: info@nzendo.org.nz
www.nzendo.co.nz
Epilepsy NZ
Freephone: 0800 37 45 37
Email: national@epilepsy.org.nz
www.epilepsy.org.nz
Family Planning
Phone: (04) 384 4349
Email: national@familyplanning.org.nz
www.familyplanning.org.nz
Page 212 HEALTHCARE HANDBOOK 2017-2018 References Charts

Fertility NZ
Freephone: 0800 333 306
Email: support@fertilitynz.org.nz
www.fertilitynz.org.nz
Healthline
Free 24-hour health advice (all ages)
Phone: 0800 611 116
Heart Foundation
Freephone: 0800 863 375
Phone: (09) 571 9191
Email: info@heartfoundation.org.nz
www.heartfoundation.org.nz
Hepatitis Foundation of New Zealand
Freephone: 0800 33 20 10
Phone: (07) 307 1259
Email: via website
www.hepatitisfoundation.org.nz
KidsCan
Phone: (09) 478 1525
www.kidscan.org.nz
Kidsline
Freephone 24/7: 0800 54 37 54
Email: info@lifeline.org.nz
www.kidsline.org.nz
Kidney Health New Zealand
Freephone: 0800 KIDNEY (0800 543 639)
Email: info@kidneys.co.nz
www.kidneys.co.nz
La Leche League New Zealand
Phone: (04) 471 0690
Email: administrator@lalecheleague.org.nz
www.lalecheleague.org.nz
Leukaemia and Blood Cancer New Zealand
Freephone: 0800 15 10 15
Phone: (09) 638 3556
Email: info@leukaemia.org.nz
www.leukaemia.org.nz
Lifeline
Freephone 24/7: 0800 543 354
Email: info@lifeline.org.nz
www.lifeline.org.nz
Look Good Feel Better
Freephone: 0800 TO LGFB (0800 865 432)
Email: info@lgfb.co.nz
www.lookgoodfeelbetter.co.nz
ME/Chronic Fatigue syndrome – ANZMES Inc
Phone: (09) 269 6374
Email: info@anzmes.org.nz
www.anzmes.org.nz
Mental Health Foundation of New Zealand
Phone: (09) 623 4812
Email: info@mentalhealth.org.nz
www.mentalhealth.org.nz
Migraine Sufferers’ Support Group
Phone: (09) 482 1331
Email: annette@migraine.co.nz
Miscarriage Support
Phone: (0508) 72 63 72
Email: via website
www.miscarriagesupport.org.nz
Motor Neurone Disease Association
Phone: (09) 624 2148
Email: via website
www.mnda.org.nz
Multiple Sclerosis Society of New Zealand
Freephone: 0800 MS LINE (0800 675 463)
Phone: (04) 499 4677
Email: info@msnz.org.nz
www.msnz.org.nz
Muscular Dystrophy Association of NZ Inc
Freephone: 0800 800 337
Phone: (09) 815 0247
Email: info@mda.org.nz
www.mda.org.nz
National Foundation for the Deaf Inc (NFD)
Freephone: 0800 TO SIGN (0800 867 446)
Phone:/TTY (09) 307 2922
Email: enquires@nfd.org.nz
www.nfd.org.nz
Neurological Foundation of New Zealand
Freephone: 0508 BRAINS (0508 272 467)
Phone: (09) 309 7749
Email: admin@neurological.org.nz
www.neurological.org.nz
Page 213

NZ Support Groups
New Zealand AIDS Foundation
24hr AIDS Hotline 0800 802 437
Email: contact@nzaf.org.nz
www.nzaf.org.nz
NZ Federation of Disability Information Centres (NZFDIC)
Phone: 021 124 8860
Email: admin@nzfdic.org.nz
www.nzfdic.org.nz
NZ Nutrition Foundation
Phone: (09) 489 3417
Email: webenquiry@nutritionfoundation.org.nz
www.nutritionfoundation.org.nz
Osteoporosis New Zealand Inc
Phone: (04) 499 4862
Email: info@osteoporosis.org.nz
www.osteoporosis.org.nz
Stroke Foundation of NZ Inc
Freephone: 0800 STROKE (0800 78 76 53)
Phone: (04) 472 8099
Email: strokenz@stroke.org.nz
www.stroke.org.nz
Suicide Crisis Helpline
Freephone 24/7: 0508 TAUTOKO (828 865)
Email: info@lifeline.org.nz
www.lifeline.org.nz
Women’s Health Action
Phone: (09) 520 5295
Email: info@womens-health.org.nz
www.womens-health.org.nz
Parents Centres NZ Inc
Phone: (04) 233 2022
Email: info@parentscentre.org.nz
www.parentscentre.org.nz
Parkinson’s Society Inc
Freephone: 0800 473 4636
Phone: (04) 472 2796
Email: info@parkinsons.org.nz
www.parkinsons.org.nz
Plunket – Royal NZ Plunket Society Inc
24hr PlunketLine 0800 933 922
Email: plunket@plunket.org.nz
www.plunket.org.nz
Prostate Cancer Foundation of NZ
Freephone: 0800 4 PROSTATE (0800 477 678)
Email: info@prostate.org.nz
www.prostate.org.nz
Psoriasis Association (Southland)
Phone: (03) 216 8662
Email: sthpsor@hyper.net.nz
www.psoriasis.org.nz
Supporting Families in Mental Illness
Freephone: 0800 SF AUCK (0800 732 825)
Phone: (09) 378 9134
Email: admin@sfauckland.org.nz
www.supportingfamilies.org.nz
Page 214 HEALTHCARE HANDBOOK 2017-2018 References Charts

1
BETTER, FASTER
PAIN RELIEF
than Paracetamol or Ibuprofen alone 1
PROVEN EFFECTIVENESS
Clinically proven to reduce pain levels by at least 32% more than a
full daily OTC dose of either Paracetamol or Ibuprofen alone 1 .
DELIVERS MAXIMUM DOSAGE
MAXIGESIC ® is the only combination analgesic that delivers the
maximum recommended daily OTC dose of Paracetamol 4000mg
and Ibuprofen 1200mg, if required.*
CODEINE FREE PAIN RELIEF
This patented combination of Paracetamol and Ibuprofen provides
double action relief from a wide range of pain – without codeine.
NEW 2017 TV CAMPAIGN
MAKE THE SWITCH TO MAXIGESIC
Hartley Atkinson
Inventor of Maxigesic
* Maximum of 8 tablets over a 24 hour period
Ref 1. Merry, A. F., Gibbs, R. D., Edwards, J., Ting, G. S., Frampton, C., Davies, E. and Anderson, B. J. (2010). “Combined acetaminophen and ibuprofen for pain relief after oral surgery in adults: a
randomized controlled trial” British Journal of Anaesthesia 104(1): 80-88. Result achieved in a trial of post-operative pain relief after removal of 1–4 wisdom teeth using Maxigesic ® compared with
Paracetamol 4000mg or Ibuprofen 1200mg alone per day in four divided doses.
Maxigesic ® film coated tablets are for temporary relief of pain and reduction of fever and the discomfort associated with fever. Incorrect use can be harmful. Do not use if you have asthma or
a stomach ulcer. Do not use in children under 12 years or if you have kidney disease. Do NOT combine with any other Paracetamol or Ibuprofen containing medicines. Do not exceed the daily
recommended dose. AFT Pharmaceuticals, Auckland. TAPS 1733HA. NZ Patent No. 552181.
Health Headlines
Hartley Atkinson M.Pharm, PhD
Founder & CEO, AFT Pharmaceuticals
0800 423 823
www.aftpharm.com

HEAT or
INFLAMMATION
Unlike heat rubs, Voltaren
is an anti-inflammatory
medicine that penetrates the skin
Effective
relief of
muscle pain
Voltaren ® Emulgel ® (diclofenac diethylammonium 11.6 mg/g). Indications and dosage: Adults and children ≥ 12 years: Temporary relief of local pain and inflammation in acute soft tissue injuries and
localised soft tissue rheumatism. Apply to affected area up to 4 times a day. Contraindications: Hypersensitivity to any ingredient; in asthma attacks, urticaria or rhinitis precipitated by aspirin or other NSAIDs;
in pregnancy or breastfeeding; in children under 12 years. Adverse reactions (common): Rash, eczema, erythema, dematitis, pruritus. For less common adverse reactions see Pack Insert.
Voltaren, Emulgel and the blue man/globe device are trade marks of the GSK group of companies or its licensor. GSK Auckland, NZ. TAPS NA 8959. CHANZ/CHVOLT/0143/16a.

2017-2018 Healthcare Handbook
OTC
Products
Page 215

OTC Products
Over-the-counter products guide
The Over-The-Counter Products Guide is a unique reference guide for health professionals. It provides easily accessible information about nonprescription
medicines available over the counter (OTC) at pharmacies, supermarkets and some clinics.
The guide includes information such as the active ingredients and approved indication of each OTC medicine, contraindications and
precautions for use, adverse effects and recommended dosage.
The OTC Products Guide aims to help identify what non-prescription medicines patients are already taking, avoid duplication of ingredients
and drug interactions, and promote safer use of medicines.
Photographed products may help patients identify products they are taking when they can’t recall the brand name.
Price bands for each product give an indication of the price the patient can expect to pay.
Each product lists the appropriate medicine classification, which defines the availability of the product in terms of health legislation for
over-the counter medicines, Pharmacist Only Medicine, Pharmacy Only Medicine and General Sale.
How to use the OTC products guide
The OTC Products Guide is divided into main therapeutic categories, with associated sub-categories. For example, the category Pain has subcategories
– headache, joint pain, migraine, muscular pain, neuropathic pain, period pain and toothache.
Products appear by alphabetical order of brand name
Medicine classifications are defined below:
General Sale products may be available through other retail outlets, as well as pharmacies.
Pharmacy Only Medicines are available for sale only through pharmacies.
Pharmacist Only Medicines are products that can be sold only by the pharmacist. The sale must be appropriately documented and the
medicines must not be available for self-selection.
Note: In certain circumstances, some medicines may now be sold through special clinics. For example, nicotine-containing smoking
cessation products may be sold from smoking cessation clinics run by registered nurses, psychologists, pharmacists or doctors.
An index of products (by alphabetical order) and participating pharmaceutical companies is available at the back of the OTC Products
Guide, starting on page 270.
Page 216 HEALTHCARE HANDBOOK 2017-2018 OTC Products

OTC Products Index
Acne
CRYSTADERM CREAM------------------------------------------------------220
Allergies
PHENERGAN------------------------------------------------------------------220
Baby Feeding
LANSINOH---------------------------------------------------------------------220
LANSINOH RANGE-----------------------------------------------------------220
NUK-----------------------------------------------------------------------------221
Bites and Stings
ANTHISAN CREAM----------------------------------------------------------221
STINGOSE---------------------------------------------------------------------221
Bruises, Scars, Spider Veins
PALMER’S SKIN THERAPY OIL---------------------------------------------221
Childhood Pain and Baby Teething
BONJELA TEETHING GEL---------------------------------------------------222
NASPIRA-----------------------------------------------------------------------222
NUROFEN FOR CHILDREN--------------------------------------------------222
NUROFEN FOR CHILDREN SOFT CHEWABLE CAPSULES 7+--------222
PAMOL ALL AGES------------------------------------------------------------223
PAMOL INFANT DROPS-----------------------------------------------------223
PARACARE FOR BABIES & YOUNG CHILDREN 3 MONTHS TO
6 YEARS-------------------------------------------------------------------223
PARACARE FOR CHILDREN 6+ YEARS & ADULTS---------------------223
Colds
BONNINGTON’S IRISH MOSS----------------------------------------------224
CODRAL ALL IN ONE--------------------------------------------------------224
CODRAL COLD & FLU-------------------------------------------------------224
CODRAL COLD & FLU + COUGH-----------------------------------------224
CODRAL DAY & NIGHT-----------------------------------------------------225
CODRAL MULTI ACTION COLD & FLU-----------------------------------225
CODRAL NIGHTIME COLD & FLU-----------------------------------------225
CODRAL RELIEF MAX STRENGTH 6 SIGNS COLD & FLU-------------225
CODRAL RELIEF MAX STRENGTH COLD & FLU +
DECONGESTANT---------------------------------------------------------226
LEMSIP COUGH MAX MUCUS HOT DRINK----------------------------226
LEMSIP MAX ALL IN ONE CAPSULES------------------------------------226
LEMSIP MAX COLD & FLU DAY & NIGHT CAPSULES-----------------226
MAXICLEAR COLD & NASAL RELIEF-------------------------------------227
NASPIRA-----------------------------------------------------------------------227
NUROFEN COLD & FLU PE-------------------------------------------------227
OTRIVIN ADULT---------------------------------------------------------------227
OTRIVIN JUNIOR--------------------------------------------------------------228
OTRIVIN PLUS-----------------------------------------------------------------228
®--------------------------------------------------------------------------------------------------------------------------- 228
VIRALEX
Cold Sores
BLISTEX MEDICATED RELIEF-----------------------------------------------228
VIRABAN-----------------------------------------------------------------------229
Constipation
COLOXYL----------------------------------------------------------------------229
COLOXYL DROPS------------------------------------------------------------229
COLOXYL WITH SENNA----------------------------------------------------229
DULCOLAX--------------------------------------------------------------------230
SENOKOT----------------------------------------------------------------------230
Coughs - Dry
BENADRYL PE DRY COUGH & NASAL CONGESTION----------------230
BONNINGTON’S IRISH MOSS----------------------------------------------230
CODRAL COLD & FLU + COUGH-----------------------------------------231
PHARMACY HEALTH CONGESTED COLD & COUGH----------------231
PHARMACY HEALTH STUBBORN DRY TICKLY COUGH--------------231
Coughs - Productive
BENADRYL CHESTY FORTE------------------------------------------------231
BENADRYL MUCUS RELIEF DOUBLE ACTION FORTE COUGH
LIQUID----------------------------------------------------------------------232
BENADRYL MUCUS RELIEF PLUS DECONGESTANT-------------------232
BENADRYL PE CHESTY COUGH & NASAL CONGESTION-----------232
BISOLVON CHESTY FORTE-------------------------------------------------232
MUCINEX MAXIMUM STRENGTH----------------------------------------233
PHARMACY HEALTH GEES LINCTUS-------------------------------------233
Cystitis (Urinary Tract Infections)
URAL---------------------------------------------------------------------------233
UROFEM (1000MG D-MANNOSE TABLETS)----------------------------233
Dandruff
COCO-SCALP-----------------------------------------------------------------234
Dermatitis & Eczema
COCO-SCALP-----------------------------------------------------------------234
PINETARSOL-------------------------------------------------------------------234
QV GENTLE WASH-----------------------------------------------------------234
QV SKIN LOTION-------------------------------------------------------------235
Diarrhoea
GASTROLYTE------------------------------------------------------------------235
Dry skin
PALMER’S SKIN THERAPY OIL---------------------------------------------235
Ear Conditions
CERUMOL---------------------------------------------------------------------235
EAR CLEAR--------------------------------------------------------------------236
EAR CLEAR EAR CLEANSER------------------------------------------------236
Eye Conditions - Dry Eye
HYLO-FRESH------------------------------------------------------------------236
OPTREX EYE WASH WITH EYE BATH------------------------------------236
OPTREX SORE EYES---------------------------------------------------------237
Eye Conditions - Macular Degeneration
MACU-VISION----------------------------------------------------------------237
Eye Conditions - Infections
BROLENE EYE DROPS-------------------------------------------------------237
OPTREX RED EYES EYE DROPS--------------------------------------------237
Page 217

OTC Products Index
Foot Care - Fungal Infections
SOLVEASY TINEA CREAM--------------------------------------------------238
Fungal Infections - Skin, Hair, Nails
LAMISIL CREAM--------------------------------------------------------------238
LAMISIL DERM GEL----------------------------------------------------------238
Fungal Nails
RESTORANAIL----------------------------------------------------------------238
Haemorrhoids
PROCTOSEDYL---------------------------------------------------------------239
Hay Fever
FLIXONASE--------------------------------------------------------------------239
KI HAY FEVER-----------------------------------------------------------------239
TELFAST Range---------------------------------------------------------------239
TELFAST ORAL LIQUID------------------------------------------------------240
Hayfever
BECONASE ALLERGY & HAYFEVER--------------------------------------240
LIVOSTIN EYE DROPS-------------------------------------------------------240
LIVOSTIN NASAL SPRAY----------------------------------------------------240
MAXICLEAR HAYFEVER & SINUS RELIEF--------------------------------241
Headache
MAXIGESIC-------------------------------------------------------------------241
NUROFEN----------------------------------------------------------------------241
NUROFEN PLUS---------------------------------------------------------------241
NUROFEN ZAVANCE--------------------------------------------------------242
NUROMOL--------------------------------------------------------------------242
PANADOL OPTIZORB--------------------------------------------------------242
PANADOL RAPID-------------------------------------------------------------242
PARACARE--------------------------------------------------------------------243
VOLTAREN RAPID 12.5------------------------------------------------------243
VOLTAREN RAPID 25--------------------------------------------------------243
Head Lice
LICE CLEAR--------------------------------------------------------------------243
MOOV HEAD LICE SOLUTION---------------------------------------------244
NEUTRALICE ADVANCE LOTION------------------------------------------244
NEUTRALICE CONDITIONER SHAMPOO LICE EGG REMOVER-----244
NEUTRALICE NATURAL SPRAY--------------------------------------------244
Heart Health - Blood Clot Prevention
ASPEC 75MG-----------------------------------------------------------------245
CARTIA-------------------------------------------------------------------------245
Indigestion, Heartburn & Gastritis
GAVISCON DOUBLE STRENGTH------------------------------------------245
GAVISCON DOUBLE STRENGTH TABLETS------------------------------245
GAVISCON DUAL ACTION LIQUID---------------------------------------246
GAVISCON DUAL ACTION TABLETS-------------------------------------246
GAVISCON INFANT----------------------------------------------------------246
GAVISCON LIQUID-----------------------------------------------------------246
GAVISCON TABLETS---------------------------------------------------------247
ZANTAC------------------------------------------------------------------------247
Influenza
CODRAL ALL IN ONE--------------------------------------------------------247
CODRAL COLD & FLU-------------------------------------------------------247
CODRAL COLD & FLU + COUGH-----------------------------------------248
CODRAL DAY & NIGHT-----------------------------------------------------248
CODRAL MULTI ACTION COLD & FLU-----------------------------------248
CODRAL NIGHTIME COLD & FLU-----------------------------------------248
CODRAL RELIEF MAX STRENGTH 6 SIGNS COLD & FLU-------------249
CODRAL RELIEF MAX STRENGTH COLD & FLU +
DECONGESTANT---------------------------------------------------------249
LEMSIP MAX COLD & FLU DAY & NIGHT CAPSULES-----------------249
Iron Deficiency - Supplements
SPATONE 100% NATURAL LIQUID IRON SUPPLEMENT--------------249
Irritable Bowel Syndrome
GASTRO-SOOTHE------------------------------------------------------------250
MINTEC------------------------------------------------------------------------250
Menopause - Symptomatic Relief
HARMONY MENOPAUSE---------------------------------------------------250
Migraine
MERSYNDOL------------------------------------------------------------------250
Muscular Aches & Pains
MAXIGESIC-------------------------------------------------------------------251
TIGER BALM OIL-------------------------------------------------------------251
TIGER BALM RED STRENGTH OINTMENT-------------------------------251
TIGER BALM WHITE REGULAR STRENGTH OINTMENT--------------251
VOLTAREN EMULGEL--------------------------------------------------------252
VOLTAREN RAPID 12.5------------------------------------------------------252
VOLTAREN RAPID 25--------------------------------------------------------252
Nappy Rash
PINETARSOL-------------------------------------------------------------------252
Oral Health - Gum Care, Ulcers, Thrush
BONJELA MOUTH ULCER GEL--------------------------------------------253
FRADOR------------------------------------------------------------------------253
MEDIJEL------------------------------------------------------------------------253
Osteoarthritis - Symptomatic Relief
PANADOL OSTEO------------------------------------------------------------253
TURMERIC EXTRA STRENGTH---------------------------------------------254
VOLTAREN OSTEO GEL 12 HOURLY--------------------------------------254
ZOSTRIX------------------------------------------------------------------------254
Period Pain & Endometriosis
MERSYNDOL------------------------------------------------------------------254
Pregnancy - Testing
EASYCHECK MIDSTREAM PREGNANCY TESTS-----------------------255
EASYCHECK OVULATION KIT---------------------------------------------255
OVUPLAN 10 DAY PREGNANCY PLANNING KIT----------------------255
OVUPLAN SCOPE------------------------------------------------------------255
PREGNOSIS EARLY PREGNANCY TEST DIP & READ-------------------256
PREGNOSIS IN STREAM EARLY PREGNANCY TEST-------------------256
Page 218 HEALTHCARE HANDBOOK 2017-2018 OTC Products

OTC Products Index
Preventive Health
TURMERIC 15800 COMPLEX----------------------------------------------256
Psoriasis
COCO-SCALP-----------------------------------------------------------------256
PINETARSOL-------------------------------------------------------------------257
QV SKIN LOTION-------------------------------------------------------------257
Sexual Wellbeing – Lubrication
ANIME LUBRICANT 50ML--------------------------------------------------257
DUREX PERFECT GLIDE-----------------------------------------------------257
Sexual Wellbeing – Contraception
DUREX EXTRA SAFE---------------------------------------------------------258
DUREX REAL FEEL------------------------------------------------------------258
Shingles - Symptomatic Relief
ZOSTRIX HP-------------------------------------------------------------------258
Sinus & Nasal Problems
SUDAFED NASAL SPRAY---------------------------------------------------258
SUDAFED PE NASAL DECONGESTANT----------------------------------259
SUDAFED PE NIGHT---------------------------------------------------------259
SUDAFED PE SINUS + ALLERGY & PAIN RELIEF------------------------259
SUDAFED PE SINUS + PAIN RELIEF----------------------------------------259
SUDAFED PE SINUS DAY + NIGHT RELIEF-------------------------------260
Sleep Problems
DOZILE-------------------------------------------------------------------------260
Smoking Cessation
HABITROL GUM--------------------------------------------------------------260
HABITROL LOZENGE--------------------------------------------------------260
HABITROL PATCH------------------------------------------------------------261
NICORETTE 16HR INVISIPATCH PATCH----------------------------------261
NICORETTE COOLDROPS LOZENGE--------------------------------------261
NICORETTE GUM------------------------------------------------------------261
NICORETTE INHALATOR----------------------------------------------------262
NICORETTE QUICKMIST----------------------------------------------------262
Sun Care
HAMILTON SUNSCREEN----------------------------------------------------265
SUNSENSE SENSITIVE INVISIBLE-------------------------------------------265
Travel (Motion) Sickness
AVOMINE----------------------------------------------------------------------265
PHENERGAN------------------------------------------------------------------265
TRAVACALM TRAVEL BAND-----------------------------------------------266
Urticaria (Hives)
Telfast 180---------------------------------------------------------------------266
TELFAST ORAL LIQUID------------------------------------------------------266
Vaginal Health
LACTIGEL----------------------------------------------------------------------266
Vitamins & Dietary Supplements
MACU-VISION----------------------------------------------------------------267
Warts
WARTIE WART REMOVER--------------------------------------------------267
Weight Loss
SYNETRIM ® SLIM-------------------------------------------------------------267
Wound Care
BETADINE ANTISEPTIC------------------------------------------------------267
CRYSTADERM CREAM------------------------------------------------------268
MICRODACYN WOUND CARE AND HYDROGEL---------------------268
SAVLON------------------------------------------------------------------------268
SOOV CREAM----------------------------------------------------------------268
Sore Throat
BETADINE SORE THROAT GARGLE---------------------------------------262
CODRAL ® SORE THROAT LOZENGES ANTIBACTERIAL HONEY
& LEMON FLAVOUR-----------------------------------------------------262
CODRAL ® SORE THROAT LOZENGES ANTIBACTERIAL
MENTHOL FLAVOUR----------------------------------------------------263
CODRAL ® SORE THROAT LOZENGES ANTIBACTERIAL + ANAESTHETIC
LIME & LEMON FLAVOUR----------------------------------------------------------------- 263
STREPFEN INTENSIVE HONEY & LEMON LOZENGES------------------263
STREPSILS PLUS ANAESTHETIC THROAT SPRAY-----------------------263
STREPSILS PLUS LOZENGES------------------------------------------------264
STREPSILS SOOTHING HONEY AND LEMON LOZENGES-------------264
STREPSILS SORE THROAT & BLOCKED NOSE--------------------------264
Strains and Sprains
VOLTAREN EMULGEL--------------------------------------------------------264
Page 219

»»
Acne
CRYSTADERM CREAM
AFT PHARMACEUTICALS LTD
Presentation: Cream: 10g, 15g, 25g tube.
Active Ingredients: Hydrogen peroxide 1% w/w.
Approved Indications: Treatment and prevention of minor skin infections such as acne, cuts, scrapes, burns or school sores.
Contraindications: Known hypersensitivity to any ingredient.
Precautions: Use under medical guidance in pregnancy and breastfeeding. Avoid contact with the eyes. Do not use in the
presence of iodine, permanganate and any other strong oxidising agents.
Adverse Effects: Mild sensation of burning may be experienced for a short time after application.
Directions: After cleansing the area, apply cream 2-3 times daily on affected area. A dry film will appear on the skin after
application, which can be washed off with water.
Price Band: $10 - $20 and over (Price varies with pack size). Available on Pharmaceutical Schedule
Subsidy Conditions: Fully subsidised (15g only)
Medicine Classification: General Sale
»»
Allergies
PHENERGAN
SANOFI CONSUMER HEALTHCARE
Presentation: Tablet: 10mg & 25mg (50 tabs). Elixir: 100mL 5mg/5mL.
Active Ingredients: Promethazine hydrochloride.
Approved Indications: Symptomatic treatment of allergic conditions. A pre-anaesthetic for prevention and control of postoperative
nausea/vomiting, anti-emetic action and anti-secretory effect. Prevention of motion sickness.
Contraindications: Hypersensitivity to any ingredient, patients with CNS depression or within 14 days of taking MAOIs. Potential for
central, peripheral apnoea, reduced arousal in children, not suitable for under 2 years.
Precautions: Pregnancy & lactation. Care in asthma, bronchitis or bronchiectasis, severe coronary artery disease, narrow angle glaucoma,
epilepsy hepatic or renal insufficiency. Avoid driving or using machinery.
Adverse Effects: Drowsiness, headaches, nightmares, disorientation, photosensitivity, blurred vision, dry mouth.
Directions: Dosage: Allergy: Child 2-5 years: 5-15mg/day; 6-12 years: 10-25mg/day; Adults: 25-75mg up to 2-3 times per day.
Dosage: Sedative (under advice of doctor or pharmacist only; limit use to 7 days): child 2-12 years: prescription only, consult a doctor. Adults: 25-75mg. One night-time dose. Dosage:
Nausea and vomiting, prevention of motion sickness (take night before journey, repeat 6-8 hours if required): 6-12 years: 10mg; Over 12 years: 25mg. For full dosage instructions,
please refer to the datasheet
Price Band: $20.00 - $25.00 Medicine Classification: Pharmacist Only
»»
Baby Feeding
LANSINOH
WILSON CONSUMER PRODUCTS LTD
Presentation: Tube, 15g, 50g.
Active Ingredients: Contains 100% Lansinoh - hypoallergenic ultra pure anhydrous lanolin (USP modified lanolin).
Indications: Soothes, heals and protects sore nipples.
Contraindications: None known.
Precautions: None known. Safe to use on even the most sensitive skin or where infant ingestion may occur.
Adverse Effects: No (0%) allergic reactions reported in a clinical trial conducted with a lanolin-sensitive population.
Directions: During breastfeeding: For treatment of sore nipples apply over the whole area of sore or damaged skin after every feed and
as needed. If the skin is cracked or very abraded, a thick layer enables faster healing. Does not need to be removed before
breastfeeding. Sore and damaged nipples commonly indicate a problem with the way the baby is attached to the breast when
feeding. If the problem persists, consult a breastfeeding specialist. During pregnancy: May also be used to condition the nipples
prior to breastfeeding by applying twice daily to ease dryness and to promote healthy, supple skin. Beyond breastfeeding:
Use on dry or cracked skin, nappy rash, and on minor cuts, burns and abrasions to soothe, protect and promote healing.
Price Band: $15 - $35
Subsidy Conditions: Not subsidised Medicine Classification: General Sale
LANSINOH RANGE
WILSON CONSUMER PRODUCTS LTD
Presentation: A range of breastfeeding products, including hot/cold therapy packs, breast milk storage bags and nursing pads.
Active Ingredients: Not applicable
Approved Indications: Not applicable
Contraindications: None known
Precautions: None known
Adverse Effects: None known
Directions: Lansinoh Therapearl 3 in 1 Breast Therapy hot and cold reusable treatment gel packs encourage
let-down and help relieve symptoms of engorgement and mastitis. They are microwaveable and can be
used alone or with a breast pump. Lansinoh Breastmilk Storage Bags are strong and leak-proof, with
a double-sealed closure and double-sealed seams. Pre-sterilised with a pour spout for convenience.
Lansinoh Ultra Thin, Stay Dry Nursing Pads are secure, discreet and super soft for maximum comfort,
and have a super absorbent Blue Lock core to quickly absorb moisture. Use as required.
Price Band: $10.00-$30.00
Medicine Classification: General Sale
Page 220 HEALTHCARE HANDBOOK 2017-2018 OTC Products

NUK
RUMINA NATURAL CARE LTD
Presentation: A range of nursing products, including pumps, breast shells, nipple shields, nursing pads and breast milk
containers and bags. Plus orthodontic shaped teats and soothers, glass and BPA-free polypropylene bottles,
accessories and specialized MedicPro products, such as cleft palate teats.
Active Ingredients: Not applicable.
Approved Indications: Not applicable.
Contraindications: None known.
Precautions: None known.
Adverse Effects: None known.
Directions: Use as required
Price Band: $5 - $170
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Bites and Stings
ANTHISAN CREAM
SANOFI CONSUMER HEALTHCARE
Presentation: Tube, 25g.
Active Ingredients: Mepyramine maleate 2%.
Approved Indications: Symptomatic relief of insect bites, stings and nettle rash.
Contraindications: Eczematous conditions or extensively broken skin.
Precautions: External use only, not for prolonged use.
Adverse Effects: Skin sensitisation rarely occurs.
Directions: Apply directly to the affected area 2-3 times daily for up to 3 days. Early application is essential for optimum
response.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
STINGOSE
ASPEN PHARMACARE
Presentation: Gel, spray.
Active Ingredients: Aluminium Sulphate 20%w/v.
Approved Indications: Calms and soothes the pain, itch and swelling of bites and stings.
Contraindications: None known.
Precautions: External use only. Always take normal first aid precautions such as the use of ice and water. Do not pre-treat
with methylated spirits. In serious cases, seek medical advice. Keep out of eyes.
Adverse Effects: None known.
Directions: Apply immediately to affected area. Re-apply as necessary.
Price Band: $10 - $15
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Bruises, Scars, Spider Veins
PALMER’S SKIN THERAPY OIL
WILSON CONSUMER PRODUCTS LTD
Presentation: Skin Therapy Oil Rosehip Fragrance 60ml.
Active Ingredients: Cocoa seed butter, vitamin E, rose canina seed extract, and cetesomate -E Complex which helps improve the skin
penetration and absorption characteristics of the formula into the epidermal layer of the skin.
Approved Indications: Formulated to help improve the appearance of scars, stretch marks, dry, damaged skin, uneven skin tone and
aging skin.
Contraindications: None known.
Precautions: Do not ingest.
Adverse Effects: None known.
Directions: Gently massage into affected area 3 times daily or as often as desired. During pregnancy apply from first trimester to help
prevent stretch marks.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 221

»»
Childhood Pain and Baby Teething
BONJELA TEETHING GEL
RECKITT BENCKISER (NZ) LTD
Presentation: Gel, 15g.
Active Ingredients: Choline salicylate 8.7% w/w.
Approved Indications: Infant teething
Contraindications: Hypersensitivity to any ingredient.
Precautions: Hypersensitivity to local anaesthetics or salicylates. Not suitable for babies under 4 months.
Adverse Effects: Asthmatics with sensitivity to aspirin or salicylates may experience asthma.
Directions: Cover the fingertip with Bonjela and rub gently into the affected area, not more than 3-hourly.
Price Band: Under $10. Available on Pharmaceutical Schedule
Subsidy Conditions: Partially subsidised
Medicine Classification: General Sale
NASPIRA
NEILMED PHARMACEUTICALS, INC.
Presentation: Oral Suction Aspirator
Active Ingredients: N/A
Indications: N/A
Contraindications: N/A
Precautions: N/A
Adverse Effects: N/A
Directions: 1. Hold the baby in an upright to semi-upright position, well secured in your arms, and be sure that the baby is comfortable. 2. Place the tip of the bulb into the baby’s
nostril and suck very gently through the mouthpiece, as if you are drinking a liquid from a straw. If needed, you can always use more suction force. The mouthpiece is a
one-way valve and will not allow you to blow into the baby’s nose. 3. A pre-treatment with a few drops of saline solution or saline spray in each nostril may help loosen
thick mucus before using the NeilMed® Naspira® Nasal-Oral Aspirator (NOA). Mucus from the baby’s nostrils will come out very easily and transfer mainly to the tip,
and if excessive, into the bulbous area during suctioning. 4. Repeat the previous steps in the same and/or the other nostril as necessary. 5. Please follow the cleaning and
disinfection protocol for the safety of yourself and your baby. 6. Change filter if it is soiled with secretions or after the acute infection is over or every week during use.
Price Band: $19.99
Medicine Classification: Medical Device
NUROFEN FOR CHILDREN
RECKITT BENCKISER (NZ) LTD
Presentation: Suspension, orange or strawberry flavour, 100ml, 200ml.
Active Ingredients: Ibuprofen 100mg/5ml.
Approved Indications: Fever reduction (including fever caused by immunisation), minor aches, mild/moderate pain, ie, headache, toothache, teething, sore
throats, earache, cold and flu symptoms, sprains and strains.
Contraindications: Hypersensitivity to any ingredient. Allergies to aspirin, ibuprofen or other anti-inflammatory medicines. Existing peptic ulceration,
renal impairment or heart disease. Children with a history of asthma, bronchospasm, rhinitis or urticaria associated with aspirin or other NSAIDs.
Children suffering dehydration. Babies under 3 months. Children under 12 months without medical advice. Pregnancy except on a doctor’s advice.
Last 3 months of pregnancy.
Precautions: Asthma, history of peptic ulceration and regular treatment with other medications.
Adverse Effects: Nausea, dyspepsia, rash, dizziness, GI bleeding (rare at OTC doses). Hepatic dysfunction and papillary necrosis may occur.
Directions: Children 3-6 months (6-8kg): 3-4ml. Children 6-12 months (8-10kg): 4-5ml. Children 1-3 years (10-14kg): 5-7ml. Children 3-5 years (14-18kg):
7-9ml. Children 5-7 years (18-22kg): 9-11ml. Children 7-9 years (22-28kg): 11-14ml. Children 9-12 years (28-40kg): 14-20ml.
Repeat dose every 8 hours as necessary, maximum 3 doses in 24 hours.
Price Band: $10 - $20 (Price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
NUROFEN FOR CHILDREN SOFT CHEWABLE CAPSULES 7+
RECKITT BENCKISER (NZ) LTD
Presentation: Soft Chewable Capsules, Orange, 12s, 24s.
Active Ingredients: Ibuprofen 100mg.
Approved Indications: Mild to moderate pain such as sore throat, dental pain, earache, headache, minor aches, sprains & strains and pain of cold & flu. Reduces fever.
Contraindications: Do not use in anyone with asthma, except on doctor’s advice, in anyone with a stomach ulcer, impaired kidney function or heart failure,
if allergic to ibuprofen or other anti-inflammatories, in children 6 years of age or less, unless on doctor’s advice, in adults 65 years and over, except
on doctor’s advice, during the first 6 months of pregnancy, except on doctor’s advice. Do not use at all during the last 3 months of pregnancy
Precautions: Seek doctor or pharmacist advice before use in children suffering from dehydration through diarrhea and/or vomitng, or with products
containing ibuprofen, aspirin or other anti-inflammatory medicines or medicines taken regularly.
Adverse Effects: In case of an allergic reaction, stop using and see your doctor immediately. Excessive use can be harmful and increase the risk of heart
attack, stroke and liver damage
Directions: The product should be chewed before swallowing. Do not give to children under 7 years of age. Doses should be given approximately every 6-8
hours (or with a minimum of 6 hours between each dose if required). Age/weight/dose: 7-10 years (22-32kg ): 2 capsules (max 8 in 24 hours);
10-12 years (32-40kg): 3 capsules (max 12 in 24 hours).
Price Band: $20.00-$30.00 Medicine Classification: General Sale
Page 222 HEALTHCARE HANDBOOK 2017-2018 OTC Products

PAMOL ALL AGES
ASPEN PHARMACARE
Presentation: Suspension, strawberry and orange flavours, colour-free and sugar-free, 100mL and 200mL.
Active Ingredients: Paracetamol 250mg/5mL.
Approved Indications: Relieves the pain and fever associated with: headache, earache, immunisation, symptoms of cold and flu,
toothache.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Watch total paracetamol dose if taking other products. Prolonged use can be harmful. Do not use for more than 48 hours
without seeking medical advice.
Adverse Effects: Side effects of paracetamol are rare. However hypersensitivity including skin rashes may occur.
Directions: For all ages 1 year and up, Children 1 - 5 years: 2.5 to 5.0mL; Children 6 - 10 years: 5.0 to 7.5mL; Children 10 - 12 years: 7.5 to
10mL; Adults and children over 12 years: 10 to 20mL. Give every 4 - 6 hours as required with not more than 4 doses in 24 hours.
Administer in water or fruit juice if necessary.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
PAMOL INFANT DROPS
ASPEN PHARMACARE
Presentation: Sugar-free, 60mL.
Active Ingredients: Paracetamol 50 mg/1ml.
Approved Indications: Relieves the pain and fever associated with: headache, earache, immunisation, symptoms of cold and flu, teething.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Watch total paracetamol dose if taking other products. Prolonged use can be harmful. Do not use for more than 48 hours
without seeking medical advice.
Adverse Effects: Side effects of paracetamol are rare. However hypersensitivity including skin rashes may occur.
Directions: Infants 3 - 6 months: 1.2 to 1.6mL; Infants 6 - 9 months: 1.6 to 2.0mL; Infants 9 - 12 months: 2.0 - 2.4mL; Give every 4 - 6
hours as required with not more than 4 doses in 24 hours. Administer in water or fruit juice if necessary.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
PARACARE FOR BABIES & YOUNG CHILDREN 3 MONTHS TO 6 YEARS
PSM HEALTHCARE LTD. T/A API CONSUMER BRANDS
Presentation: Oral suspension. Strawberry flavour: 200ml, 1 litre. Colour-free: 200ml. Free from aspirin, alcohol and sugar.
Active Ingredients: Paracetamol 120mg/5ml.
Approved Indications: For gentle relief of pain and fever in common childhood illnesses such as teething, common cold, earaches, viral
infections, headaches, sore throat and vaccination reactions in babies and young children 3 months to 6 years.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Patients with impaired liver or kidney function. Prolonged or excessive use may be harmful. Do not use for longer than 48
hours except on a doctor’s advice. Do not give to children under 2 years except on medical advice. Watch total paracetamol dose
if taking other products containing paracetamol.
Adverse Effects: Side effects of paracetamol are rare and usually mild. Haematological and hypersensitivity reactions have been reported.
Overdose may cause severe liver damage and, less often, renal tubular necrosis.
Directions: Infants 3-12 months: 2.5ml-5ml. Children 1-3 years: 5-7.5ml. 3-6 years: 7.5-10ml. If necessary dosage may be repeated every
4-6 hours up to a maximum of 4 doses in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
PARACARE FOR CHILDREN 6+ YEARS & ADULTS
PSM HEALTHCARE LTD. T/A API CONSUMER BRANDS
Presentation: Oral suspension. Orange flavour and colouring: 200ml, 1 litre. Free from aspirin, alcohol and sugar.
Active Ingredients: Paracetamol 250mg/5ml.
Approved Indications: For relief of mild to moderate pain and fever associated with common cold, flu, earaches, headaches, sore throat,
fever and viral infections in adults and children 6 years and over.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Patients with impaired liver or kidney function. Prolonged or excessive use may be harmful. Do not use for more than 48
hours except on a doctor’s advice. Do not give to children under 6 years except on medical advice. Watch total paracetamol dose
if taking other products containing paracetamol.
Adverse Effects: Side effects of paracetamol are rare and usually mild. Haematological and hypersensitivity reactions have been reported.
Overdose may cause severe liver damage and, less often, renal tubular necrosis.
Directions: Children 6-12 years: 5-10ml. Adults and children 12 years and older: 10-20ml. If necessary dosage may be repeated every 4-6
hours up to a maximum of 4 doses in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
Page 223

»»
Colds
BONNINGTON’S IRISH MOSS
ASPEN PHARMACARE
Presentation: Cough Syrup, 200mL bottle
Active Ingredients: Each 10mL contains: 1.7 mg menthol, 9 mg camphor, 240 mg liquorice extract, 13 mg carrageenan,
3.8 uL ipecacuanha
Approved Indications: Soothes and relieves coughs and sore throats.
Contraindications: None known
Precautions: Use only as directed. If symptoms persist, see your doctor. Store below 30 degrees celsius.
Adverse Effects: None known
Directions: For adults and children over 12 years, take 10mls and repeat every 2 hours as needed.
Price Band: $14-16 per 200mL bottle
Medicine Classification: General Sale
CODRAL ALL IN ONE
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Capsules, 24s
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg.
Night: Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy, do not drive or operate machinery. Avoid alcohol. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red and white night capsules at
bedtime. Allow 4-6 hours as necessary between doses. Maximum 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches, fever, body aches and pains, blocked and runny
nose, and sore throat.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems or are
pregnant or breastfeeding, are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected do not drive
a vehicle or operate machinery. Keep to the recommended dose.
Directions: For adults and children 12 years and over: take 2 day tablets every 4-6 hours as necessary. Maximum 8 tablets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL COLD & FLU + COUGH
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg.
Night: Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs, and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy do not drive or operate machinery. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red night capsules at bedtime.
Allow 4-6 hours as necessary between doses. Maximum: 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
Page 224 HEALTHCARE HANDBOOK 2017-2018 OTC Products

CODRAL DAY & NIGHT
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Day; Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg. Night; paracetamol 500mg,
phenylephrine hydrochloride 5mg, chlorpheniramine maleate 2mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches and fever, body aches and pains, blocked and
runny nose and sore throat.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products.
Precautions: Ask a doctor before use if you have high blood pressure, heart problems, are pregnant or breastfeeding, are taking antidepressants,
are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected, do not drive or
operate machinery. Keep to the recommended dose.
Directions: For adults and children 12 years and over: take 2 white day tablets morning, midday and afternoon, and 2 orange night tablets
at bedtime. Allow 4 - 6 hours as necessary between doses. Maximum: 6 day tablets and 2 night tablets in 24 hours.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
CODRAL MULTI ACTION COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s.
Active Ingredients: Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg,
chlorpheniramine maleate 2mg.
Approved Indications: For temporary relief of cold and flu symptoms, including headache, body aches and pains, sneezing,
watery eyes, blocked and runny nose, fever.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products; if you have taken
antihistamines.
Precautions: Ask a doctor before use if you have high blood pressure, heart problems, are pregnant or breastfeeding, are taking
antidepressants, are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected do not
drive a vehicle or operate machinery. Keep to the recommended dose.
Directions: Take 2 tablets once every 4 to 6 hours as necessary. Maximum of 8 tablets in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
CODRAL NIGHTIME COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s.
Active Ingredients: Paracetamol 500mg, phenylephrine hydrochloride 5mg, chlorpheniramine maleate 2mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches and fever, blocked or runny nose, body
aches and pains, and sneezing and watery eyes.
Contraindications: Do not use for children under 12 years. If you have taken other paracetamol containing products; or if you
have taken antihistamines.
Precautions: Ask a doctor before use if you have high blood pressure, heart problems, are pregnant or breastfeeding, are taking
antidepressants, are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine may cause drowsiness. If drowsy,
do not drive a vehicle or operate machinery. Keep to recommended dose.
Directions: Take 2 tablets every 4-6 hours at nighttime as necessary. Maximum of 8 tablets in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL RELIEF MAX STRENGTH 6 SIGNS COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Sachets, 10s
Active Ingredients: Paracetamol 1000mg, phenylephrine hydrochloride 12.2mg, guaiphenesin 200mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, sore throat, or chesty cough.
Contraindications: Do not use for children under 12 years; with other products containing paracetamol.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Keep to the recommended dose.
Directions: Adults and children over 12 years: Pour the contents of one sachet into a mug. Fill with hot (not boiling) water. Stir until
dissolved and drink. Allow 4-6 hours as necessary between doses. Maximum: 4 sachets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 225

CODRAL RELIEF MAX STRENGTH COLD & FLU + DECONGESTANT
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Sachets, 10s.
Active Ingredients: Paracetamol 1000mg, phenylephrine hydrochloride 12.2mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, or sore throat.
Contraindications: Do not use for children under 12 years; with other products containing paracetamol.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Keep to the recommended dose.
Directions: Adults and children over 12 years: Pour the contents of one sachet into a mug. Fill with hot (not boiling) water. Stir until
dissolved and drink. Allow 4-6 hours as necessary between doses. Maximum of 4 sachets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
LEMSIP COUGH MAX MUCUS HOT DRINK
RECKITT BENCKISER (NZ) LTD
Presentation: Sachets: 10s. Lemon, Wild Berry and Hot Orange flavours.
Active Ingredients: Paracetamol 1000mg, phenylephrine HCl 12.2mg, guaiphenesin 200mg.
Indications: Relief of blocked or runny noses, fever, headache, sore throat, chesty cough, and body aches and pains associated with colds
and flu.
Contraindications: Hypersensitivity to any ingredient. Severe heart disease. MAOI use or within 2 weeks of stopping MAOIs.
Precautions: Hepatic or renal impairment, hypertension, hyperthyroidism, heart disease, diabetes, Raynaud’s syndrome, pregnancy. Do not
take with other sympathomimetics, vasodilators or beta blockers. Watch total paracetamol dose if taking other products.
Adverse Effects: Dry mouth, headache, allergic reactions. Very rarely, palpitations or raised blood pressure.
Directions: Adults and children over 12 years: 1 sachet every 4-6 hours. Maximum 4 sachets in 24 hours. Dissolve in a cup of hot, but not
boiling, water.
Price Band: Under $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
LEMSIP MAX ALL IN ONE CAPSULES
RECKITT BENCKISER (NZ) LTD
Presentation: Capsules, 16s.
Active Ingredients: Paracetamol 500mg, phenylephrine HCl 6.1mg, guaiphenesin 100mg.
Indications: Relief of blocked or runny noses, fever, headache, sore throat, chesty cough, and body aches and pains associated with colds
and flu.
Contraindications: Hypersensitivity to any ingredient. Severe heart disease. MAOI use or within 2 weeks of stopping MAOIs.
Precautions: Hepatic or renal impairment, hypertension, hyperthyroidism, heart disease, diabetes, Raynaud’s syndrome, pregnancy.
Do not take with other sympathomimetics, vasodilators or beta-blockers. Watch total paracetamol dose if taking other products.
Adverse Effects: Dry mouth, headache, allergic reactions. Very rarely, palpitations or raised blood pressure.
Directions: Adults and children over 16 years: 2 capsules 4-6 hourly. Max 8 Capsules per 24 hours. Children 12-15 years: 1 capsule 4-6
hourly. Max 4 capsules per 24 hours. Not for children under 12 years.
Price Band: Under $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
LEMSIP MAX COLD & FLU DAY & NIGHT CAPSULES
RECKITT BENCKISER (NZ) LTD
Presentation: Capsules, 16s.
Active Ingredients: Each day capsule contains paracetamol 500mg, phenylephrine HCl 6.1mg, caffeine 25mg. Each night capsule
contains paracetamol 500mg, phenylephrine HCl 6.1mg.
Indications: Relief of daytime fatigue, blocked nose, fever, pain, headache, sore throat and body aches associated with colds and flu.
Contraindications: Hypersensitivity to any ingredient, severe heart disease, uncontrolled hypertension, hyperthyroidism. MAOI use or
use within 2 weeks of stopping MAOIs.
Precautions: Hepatic or renal impairment, heart disease, diabetes, Raynaud’s syndrome, pregnancy. Do not take with other
sympathomimetics, vasodilators or beta blockers. Do not take with other paracetamol-containing products.
Adverse Effects: Dry mouth, headache, allergic reactions. Very rarely, palpitations or raised blood pressure.
Directions: Adults and children over 12 years: 2 day capsules up to 3 times a day (every 4-6 hours), 2 night capsules at night. Do not
exceed 8 capsules in 24 hours. Do not give to children under 12.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 226 HEALTHCARE HANDBOOK 2017-2018 OTC Products

MAXICLEAR COLD & NASAL RELIEF
AFT PHARMACEUTICALS LTD
Presentation: Tablet, 30s.
Active Ingredients: Loratadine 2.5mg & phenylephrine hydrochloride 10mg.
Indications: For the relief of runny nose, watery and itchy eyes, sneezing and sinus congestion.
Contraindications: Hypersensitivity to Phenylephrine, severe hypertension, coronary heart disease, narrow angle glaucoma,
prostate hyperplasia, hypersensitivity to loratadine.
Precautions: Do not use in children under 12 years. Prolonged or excessive use may be harmful.
Adverse Effects: Phenylephrine may cause insomnia or sleeplessness in some people.
Directions: Adults and children over 12 years: One tablet four times daily. Do not exceed the recommended dosage.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
NASPIRA
NEILMED PHARMACEUTICALS, INC.
Presentation: Oral Suction Aspirator
Active Ingredients: N/A
Indications: N/A
Contraindications: N/A
Precautions: N/A
Adverse Effects: N/A
Directions: 1. Hold the baby in an upright to semi-upright position, well secured in your arms, and be sure that the baby is comfortable. 2. Place the tip of the bulb into the baby’s
nostril and suck very gently through the mouthpiece, as if you are drinking a liquid from a straw. If needed, you can always use more suction force. The mouthpiece is a
one-way valve and will not allow you to blow into the baby’s nose. 3. A pre-treatment with a few drops of saline solution or saline spray in each nostril may help loosen
thick mucus before using the NeilMed® Naspira® Nasal-Oral Aspirator (NOA). Mucus from the baby’s nostrils will come out very easily and transfer mainly to the tip,
and if excessive, into the bulbous area during suctioning. 4. Repeat the previous steps in the same and/or the other nostril as necessary. 5. Please follow the cleaning and
disinfection protocol for the safety of yourself and your baby. 6. Change filter if it is soiled with secretions or after the acute infection is over or every week during use.
Price Band: $19.99
Medicine Classification: Medical Device
NUROFEN COLD & FLU PE
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets, 24s, 48s.
Active Ingredients: Ibuprofen 200mg, phenylephrine hydrochloride 5mg.
Approved Indications: Symptoms of cold and flu including headache, sore throat, runny or blocked nose, sinus pain, fever, and body
aches and pains.
Contraindications: Hypersensitivity to any ingredient. Existing peptic ulceration. History of bronchospasm, asthma, urticaria or rhinitis
associated with aspirin or other NSAIDs. Renal impairment or heart failure. First 6 months of pregnancy except on a doctor’s
advice; last 3 months of pregnancy.
Precautions: Asthma, history of peptic ulceration, regular treatment with other medications (particularly if containing ibuprofen, aspirin,
or other NSAIDS), high blood pressure, treatment with antidepressants.
Adverse Effects: Nausea, dyspepsia, rash, dizziness, GI bleed (rare at OTC dose). Hepatic dysfunction and papillary necrosis may occur.
Directions: Adults and children from 12 years: 2 tablets, then 1 or 2 tablets every 4 hours as necessary. Maximum 6 tablets in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
OTRIVIN ADULT
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Metered-dose spray or drops. 10mL.
Active Ingredients: Xylometazoline hydrochloride 1mg/ml.
Approved Indications: Relief of nasal congestion caused by colds, flus, sinusitis, hay fever or other allergic sinusitis.
Contraindications: Hypersensitivity to xylometazoline or to any of the excipients, after recent surgery through the nose or mouth, narrow
angle glaucoma.
Precautions: Consult a doctor or pharmacist before use in patients who are pregnant or breast-feeding and in patients with high blood
pressure, heart disease, overactive thyroid or diabetes. Should not be used in children under 12 years. If congestion persists for
more than 3 days, seek medical advice.
Adverse Effects: Headache, nasal dryness or discomfort, nausea and application site burning. See datasheet for more information.
Directions: 1 spray or 2 to 3 drops in each nostril, 2 to 3 times daily as necessary. Do not use more often than every 8 - 10 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 227

OTRIVIN JUNIOR
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Metered-dose spray or drops. 10mL.
Active Ingredients: Xylometazoline hydrochloride 0.5 mg/mL.
Approved Indications: Relief of nasal congestion caused by colds, flus, sinusitis, hay fever or other allergic sinusitis.
Contraindications: Hypersensitivity to xylometazoline or to any of the excipients, after recent surgery through the nose or mouth, narrow
angle glaucoma.
Precautions: Consult a doctor or pharmacist before use in patients who are pregnant or breast-feeding and in patients with high blood
pressure, heart disease, overactive thyroid or diabetes. Should not be used in children under 6 years. If congestion persists for
more than 3 days, seek medical advice.
Adverse Effects: Headache, nasal dryness or discomfort, nausea and application site burning. See datasheet for more information.
Directions: 2 sprays or 2 to 3 drops in each nostril, 2 to 3 times daily as necessary. Do not use more often than every 8-10 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
OTRIVIN PLUS
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Metered-dose spray. 10mL.
Active Ingredients: Xylometazoline hydrochloride 0.5 mg/mL and ipratropium bromide 0.6 mg/mL.
Approved Indications: Relief of nasal congestion and running nose (rhinorrhea) associated with the common cold.
Contraindications: Should not be given to children under the age of 18, known hypersensitivity to xylometazoline, ipratropium, atropine
or to any of the excipients, after recent surgery through the nose or mouth, glaucoma and inflammatory nasal dryness (rhinitis
sicca).
Precautions: Sensitive to certain adrenergic substances, cardiovascular disease, high blood pressure, diabetes, pheochromocytoma,
hyperthyroidism, enlargement of the prostate, narrow passage through the urethra, predisposed to narrow-angle glaucoma,
frequent nosebleeds, obstruction of the intestine or cystic fibrosis, benign tumour producing high amounts of adrenaline and
noradrenaline, pregnant or breast-feeding.
Adverse Effects: Nose bleeding, dry and irritated nasal mucous membrane or throat, dry mouth, headache, stinging in the nose and
throat, sneezing, burning sensation and runny nose. See leaflet for more information.
Directions: 1 spray per nostril, as necessary. Do not use more often than every 6 hours. Do not use more than 3 times a day.
Price Band: $10 - $20 Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
VIRALEX ®
GOOD HEALTH NZ PRODUCTS (DISTRIBUTED BY BRANDFOLIO)
Presentation: Capsules: 30s, 60s.
Active Ingredients: Ingredients: (per capsule) herbal extract equivalent to dry, olive leaf (Olea europaea) 4500mg (Equivalent to
Oleuropein 100mg), Astragalus (Astragalus membranaceus) 200mg. Other ingredients: Saccharomyces cerevisiae 100mg
(providing Beta Glucans), Zinc (from Gluconate) 1mg, vitamin D3 (cholecalciferol) 250IU.
Approved Indications: Everyday immune support to naturally strengthen the immune system.
Contraindications: Pregnancy and breastfeeding.
Precautions: Take with food.
Beneficial interaction: Olive leaf extract may help lower blood pressure and blood sugar levels in some people.
Adverse Effects: None known.
Directions: Maintenance dose: Adults: Take 4 capsules daily with food. Acute dose: 4 capsules 2 x daily with food.
Maintenance dose: Children: 6-12 years: 1 capsule daily with food. Acute dose: 2 capsules daily with food.
Price Band: $17.00-$45.00
Medicine Classification: General Sale
»»
Cold Sores
BLISTEX MEDICATED RELIEF
WILSON CONSUMER PRODUCTS LTD
Presentation: Tube SPF15.
Active Ingredients: Padimate O 7.5%, Oxybenzone 2.0% and Camphor 1.0%.
Approved Indications: Protects from sun, wind and cold. May help prevent recurrence of cold sores induced by the sun. Helps relieve the
discomfort of cold sores, sunburnt lips, dry and chapped lips.
Contraindications: None known.
Precautions: Not to be used on infants under 12 months except on medical advice. Discontinue if signs of irritation or rash appear.
If conditions persist consult a healthcare professional.
Adverse Effects: None known.
Directions: Apply liberally before sun exposure and after swimming. Reapply as required. For cold sore relief apply every half hour as
necessary.
Price Band: $6 - $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 228 HEALTHCARE HANDBOOK 2017-2018 OTC Products

VIRABAN
AFT PHARMACEUTICALS LTD
Presentation: Cream, 5g.
Active Ingredients: Aciclovir 5% w/w.
Approved Indications: Treatment of herpes simplex of the lips and face (cold sores). Viraban can prevent cold sores developing
and/or shorten healing time.
Contraindications: Hypersensitivity to aciclovir.
Precautions: Not for use on mucous membranes and eyes.
Adverse Effects: Transient burning, stinging and flaking of the skin, erythema, itching.
Directions: Apply 5 times daily during waking hours, for 5 days. Treatment may be continued for up to an additional 5 days.
Start treatment as early as possible.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Constipation
COLOXYL
ASPEN PHARMACARE
Presentation: 100 tablet packs.
Active Ingredients: Docusate sodium 50mg and 120mg.
Approved Indications: Treatment of constipation.
Contraindications: Intestinal obstruction, abdominal pain of unknown cause, undiagnosed rectal bleeding.
Precautions: Prolonged use. If symptoms persist, seek medical advice.
Adverse Effects: Rarely may cause diarrhoea, nausea, abdominal cramps, skin rash.
Directions: Adults and children over 12 years: Take between 2 and 3 tablets daily after the evening meal.
Price Band: $8 - $15 [Price varies with pack size]. Available on Pharmaceutical Schedule
Subsidy Conditions: Fully subsidised
Medicine Classification: General Sale
COLOXYL DROPS
ASPEN PHARMACARE
Presentation: Drops (30mL bottle)
Active Ingredients: Poloxamer.
Approved Indications: Treatment of constipation in infants and children.
Contraindications: Suspected appendicitis, undiagnosed rectal bleeding, abdominal pain, intestinal obstruction.
Precautions: Drink plenty of fluids.
Adverse Effects: Abdominal discomfort including colic, cramps.
Directions: Administer 3 times daily in feeding bottle or fruit juice. Children

DULCOLAX
SANOFI CONSUMER HEALTHCARE
Presentation: Suppositories: 10mg 6s, Tablets: 5mg 30s and 100s.
Active Ingredients: Bisacodyl.
Approved Indications: Used for the treatment of constipation.
Contraindications: Hypersensitivity to any ingredient, intestinal obstruction, abdominal pain, or dehydration.
Precautions: Not recommended for long term and excessive use. Pregnancy.
Adverse Effects: Abdominal pain and diarrhoea. Contact your healthcare professional if you notice a rash, difficulty breathing or swelling
of the face.
Directions: Tablets: Swallow tablets whole with glass of water. Do not crush or chew tablets. Adults and children over 10 years: Take 1 to 2
coated tablets at night (5 to 10mg). Children 4 to 10 years: One coated tablet at night (5mg). Suppository: Remove all of the foil
wrapper, then push the suppository gently and slowly, pointed end first, into the rectum (back passage). Adults and children over
10 years: One suppository (10mg).
Price Band: $6 - $17
Medicine Classification: Pharmacy Only Medicine
SENOKOT
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets, 100s.
Active Ingredients: Standardised sennosides 7.5mg.
Approved Indications: Relief of constipation, including treatment of constipation in elderly, pregnancy, conservative treatment of
haemorrhoids, avoidance of straining at stool, control of defecation reflex in incontinent patients, secondary to other causes.
Contraindications: Hypersensitivity to any ingredient, undiagnosed acute or persistent abdominal symptoms such as cramps, colic,
nausea, vomiting, abdominal pain or other symptoms of appendicitis.
Precautions: Prolonged excessive use of laxatives may produce altered bowel habits, nausea, vomiting, weight loss, steatorrhoea,
malabsorption, cathartic colon, water loss and electrolyte disturbances. Not recommended in children under 6 years.
Adverse Effects: Colic, cramps, mild griping.
Directions: Adults: 2-4 tablets at bedtime; children over 6 years: 1-2 tablets in the morning. Start with the lowest dose, increasing by half
the initial dose each day until a comfortable, formed motion is produced. Seek medical advice if no bowel motion after 3 days.
Reduce or stop the dose once regularity is achieved.
Price Band: $10 - $20. Available on Pharmaceutical Schedule
Subsidy Conditions: Partially subsidised Medicine Classification: Pharmacy Only Medicine
»»
Coughs - Dry
BENADRYL PE DRY COUGH & NASAL CONGESTION
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Oral Liquid 200mL.
Active Ingredients: Dextromethorphan hydrobromide 10mg/5ml, phenylephrine hydrochloride 5mg/5ml.
Approved Indications: Relieves symptoms of cough and cold, chesty cough, runny nose and nasal congestion.
Contraindications: Children under 6 years.
Precautions: Ask your doctor before use if you have high blood pressure, are taking anti-depressants, have heart problems, or are
pregnant.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Sorbitol may have a laxative effect or cause diarrhoea.
Directions: Adults and children over 12 years:10ml every four hours as necessary. Children 6-12 year: 5ml every 4 hours as necessary.
No more than 6 doses in 24hrs.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
BONNINGTON’S IRISH MOSS
ASPEN PHARMACARE
Presentation: Cough Syrup, 200mL bottle
Active Ingredients: Each 10mL contains: 1.7 mg menthol, 9 mg camphor, 240 mg liquorice extract, 13 mg carrageenan,
3.8 uL ipecacuanha
Approved Indications: Soothes and relieves coughs and sore throats.
Contraindications: None known
Precautions: Use only as directed. If symptoms persist, see your doctor. Store below 30 degrees celsius.
Adverse Effects: None known
Directions: For adults and children over 12 years, take 10mls and repeat every 2 hours as needed.
Price Band: $14-16 per 200mL bottle
Medicine Classification: General Sale
Page 230 HEALTHCARE HANDBOOK 2017-2018 OTC Products

CODRAL COLD & FLU + COUGH
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg. Night:
Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs, and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy do not drive or operate machinery. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red night capsules at bedtime.
Allow 4-6 hours as necessary between doses. Maximum: 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
PHARMACY HEALTH CONGESTED COLD & COUGH
PSM HEALTHCARE LTD. T/A API CONSUMER BRANDS
Presentation: Oral Liquid 200ml
Active Ingredients: Each 10mL of oral liquid contains: Dextromethorphan hydrobromide BP 20mg, phenylephrine hydrochloride BP 10mg,
brompheniramine maleate BP 4mg.
Indications: This medicine provides relief of cold symptoms including, watery or itchy eyes, nasal congestion, runny nose, sneezing and
suppresses coughs.
Contraindications: Must not be used in children under 6 years of age.
Precautions: Consult a healthcare professional before using in children aged 6 - 12 years. See doctor before using another cough and
cold medicine. Do not use with other antihistamines. Avoid alcohol. Please consult your doctor or pharmacist before taking this
product if you have high blood pressure or heart problems or are taking antidepressant medication. Check with your doctor
before use if you are pregnant or may become pregnant.
Adverse Effects: This medicine may cause drowsiness. Be cautious about driving a vehicle or operating machinery within 8 hours of taking this medicine.
Directions: Children 6 - 12 years: 5mL every 4 hours if required. Adults and Children 12 years and over: 10mL every 4 hours if required. Do not exceed 6 doses in 24 hours.
Price Band: $18 - $22
Medicine Classification: Pharmacy Only
PHARMACY HEALTH STUBBORN DRY TICKLY COUGH
PSM HEALTHCARE LTD. T/A API CONSUMER BRANDS
Presentation: Oral Liquid 200ml.
Active Ingredients: Each 5mL of oral liquid contains: Pholcodine BP 10mg.
Indications: This medicine provides relief from a stubborn cough and dry tickly cough for up to 8 hours.
Contraindications: Must not be used in children under 6 years of age.
Precautions: This preparation contains alcohol (13.2% v/v) and methyl paraben as preservative. Consult a healthcare professional
before using in children aged 6 - 12 years. Consult a doctor/pharmacist before using with other medicines intended to treat the
symptoms of the common cold. Do not use for more than a few days without medical advice.
Adverse Effects: May have a mild sedative effect in some people. Avoid driving or operating machinery if affected.
Directions: Children over 6 years: 2.5mL up to four times daily. Adults and Children over 12 years: 5mL up to four times daily if required.
Maximum: four doses in 24 hours.
Price Band: $18 - $22
Medicine Classification: Pharmacy Only
»»
Coughs - Productive
BENADRYL CHESTY FORTE
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Oral liquid, 200ml.
Active Ingredients: Bromhexine hydrochloride 3mg/5mL Guaiphenesin 100mg/5ml.
Approved Indications: Expectorant and respiratory mucolytic - relief of heavy chesty coughs.
Contraindications: Children under 6 years.
Precautions: Ask your doctor before use for children 6 years and over. Do not use in children under 6 years.
Adverse Effects: None known.
Directions: Adults and children over 12 years 10-20ml; children 6-12 years 5-7.5ml. Take 6 hourly as required. Maximum 4 doses in 24hrs.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 231

BENADRYL MUCUS RELIEF DOUBLE ACTION FORTE COUGH LIQUID
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: 200mL Cough Liquid
Active Ingredients: Guaiphenesin 100mg/5ml. Bromhexine Hydrochloride 4mg/5ml
Indications: Expectorant and respiratory mucolytic – relief of heavy chesty coughs.
Contraindications: Do not use in children under 6 years.
Precautions: Ask your doctor before using for children aged 6-12 years or if you are taking any other medicines to treat a cough or cold.
Adverse Effects: Product contains sorbitol (21g/60mL). Sorbitol may have a laxative effect or cause diarrhoea.
Directions: Children 6 to 12 years: 5-10 mL every 8 hours. Adults and children over 12 years: 10-20 mL every 8 hours. Maximum: 3 doses
in 24 hrs.
Price Band: $10-$20
Medicine Classification: Pharmacy Only
BENADRYL MUCUS RELIEF PLUS DECONGESTANT
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Oral Liquid 100mL, 200mL.
Active Ingredients: Guaiphenesin 20mg/ml; Phenylephrine hydrochloride 1mg/ml.
Approved Indications: Thins heavy chest mucus. Relieves the symptoms of cough and cold - chesty cough, runny nose and nasal
congestion.
Contraindications: Children under 6 years.
Precautions: Ask your doctor before use if you have high blood pressure, are taking anti-depressants, have heart problems, or are
pregnant.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Sorbitol may have a laxative effect or cause diarrhoea.
Directions: Adults and children over 12 years: 10ml every four hours as necessary. Children 6-12 years: 5ml every 4 hours as necessary. No
more than 6 doses in 24hrs.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
BENADRYL PE CHESTY COUGH & NASAL CONGESTION
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Oral Liquid 200mL.
Active Ingredients: Guaiphenesin 20mg/ml; Phenylephrine hydrochloride 1mg/ml.
Approved Indications: Relieves symptoms of cough and cold - chesty cough, runny nose and nasal congestion.
Contraindications: Children under 6 years.
Precautions: Ask your doctor before use if you have high blood pressure, are taking anti-depressants, have heart problems, or are
pregnant.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Sorbitol may have a laxative effect or cause diarrhoea.
Directions: Adults and children over 12 years: 10ml every four hours as necessary. Children 6-12 year: 5ml every 4 hours as necessary.
No more than 6 doses in 24hrs.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
BISOLVON CHESTY FORTE
SANOFI CONSUMER HEALTHCARE
Presentation: 200mL Liquid (8mg/5mL Bromhexine HCl) & 50 tablets (8mg Bromhexine HCl)
Active Ingredients: Bromhexine hydrochloride
Approved Indications: Relief of chesty coughs and breathing difficulties due to excess mucus in cold, flu and respiratory
tract infections.
Contraindications: Hypersensitivity to any ingredient or galactose intolerance. Liver problems, kidney problems or stomach
ulcers. Not suitable for children under 6 years old.
Precautions: Pregnancy & lactation. Children aged 6-11 years on the advice of a healthcare professional.
Adverse Effects: Occasional stomach problems, headache, dizziness. Contact your healthcare professional if you develop a
skin rash or breathing problems.
Directions: Liquid: Adults & Children > 12 years: 5mL 3 times a day when necessary. May be increased to 10mL 3 times a
day for the first 7 days. Children 6 - 11 years: 5mL 3 times a day when necessary. Tablets: Adults & Children over
12 years: 1 tablet 3 times a day when necessary. May be increased to 2 tablets 3 times a day for the first 7 days.
Children 6 - 11 years: 1 tablet 3 times a day when necessary.
Price Band: $20-$28 Medicine Classification: Pharmacy Only Medicine
Page 232 HEALTHCARE HANDBOOK 2017-2018 OTC Products

MUCINEX MAXIMUM STRENGTH
RECKITT BENCKISER (NZ) LTD
Presentation: 12-hour modified release tablet, 14’s.
Active Ingredients: Guaiphenesin 1200mg.
Indications: Helps loosen phlegm and thin bronchial secretions. Symptomatic relief of deep chesty coughs.
Contraindications: Hypersensitivity to guaiphenesin or any of the ingredients.
Precautions: Seek medical advice for patients with: asthma, bronchitis, chronic obstructive pulmonary disease (COPD), emphysema,
smoker’s cough, porphyria. Chronic overdosing has caused urinary calculi. Guaiphenesin is rapidly metabolised and excreted
in urine. Seek medical advice before taking this product if pregnant or breastfeeding. Does not affect the ability to drive or use
machinery.
Adverse Effects: Few reported at recommended dosages. High doses may cause gastrointestinal discomfort, nausea and vomiting.
Directions: Swallow tablet whole with a full glass of water. Do not crush, chew or break tablet. Adults and children 12 years and over:
1 tablet every 12 hours. Do not exceed 2 tablets in 24 hours. Do not give to children under 12 years of age.
Price Band: $30 - $40
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
PHARMACY HEALTH GEES LINCTUS
PSM HEALTHCARE LTD. T/A API CONSUMER BRANDS
Presentation: Linctus 200mL
Active Ingredients: Anhydrous Morphine 0.0165% w/v, squill 1.67% w/v.
Indications: Relief from wet, productive and irritating cough.
Contraindications: This product is not recommended for children under 12 years of age.
Precautions: Consult a doctor/pharmacist if you are pregnant or breastfeeding and before using with other medicines intended to treat
the symptoms of the common cold. Do not use for prolonged periods. This preparation contains alcohol 20% v/v. Keep out of
reach of children.
Adverse Effects: May cause drowsiness. Do not drive a vehicle or operate heavy machinery within 8 hours of taking this medicine.
Directions: Adults and children over 12 years: take 5mL sipped slowly or added to 10mL of warm water and sipped slowly. To be taken up
to 3 - 4 times daily as required.
Price Band: $18 - $22
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only
»»
Cystitis (Urinary Tract Infections)
URAL
ASPEN PHARMACARE
Presentation: 4g Sachets
Active Ingredients: Each sachet contains:1.76 g sodium bicarbonate, 890 mg tartaric acid, 720 mg citric acid, anhydrous,
630 mg sodium citrate, anhydrous
Approved Indications: Relief from the painful burning symptoms of urinary tract infections. For Adults and children
12 years and over.
Contraindications: Do not take for longer than 5 days or give to children under 12 except on medical advice.
Concomitant use of quinolone antibiotics.
Precautions: Check with a doctor or pharmacist before using this medicine for people with kidney problems, heart
problems, or high blood pressure.
Adverse Effects: Prolonged and excessive use may cause a systemic alkalosis and/or hypernatraemia.
Directions: Dissolve 1-2 sachets in a glass of cold water. May be taken up to 4 times daily.
Price Band: $5-7 for 8 pack, $10-15 for 28 pack. Available on Pharmaceutical Schedule
Subsidy Conditions: 28-pack is funded
Medicine Classification: General Sale
UROFEM (1000MG D-MANNOSE TABLETS)
TE ARAI BIOFARMA
Presentation: Tablets 50/60 x 1,000mg.
Active Ingredients: Pure d-mannose.
Approved Indications: Discourages potentially harmful bacteria from attaching to the bladder wall and urinary tract, the bacteria are
flushed away on urination. Maintains a healthy bladder and urinary tract. Supports healthy bacteria balance.
Contraindications: None known.
Precautions: If urinary and bladder symptoms continue see your healthcare professional.
Adverse Effects: Mild Gastrointestinal upset, similar rate to placebo.
Directions: Maintenance: take 1 UroFem tablet twice daily. Acute: take 1 UroFem tablet three times daily. Non-antibiotic UroFem is
specialist recommended.
Price Band: $33.00-$40.00
Subsidy Conditions: ACC Funded
Medicine Classification: Dietary Supplement
Page 233

»»
Dandruff
COCO-SCALP
AFT PHARMACEUTICALS LTD
Presentation: Ointment, 40g tube.
Active Ingredients: Coal tar solution 12.0% w/w, sulphur for external use 4.0% w/w, salicylic acid 2.0% w/w.
Approved Indications: For treatment of common scaly skin disorders of the scalp such as psoriasis, eczema, seborrhoeic dermatitis and
dandruff.
Contraindications: Known sensitivity to any ingredients, in the presence of acute local infections or acute pustular psoriasis.
Precautions: Avoid contact with eyes - wash hands immediately after use. Stop use if irritation develops. If symptoms persist after 4
weeks, consult a doctor. Use during pregnancy/breastfeeding at physician’s discretion. Not recommended in children under 6
years. Children 6-12 years: Use under medical supervision only.
Adverse Effects: Skin irritation, folliculitis and rarely, photosensitivity.
Directions: Adults and children over 12 years: Mild dandruff - use intermittently as adjunctive treatment, about once a week. Psoriasis,
eczema, seborrhoeic dermatitis and severe dandruff - use daily for 3-7 days until improvement. Intermittent repeated
applications may be necessary to maintain improvement. Affected area should be treated and shampooed off, using warm water,
approximately 1 hour later.
Price Band: $10 - $20. Available on Pharmaceutical Schedule Subsidy Conditions: Fully subsidised Medicine Classification: General Sale
»»
Dermatitis & Eczema
COCO-SCALP
AFT PHARMACEUTICALS LTD
Presentation: Ointment, 40g tube.
Active Ingredients: Coal tar solution 12.0% w/w, sulphur for external use 4.0% w/w, salicylic acid 2.0% w/w.
Approved Indications: For treatment of common scaly skin disorders of the scalp such as psoriasis, eczema, seborrhoeic dermatitis and
dandruff.
Contraindications: Known sensitivity to any ingredients, in the presence of acute local infections or acute pustular psoriasis.
Precautions: Avoid contact with eyes - wash hands immediately after use. Stop use if irritation develops. If symptoms persist after 4
weeks, consult a doctor. Use during pregnancy/breastfeeding at physician’s discretion. Not recommended in children under 6
years. Children 6-12 years: Use under medical supervision only.
Adverse Effects: Skin irritation, folliculitis and rarely, photosensitivity.
Directions: Adults and children over 12 years: Mild dandruff - use intermittently as adjunctive treatment, about once a week. Psoriasis,
eczema, seborrhoeic dermatitis and severe dandruff - use daily for 3-7 days until improvement. Intermittent repeated
applications may be necessary to maintain improvement. Affected area should be treated and shampooed off, using warm water,
approximately 1 hour later.
Price Band: $10 - $20. Available on Pharmaceutical Schedule Subsidy Conditions: Fully subsidised Medicine Classification: General Sale
PINETARSOL
DOUGLAS PHARMACEUTICALS LTD
Presentation: Liquid: 100ml, 200ml, 500ml, 1 litre. Gel: 100g. Bar, 100g.
Active Ingredients: Pine tar.
Approved Indications: Soap alternative. Relief of red and itchy skin conditions.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Avoid contact with eyes, avoid exposure to sun, may stain clothing. External use only.
Adverse Effects: None known.
Directions: Add 15-30ml of liquid to a tepid bath.
Price Band: Under $10 - $20 (Price varies with pack size). Available on Pharmaceutical Schedule
Subsidy Conditions: 500ml, 1 litre liquid only
Medicine Classification: General Sale
QV GENTLE WASH
DOUGLAS PHARMACEUTICALS LTD
Presentation: Gentle, soap-free cleanser for delicate skin. 250mL flip-top bottle, 500mL pump pack, 1L pump pack.
Active Ingredients: Aqua (water), glycerin, sodium lauroyl sarcosinate, disodium cocoamphodiacetate, lauryl betaine,
sodium cocoyl isethionate, acrylates/ C10-30 alkyl acrylate crosspolymer, styrene/acrylates copolymer,
aminomethyl propanol, methylparaben, propylparaben.
Approved Indications: QV Gentle Wash is designed for dry and sensitive skin. It works to maintain hydration during
cleansing so skin is left clean and soft. QV Gentle Wash is also non-comedogenic so it won’t block pores. Suitable
for use with conditions such as dermatitis, eczema and psoriasis.
Contraindications: None known.
Precautions: None known.
Adverse Effects: None known.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 234 HEALTHCARE HANDBOOK 2017-2018 OTC Products

QV SKIN LOTION
DOUGLAS PHARMACEUTICALS LTD
Presentation: Lotion, 250ml, 500ml, 1 litre. Cream, 100g, 250g. Bath oil, 200ml, 250ml, 1 litre. Wash, 250ml, 500ml, 1 litre. Bar, 100g.
Gentle Wash, 250ml, 500ml, 1 litre. Intensive shower pack, 240ml. Intensive moisturiser, 450g.
Active Ingredients: Variety of emollient ingredients. Lanolin and perfume-free, pH adjusted.
Approved Indications: Cleanser and moisturiser for normal to dry and sensitive skin.
Contraindications: Hypersensitivity to any ingredient.
Precautions: For external use only.
Adverse Effects: None known.
Directions: Apply cream and lotion as required. Use wash and bar as soap substitutes.
Price Band: $10 - $20 and over. Available on Pharmaceutical Schedule
Subsidy Conditions: Lotion 250ml only, part charge
Medicine Classification: General Sale
»»
Diarrhoea
GASTROLYTE
SANOFI CONSUMER HEALTHCARE
Presentation: Sachets: orange, 10s. Effervescent tablets: blackcurrant, lemon, raspberry, 20s.
Active Ingredients: Sachet: Sodium chloride 0.47g, potassium chloride 0.3g, sodium acid citrate 0.53g, glucose 3.56g. Tablet: sodium
chloride 0.117g, potassium chloride 0.186g, citric acid 0.384g, sodium bicarbonate 0.336g, glucose 1.62g.
Approved Indications: Oral correction of fluid and electrolyte loss in infants, children and adults.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Oral administration only. Make up sachets/tablets to exact concentration specified - too strong may cause hypernatraemia,
too weak will provide insufficient glucose and electrolytes. Dilute only with water.
Adverse Effects: None known.
Directions: Dosage depends on severity of condition, age and weight of patient. Dissolve sachets/tablets in water. Use strictly as directed
on pack, or by doctor.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Dry skin
PALMER’S SKIN THERAPY OIL
WILSON CONSUMER PRODUCTS LTD
Presentation: Skin Therapy Oil Rosehip Fragrance 60ml.
Active Ingredients: Cocoa seed butter, vitamin E, rose canina seed extract, and cetesomate -E Complex which helps improve the skin
penetration and absorption characteristics of the formula into the epidermal layer of the skin.
Approved Indications: Formulated to help improve the appearance of scars, stretch marks, dry, damaged skin, uneven skin tone and
aging skin.
Contraindications: None known.
Precautions: Do not ingest.
Adverse Effects: None known.
Directions: Gently massage into affected area 3 times daily or as often as desired. During pregnancy apply from first trimester to help
prevent stretch marks.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Ear Conditions
CERUMOL
BDM GRANGE LIMITED
Presentation: Drops 10ml.
Active Ingredients: Chlorbutol 5% w/v, ortho-dichlorobenzene 14% w/v, para-dichlorobenzene 2% w/v. arachis (peanut) oil 57% w/v.
Approved Indications: Softens and loosens impacted earwax, to aid removal.
Contraindications: Nut allergies (contains peanut oil), perforated eardrum. Otitis externa, seborrhoeic dermatitis and eczema affecting
the external ear.
Precautions: Avoid contact with eyes and skin, avoid breathing vapour. Contains product derived from peanuts.
Adverse Effects: None known
Directions: Ensure ear is not inflamed. With the head inclined, instil 5 drops in the ear. Moisten a plug of cotton wool and plug the ear to
retain liquid. Remove after 1 hour and repeat twice daily for up to 3 days.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 235

EAR CLEAR
WILSON CONSUMER PRODUCTS LTD
Presentation: Drops, 12ml.
Active Ingredients: Carbamide peroxide 65mg.
Approved Indications: Soften and loosens impacted earwax to aid removal.
Contraindications: Hypersensitivity to any ingredient, perforated eardrum.
Precautions: Avoid use in children less than 12 years, except on medical advice.
Adverse Effects: None known.
Directions: Instill 5-10 drops in each ear twice daily for up to 4 days.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
EAR CLEAR EAR CLEANSER
WILSON CONSUMER PRODUCTS LTD
Presentation: Spray, 100ml.
Active Ingredients: Isotonic saline solution pH-balanced with bicarbonate.
Approved Indications: Keeps ears clean by washing away excess wax and debris. Regular use helps prevent wax build-up.
A gentle alternative to cotton buds.
Contraindications: Hypersensitivity to any ingredient, perforated eardrum.
Precautions: Avoid use in children less than 12 years, except on medical advice.
Adverse Effects: None known.
Directions: For best results, use once a day for 10 days, then 2-3 times a week.
Price Band: $10.00- $20.00
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Eye Conditions - Dry Eye
HYLO-FRESH
AFT PHARMACEUTICALS LTD
Presentation: Preservative-free, phosphate-free and sterile multi-dose lubricating eye drops 10ml.
Active Ingredients: Sodium hyaluronate 1mg/mL.
Approved Indications: Ocular lubricant for the temporary relief of moderate to severe dry eye symptoms.
Contraindications: Hypersensitivity to any ingredient.
Precautions: For external use only. Discard 6 months after opening.
Adverse Effects: Hypersensitivity reactions may occur, eg. burning or excessive watering of the eye.
Directions: 1 drop per eye, 3 times daily, or more as needed or directed. Compatible with all contact lenses. Can be used for 6 months
after opening.
Price Band: $30 - $40. Available on Pharmaceutical Schedule
Subsidy Conditions: Special Authority (SA1388) criteria apply. Confirmed diagnosis by slit lamp of severe secretory dry eye; and either:
patient is using eye drops more than four times daily on a regular basis; or patient has had a confirmed allergic reaction to
preservative in eye drop
Medicine Classification: Medical device
OPTREX EYE WASH WITH EYE BATH
RECKITT BENCKISER (NZ) LTD
Presentation: Wash with eye bath, 110ml, 300ml.
Active Ingredients: Distilled witch hazel 13% v/v.
Indications: Soothes sore, irritated and tired eyes.
Contraindications: Sensitivity to ingredients, while or just before wearing soft contact lenses.
Precautions: For external use only.
Adverse Effects: Allergic reactions may occur.
Directions: Wash: Fill eyebath 1/3 full and use as eyewash. Use fresh wash for each eye.
Price Band: Under $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Classification: Medical Device
Page 236 HEALTHCARE HANDBOOK 2017-2018 OTC Products

OPTREX SORE EYES
RECKITT BENCKISER (NZ) LTD
Presentation: Drops 10ml
Active Ingredients: Witch Hazel
Indications: Soothes & Cleanses
Contraindications: None known
Precautions: Do not use just before or whilst wearing contact lenses
Adverse Effects: None recorded
Directions: 1-2 drops into each eye as required.
Price Band: $5.00-$15.00
Medicine Classification: Medical Device
»»
Eye Conditions - Macular Degeneration
MACU-VISION
BLACKMORES
Presentation: Tablets 90s. Film coated.
Active Ingredients: Ascorbic acid (vitamin C) 250 mg, zinc oxide 49.8 mg (equivalent to zinc 40 mg), alpha tocopheryl acid succinate
(vitamin E) 165 mg (equivalent to 200 IU), cupric oxide 1.25 mg (equivalent to copper 1 mg).
Approved Indications: An antioxidant formula for eye health based on the AREDS research. May help to provide important nutrients to
the macular region of the eye, defend against free radical damage to the retina, including the macular region and lens of the eye
and maintain overall eye health.
Contraindications: Not recommended during pregnancy or breastfeeding. Not recommended for children under 18.
Precautions: Zinc may decrease the absorption and efficacy of some medications. If taking tetracycline or quinolone antibiotics, separate
doses by at least two hours. Contains zinc, which may be dangerous when taken in large amounts or for a long period.
Adverse Effects: May occasionally cause gastric irritation if taken without food.
Directions: Take one tablet a day with your main meal.
Price Band: 49.99
Subsidy Conditions: N/A
Medicine Classification: General Sale
»»
Eye Conditions - Infections
BROLENE EYE DROPS
SANOFI CONSUMER HEALTHCARE
Presentation: Drops, 10mL.
Active Ingredients: Propamidine isethionate 0.1%.
Approved Indications: Treatment of eye infections such as acute and chronic conjunctivitis, and prevention of infection resulting from
minor injury to the eye.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Seek medical advice if no improvement after 2 days of use. Do not use with soft or gas-permeable contact lenses.
Adverse Effects: Rarely, skin sensitisation.
Directions: Ideally, first cleanse affected eye with saline or warm water that has been previously boiled. Instill 1-2 drops 4 times daily into
infected eye, for not more than 1 week. Discard 1 month after opening.
Price Band: $10 - $20. Available on Pharmaceutical Schedule
Subsidy Conditions: Partially subsidised
Medicine Classification: Pharmacy Only Medicine
OPTREX RED EYES EYE DROPS
RECKITT BENCKISER (NZ) LTD
Presentation: Eye drops, 10ml.
Active Ingredients: Naphazoline hydrochloride 0.01% w/v, distilled witch hazel 12.5% v/v.
Approved Indications: Helps remove redness.
Contraindications: Hypersensitivity to any ingredient, narrow angle glaucoma or anatomically narrow angle, MAOI use, while or just
before wearing soft contact lenses.
Precautions: For external use only. Heart disease, hypertension, glaucoma, serious eye infections, concomitant eye medication, depression,
diabetes and thyroid disorders. Prolonged use is not recommended. Seek medical advice if taking digoxin, quinidine or tricylic
antidepressants.
Adverse Effects: Transient irritation, pupil dilation with increased intraocular pressure.
Directions: Adults and children over 12 years: Instil 2 drops into each eye up to 3 times daily.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 237

»»
Foot Care - Fungal Infections
SOLVEASY TINEA CREAM
DOUGLAS PHARMACEUTICALS LTD
Presentation: Topical cream.
Active Ingredients: Terbinafine hydrochloride 1%w/w.
Approved Indications: Tinea, athlete’s foot, jock itch, ringworm.
Contraindications: None known.
Precautions: Not recommended for children under 12 years of age. Seek medical advice in pregnancy or during breast
feeding.
Adverse Effects: None known.
Directions: Clean and dry the affected area thoroughly. Apply SolvEasy Tinea Cream once daily to the affected area and the
surrounding skin. For tinea use for ONE WEEK. If the infection is on the sole of your foot, use for 2-4 weeks. For
thrush infections of the skin use for 1-2 weeks.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Fungal Infections - Skin, Hair, Nails
LAMISIL CREAM
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Cream: 15g tube.
Active Ingredients: Terbinafine hydrochloride.
Approved Indications: Treatment of tinea of the feet, body and groin region commonly known as athlete’s foot, ringworm
and jock itch. Also useful to treat candida (yeast) infections of the skin.
Contraindications: Hypersensitivity to terbinafine or any of the excipients in the formulation.
Precautions: External use only. Avoid contact with the eyes. Pregnancy and breastfeeding.
Adverse Effects: Redness, itching or stinging may occasionally occur at the site of application. Refer to leaflet for further
information
Directions: Apply once daily. Athlete’s foot, jock itch and ringworm require once daily application for 1 week. Plantar/
Moccasin type tinea requires once daily application for 2 to 4 weeks. Cutaneous candidiasis requires once daily
application for 1 to 2 weeks.
Price Band: $15 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
LAMISIL DERM GEL
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Gel: 15g tube. Spray:15ml solution.
Active Ingredients: Terbinafine hydrochloride.
Approved Indications: Treatment of tinea of the feet, body and groin region commonly known as athlete’s foot, ringworm
and jock itch.
Contraindications: Hypersensitivity to terbinafine or any of the excipients in the formulation.
Precautions: External use only. Avoid contact with the eyes. Caution with use in pregnancy and breastfeeding. Use with
caution in people with lesions that may be irritated by alcohol. Do not use on the face.
Adverse Effects: Redness, itching or stinging occasionally occur at the site of application. Refer to leaflet for further
information.
Directions: Athlete’s foot, jock itch and ringworm require once daily application for 1 week.
Price Band: $15 - $25
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Fungal Nails
RESTORANAIL
AFT PHARMACEUTICALS LTD
Presentation: Nail Solution, 15ml
Active Ingredients: Poly-ureaurethane 16% in organic solvents
Indications: Indicated for use with nail dystrophy and fungal nail infections
Contraindications: Do not apply directly to deep, open or profusely bleeding wounds.
Precautions: Avoid contact with eyes and skin. Avoid breathing vapour. Do not swallow. Irritant. Avoid using near open flame and sources
of ignition. Use in well ventilated areas. For external use only. Keep out of reach of children.
Adverse Effects: May temporarily sting upon application. Should redness or other signs of irritation appear, discontinue use and consult a
healthcare professional.
Directions: Apply once daily (preferably at bedtime) to all affected nails. Remove cap, dip applicator into bottle and wipe off excess
solution on the lip of the bottle. Apply a thin layer of solution in even strokes to the whole affected nail. Allow to dry completely
before applying dressings or clothing. Replace cap on bottle when not in use. Clean affected nails with nail polish remover once
a week.
Price Band: $70 and above
Medicine Classification: Medical Device
Page 238 HEALTHCARE HANDBOOK 2017-2018 OTC Products

»»
Haemorrhoids
PROCTOSEDYL
SANOFI CONSUMER HEALTHCARE
Presentation: Ointment 15g and 30g, Suppository 12.
Active Ingredients: hydrocortisone 5mg, cinchocaine hydrochloride 5mg.
Approved Indications: Relief from discomfort of haemorrhoids (piles).
Contraindications: Hypersensitivity to any ingredient and children under the age of 12.
Precautions: Avoid use if you have an infection in the area of the anus. Consult a doctor if symptoms persist after 7 days.
Adverse Effects: Mild burning sensation. Contact your healthcare professional if you notice a rash, difficulty breathing, or
swelling of the face.
Directions: Ointment - if the affected area is on the surface, use your finger to apply just enough ointment to cover the
painful area. Suppository - insert the suppository gently into the rectum (back passage). Store suppositories in a
refrigerator.
Price Band: $10.00 - $15.00. Available on Pharmaceutical Schedule
Subsidy Conditions: Proctosedyl 30g and suppositories are subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Hay Fever
FLIXONASE
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Nasal spray, 120 sprays.
Active Ingredients: Fluticasone propionate 50mcg per spray.
Approved Indications: For the prevention and treatment of seasonal and allergic rhinitis including hay fever.
Contraindications: Hypersensitivity to fluticasone propionate or any other of the ingredients.
Precautions: Nosebleeds, nasal infection, pregnancy and lactation.
Adverse Effects: Epistaxis, nasal dryness, nasal irritation, throat dryness, throat irritation, headache. Very rarely, hypersensitivity reactions,
anaphylaxis/anaphylactic reactions, bronchospasm, skin rash, oedema of the face or tongue, glaucoma, raised intraocular
pressure, cataract, nasal septal perforation.
Directions: For adults 18 years and over two sprays in each nostril once daily.
Price Band: $25.00-$30.00
Medicine Classification: Pharmacy Only Medicine
KI HAY FEVER
MARTIN & PLEASANCE DISTRIBUTED BY BRANDFOLIO
Presentation: Tablets: 30, 60s.
Active Ingredients: Rhina-mp ® 2.88g, Astragalus membranaceus root 2.12g, Ginger 1.5g, Magnolia liliflora flower 1.5g, Quercetin 200mg
Approved Indications: For the symptoms of hayfever and to enhance the immune system
Contraindications: Not recommended during pregnancy or breastfeeding. Not suitable for children under 12 years of age unless directed
by a healthcare practitioner.
Precautions: Caution is advised in thyroid disease. Quercetin may possess anti-thyroid properties (experimental studies). Caution is
advised when taking blood thinning medication due to the potential anti-platelet effect of Ginger. The level of Ginger thought to
have this effect is well above that in the recommended daily dose of Ki Hayfever Control Formula.
Adverse Effects: Not known
Directions: 2 tablets daily. Preventative dose: 1 tablet daily 4 weeks prior to exposure to allergen. Maintenance: 1 tablet daily. May be
taken ongoing to support immune function. The full effects of Ki Hayfever Control Formula should be felt after 3 weeks. Therefore
when commencing Ki Hayfever Control Formula, other hayfever medications may be taken during these first few weeks.
Price Band: $35.00-$50.00
Medicine Classification: General Sale Supplements
TELFAST RANGE
SANOFI CONSUMER HEALTHCARE
Presentation: Tablet. 60mg (20 tabs), 120mg (10 & 30 tabs) and 180mg (10,30 & 50 tabs).
Active Ingredients: Fexofenadine hydrochloride
Approved Indications: 60mg: For the symptomatic relief of perennial allergic rhinitis and seasonal allergic rhinitis (hay
fever). 120mg: For the symptomatic relief of seasonal allergic rhinitis (hay fever). 180mg: For the symptomatic
relief of seasonal allergic rhinitis (hay fever), itchy skin rash and urticaria (hives).
Contraindications: Hypersensitivity to any ingredient.
Precautions: Pregnancy & lactation
Adverse Effects: Occasional headache, drowsiness, nausea, fatigue and dizziness.
Directions: Adults and children over 12. 60mg: 2 tablets daily as required, 120mg and 180mg: 1 tablet daily.
Price Band: $20.00-$70.00
Subsidy Conditions: 60mg & 120mg partially reimbursed
Medicine Classification: Pharmacy Only Medicine
Page 239

TELFAST ORAL LIQUID
SANOFI CONSUMER HEALTHCARE
Presentation: Oral liquid 150mL bottle. 30mg/5mL.
Active Ingredients: Fexofenadine hydrochloride.
Approved Indications: Relief of the symptoms of seasonal allergic rhinitis (hay fever), perennial allergic rhinitis and urticaria (hives).
Contraindications: Hypersensitivity to any ingredient.
Precautions: Pregnancy & lactation.
Adverse Effects: Occasional headache, drowsiness, nausea, fatigue and dizziness.
Directions: 6-23 months for itchy skin/hives: 2.5mL twice daily as required. 2-11 year for itchy skin/hives & hay fever allergies: 5mL twice
daily as required.
Price Band: $25
Medicine Classification: Pharmacy Only Medicine
»»
Hayfever
BECONASE ALLERGY & HAYFEVER
ASPEN PHARMACARE
Presentation: Nasal spray, 200 sprays.
Active Ingredients: Beclomethasone dipropionate 50mcg per spray.
Approved Indications: Short-term treatment or prevention of seasonal allergic rhinitis.
Contraindications: Hypersensitivity to beclomethasone dipropionate or to any ingredient listed on the leaflet; or recurrent nosebleeds.
Precautions: Nasal infection or wound, steroid dependency, pregnancy, lactation, tuberculosis. Consult with doctor after 3 months of
continuous use.
Adverse Effects: Rarely, nasal and throat irritation, sneezing, epistaxis, headache, raised intraocular pressure or glaucoma. Very rarely,
nasal septal perforation.
Directions: Adults and children 12 years and over: 2 sprays into each nostril twice daily.
Price Band: $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
LIVOSTIN EYE DROPS
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Eye drops 4mL.
Active Ingredients: Levocabastine hydrochloride 0.5mg/mL.
Approved Indications: Relieves watery, itchy or red eyes due to hayfever or allergic conjunctivitis.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Ask your doctor before using if you are pregnant or breastfeeding, have or have ever had kidney impairment or you wear
contact lenses.
Adverse Effects: Occasional, transient local irritation.
Directions: Adults and children: 1 drop in the effected eye(s), twice daily. If necessary the dose may be increased to 1 drop 3-4 times daily.
Do not use for longer than 8 weeks.
Price Band: $10 - $20. Available on Pharmaceutical Schedule
Medicine Classification: Pharmacy Only Medicine
LIVOSTIN NASAL SPRAY
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Nasal Spray 10mL.
Active Ingredients: Levocabastine hydrochloride 0.5mg/mL.
Indications: Relieves an itchy or runny nose and sneezing due to hayfever and allergic rhinitis.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Ask your doctor before using if you are pregnant or breastfeeding, have or have ever had kidney impairment.
Adverse Effects: Occasional, transient local irritation.
Directions: Adults and children: 2 sprays in each nostril, twice daily. If necessary the dose may be increased to 2 sprays 3-4 times daily.
Do not use for longer than 8 weeks.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 240 HEALTHCARE HANDBOOK 2017-2018 OTC Products

MAXICLEAR HAYFEVER & SINUS RELIEF
AFT PHARMACEUTICALS LTD
Presentation: Tablets: 30s.
Active Ingredients: Loratadine 2.5mg, phenylephrine hydrochloride 10mg.
Indications: For the relief of nasal and sinus congestion, hayfever, runny nose, watery and itchy eyes and sneezing.
Contraindications: Hypersensitivity to phenylephrine, severe hypertension, coronary heart disease, narrow angle glaucoma,
prostate hyperplasia, hypersensitivity to loratadine.
Precautions: Do not use in children under 12 years. Prolonged or excessive use may be harmful.
Adverse Effects: Phenylephrine may cause insomnia or sleeplessness in some people.
Directions: Adults and children over 12 years: 1 tablet 4 times daily. Do not exceed recommended dosage.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Headache
MAXIGESIC
AFT PHARMACEUTICALS LTD
Presentation: Tablets: 10s, 16s, 32s, 50s, 100s.
Active Ingredients: Paracetamol 500mg & ibuprofen 150mg.
Approved Indications: For relief of pain and reduction of fever and inflammation. For use in headache, toothache, arthritis, rheumatic
pain, migraine headache, dental procedures, tennis elbow, aches and pains associated with cold and flu, tension headache,
backache, period pain, sinus pain, sore throat, and muscular pain.
Contraindications: Hypersensitivity to any ingredient. Existing peptic ulceration or other stomach disorders, asthma, impaired kidney
function or heart failure. Urticaria or rhinitis associated with aspirin or other NSAIDS, pregnancy except on Doctors advice.
Do not use in the last 3 months of pregnancy.
Precautions: Do not combine with any other paracetamol or ibuprofen containing medications. Do not exceed the recommended dose.
Adverse Effects: Nausea, dyspepsia, rash, constipation, dizziness, GI bleeding (rare at OTC dose). Hepatic dysfunction and papillary
necrosis may occur.
Directions: Adults & children over 12 years: Take 1 or 2 tablets every 4 to 6 hours as required up to a maximum of 8 tablets in 24 hours.
Not recommended for children under 12 years old.
Price Band: $10 - $20 and over (Price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: General Sale (10s, 16s) Pharmacy Only (32s, 50s, 100s)
NUROFEN
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets: 12s, 24s, 48s, 96s. Caplets: 12s, 24s.
Active Ingredients: Ibuprofen 200mg.
Approved Indications: Headache, tension headache, migraine headache, cold and flu symptoms, back pain, fever, period
pain, sinus pain, dental pain, arthritic pain and muscular pain.
Contraindications: Hypersensitivity to any ingredient. Existing peptic ulceration, history of asthma or bronchospasm,
urticaria or rhinitis associated with aspirin or other NSAIDs. Renal impairment or heart failure. Pregnancy except
on doctor’s advice. Last 3 months of pregnancy.
Precautions: Asthma, history of peptic ulceration, regular treatment with other medications.
Adverse Effects: Nausea, dyspepsia, rash, dizziness. GI bleeding (rare at OTC dose). Hepatic dysfunction and papillary necrosis may occur.
Directions: Adults and children from 12 years: 2 tablets, then 1-2 tablets every 4-6 hours as required, maximum 6 tablets in 24 hours.
Children 7-12 years: 1 tablet every 6-8 hours as required, maximum 4 tablets in 24 hours. Does not need to be taken with food.
Price Band: Under $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale (packs up to 25), Pharmacy Only Medicine (packs more than 25)
NUROFEN PLUS
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets, 12s, 30s
Active Ingredients: Ibuprofen 200mg, codeine phosphate 12.8mg.
Approved Indications: Tension headache, migraine headache, period pain, dental pain, neuralgia, back pain, rheumatic pain, muscular
pain, arthritic pain, headache.
Contraindications: Hypersensitivity to any ingredient. Existing peptic ulceration. History of bronchospasm, asthma, rhinitis or urticaria
associated with aspirin or other NSAIDs. Pregnancy except on a doctor’s advice. Last 3 months of pregnancy. Renal impairment,
heart failure, chronic constipation, breathing difficulties. Breastfeeding, except on doctor’s advice. For more than 3 days, except
on doctor’s advice.
Precautions: Asthma, history of peptic ulceration, regular treatment with other medications, constipation, head injuries.
Adverse Effects: Nausea, dyspepsia, rash, dizziness, GI bleed (rare at OTC dose), constipation, drowsiness (rare), respiratory depression,
cough suppression. Hepatic dysfunction and papillary necrosis may occur.
Directions: Adults and children from 12 years: 2 tablets, then 1-2 tablets every 4-6 hours as required, maximum 6 tablets in 24 hours. Does
not need to be taken with food.
Price Band: $10 - $20 and over (Price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: Pharmacist Only
Page 241

NUROFEN ZAVANCE
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets, 12s, 24s, 48s, 72s. Caplets, 12s, 24s.
Active Ingredients: Sodium ibuprofen dihydrate 256mg (equivalent to ibuprofen 200mg).
Approved Indications: Headache, tension headache, migraine headache, cold and flu symptoms, back pain, fever, period
pain, sinus pain, dental pain, arthritic pain and muscular pain.
Contraindications: Hypersensitivity to any ingredient. Existing peptic ulceration. History of asthma or bronchospasm,
urticaria or rhinitis associated with aspirin or other NSAIDs. Renal impairment or heart failure. Pregnancy except
on doctor’s advice. Last 3 months of pregnancy.
Precautions: Asthma, history of peptic ulceration. If on a low-sodium diet. Regular treatment with other medications.
Adverse Effects: Nausea, dyspepsia, rash, dizziness. GI bleeding (rare at OTC dose). Hepatic dysfunction and papillary necrosis may occur.
Directions: Adults and children from 12 years: 2 tablets, then 1-2 tablets every 4-6 hours as required. Maximum 6 tablets in 24 hours.
Children 7-12 years: 1 tablet every 6-8 hours as required, maximum 4 tablets in 24 hours. Does not need to be taken with food.
Price Band: Under $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale (packs up to 25), Pharmacy Only Medicine (packs more than 25)
NUROMOL
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets 12s, 24s, 48s, 72s.
Active Ingredients: Ibuprofen 200mg and Paracetamol 500mg.
Approved Indications: Back pain, period pain, cold & flu symptoms, muscular pain, sore throat, rheumatic pain and nonserious
arthritic pain, dental pain, migraine headache, tension headache, headache, reduces fever.
Contraindications: Hypersensitivity to any ingredient. Existing peptic ulceration, history of asthma or bronchospasm,
urticaria or rhinitis associated with aspirin or other NSAIDS. Renal impairment or heart failure. Pregnancy except
on doctors advice. Last 3 months of pregnancy.
Precautions: Asthma, history of peptic ulceration, regular treatment with other medications.
Adverse Effects: Nausea, dyspepsia, rash dizziness. GI bleeding (rare at OTC dose). Hepatic dysfunction and papillary necrosis may occur.
Directions: Take with water. Adults and children from 12 years: 1 or 2 tablets every 6 to 8 hours as necessary (maximum 6 tablets in 24
hours). Keep to the recommended dose. Do not take for more than 3 days at a time, except with your doctor’s advice. Do not give
Nuromol tablets to children under 12 years. Nurofen for Children products are available.
Price Band: Under $10 - $20 and over. (Price varies with pack size)
Subsidy Conditions: Not subsidised Medicine Classification: General Sale : Pack up to 20. Pharmacy Only: Packs more than 20
PANADOL OPTIZORB
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tablets 12s, 20s, 50s, 100s. Caplets 12s, 20s, 48s.
Active Ingredients: 500mg paracetamol per tablet/caplet.
Approved Indications: For the temporary relief of pain and fever.
Contraindications: Patients with a previous history of hypersensitivity to paracetamol or to any of the excipients; in
children under 7 years.
Precautions: Allergy to paracetamol. Liver or kidney disease.
Adverse Effects: Very rare, Thrombocytopenia; anaphylaxis, cutaneous hypersensitivity reactions including skin rashes,
angioedema and Stevens Johnson syndrome; bronchospasm, especially in patients sensitive to aspirin and other
NSAIDs; hepatic dysfunction.
Directions: Adults and children 12 years: 1 – 2 tablets/caplets every 4-6 hours (maximum 8 tablets/caplets in 24 hrs).
Price Band: $5.00-$25.00
Medicine Classification: General Sale
PANADOL RAPID
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Caplet 10s, 20s, 40s. Tablet 20s.
Active Ingredients: 500mg paracetamol per tablet/caplet.
Approved Indications: Headache, migraine headache, cold & flu symptoms, muscular aches, toothache, period pain.
Contraindications: Patients with a previous history of hypersensitivity to paracetamol or to any of the excipients; in
children under 12 years. Those on a low sodium diet
Precautions: Allergy to paracetamol. Liver or kidney disease.
Adverse Effects: (very rare) Thrombocytopenia; anaphylaxis, cutaneous hypersensitivity reactions including skin rashes,
angioedema and Stevens Johnson syndrome; bronchospasm, especially in patients sensitive to aspirin and other
NSAIDs; hepatic dysfunction.
Directions: Adults and children 12 years: 2 caplets every 4-6 hours (maximum 8 tablets/caplets in 24 hrs).
Price Band: $10.00 - $20.00
Medicine Classification: Pharmacy Only Medicine General Sale for packs up to 20, Pharmacy Only for packs over 20
Page 242 HEALTHCARE HANDBOOK 2017-2018 OTC Products

PARACARE
PSM HEALTHCARE LTD. T/A API CONSUMER BRANDS
Presentation: Coated tablets, blister packs of 20, 50 or 100 tablets.
Active Ingredients: Paracetamol 500mg/tablet.
Approved Indications: Relief of pain and discomfort from headaches, cold and flu symptoms, menstrual pain, dental pain,
rheumatic pain and muscular pain.
Contraindications: Hypersensitivity to any ingredient. Not suitable for children under 6 years of age.
Precautions: Patients with impaired liver or kidney function, or with alcohol dependence. Prolonged or excessive use may
be harmful. Do not use for longer than 48 hours except on doctor’s advice. Watch total paracetamol dose if taking
other products containing paracetamol.
Adverse Effects: Side effects of paracetamol are rare and usually mild. Haematological and hypersensitivity reactions have
been reported. Overdose may cause severe liver damage and, less often, renal tubular necrosis.
Directions: Adults: 1-2 tablets with water. Children 6-12 years: 1/2-1 tablet with water. If necessary dosage may be repeated every 4 to 6
hours, up to a maximum of 4 doses in 24 hours.
Price Band: Under $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised Medicine Classification: General Sale 20s. Pharmacy Only Medicine: 50s & 100s
VOLTAREN RAPID 12.5
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tablets available in packs of 10, 20 or 30 or Liquid Capsules available in a pack of 20.
Active Ingredients: Diclofenac potassium 12.5mg.
Approved Indications: Temporary relief of painful conditions such as headache, dental pain, period pain, rheumatic and muscular
pain, backache, symptoms of colds and flu (including aches and pains, sore throat) and reduction of fever.
Contraindications: Active gastric or intestinal ulcer, bleeding or perforation. Severe hepatic, renal or cardiac failure. Known
hypersensitivity to any ingredient. Patients in whom attacks of asthma, urticaria, or acute rhinitis are precipitated by aspirin
or other NSAIDs. Last trimester of pregnancy.
Precautions: See leaflet or datasheet.
Adverse Effects: Headache, dizziness, vertigo, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence, anorexia,
transaminases increases and skin reaction. Refer to leaflet or datasheet for full list.
Directions: Adults and children 14 years and over; take 2 tablets initially with liquid. Then, if necessary, take 1-2 tablets every 4 to 6 hours.
Maximum 6 tablets per day. See leaflet for full information.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
VOLTAREN RAPID 25
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tablets available in packs of 20 or 30.
Active Ingredients: Diclofenac potassium 25mg.
Approved Indications: Short-term treatment for acute painful and inflammatory conditions such as: sprains, strains and
tendinitis, post-operative pain, dental pain, backache, period pain, headache and migraine, and as an adjuvant in
severe painful inflammatory infections of the ear, nose, or throat.
Contraindications: Active gastric or intestinal ulcer, bleeding or perforation. Severe hepatic, renal or cardiac failure. Known
hypersensitivity to any ingredient. Patients in whom attacks of asthma, urticaria, or acute rhinitis are precipitated
by aspirin or other NSAIDs. Last trimester of pregnancy.
Precautions: See leaflet or datasheet.
Adverse Effects: Headache, dizziness, vertigo, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence, anorexia,
transaminases increases and skin reaction. Refer to leaflet or datasheet for full list.
Directions: Adults; take 2 tablets initially with liquid. Then, if necessary, take 1-2 tablets every 8 hours. Maximum of 6 tablets per day.
Children 14 years and over; take 1 tablet, 3 times daily. Maximum 3 tablets per day. See leaflet for full information.
Price Band: $15 - $25 (price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: Pharmacist Only
»»
Head Lice
LICE CLEAR
AFT PHARMACEUTICALS LTD
Presentation: Lotion, 30mL.
Active Ingredients: Permethrin 1% w/w.
Indications: For the treatment of head lice and their eggs (nits) in adults and children aged 2 years of age and older.
Contraindications: Hypersensitivity to any other ingredient.
Precautions: For external use only. Avoid contact with eyes. Seek medical advice before using on children between 2 months and 2 years
of age. Not recommended for pregnant or breast-feeding women.
Adverse Effects: Skin irritation. If irritation occurs discontinue use. If symptoms persist consult your healthcare professional.
Directions: Shake gently before use. Wash and towel dry the hair - do not use any hair conditioner. Apply enough to saturate the hair and
scalp. Leave on for 10 minutes then rinse off with water. Repeat treatment after 7 days.
Price Band: $10.00 - $20.00
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 243

MOOV HEAD LICE SOLUTION
DOUGLAS PHARMACEUTICALS LTD
Presentation: Moov Solution 200ml. (Also in Moov range: Combing Conditioner 200ml, Defense Spray 120ml, Sensitive 200ml). *
Active Ingredients: Moov Solution: eucalyptus oil 11% w/w. Lemon Tea Tree Oil 1% w/w.
Approved Indications: Solution: Clinically proven to kill head lice and eggs. Contains no synthetic pesticides.
Contraindications: Hypersensitivity to any ingredient.
Precautions: For external use only. Avoid eyes.
Adverse Effects: If irritation occurs, discontinue use.
Directions: Apply product to dry hair, behind ears and back of neck first. Apply to rest of hair and use sufficient product to thoroughly wet
hair. Leave for 10 minutes then rinse thoroughly.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine General Sale
NEUTRALICE ADVANCE LOTION
WILSON CONSUMER PRODUCTS LTD
Presentation: Advance Lotion 200ml and 475ml.
Active Ingredients: Water, benzyl alcohol, mineral oil, polysorbate 80, sorbitan monooleate, carbopol 934 and triethanolamine.
Indications: Kills head lice and eggs.
Contraindications: Hypersensitivity of any ingredients.
Precautions: Not recommended for use on infants under 6 months. Keep out of ears and eyes. For external use only.
Adverse Effects: If irritation occurs discontinue use. If symptoms persist consult your health care professional.
Directions: Apply a generous amount to dry hair until all hair is wet with the lotion. Rub vigorously into the scalp and hair and leave on
for 10 minutes. Use a comb to remove all dead lice and eggs and rinse with water. Repeat application 7 and 14 days after initial
application.
Price Band: $15 - $35 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
NEUTRALICE CONDITIONER SHAMPOO LICE EGG REMOVER
WILSON CONSUMER PRODUCTS LTD
Presentation: Hair cleanser 200ml.
Active Ingredients: Acetic acid.
Indications: Removes dead lice and eggs from the hair.
Contraindications: Hypersensitivity to any ingredients.
Precautions: Keep out of eyes and ears. If you have sensitive skin do a patch test on inside elbow before use. For external use only.
Use only as directed.
Adverse Effects: If scalp irritation occurs discontinue use.
Directions: Massage into wet hair and rinse. Massage into hair again and comb through. Leave for a further 2 minutes and then rinse.
Comb damp hair for at least 5 minutes with a comb. Continue to use daily until no more lice are present.
Price Band: $15 - $25
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
NEUTRALICE NATURAL SPRAY
WILSON CONSUMER PRODUCTS LTD
Presentation: Natural Spray 200ml.
Active Ingredients: Melaleuca Oil 10% w/w, lavender oil 1% w/w.
Indications: Helps with the removal of head lice and their eggs.
Contraindications: Hypersensitivity of any ingredients.
Precautions: Not recommended for use on infants under 4 years. Keep out of ears and eyes. For external use only. Not to be swallowed or
inhaled.
Adverse Effects: If irritation occurs discontinue use. If symptoms persist consult your health care professional.
Directions: Spray a generous amount onto dry hair, ensuring hair is completely wet with solution. Rub vigorously and then leave on for 10
minutes. Use a lice comb to remove dead lice and eggs and rinse hair with water. Repeat application 7 and 14 days after initial
application.
Price Band: $15 - $25
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 244 HEALTHCARE HANDBOOK 2017-2018 OTC Products

»»
Heart Health - Blood Clot Prevention
ASPEC 75MG
PSM HEALTHCARE LTD. T/A API CONSUMER BRANDS
Presentation: Enteric coated tablets in blister packs of 90 tablets.
Active Ingredients: Aspirin 75mg/tablet.
Approved Indications: For inhibition of platelet aggregation. Reduces the risk of heart attack and stroke by inhibiting blood clotting.
Contraindications: Patients with severe renal or hepatic impairment, blood disorders, stomach ulcers, allergies to aspirin or other antiinflammatory
medicines. Do not use during the last 3 months of pregnancy or if breast-feeding.
Precautions: Except on a doctor’s advice, do not use in children under 12 years of age; in teenagers with chickenpox, influenza or fever;
if you have asthma; during the first 6 months of pregnancy. Prolonged or excessive use can be harmful. Do not use for more than
a few days at a time except on a doctor’s advice. Should be discontinued several days before a scheduled surgical procedure.
Adverse Effects: Gastro-intestinal disturbances such as nausea, dyspepsia and vomiting; irritation of the gastric mucosa; minor
gastro-intestinal bleeding; increases bleeding time; hypersensitivity reactions; dizziness, tinnitus, headache, increased sweating.
Directions: Adults: 1 tablet daily. Swallow whole, do not crush or chew.
Price Band: $10.00 - $20.00
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
CARTIA
ASPEN PHARMACARE
Presentation: Enteric coated tablet, 28s, 84s.
Active Ingredients: Aspirin 100mg.
Approved Indications: Inhibition of platelet aggregation. Inhibits blood clotting and reduces risk of heart attack and stroke.
Contraindications: Hypersensitivity to an ingredient, severe hepatic disease or renal damage, bleeding disorders, gastric ulceration.
Patients in whom attacks of asthma, urticaria or acute rhinitis are precipitated by aspirin or other NSAIDs. Concomitant
anticoagulant therapy.
Precautions: Withdraw 1 week before surgery, concomitant gastric irritants (eg NSAIDs), dehydration, asthma, pregnancy or lactation.
Not recommended for children except under medical advice.
Adverse Effects: Minor gastrointestinal bleeding, nausea, vomiting, increased bleeding times, tinnitus, vertigo, hypersensitivity including
bronchospasm.
Directions: Adults: 1 tablet daily. Swallow whole, do not crush or chew.
Price Band: Under $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Indigestion, Heartburn & Gastritis
GAVISCON DOUBLE STRENGTH
RECKITT BENCKISER (NZ) LTD
Presentation: Liquid, 500ml.
Active Ingredients: Sodium alginate 1000mg, potassium bicarbonate 200mg, calcium carbonate 200mg per 10ml.
Approved Indications: Gastro-oesophageal reflux, heartburn of pregnancy, flatulence and dyspepsia associated with gastric reflux, hiatus
hernia, reflux oesophagitis, regurgitation.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Not recommended for infants and young children. Sodium-restricted diet, renal impairment, hypophosphataemia.
Adverse Effects: Rarely, hypernatraemia, if sodium-restricted.
Directions: Adults and children over 12 years: 5-10ml, 4 times daily, after meals and 30 minutes before bedtime.
Price Band: $10.00- $20.00
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
GAVISCON DOUBLE STRENGTH TABLETS
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets, peppermint, 60s.
Active Ingredients: Sodium alginate 500mg, sodium bicarbonate 267mg, calcium carbonate 160mg.
Approved Indications: Gastro-oesophageal reflux, heartburn of pregnancy, flatulence and dyspepsia associated with gastric reflux, hiatus
hernia, reflux oesophagitis, regurgitation.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Not recommended for infants and young children. Sodium-restricted diet, renal impairment, hypophosphataemia.
Adverse Effects: Rarely, hypernatraemia, if sodium-restricted.
Directions: Adults and children over 12 years: chew 1-2 tablets 4 times a day. Chew tablets after meals and 30 minutes before bedtime.
Price Band: Under $10 - $20 (Price varies with pack size). Available on Pharmaceutical Schedule
Subsidy Conditions: Partially subsidised
Medicine Classification: General Sale
Page 245

GAVISCON DUAL ACTION LIQUID
RECKITT BENCKISER (NZ) LTD
Presentation: Liquid, peppermint flavour, 300ml, 600ml.
Active Ingredients: Each 10mL contains 500mg sodium alginate, 213mg sodium bicarbonate and 325mg calcium carbonate.
Approved Indications: Gastro-oesophageal reflux, heartburn in pregnancy, flatulence and dyspepsia associated with gastric reflux,
hiatus hernia, reflux oesophagitis, regurgitation.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Not recommended for infants and young children. Sodium-restricted diet, renal impairment, hypophosphataemia.
Adverse Effects: Rarely hypernatraemia, if sodium-restricted.
Directions: Adults and children over 12 years: 20mL, 4 times a day. Children 6-12 years: 10mL, 4 times a day. Take after meals and
30 minutes before bedtime.
Price Band: $10 - $30 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
GAVISCON DUAL ACTION TABLETS
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets (peppermint), 16s, 32s, 48s.
Active Ingredients: Each tablet contains 250mg sodium alginate, 106.5mg sodium bicarbonate and 187.5mg calcium
carbonate.
Approved Indications: Gastro-oesophageal reflux, heartburn in pregnancy, flatulence and dyspepsia associated with
gastric reflux, hiatus hernia, reflux oesophagitis, regurgitation.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Not recommended for infants and young children. Sodium-restricted diet. Renal impairment.
Hypophosphataemia.
Adverse Effects: Rarely - hypernatraemia, if sodium-restricted.
Directions: Adults and children over 12 years: 4 tablets, 4 times a day. Children 6-12 years: 2 tablets, 4 times a day. Take
after meals and 30 minutes before bedtime.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
GAVISCON INFANT
RECKITT BENCKISER (NZ) LTD
Presentation: Sachets, 30s.
Active Ingredients: Sodium alginate 225mg, magnesium alginate 87.5mg per sachet. Also contains mannitol E421.
Approved Indications: Regurgitation and gastric reflux in infants and young children.
Contraindications: Intestinal obstruction, diarrhoea or gastroenteritis. Premature infants or potential dehydration. Known/suspected
impaired renal function impairment.
Precautions: Review patient’s condition 7 days after initiating treatment, or before if symptoms worsen. Special caution in gastric stasis.
Acts by thickening gastric contents. Do not use with other feed thickeners or thickened infant milk formulas. Care if infant is on
low sodium-diet - each sachet contains 21mg sodium. Fever and vomiting.
Adverse Effects: Rarely, intragastric mass formation, usually associated with incorrect administration, excessive dose or gastric stasis.
Directions: Not for infants under 1 year except under medical supervision. Prepare immediately before use. No more than 6 doses in 24
hours. Do not exceed correct dose. Infants under 4.5kg: 1 sachet; over 4.5kg, 2 sachets. Breast-fed: Mix with 15ml of cooled,
boiled water and give after feed. Bottle-fed: Mix 1 sachet in not less than 115ml of feed; 2 sachets with not less than 225ml of
feed. Young children: 2 sachets as for breast-fed infants.
Price Band: Under $10. Available on Pharmaceutical Schedule Subsidy Conditions: Fully subsidised Medicine Classification: General Sale
GAVISCON LIQUID
RECKITT BENCKISER (NZ) LTD
Presentation: Liquid, peppermint or aniseed flavours, 600ml.
Active Ingredients: Sodium alginate 500mg, calcium carbonate 160mg, sodium bicarbonate 267mg in 10ml.
Approved Indications: Gastro-oesophageal reflux, heartburn of pregnancy, flatulence and dyspepsia associated with gastric reflux,
hiatus hernia, reflux oesophagitis, regurgitation.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Not recommended for infants and young children. Sodium-restricted diet, renal impairment, hypophosphataemia.
Adverse Effects: Rarely, hypernatraemia, if sodium-restricted.
Directions: Adults and children over 12 years: 10-20ml, 4 times a day; children 6-12 years: 5-10ml, 4 times a day. Take after meals and
30 minutes before bedtime.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 246 HEALTHCARE HANDBOOK 2017-2018 OTC Products

GAVISCON TABLETS
RECKITT BENCKISER (NZ) LTD
Presentation: Tablets, strawberry and peppermint, 24s.
Active Ingredients: Sodium alginate 250mg, sodium bicarbonate 133.5mg, calcium carbonate 80mg.
Approved Indications: Gastro-oesophageal reflux, heartburn of pregnancy, flatulence and dyspepsia associated with
gastric reflux, hiatus hernia, reflux oesophagitis, regurgitation.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Not recommended for infants and young children. Sodium-restricted diet, renal impairment,
hypophosphataemia.
Adverse Effects: Rarely, hypernatraemia, if sodium-restricted.
Directions: Adults and children over 12 years: 2-4 tablets, 4 times a day. Children 6-12 years: 1-2 tablets, 4 times a day.
Take after meals and 30 minutes before bed.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
ZANTAC
ASPEN PHARMACARE
Presentation: Tablets.
Active Ingredients: Ranitidine hydrochloride 150mg. Extra Strength 300mg.
Approved Indications: Relief of heartburn and acid indigestion (for 12 hours at 150mg dose; for 24 hours at 300mg dose). Zantac works
by controlling the production of stomach acid.
Contraindications: Allergy to ranitidine, pregnancy or breastfeeding, children under 12 years.
Precautions: Allergy to any food or medicine; kidney or liver problems; any other medical condition; on any other medication (see product
information sheet for further information).
Adverse Effects: Rare, but include headache, joint or muscle pains, dizziness, drowsiness or sleepiness, depression or agitation, inability to
sleep, constipation, diarrhoea, nausea, stomach cramps or pain (see product information sheet for more detailed information).
Directions: 150mg: 1 tablet when symptoms appear; no more than 2 tablets in 24 hours. 300mg: 1 tablet when symptoms appear; no
more than 1 tablet in 24 hours.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Influenza
CODRAL ALL IN ONE
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Capsules, 24s
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg. Night:
Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy, do not drive or operate machinery. Avoid alcohol. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red and white night capsules at
bedtime. Allow 4-6 hours as necessary between doses. Maximum 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
CODRAL COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches, fever, body aches and pains, blocked and runny
nose, and sore throat.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems or are
pregnant or breastfeeding, are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected do not drive a
vehicle or operate machinery. Keep to the recommended dose.
Directions: For adults and children 12 years and over: take 2 day tablets every 4-6 hours as necessary. Maximum 8 tablets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 247

CODRAL COLD & FLU + COUGH
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Day: Paracetamol 500mg, phenylephrine hydrochloride 5mg, dextromethorphan hydrobromide 10mg. Night:
Paracetamol 500mg, chlorpheniramine maleate 2mg, dextromethorphan hydrobromide 10mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, dry irritating coughs, and sore throat.
Contraindications: Do not use for children under 12 years; with other products containing either paracetamol or antihistamines.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine maleate (night tablet) may make you drowsy.
If drowsy do not drive or operate machinery. Keep to the recommended dose.
Directions: Adults and children over 12 years: 2 green day capsules morning, midday and afternoon, and 2 red night capsules at bedtime.
Allow 4-6 hours as necessary between doses. Maximum: 6 day and 2 night capsules in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
CODRAL DAY & NIGHT
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s and 48s.
Active Ingredients: Day; Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg. Night; paracetamol 500mg,
phenylephrine hydrochloride 5mg, chlorpheniramine maleate 2mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches and fever, body aches and pains, blocked and
runny nose and sore throat.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products.
Precautions: Ask a doctor before use if you have high blood pressure, heart problems, are pregnant or breastfeeding, are taking antidepressants,
are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected, do not drive or
operate machinery. Keep to the recommended dose.
Directions: For adults and children 12 years and over: take 2 white day tablets morning, midday and afternoon, and 2 orange night tablets
at bedtime. Allow 4 - 6 hours as necessary between doses. Maximum: 6 day tablets and 2 night tablets in 24 hours.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
CODRAL MULTI ACTION COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s.
Active Ingredients: Paracetamol 500mg, codeine phosphate 9.5mg, phenylephrine hydrochloride 5mg, chlorpheniramine maleate 2mg.
Approved Indications: For temporary relief of cold and flu symptoms, including headache, body aches and pains, sneezing, watery eyes,
blocked and runny nose, fever.
Contraindications: Do not use for children under 12 years; with other paracetamol-containing products; if you have taken antihistamines.
Precautions: Ask a doctor before use if you have high blood pressure, heart problems, are pregnant or breastfeeding, are taking
antidepressants, are taking any other medicines to treat cough and cold. Codeine can be addictive. Avoid alcohol.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. This medicine may cause drowsiness. If affected do not drive a
vehicle or operate machinery. Keep to the recommended dose.
Directions: Take 2 tablets once every 4 to 6 hours as necessary. Maximum of 8 tablets in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
CODRAL NIGHTIME COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s.
Active Ingredients: Paracetamol 500mg, phenylephrine hydrochloride 5mg, chlorpheniramine maleate 2mg.
Approved Indications: Temporary relief of cold and flu symptoms, including headaches and fever, blocked or runny nose, body aches and
pains, and sneezing and watery eyes.
Contraindications: Do not use for children under 12 years. If you have taken other paracetamol containing products; or if you have taken
antihistamines.
Precautions: Ask a doctor before use if you have high blood pressure, heart problems, are pregnant or breastfeeding, are taking
antidepressants, are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Chlorpheniramine may cause drowsiness. If drowsy, do not drive
a vehicle or operate machinery. Keep to recommended dose.
Directions: Take 2 tablets every 4-6 hours at nighttime as necessary. Maximum of 8 tablets in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 248 HEALTHCARE HANDBOOK 2017-2018 OTC Products

CODRAL RELIEF MAX STRENGTH 6 SIGNS COLD & FLU
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Sachets, 10s
Active Ingredients: Paracetamol 1000mg, phenylephrine hydrochloride 12.2mg, guaiphenesin 200mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, sore throat, or chesty cough.
Contraindications: Do not use for children under 12 years; with other products containing paracetamol.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Keep to the recommended dose.
Directions: Adults and children over 12 years: Pour the contents of one sachet into a mug. Fill with hot (not boiling) water. Stir until
dissolved and drink. Allow 4-6 hours as necessary between doses. Maximum: 4 sachets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
CODRAL RELIEF MAX STRENGTH COLD & FLU + DECONGESTANT
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Sachets, 10s.
Active Ingredients: Paracetamol 1000mg, phenylephrine hydrochloride 12.2mg.
Approved Indications: Temporary relief of cold and flu symptoms including headaches, body aches and pains, blocked and runny nose,
fever, or sore throat.
Contraindications: Do not use for children under 12 years; with other products containing paracetamol.
Precautions: Ask your doctor before using if you have high blood pressure, are taking antidepressants, have heart problems, are pregnant,
are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness in some people. Keep to the recommended dose.
Directions: Adults and children over 12 years: Pour the contents of one sachet into a mug. Fill with hot (not boiling) water. Stir until
dissolved and drink. Allow 4-6 hours as necessary between doses. Maximum of 4 sachets in 24 hours.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
LEMSIP MAX COLD & FLU DAY & NIGHT CAPSULES
RECKITT BENCKISER (NZ) LTD
Presentation: Capsules, 16s.
Active Ingredients: Each day capsule contains paracetamol 500mg, phenylephrine HCl 6.1mg, caffeine 25mg. Each night
capsule contains paracetamol 500mg, phenylephrine HCl 6.1mg.
Indications: Relief of daytime fatigue, blocked nose, fever, pain, headache, sore throat and body aches associated with
colds and flu.
Contraindications: Hypersensitivity to any ingredient, severe heart disease, uncontrolled hypertension, hyperthyroidism.
MAOI use or use within 2 weeks of stopping MAOIs.
Precautions: Hepatic or renal impairment, heart disease, diabetes, Raynaud’s syndrome, pregnancy. Do not take with other
sympathomimetics, vasodilators or beta blockers. Do not take with other paracetamol-containing products.
Adverse Effects: Dry mouth, headache, allergic reactions. Very rarely, palpitations or raised blood pressure.
Directions: Adults and children over 12 years: 2 day capsules up to 3 times a day (every 4-6 hours), 2 night capsules at night.
Do not exceed 8 capsules in 24 hours. Do not give to children under 12.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised Medicine Classification: General Sale
»»
Iron Deficiency - Supplements
SPATONE 100% NATURAL LIQUID IRON SUPPLEMENT
MARTIN & PLEASANCE DISTRIBUTED BY BRANDFOLIO
Presentation: Oral liquid sachets: 14s, 28s.
Active Ingredients: Each sachet contains 25mL Trefriw Wells mineral water equivalent to 5mg elemental iron as ferrous iron (Fe2+).
Approved Indications: A natural source of iron to aid in maintaining healthy iron levels.
Contraindications: People with haemochromatosis should not take iron supplements including Spatone.
Precautions: Do not exceed 4 sachets daily. Not to be used in children under 2 years of age without medical advice. Some foods and medications may
affect iron absorption so it is best to take Spatone on an empty stomach (at least 30 minutes before meals) for optimal absorption.
Adverse Effects: In clinical trials, the side effect profile of Spatone was comparable to placebo, thus gastrointestinal side effects like constipation, nausea
and bloating are unlikely. Liquid iron supplements may contribute to staining of teeth, however reports of this are rare with Spatone. May react
with substances like tannins (found in tea, coffee and chocolate) causing plaque discolouration. Regular brushing and professional dental care
may help. Drinking Spatone through a straw may minimize plaque contact.
Directions: Adults: Take the contents of 1-2 sachets daily. Pregnant woman: Take the contents of 2 sachets daily. Children 2-12 years: Take the contents of
1 sachet daily.
Price Band: $24.00-$38.00
Medicine Classification: General Sale Supplement
Page 249

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Irritable Bowel Syndrome
GASTRO-SOOTHE
AFT PHARMACEUTICALS LTD
Presentation: Tablet, 20s.
Active Ingredients: Hyoscine butylbromide 10mg.
Approved Indications: Muscle spasm of the gastrointestinal tract.
Contraindications: Myasthenia gravis, megacolon and in patients who have demonstrated prior sensitivity to the product.
Precautions: Not recommended for children less than 6 years. Should be administered with caution in patients susceptible
to narrow angle glaucoma, intestinal or urinary outlet obstruction, and those inclined to tachycardia.
Adverse Effects: Anticholinergic effects (eg, dry mouth, visual disturbances, urinary retention). Rarely, dyspnoea, dizziness,
hypotension, flushing.
Directions: Adults and children over 6 years: 20mg 4 times a day. Tablets should be swallowed whole with fluid.
Price Band: $10 - $20
Subsidy Conditions: Fully subsidised
Medicine Classification: Pharmacist Only
MINTEC
WILSON CONSUMER PRODUCTS LTD
Presentation: Tablets, 20s, 60s.
Active Ingredients: Peppermint oil.
Indications: Natural relief of symptoms of irritable bowel syndrome, abdominal pain, bloating, discomfort, cramping, wind.
Contraindications: Mintec may cause heartburn. Very rarely, patients may be allergic to Mintec.
Precautions: If symptoms do not improve, contact your doctor. If you suffer from heartburn, Mintec may make this
symptom worse. Mintec is not recommended for children or for use during pregnancy, unless on the advice of a
doctor.
Adverse Effects: None known.
Directions: Take 1 capsule 3 times daily. Take Mintec 30 minutes before meals with a little water.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Menopause - Symptomatic Relief
HARMONY MENOPAUSE
MARTIN & PLEASANCE DISTRIBUTED BY BRANDFOLIO
Presentation: Tablets 60, 120s.
Active Ingredients: Rehmannia glutinosa root 1.2g, Vitex agnus-castus fruit 100mg, Angelica polymorpha root 200mg, Dioscorea
opposita root 200mg, Paeonia lactiflora root 200mg, Bupleurum falcatum root 200mg, calcium amino acid chelate 50mg,
magnesium amino acid chelate 50mg, cholecalciferol 2.5mcg, calcium hydrogen phosphate 350mg.
Approved Indications: For relief of symptoms related to menopause such as hot flushes, night sweats, fatigue, irritability, sleeplessness
and muscle aches.
Contraindications: Not recommended during pregnancy or breastfeeding. Also, not recommended if taking contraceptives or Hormone
Replacement Therapy.
Precautions: Caution is advised when taking blood thinning medication due to the blood-thinning properties from Paeonia lactiflora root.
Adverse Effects: None known
Directions: 1-2 tablets per day
Price Band: $35.00-60.00
Medicine Classification: General Sale Supplement
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Migraine
MERSYNDOL
SANOFI CONSUMER HEALTHCARE
Presentation: Tablet, 20s.
Active Ingredients: Paracetamol 450mg, doxylamine succinate 5mg, codeine phosphate 9.75mg.
Indications: Moderate to severe pain including headache, toothache, backache, period pain or pain associated with trauma or surgery.
Calmative effects may be useful in tension headache and migraine treatment.
Contraindications: Hypersensitivity to any ingredient, pre-existing respiratory depression, asthma.
Precautions: Hepatic or renal impairment, pregnancy, lactation. Avoid alcohol and prolonged use. Watch total paracetamol dose if taking
other products. Codeine can cause addiction. Do not use for more than 3 days at a time.
Adverse Effects: Constipation, respiratory depression, drowsiness, dry mouth, anorexia, dizziness, rash, gastrointestinal upset. Do not
drive a vehicle or operate machinery within 8 hours of last dose.
Directions: Adults and children over 12 years: 1-2 tablets every 4-6 hours as required, maximum 8 tablets in 24 hours. Not recommended
in children under 12 years.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacist Only
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Muscular Aches & Pains
MAXIGESIC
AFT PHARMACEUTICALS LTD
Presentation: Tablets: 10s, 16s, 32s, 50s, 100s.
Active Ingredients: Paracetamol 500mg & ibuprofen 150mg.
Approved Indications: For relief of pain and reduction of fever and inflammation. For use in headache, toothache, arthritis, rheumatic
pain, migraine headache, dental procedures, tennis elbow, aches and pains associated with cold and flu, tension headache,
backache, period pain, sinus pain, sore throat, and muscular pain.
Contraindications: Hypersensitivity to any ingredient. Existing peptic ulceration or other stomach disorders, asthma, impaired kidney
function or heart failure. Urticaria or rhinitis associated with aspirin or other NSAIDS, pregnancy except on Doctors advice.
Do not use in the last 3 months of pregnancy.
Precautions: Do not combine with any other paracetamol or ibuprofen containing medications. Do not exceed the recommended dose.
Adverse Effects: Nausea, dyspepsia, rash, constipation, dizziness, GI bleeding (rare at OTC dose). Hepatic dysfunction and papillary
necrosis may occur.
Directions: Adults & children over 12 years: Take 1 or 2 tablets every 4 to 6 hours as required up to a maximum of 8 tablets in 24 hours.
Not recommended for children under 12 years old.
Price Band: $10 - $20 and over (Price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: General Sale (10s, 16s) Pharmacy Only (32s, 50s, 100s)
TIGER BALM OIL
WILSON CONSUMER PRODUCTS LTD
Presentation: Oil.
Active Ingredients: Menthol 10%, Camphor 9%, Cajuput Oil 7%, Mint Oil, 6%, Clove Bud Oil 5%.
Approved Indications: Provides temporary relief for aches and pains of muscles and joints, arthritis, rheumatism and backaches.
Contraindications: Hypersensitivity to any ingredients.
Precautions: External use only, avoid contact with eyes. Can be fatal to children if swallowed.
Adverse Effects: Possible skin irritation.
Directions: Apply to the affected area 3 or 4 times daily.
Price Band: $15 - $25
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
TIGER BALM RED STRENGTH OINTMENT
WILSON CONSUMER PRODUCTS LTD
Presentation: Ointment.
Active Ingredients: camphor 11%, menthol 10%, cajuput oil 7%, mint oil 6%, clove bud oil 5%, cassia oil 5%.
Approved Indications: For temporary relief of muscular aches and pains of muscles and joints, arthritis, rheumatism and backaches.
Contraindications: Hypersensitivity to any ingredients.
Precautions: Not to be taken orally, can be fatal to children if sucked or swallowed. Not to be used on infants under 2 years of age.
Avoid contact with eyes.
Adverse Effects: Possible skin irritation.
Directions: Apply to affected areas 3 to 4 times daily. Rub gently in circular motion.
Price Band: $10 - $15
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
TIGER BALM WHITE REGULAR STRENGTH OINTMENT
WILSON CONSUMER PRODUCTS LTD
Presentation: Ointment.
Active Ingredients: Mint oil 16%, cajuput Oil 13%, camphor 11%, menthol 8%, clove bud oil 1.5%.
Approved Indications: For temporary relief of muscular aches and pains of muscles and joints, arthritis, rheumatism and backaches.
Can also be used to relieve the nasal congestion of colds by inhalation.
Contraindications: Hypersensitivity to any ingredients.
Precautions: Not to be taken orally, can be fatal to children if sucked or swallowed. Not to be used on infants under 2 years of age.
Avoid contact with eyes.
Adverse Effects: Possible skin irritation.
Directions: Apply to affected areas 3 to 4 times daily. Rub in gently in a circular motion. For the relief of nasal congestion place Tiger Balm
on a tissue beside head or rub into throat and chest.
Price Band: $10 - $15
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 251

VOLTAREN EMULGEL
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tube 20g, 50g, 100g, 150g
Active Ingredients: Diclofenac diethylammonium 1.16% w/w.
Approved Indications: For short term (up to 2 weeks) local symptomatic treatment of the following musculoskeletal inflammatory
conditions; acute soft-tissue injuries, including sprains, strains, tendinitis and sports injuries and localised forms of soft tissue
rheumatism including tendinitis and bursitis.
Contraindications: Known hypersensitivity to any ingredient. Patients whom attacks of asthma, urticaria, or acute rhinitis are precipitated
by aspirin or other NSAIDs. Last trimester of pregnancy.
Precautions: Only apply to intact and healthy skin, avoid eyes and mucous membranes. Not to be taken by mouth. Should not be used with occlusive dressing. Pregnancy or breastfeeding.
Patients with a history of or active gastro-intestinal ulceration or bleeding, or severe renal impairment. The likelihood of systemic side effects occurring following topical diclofenac
is small compared with oral diclofenac. However, the possibility of systemic side effects cannot be excluded, particularly when applied to relatively large areas of skin or for
periods longer than 3 weeks. Do not give to children under 12 years of age.
Adverse Effects: Rash, eczema, erythema, dermatitis, pruritus. For less common adverse reactions see pack Insert.
Directions: Adults and children ≥ 12 years: Apply to affected area up to 4 times a day. Do not use for more than 2 weeks except on medical advice
Price Band: $10 - $35 (Price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: General Sale
VOLTAREN RAPID 12.5
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tablets available in packs of 10, 20 or 30 or Liquid Capsules available in a pack of 20.
Active Ingredients: Diclofenac potassium 12.5mg.
Approved Indications: Temporary relief of painful conditions such as headache, dental pain, period pain, rheumatic and
muscular pain, backache, symptoms of colds and flu (including aches and pains, sore throat) and reduction of fever.
Contraindications: Active gastric or intestinal ulcer, bleeding or perforation. Severe hepatic, renal or cardiac failure. Known
hypersensitivity to any ingredient. Patients in whom attacks of asthma, urticaria, or acute rhinitis are precipitated by
aspirin or other NSAIDs. Last trimester of pregnancy.
Precautions: See leaflet or datasheet.
Adverse Effects: Headache, dizziness, vertigo, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence, anorexia,
transaminases increases and skin reaction. Refer to leaflet or datasheet for full list.
Directions: Adults and children 14 years and over; take 2 tablets initially with liquid. Then, if necessary, take 1-2 tablets every 4 to 6 hours.
Maximum 6 tablets per day. See leaflet for full information.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised Medicine Classification: Pharmacy Only Medicine
VOLTAREN RAPID 25
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tablets available in packs of 20 or 30.
Active Ingredients: Diclofenac potassium 25mg.
Approved Indications: Short-term treatment for acute painful and inflammatory conditions such as: sprains, strains and
tendinitis, post-operative pain, dental pain, backache, period pain, headache and migraine, and as an adjuvant in
severe painful inflammatory infections of the ear, nose, or throat.
Contraindications: Active gastric or intestinal ulcer, bleeding or perforation. Severe hepatic, renal or cardiac failure. Known
hypersensitivity to any ingredient. Patients in whom attacks of asthma, urticaria, or acute rhinitis are precipitated by
aspirin or other NSAIDs. Last trimester of pregnancy.
Precautions: See leaflet or datasheet.
Adverse Effects: Headache, dizziness, vertigo, nausea, vomiting, diarrhoea, dyspepsia, abdominal pain, flatulence, anorexia,
transaminases increases and skin reaction. Refer to leaflet or datasheet for full list.
Directions: Adults; take 2 tablets initially with liquid. Then, if necessary, take 1-2 tablets every 8 hours. Maximum of 6 tablets per day.
Children 14 years and over; take 1 tablet, 3 times daily. Maximum 3 tablets per day. See leaflet for full information.
Price Band: $15 - $25 (price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: Pharmacist Only
»»
Nappy Rash
PINETARSOL
DOUGLAS PHARMACEUTICALS LTD
Presentation: Liquid: 100ml, 200ml, 500ml, 1 litre. Gel: 100g. Bar, 100g.
Active Ingredients: Pine tar.
Approved Indications: Soap alternative. Relief of red and itchy skin conditions.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Avoid contact with eyes, avoid exposure to sun, may stain clothing. External use only.
Adverse Effects: None known.
Directions: Add 15-30ml of liquid to a tepid bath.
Price Band: Under $10 - $20 (Price varies with pack size). Available on Pharmaceutical Schedule
Subsidy Conditions: 500ml, 1 litre liquid only
Medicine Classification: General Sale
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Oral Health - Gum Care, Ulcers, Thrush
BONJELA MOUTH ULCER GEL
RECKITT BENCKISER (NZ) LTD
Presentation: Gel, 15g.
Active Ingredients: Choline salicylate 8.7% w/w.
Approved Indications: Mouth ulcers and sores, cold sores, infant teething and denture irritation.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Hypersensitivity to local anaesthetics or salicylates. Not suitable for babies under 4 months.
Adverse Effects: Asthmatics with sensitivity to aspirin or salicylates may experience asthma.
Directions: Cover the fingertip with Bonjela and rub gently into the affected area, not more than 3-hourly.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
FRADOR
WILSON CONSUMER PRODUCTS LTD
Presentation: 3.5ml liquid.
Active Ingredients: Chlorbutol B.P. 1.0% w/w.
Indications: Gives prompt relief from the pain associated with mouth ulcers and gum sores and on-going protection from
saliva, bacteria and food whilst healing proceeds.
Contraindications: None known.
Precautions: For adult use only, avoid use in pregnancy.
Adverse Effects: None known.
Directions: Stand bottle in tray provided, and dry ulcer. Using the applicator, apply Frador directly to the mouth ulcer.
Keep mouth open for several seconds to allow Frador to dry.
Price Band: $10.00- $20.00
Medicine Classification: Pharmacy Only
MEDIJEL
WILSON CONSUMER PRODUCTS LTD
Presentation: Gel, 15g.
Active Ingredients: Lignocaine hydrochloride 0.66% w/w, aminacrine hydrochloride 0.05% w/w, ethanol 10% w/w.
Indications: Relief of pain from mouth ulcers, sore gums and denture rubbing.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Avoid excess and prolonged treatment for infant teething disorders.
Adverse Effects: None known.
Directions: Apply a small quantity to painful area. Repeat after 20 minutes, if necessary.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
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Osteoarthritis - Symptomatic Relief
PANADOL OSTEO
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Caplet 96s.
Active Ingredients: 665mg paracetamol per tablet/caplet.
Approved Indications: For the relief of persistent pain associated with Osteoarthritis.
Contraindications: Patients with a previous history of hypersensitivity to paracetamol or to any of the excipients; in
children under 12 years.
Precautions: Equally space dosage within a day. Do not take if allergic to paracetamol, seek medical advice with liver or
kidney disease.
Adverse Effects: (very rare) Thrombocytopenia; anaphylaxis, cutaneous hypersensitivity reactions including skin rashes,
angioedema and Stevens Johnson syndrome; bronchospasm, especially in patients sensitive to aspirin and other
NSAIDs; hepatic dysfunction.
Directions: Adults and children 12 years: 2 caplets every 6-8 hours (maximum 6 tablets/caplets in 24 hrs).
Price Band: $10.00 - $20.00
Medicine Classification: Pharmacy Only Medicine
Page 253

TURMERIC EXTRA STRENGTH
GOOD HEALTH NZ PRODUCTS (DISTRIBUTED BY BRANDFOLIO)
Presentation: Capsules; 30s, 60s.
Active Ingredients: Active Ingredients: (per vege capsule) CurcuWIN® Turmeric extract 200mg. Equivalent curcumin 40 mg
herbal extract equivalent to dry: boswellia serrata (boswellia) gum 500mg. Equivalent to acetyl keto – Boswellic
acid (AKBA) 15mg; Artemisia annua (Sweet Wormwood) herb 500mg.
Approved Indications: Natural extra-strength anti-inflammatory for extra support and comfort. For joint aches and pains and total
wellbeing.
Contraindications: Anti-coagulant medication unless blood is monitored. Bile duct obstruction or people on chemotherapy medications.
Pregnancy and breastfeeding.
Precautions: Take with food.
Adverse Effects: If dose is too strong for some people they may experience diarrhea.
Directions: Take 1 capsule daily with food.
Acute dose: Take up to 2 capsules daily with food.
Price Band: $40.00-$68.00
Medicine Classification: General Sale
VOLTAREN OSTEO GEL 12 HOURLY
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tube, 100g.
Active Ingredients: Diclofenac diethylammonium 23.2 mg/g.
Approved Indications: For short-term (up to 3 weeks) pain relief of mild and localised forms of osteoarthritis of the knees
and fingers.
Contraindications: Hypersensitivity to any ingredient; in asthma attacks, urticaria or rhinitis precipitated by aspirin or other
NSAIDs; in pregnancy or breastfeeding; in children under 12 years.
Precautions: Allergy to diclofenac.
Adverse Effects: Rash, eczema, erythema, dermatitis, pruritus.
Directions: Adults and children ≥ 12 years: Apply to affected area up to 2 times a day.
Price Band: $40-$45
Medicine Classification: General Sale
ZOSTRIX
AFT PHARMACEUTICALS LTD
Presentation: Cream, 25g, 45g tube.
Active Ingredients: Capsaicin 0.025% w/w.
Approved Indications: For the symptomatic relief of pain associated with osteoarthritis.
Contraindications: Broken or irritated skin. Not suitable for children.
Precautions: Patients should avoid taking a hot bath/shower just before or after applying Zostrix, as it can enhance the
burning sensation. Keep away from eyes. If condition worsens, seek medical advice. Tight bandages should not be
applied on top of Zostrix cream.
Adverse Effects: Transient burning on application.
Directions: Apply a small amount to the affected area 3-4 times per day, not more than every 4 hours. After applying
cream, hands should be washed thoroughly. Do not apply near eyes. Avoid taking a hot bath or shower directly
before or after application.
Price Band: $10 - $20 and over (Price varies with pack size)
Subsidy Conditions: Fully subsidised. Special Authority criteria applies (SA 1289)
Medicine Classification: General Sale
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Period Pain & Endometriosis
MERSYNDOL
SANOFI CONSUMER HEALTHCARE
Presentation: Tablet, 20s.
Active Ingredients: Paracetamol 450mg, doxylamine succinate 5mg, codeine phosphate 9.75mg.
Indications: Moderate to severe pain including headache, toothache, backache, period pain or pain associated with trauma or surgery.
Calmative effects may be useful in tension headache and migraine treatment.
Contraindications: Hypersensitivity to any ingredient, pre-existing respiratory depression, asthma.
Precautions: Hepatic or renal impairment, pregnancy, lactation. Avoid alcohol and prolonged use. Watch total paracetamol dose if taking
other products. Codeine can cause addiction. Do not use for more than 3 days at a time.
Adverse Effects: Constipation, respiratory depression, drowsiness, dry mouth, anorexia, dizziness, rash, gastrointestinal upset. Do not
drive a vehicle or operate machinery within 8 hours of last dose.
Directions: Adults and children over 12 years: 1-2 tablets every 4-6 hours as required, maximum 8 tablets in 24 hours. Not recommended
in children under 12 years.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacist Only
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Pregnancy - Testing
EASYCHECK MIDSTREAM PREGNANCY TESTS
PHOENIX MEDCARE LIMITED
Presentation: Midstream pregnancy tests: 1 and 3 tests.
Active Ingredients: None
Indications: The EasyCheck hCG Pregnancy Test Midstream is a rapid, one step test for the qualitative detection of human chorionic
gonadotropin (hCG) in urine, as an aid for the early detection of pregnancy. The test is intended for in vitro diagnostic self-testing.
Contraindications: None.
Precautions: Always follow instructions for use.
Adverse Effects: None.
Directions: Always follow instructions for use.
Price Band: $10.99-$17.99
Medicine Classification: Medical Device
EASYCHECK OVULATION KIT
PHOENIX MEDCARE LIMITED
Presentation: Ovulation Kit, LH test strips and hCG midstream test.
Active Ingredients: N/A
Indications: The EasyCheck LH Ovulation Test is a rapid one step assay designed for qualitative detection of human luteinising hormone
(LH) in urine to predict time of ovulation. The EasyCheck hCG Pregnancy Test Midstream is a rapid, one step test for the
qualitative detection of human chrorionic gonadotropin (hCG) in urine, as an aid for the early detection of pregnancy. Products
are for self-testing and in vitro diagnostic use only.
Contraindications: N/A.
Precautions: Always follow instructions for use.
Adverse Effects: N/A.
Directions: Always follow instructions for use.
Price Band: $24.99-$28.99
Medicine Classification: Medical Device
OVUPLAN 10 DAY PREGNANCY PLANNING KIT
WILSON CONSUMER PRODUCTS LTD
Presentation: 10 ovulation tests, 1 Mid-stream pregnancy test.
Approved Indications: Designed to detect when ovulation occurs by measuring a surge in LH in the urine. Ovulatin occurs 24-36 hours
after the LH surge.
Contraindications: None known
Precautions: Do not use after expiry date, do not open foil pouch until ready to take the test, do not consume an excess amount of liquid
for at least 2 hours prior to taking the test to avoid dilution of LH in your urine, do not use as an indicator for contraception.
Adverse Effects: None known
Directions: Collect urine sample using the container supplied. Open the foil packet and slide the foam ring onto the test strip past the
arrow marked section until the bottom of the foam ring is on the purple line. Float the strip in the urine sample with arrow
marked section submerged. Do not splash the result window with urine. Read the result after 5 minutes have passed but before
10 minutes have passed. A control line will appear and a test line will appear if you are having your LH surge.
Price Band: $20-30
Medicine Classification: General Sale
OVUPLAN SCOPE
WILSON CONSUMER PRODUCTS LTD
Presentation: 1 Saliva Ovulation Prediction Microscope.
Active Ingredients: None.
Approved Indications: Reusable mini-microscope that helps you monitor your cycle to predict the days you are most likely to become
pregnant.
Contraindications: The accuracy of this test will depend on how closely the instructions are followed.
Precautions: None known.
Adverse Effects: None known.
Directions: Dip a clean finger into the pool of saliva under your tongue. Touch a full drop onto the surface of the lens on the white
coloured side. Allow the sample to dry for 15 to 20 minutes. Hold the purple coloured side to your eye and look through thr lens
towards a bright light source. Compare the images to the one sin yourresult chart (included in the box). This will tell you if you
are in your fertile or non-fertile period.
Price Band: $49.99
Medicine Classification: General Sale
Page 255

PREGNOSIS EARLY PREGNANCY TEST DIP & READ
WILSON CONSUMER PRODUCTS LTD
Presentation: Dip & read early pregnancy tests.
Active Ingredients: Not applicable.
Approved Indications: Early pregnancy test. 99% accurate, detects pregnancy hormones as low as 25IU/L normally reached by the first
day of the missed period.
Contraindications: None known.
Precautions: Fertility drugs containing HCG may give a false positive result.
Adverse Effects: None known.
Directions: Collect urine sample in the container supplied. Slide foam ring supplied in the pack onto the test strip. Float the strip in the
urine sample. After 1 minute the result will be visible.
Price Band: $5 - $15
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
PREGNOSIS IN STREAM EARLY PREGNANCY TEST
WILSON CONSUMER PRODUCTS LTD
Presentation: 1 and 3 Mid Stream Pregnancy Tests.
Approved Indications: Early Pregnancy test, over 99% accurate. Used any time of the day and you can test 7 to 10 days after conception.
Can detect hormone levels as low as 25 IU/L.
Contraindications: None known.
Precautions: Fertility drugs containing HCG may give a false positive result.
Adverse Effects: None known.
Directions: Remove test device from foil envelope. Remove cap. Hold the test device by the grip with the exposed absorbent tip pointing
directly into urine stream for at least 10 seconds or thoroughly wet. After removing from the urine immediately replace cap, lay
the test on a flat surface with the result area facing upwards. Read the result at 3 minutes if no coloured line appears wait one
minute longer. Do not read result after 10 minutes.
Price Band: $10-$20
Medicine Classification: General Sale
»»
Preventive Health
TURMERIC 15800 COMPLEX
GOOD HEALTH NZ PRODUCTS (DISTRIBUTED BY BRANDFOLIO)
Presentation: capsules; 30s, 60s.
Active Ingredients: Active Ingredients: (per capsule) extract equivalent to dry, curcuma longa (turmeric) rhizome dry 15800mg, equivalent
to curcuminoids 600mg, boswellia serrata gum (Boswellia) 100mg; zingiber officinale rhizome (ginger) 100mg; withania
somnifera root (ashwagandha) 100mg. Extract: Bioperine® (Black Pepper) 6mg.
Approved Indications: Natural anti-inflammatory. For joint aches and pains and Gastro-intestinal health.
Contraindications: Anti-coagulant medication unless blood is monitored. Bile duct obstruction or people on chemotherapy medications.
Pregnancy and breastfeeding.
Precautions: Take with food.
Adverse Effects: If dose is too strong for some people they may experience diarrhea.
Directions: Take 1 capsule daily with food. May take up to 1 capsule 3 x daily if needed but start at lower dose first and build up.
Price Band: $35.00-$60.00
Medicine Classification: General Sale
»»
Psoriasis
COCO-SCALP
AFT PHARMACEUTICALS LTD
Presentation: Ointment, 40g tube.
Active Ingredients: Coal tar solution 12.0% w/w, sulphur for external use 4.0% w/w, salicylic acid 2.0% w/w.
Approved Indications: For treatment of common scaly skin disorders of the scalp such as psoriasis, eczema, seborrhoeic dermatitis and
dandruff.
Contraindications: Known sensitivity to any ingredients, in the presence of acute local infections or acute pustular psoriasis.
Precautions: Avoid contact with eyes - wash hands immediately after use. Stop use if irritation develops. If symptoms persist after
4 weeks, consult a doctor. Use during pregnancy/breastfeeding at physician’s discretion. Not recommended in children under
6 years. Children 6-12 years: Use under medical supervision only.
Adverse Effects: Skin irritation, folliculitis and rarely, photosensitivity.
Directions: Adults and children over 12 years: Mild dandruff - use intermittently as adjunctive treatment, about once a week. Psoriasis,
eczema, seborrhoeic dermatitis and severe dandruff - use daily for 3-7 days until improvement. Intermittent repeated
applications may be necessary to maintain improvement. Affected area should be treated and shampooed off, using warm water,
approximately 1 hour later.
Price Band: $10 - $20. Available on Pharmaceutical Schedule Subsidy Conditions: Fully subsidised Medicine Classification: General Sale
Page 256 HEALTHCARE HANDBOOK 2017-2018 OTC Products

PINETARSOL
DOUGLAS PHARMACEUTICALS LTD
Presentation: Liquid: 100ml, 200ml, 500ml, 1 litre. Gel: 100g. Bar, 100g.
Active Ingredients: Pine tar.
Approved Indications: Soap alternative. Relief of red and itchy skin conditions.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Avoid contact with eyes, avoid exposure to sun, may stain clothing. External use only.
Adverse Effects: None known.
Directions: Add 15-30ml of liquid to a tepid bath.
Price Band: Under $10 - $20 (Price varies with pack size). Available on Pharmaceutical Schedule
Subsidy Conditions: 500ml, 1 litre liquid only
Medicine Classification: General Sale
QV SKIN LOTION
DOUGLAS PHARMACEUTICALS LTD
Presentation: Lotion, 250ml, 500ml, 1 litre. Cream, 100g, 250g. Bath oil, 200ml, 250ml, 1 litre. Wash, 250ml, 500ml, 1 litre. Bar, 100g.
Gentle Wash, 250ml, 500ml, 1 litre. Intensive shower pack, 240ml. Intensive moisturiser, 450g.
Active Ingredients: Variety of emollient ingredients. Lanolin and perfume-free, pH adjusted.
Approved Indications: Cleanser and moisturiser for normal to dry and sensitive skin.
Contraindications: Hypersensitivity to any ingredient.
Precautions: For external use only.
Adverse Effects: None known.
Directions: Apply cream and lotion as required. Use wash and bar as soap substitutes.
Price Band: $10 - $20 and over. Available on Pharmaceutical Schedule
Subsidy Conditions: Lotion 250ml only, part charge
Medicine Classification: General Sale
»»
Sexual Wellbeing – Lubrication
ANIME LUBRICANT 50ML
PHOENIX MEDCARE LIMITED
Presentation: Tube 50ml
Active Ingredients: Hyaluronic acid sodium and lactic acid
Indications: Intimate lubricant and moisturiser for external temporary use for intercourse or for woman with vaginal dryness caused by
breast feeding, menopause, stress or other factors.
Contraindications: Allergy or known side effects to an ingredient in the product
Precautions: Not a contraceptive device
Adverse Effects: Low risk of side effects. If discomfort is experienced discontinue use.
Directions: Apply the desired amount of gel directly or with fingers.
Price Band: $15.99
Medicine Classification: Medical Device
DUREX PERFECT GLIDE
RECKITT BENCKISER (NZ) LTD
Presentation: Lubricant 50ml.
Active Ingredients: Silicone.
Indications: Vaginal lubricant.
Contraindications: Known allergy to the active ingredient.
Precautions: Avoid contact with eyes. Avoid use if pregnant or breast-feeding.
Adverse Effects: Refer to packaging.
Directions: Refer to packaging.
Price Band: $10.00 - $20.00
Medicine Classification: Medical Device. Vaginal lubricant
Page 257

»»
Sexual Wellbeing – Contraception
DUREX EXTRA SAFE
RECKITT BENCKISER (NZ) LTD
Presentation: Condoms 12s.
Active Ingredients: Latex.
Indications: Prevention of pregnancy and STI’s.
Contraindications: Allergy to latex.
Precautions: No method of contraception can give you 100% protection against pregnancy, HIV or STI’s.
Adverse Effects: Refer to packaging.
Directions: Refer to packaging.
Price Band: $10.00 - $20.00. Available on Pharmaceutical Schedule
Subsidy Conditions: None
Medicine Classification: Medical Device
DUREX REAL FEEL
RECKITT BENCKISER (NZ) LTD
Presentation: Condoms 8’s (non-latex).
Active Ingredients: Polyisoprene.
Indications: Prevention of pregnancy and STI’s.
Contraindications: Allergy to polyisoprene.
Precautions: No method of contraception can give you 100% protection against pregnancy, HIV or STI’s.
Adverse Effects: Refer to packaging.
Directions: Refer to packaging.
Price Band: $10.00 - $20.00
Medicine Classification: Medical Device
»»
Shingles - Symptomatic Relief
ZOSTRIX HP
AFT PHARMACEUTICALS LTD
Presentation: Cream, 45g tube.
Active Ingredients: Capsaicin 0.075% w/w.
Approved Indications: Symptomatic relief of neuralgia associated with herpes zoster infections (postherpetic neuralgia)
after open skin lesions have healed. Symptomatic management of painful diabetic peripheral polyneuropathy.
Contraindications: Broken or irritated skin. Not suitable for children.
Precautions: Keep away from eyes. If condition worsens, seek medical advice. Do not apply to broken or sensitive skin.
Tight bandages should not be applied on top of Zostrix HP. Avoid taking hot bath/shower.
Adverse Effects: Transient burning on application.
Directions: Apply a small amount to affected area 3-4 times daily, not more often than every 4 hours. After applying cream,
hands should be washed thoroughly. Do not apply near eyes. Avoid taking a hot bath or shower directly before or
after application.
Price Band: $20 and over. Available on Pharmaceutical Schedule
Subsidy Conditions: Fully subsidised
Medicine Classification: General Sale
»»
Sinus & Nasal Problems
SUDAFED NASAL SPRAY
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: 20mL nasal spray.
Active Ingredients: Oxymetazoline hydrochloride 500mcg/ml.
Approved Indications: For the relief of nasal congestion due to colds, influenza, allergies, and sinusitis.
Contraindications: Hypersensitivity to any ingredients. Do not use in children under 6 years.
Precautions: Continual use of this product for a period longer than three days for adults or two days for children is not recommended,
unless advised by a doctor. Ask your doctor before using in children aged six to eleven years. Caution if you are taking any other
medicines to treat cough and cold. Ask your doctor for children 6-11 years.
Adverse Effects: Transient stinging, rebound congestion with prolonged use.
Directions: Adults and children over 6 years of age: 1-2 sprays repeated two to three times a day when necessary.
Maximum: 6 sprays per day.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 258 HEALTHCARE HANDBOOK 2017-2018 OTC Products

SUDAFED PE NASAL DECONGESTANT
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s, 48s.
Active Ingredients: Phenylephrine hydrochloride 10mg.
Approved Indications: Relief of sinus and nasal congestion, blocked or runny noses.
Contraindications: Do not use in children under 12 years. If you are taking antidepressants. If you are taking any other
medicines to treat cough and cold.
Precautions: Hypertension, heart disease, renal impairment, diabetes, hyperthyroidism, prostatic hypertrophy, pregnancy.
Adverse Effects: Sleeplessness.
Directions: Adults and children over 12 years: 1 tablet every 4 hours. Maximum 6 tablets in 24 hours.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
SUDAFED PE NIGHT
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets
Active Ingredients: Phenylephrine hydrochloride 5mg, paracetamol 500mg, chlorpheniramine maleate 2mg per tablet.
Approved Indications: Relief of allergy and hay fever symptoms, sinus pain, blocked or runny nose.
Contraindications: Concurrent use of anti-histamines, paracetamol or antidepressants. Hypersensitivity to any of the
ingredients. Children under 12 years old.
Precautions: Hypertension, heart disease, renal impairment, diabetes, hyperthyroidism, prostatic hypertrophy, pregnancy.
Chlorpheniramine may cause drowsiness. Phenylephrine may cause sleeplessness. If you are taking any other
medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness. Chlorpheniramine may cause drowsiness.
Directions: Adults and children over 12 years: 2 tablets every 4 to 6 hours as necessary. Maximum: 8 tablets in 24 hours.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
SUDAFED PE SINUS + ALLERGY & PAIN RELIEF
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s, 48s.
Active Ingredients: Phenylephrine hydrochloride 5mg, paracetamol 500mg, chlorpheniramine maleate 2mg per tablet.
Approved Indications: Relief of allergy and hay fever symptoms, sinus pain, blocked or runny nose.
Contraindications: Concurrent use of anti-histamines, paracetamol or antidepressants. Hypersensitivity to any of the
ingredients. Children under 12 years old.
Precautions: Hypertension, heart disease, renal impairment, diabetes, hyperthyroidism, prostatic hypertrophy, pregnancy,
watch total paracetamol dose if taking other medicines. Chlorpheniramine may cause drowsiness. Phenylephrine
may cause sleeplessness. If you are taking any other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness. Chlorpheniramine may cause drowsiness.
Directions: Adults and children over 12 years: 2 tablet every 4 -6 hours as necessary. Maximum 8 tablets in 24 hours.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
SUDAFED PE SINUS + PAIN RELIEF
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s, 48s.
Active Ingredients: Phenylephrine hydrochloride 5mg, paracetamol 500mg.
Approved Indications: Relief of sinus pain, sinus headaches, blocked or runny noses.
Contraindications: Hypersensitivity to any ingredient, MAOI use or within 2 weeks of stopping MAOI.
Precautions: Hypertension, heart disease, renal impairment, diabetes, hyperthyroidism, prostatic hypertrophy, pregnancy,
watch total paracetamol dose if taking other medicines, if you are taking antidepressants, if you are taking any
other medicines to treat cough and cold.
Adverse Effects: Phenylephrine may cause sleeplessness.
Directions: Adults and children over 12 years: 1-2 tablet every 4 - 6 hours as necessary. Maximum 8 tablets in 24 hours.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
Page 259

SUDAFED PE SINUS DAY + NIGHT RELIEF
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Tablets, 24s, 48s.
Active Ingredients: Day Tablet: Phenylephrine hydrochloride 5mg, paracetamol 500mg. Night Tablet: Phenylephrine
hydrochloride 5mg, paracetamol 500mg chlorpheniramine maleate 2mg.
Approved Indications: Relief of sinus and nasal congestion and associated pain.
Contraindications: Concurrent use of anti-histamines, paracetamol or antidepressants, or within 2 weeks of stopping an
MAOI.
Precautions: Ask your doctor before taking if you have high blood pressure, heart problems, are pregnant, or take other
medicines for cough or cold.
Adverse Effects: Phenylephrine may cause sleeplessness. Chlorpheniramine may cause drowsiness.
Directions: Adults and children over 12 years: 2 tablets every 4-6 hours. Maximum 6 day & 2 night tablets in 24 hours.
Price Band: $10 - $20 (Price varies with pack size)
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Sleep Problems
DOZILE
WILSON CONSUMER PRODUCTS LTD
Presentation: Gel capsule, 10.
Active Ingredients: Doxylamine succinate 25mg.
Approved Indications: For the temporary relief of sleeplessness.
Contraindications: Hypersensitivity to any ingredient.
Precautions: Not recommended for children under 12 years. Dozile should be avoided during pregnancy or lactation. Do
not use if packaging is torn or shows signs of tampering. Avoid alcohol. If tired, drowsy, dizzy or light-headed, do
not drive or operate machinery. Do not use for more than 7-10 consecutive days.
Adverse Effects: Most common side effects are dizziness, clumsiness, over-excitement. These are mostly mild and
short-lived. Less common side effects are nausea, vomiting, diarrhoea, stomach problems, headache, dry mouth,
difficulty passing urine, blurred vision, thick mucus from lungs, palpitations.
Directions: Swallow 1 capsule whole with a glass of water 30 minutes before bedtime.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacist Only
»»
Smoking Cessation
HABITROL GUM
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Nicotine Chewing Gum: 2 mg and 4 mg. Fruit, Classic or Mint flavour. 96 pack (retail) and 384 pack (Dispensary).
Active Ingredients: Nicotine.
Approved Indications: Relief of nicotine withdrawal symptoms, as an aid for smoking cessation, smoking reduction or temporary abstinence from smoking.
Contraindications: Non-smokers or occasional smokers, children under 12 years or known hypersensitivity to any ingredient in the formulation.
Precautions: Medical advice before use in patients with a recent heart attack or stroke, uncontrolled hypertension, unstable or worsening angina or severe arrhythmia. A HCPs advice
is needed if the patient has severe hypertension, stable angina, suffered a stroke, heart disease, heart failure, hyperthyroidism or pheochromocytoma, moderate to severe
liver or kidney impairment, active peptic ulcer, diabetes, mouth/throat inflammation, dentures, under 18 years, inability to tolerate fructose, pregnant or breastfeeding.
Discontinue if symptoms of nicotine overdose appear. Keep out of reach of children.
Adverse Effects: Dizziness, headaches, insomnia, slight mouth/throat irritation, increased salivation, hiccupping, minor indigestion or heartburn, nausea, flatulence, gastritis, jaw
muscle ache or a sore mouth or throat. Refer to datasheet for less common side effects.
Directions: Those smoking more than 20 cigarettes/day, as well as smokers who failed to quit using 2mg gum, should use 4 mg strength. Otherwise, the 2 mg strength should be
used. Only 2mg strength can be used in combination with patch. Refer to pack leaflet for more information.
Price Band: $20 - $30 (Retail price varies with pack size). Available on Pharmaceutical Schedule
Subsidy Conditions: Dispensing pack available with provision of Quitline card Medicine Classification: General Sale
HABITROL LOZENGE
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Lozenge 1 mg and 2 mg. Mint flavour. 36 (retail) and 216 (dispensing) packs.
Active Ingredients: Nicotine.
Approved Indications: Relief of nicotine withdrawal symptoms, as an aid for smoking cessation, smoking reduction or temporarily abstinence from smoking.
Contraindications: Non-smokers or occasional smokers, children under 12 years or known hypersensitivity to any ingredient in the formulation.
Precautions: Medical advice before use in patients with a recent heart attack or stroke, uncontrolled hypertension, unstable or worsening angina or severe arrhythmia. A HCPs advice
is needed if the patient has severe hypertension, stable angina, suffered a stroke, heart disease, heart failure, hyperthyroidism or pheochromocytoma, moderate to severe
liver or kidney impairment, active peptic ulcer, diabetes, mouth/throat inflammation, under 18 years, pregnant or breastfeeding, phenylketonuria. Discontinue if symptoms of
nicotine overdose appear. Keep out of reach of children.
Adverse Effects: Dizziness, headaches, insomnia, slight mouth/throat irritation, increased salivation, hiccupping, minor indigestion or heartburn, nausea, flatulence, gastritis and
dryness of the mouth. Refer to datasheet for less common side effects.
Directions: Those smoking more than 20 cigarettes/day, as well as smokers who failed to quit using 1mg lozenge, should use 2 mg strength. Otherwise, the 1 mg strength should be
used. Only 1mg strength can be used in combination with patch. Refer to pack leaflet for more information.
Price Band: $20 - $25 (Retail price varies). Available on Pharmaceutical Schedule
Subsidy Conditions: Dispensing pack available with provision of Quitline card Medicine Classification: General Sale
Page 260 HEALTHCARE HANDBOOK 2017-2018 OTC Products

HABITROL PATCH
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Patch: Step 1 (21mg/24hrs), Step 2 (14mg/24hrs) and Step 3 (7mg/24hrs). Pack of 7 (retail) or 28 (dispensary).
Active Ingredients: Nicotine.
Approved Indications: Treatment of nicotine dependence, to aid smoking cessation. Combination therapy with Habitrol 2 mg gum or
Habitrol 1 mg lozenge is permitted.
Contraindications: Non-smokers or occasional smokers, under 12 years, generalised dermatological disorders such as psoriasis or chronic
dermatitis that may complicate patch therapy or known hypersensitivity to any ingredient in the formulation.
Precautions: Seek medical advice before use in people with a history of recent heart attack or stroke, uncontrolled hypertension, unstable or worsening angina or severe arrhythmias.
Seek a doctor or pharmacists advice before using with other conditions of concern (see leaflet or datasheet). Discontinue treatment if symptoms of nicotine overdose appear.
Keep out of reach of children.
Adverse Effects: Application site reactions, agitation, anxiety, nervousness, insomnia, abnormal dreams, headache, dizziness, motor dysfunction, cough, nausea, abdominal pain,
dyspepsia, myalgia and arthritis. Refer to datasheet for more information.
Directions: Apply 1 patch daily. Those smoking more than 20 cigarettes/day should start with Step 1 Patch. Those smoking less than 20 cigarettes/day start with Habitrol Step 2. Refer
to leaflet for further directions Medicine Classification: General Sale
Price Band: $20 - $30 (Retail price varies with pack size). Available on Pharmaceutical Schedule Subsidy Conditions: Dispensing pack available with provision of Quitline card.
NICORETTE 16HR INVISIPATCH PATCH
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Patch: Step 1 (25mg/16hr), Step 2 (15mg/16hr) and Step 3 (10mg/16hr). Packs of 7s.
Active Ingredients: Nicotine.
Indications: Smoking cessation aid. Smoking reduction. 2mg gum, 2mg Cooldrops lozenge, QuickMist and 15mg inhalator are approved
for combination use with NICORETTE® patch.
Contraindications: Generalised chronic dermatological disorders, such as psoriasis, chronic dermatitis or urticarial, hypersensitivity to
nicotine, non-smokers, children, breast feeding.
Precautions: Concomitant smoking, cardiovascular disease (including recent myocardial infarction), diabetes, hyperthyroidism,
phaeochromocytoma, pregnancy, dermatological disorders.
Adverse Effects: Headache, dizziness, gastrointestinal discomfort, nausea, vomiting erythema, itching of the skin.
Directions: For adults 18+ who smoke more than 15 cigarettes per day, use one 25mg/16hr patch daily for the first 8 weeks followed by
one 15mg/16hr patch daily for the next 2 weeks and 10mg/16hr patch daily for a further 2 weeks. For adults 18+ who smoke less
than 15 cigarettes per day, use one 15mg/16hr patch daily for the first 8 weeks followed by one 10mg/16hr patch daily for the
next 4 weeks
Price Band: $25 - $35 and over Subsidy Conditions: Not subsidised Medicine Classification: General Sale
NICORETTE COOLDROPS LOZENGE
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Lozenge (Icy Mint), 2 mg or 4 mg strength in packs of 80s.
Active Ingredients: Nicotine.
Indications: Smoking cessation aid. Temporary abstinence. Smoking reduction. 2mg is also approved for combination use with
NICORETTE® Patch.
Contraindications: Hypersensitivity to nicotine, non-smokers, children.
Precautions: Concomitant smoking, peptic ulcer disease, cardiovascular disease (including recent myocardial infarction), diabetes, GI
disease, hyperthyroidism, phaeochromocytoma, pregnancy or nursing mothers.
Adverse Effects: Hiccups, nausea, headache, dizziness, heartburn, mouth irritation and indigestion, coughing, sore throat and chest
palpitations.
Directions: 2mg for adults 18+ who smoke 20 cigarettes or less per day. 4mg for adults 18+ who smoke more than 20 cigarettes per day.
During weeks 1-12: use 1 lozenge when you have an urge to smoke or every 1-2 hours. After 12 weeks: Gradually reduce to 1-2
lozenges/day and then stop use. Do not use more than 15 lozenges per day.
Price Band: $35 - $45 and over
Subsidy Conditions: Not subsidised Medicine Classification: General Sale
NICORETTE GUM
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Gum (Icy Mint), 2mg or 4mg in packs of 15s or 105s. Gum (Classic) 2mg or 4mg in packs of 105s.
Active Ingredients: Nicotine.
Indications: Smoking cessation aid. Temporary abstinence. Smoking reduction. 2mg is also approved for combination use with Nicorette
Patch.
Contraindications: Hypersensitivity to nicotine, non-smokers, children.
Precautions: Concomitant smoking, peptic ulcer disease, cardiovascular disease (including recent myocardial infarction), diabetes,
hyperthyroidism, phaeochromocytoma, pregnancy or nursing mothers.
Adverse Effects: Occasionally, irritation of mouth and throat, hiccups, cough, indigestion, headache, nausea, vomiting.
Directions: 2mg for adults 18+ who smoke less than 20 cigarettes per day. 4mg for adults 18+ who smoke more than 20 cigarettes per
day. During weeks 1-12: Chew 1 pc when you have an urge to smoke or every 1-2 hours. After 12 weeks: Gradually reduce to 1-2
pcs a day and then stop use. Do not use more than 20pcs per day of the 2mg gum or 10 pcs per day of the 4mg gum.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 261

NICORETTE INHALATOR
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Inhalator 15mg packs of 4 cartridges, 20 cartridges.
Active Ingredients: Nicotine 15mg.
Approved Indications: Smoking cessation aid. Temporary abstinence. Smoking reduction. Also indicated for combination use with
Nicorette Patch.
Contraindications: Non smokers, hypersensitivity to nicotine or menthol, children.
Precautions: Concomitant smoking, peptic ulcer disease, cardiovascular disease (including recent myocardial infarction), diabetes,
hyperthyroidism, phaeochromocytoma, pregnancy, lactation.
Adverse Effects: Headache, transient cough, irritation of mouth and throat.
Directions: For adults 18+ who smoke more than 10 cigarettes a day. During weeks 1-12: 1 cartridge when you have an urge to smoke
every 2-4 hours. For best results use 3-6 cartridges/day. After 12 weeks: Gradually reduce to 1-2 cartridges/day and then stop use.
Use beyond 12 months is not recommended.
Price Band: $10 - $50
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
NICORETTE QUICKMIST
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Mouth spray. Available in single pack (1 x 150 sprays).
Active Ingredients: Nicotine 1mg/spray.
Indications: Smoking cessation aid. Temporary abstinence. Smoking reduction. Also indicated for combination use with Nicorette Patch.
Contraindications: Non smokers, hypersensitivity to nicotine, children.
Precautions: Concomitant smoking, peptic ulcer disease, cardiovascular disease (including recent myocardial infarction), diabetes,
hyperthyroidism, phaeochromocytoma, pregnancy, lactation.
Adverse Effects: Headache, nausea, dyspepsia, burning lips, dry mouth and/or throat.
Directions: For adults 18+. During weeks 1-6: Use 1 or 2 sprays when cigarettes normally would have been smoked or if cravings emerge.
If after a single spray cravings are not controlled within a few minutes, a second spray should be used. If 2 sprays are required,
future doses may be delivered as 2 consecutive sprays. Weeks 7-9: Start reducing the number of sprays/day. Weeks 10-12:
gradually reduce to 2-4 sprays/day and then stop use. Regular use beyond 6 months is not recommended.
Price Band: $40 - $50 and over
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Sore Throat
BETADINE SORE THROAT GARGLE
SANOFI CONSUMER HEALTHCARE
Presentation: Concentrate: 15mL and 40mL with measure. Ready-to-use: 120mL.
Active Ingredients: Concentrate: Povidone iodine 7.5%, ethanol. Ready-to-use: Povidone iodine 10mg/mL, ethanol.
Approved Indications: Antibacterial sore throat treatment.
Contraindications: Hypersensitivity to iodine.
Precautions: Pregnancy or lactation. May affect thyroid function tests. Do not swallow.
Adverse Effects: Skin irritation, redness.
Directions: Concentrate: Dilute 1mL to 20mL with water; gargle for 30 seconds, repeat 3 - 4 hourly. Ready-to-use: Pour to line on provided
measuring cup (15mL) and gargle for 30 seconds, repeat 3-4 hourly.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
CODRAL ® SORE THROAT LOZENGES ANTIBACTERIAL HONEY & LEMON FLAVOUR
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Lozenge 16s and 36s.
Active Ingredients: Cetylpyridinium chloride 1.47mg, benzyl alcohol 6.5mg
Approved Indications: Antibacterial treatment for sore throat
Contraindications: Do not use for children under 6 years. Do not use if foil is broken.
Precautions: Do not take hot food or drink soon after using this product because it may burn your mouth. See your doctor if symptoms
persist. Contains glucose and sucrose.
Directions: For adults and children over 6 years. Dissolve 1 lozenge slowly in the mouth every 2-3 hours as required.
Maximum: 12 lozenges in 24 hours.
Price Band: $6.99 - $10.99
Medicine Classification: General Sale
Page 262 HEALTHCARE HANDBOOK 2017-2018 OTC Products

CODRAL ® SORE THROAT LOZENGES ANTIBACTERIAL MENTHOL FLAVOUR
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Lozenge 16s.
Active Ingredients: Cetylpyridinium chloride 1.47mg, benzyl alcohol 6.5mg
Approved Indications: Antibacterial treatment for sore throat.
Contraindications: Do not use for children under 12 years. Do not use if foil seal is broken.
Precautions: Do not take hot food or drink soon after using this product because it may burn your mouth.
See your doctor if symptoms persist. Contains glucose and sucrose.
Directions: For adults and children over 12 years: dissolve 1 lozenge slowly in the mouth every 2-3 hours as required.
Maximum: 12 lozenges in 24 hours.
Price Band: $6.99
Medicine Classification: General Sale
CODRAL ® SORE THROAT LOZENGES ANTIBACTERIAL + ANAESTHETIC LIME & LEMON FLAVOUR
JOHNSON & JOHNSON (NEW ZEALAND) LTD
Presentation: Lozenge 16s and 36s.
Active Ingredients: Benzocaine 10mg, cetylpyridinium chloride 1.4mg
Approved Indications: Antibacterial and anaesthetic treatment for sore throat. Anaesthetic numbs the throat.
Contraindications: Do not use for children under 6 years. Do not use if foil seal is broken.
Precautions: Do not take hot food or drink soon after using this product because it may burn your mouth. See your doctor
if symptoms persist. Contains glucose and sucrose.
Adverse Effects: May numb tongue. Mouth numbness may limit the ability to identify hot substances.
Directions: For adults and children over 6 years. Dissolve 1 lozenge slowly in the mouth every 2-3 hours as required.
Maximum 8 lozenges in 24 hours.
Price Band: $7.99 - $12.99
Medicine Classification: General Sale
STREPFEN INTENSIVE HONEY & LEMON LOZENGES
RECKITT BENCKISER (NZ) LTD
Presentation: Lozenge, 16s (also in orange sugar-free).
Active Ingredients: Flurbiprofen 8.75mg.
Approved Indications: Relief from painful and swollen sore throats. Anti-inflammatory.
Contraindications: Hypersensitivity to flurbiprofen or other lozenge ingredients. Existing peptic ulceration. Patients with a
history of bronchospasm, asthma, urticaria or rhinitis associated with aspirin or other NSAIDs. Pregnancy except
on doctor’s advice. Last 3 months of pregnancy. Renal impairment. Heart failure.
Precautions: Asthma. History of peptic ulceration. Regular treatment with other medications.
Adverse Effects: Transient taste perversion, tingling sensation in the mouth.
Directions: Adults and children over 12 years: suck 1 lozenge every 3-6 hours, maximum 8 lozenges in 24 hours.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
STREPSILS PLUS ANAESTHETIC THROAT SPRAY
RECKITT BENCKISER (NZ) LTD
Presentation: Spray, 20ml.
Active Ingredients: Lignocaine hydrochloride 0.6% w/v, amylmetacresol 0.223% w/v, dichlorobenzyl alcohol 0.446% w/v.
Approved Indications: Antibacterial, anaesthetic relief from mouth and throat infections, including sore throat, and mouth and dental
ulcers. Relieves discomfort associated with tonsillitis and pharyngitis.
Contraindications: Hypersensitivity to local anaesthetics.
Precautions: Do not exceed maximum dose or dilute spray. Caution in asthmatics. Be careful consuming hot foods or liquids after use.
Adverse Effects: Taste disturbance. Rarely, hypersensitivity reactions.
Directions: Adults and children over 12 years: Aim nozzle at back of the throat and spray 2 times. Children 6-12 years: Apply only 1 spray
to the back of the throat. Repeat every 2 hours as required. Maximum 8 doses (16 sprays) every 24 hours. Do not inhale spray.
Price Band: $10 - $20
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 263

STREPSILS PLUS LOZENGES
RECKITT BENCKISER (NZ) LTD
Presentation: Lozenge, 16s, 36s.
Active Ingredients: Dichlorobenzyl alcohol 1.2mg, amylmetacresol 0.6mg, lignocaine hydrochloride 10mg.
Approved Indications: Antibacterial and anaesthetic treatment for sore throats and mouth infections. Anaesthetic numbs the throat.
Contraindications: Hypersensitivity to local anaesthetic or to any ingredient.
Precautions: Care when consuming hot foods or liquids after taking.
Adverse Effects: Taste disturbances, hypersensitivity reactions (rare).
Directions: Adults and children over 6 years: 1 lozenge every two hours as required. Do not exceed 8 lozenges in 24 hours.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
STREPSILS SOOTHING HONEY AND LEMON LOZENGES
RECKITT BENCKISER (NZ) LTD
Presentation: Lozenge, 36s. Also available in orange and strawberry sugar free. 16s, 36s.
Active Ingredients: Dichlorobenzyl alcohol 1.2mg, amylmetacresol 0.6mg.
Approved Indications: Antibacterial treatment for sore throats and mouth infections.
Contraindications: Hypersensitivity to any ingredients.
Precautions: Sugar free only: contains isomalt and maltitol - excessive consumption may have a laxative effect.
Adverse Effects: Side effects extremely rare.
Directions: 1 lozenge every 2-3 hours.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
STREPSILS SORE THROAT & BLOCKED NOSE
RECKITT BENCKISER (NZ) LTD
Presentation: Lozenge, 16s, 36s.
Active Ingredients: Dichlorobenzyl alcohol 1.2mg, amylmetacresol 0.6mg.
Approved Indications: Gentle, warming sensation. Antibacterial treatment for sore throats and mouth infections.
Contraindications: Hypersensitivity to any ingredients.
Precautions: Not suitable for children under 6 years.
Adverse Effects: Side effects extremely rare.
Directions: 1 lozenge every 2-3 hours.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Strains and Sprains
VOLTAREN EMULGEL
GLAXOSMITHKLINE CONSUMER HEALTHCARE
Presentation: Tube 20g, 50g, 100g, 150g
Active Ingredients: Diclofenac diethylammonium 1.16% w/w.
Approved Indications: For short term (up to 2 weeks) local symptomatic treatment of the following musculoskeletal inflammatory
conditions; acute soft-tissue injuries, including sprains, strains, tendinitis and sports injuries and localised forms of soft tissue
rheumatism including tendinitis and bursitis.
Contraindications: Known hypersensitivity to any ingredient. Patients whom attacks of asthma, urticaria, or acute rhinitis are precipitated
by aspirin or other NSAIDs. Last trimester of pregnancy.
Precautions: Only apply to intact and healthy skin, avoid eyes and mucous membranes. Not to be taken by mouth. Should not be used with occlusive dressing. Pregnancy or
breastfeeding. Patients with a history of or active gastro-intestinal ulceration or bleeding, or severe renal impairment. The likelihood of systemic side effects occurring
following topical diclofenac is small compared with oral diclofenac. However, the possibility of systemic side effects cannot be excluded, particularly when applied to
relatively large areas of skin or for periods longer than 3 weeks. Do not give to children under 12 years of age.
Adverse Effects: Rash, eczema, erythema, dermatitis, pruritus. For less common adverse reactions see pack Insert.
Directions: Adults and children ≥ 12 years: Apply to affected area up to 4 times a day. Do not use for more than 2 weeks except on medical advice
Price Band: $10 - $35 (Price varies with pack size) Subsidy Conditions: Not subsidised Medicine Classification: General Sale
Page 264 HEALTHCARE HANDBOOK 2017-2018 OTC Products

»»
Sun Care
HAMILTON SUNSCREEN
WILSON CONSUMER PRODUCTS LTD
Presentation: Lotion.
Active Ingredients: Octyl Salicylate, homosalate, butyl methoxydibenzoylmethane, octocrylene.
Approved Indications: SPF50+ very high protection sunscreen. Dry Touch formula, UVA/UVB broad spectrum and 4-hours
water-resistant.
Contraindications: None known.
Precautions: For external use only. Not to be swallowed. Avoid contact with eyes. Discontinue if signs of irritation or rash
appear. Use on children under 6 months of age on doctors’ advice.
Adverse Effects: None known.
Directions: Apply generously 20 minutes before sun exposure. Reapply every 4 hours and after swimming, heavy
perspiration, or toweling.
Price Band: $15 - $40
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
SUNSENSE SENSITIVE INVISIBLE
DOUGLAS PHARMACEUTICALS LTD
Presentation: Lotion SPF 50+, 75g and 200g.
Active Ingredients: (w/w): Zinc Oxide 15%. Contains no chemical absorbers.
Approved Indications: Protection against sunburn and sun damage for sensitive skin. For face and body. Paediatrician tested. 4-hour
water-resistant.
Contraindications: Hypersensitivity to any ingredient.
Precautions: External use only. Avoid eyes.
Adverse Effects: None known.
Directions: Apply to clean, dry skin prior to sun exposure. Reapply every 4 hours.
Price Band: $18 - $30
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
»»
Travel (Motion) Sickness
AVOMINE
SANOFI CONSUMER HEALTHCARE
Presentation: 10 tablets.
Active Ingredients: Promethazine theoclate (25 mg).
Approved Indications: Prevention and treatment of motion sickness.
Contraindications: Hypersensitivity to promethazine, patients with CNS depression or within 14 days of taking MAOIs.
Precautions: Care in asthma, respiratory disease, severe coronary artery disease, narrow angle glaucoma, epilepsy, hepatic
or renal insufficiency. Avoid during pregnancy and lactation. Avoid driving or using machinery.
Adverse Effects: Drowsiness, blurred vision, gastrointestinal upset.
Directions: Adults and children over 10 years. Prevention: 1 tablet each night at bedtime commencing on the night
before a long journey. For short journeys: 1 tablet to be taken 1 to 2 hours before the journey commences.
Treatment: 1 tablet followed by a second tablet the same evening and a third tablet on the following evening.
Price Band: $10 - $20 and over
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
PHENERGAN
SANOFI CONSUMER HEALTHCARE
Presentation: Tablet: 10mg & 25mg (50 tabs). Elixir: 100mL 5mg/5mL.
Active Ingredients: Promethazine hydrochloride.
Approved Indications: Symptomatic treatment of allergic conditions. A pre-anaesthetic for prevention and control of postoperative
nausea/vomiting, anti-emetic action and anti-secretory effect. Prevention of motion sickness.
Contraindications: Hypersensitivity to any ingredient, patients with CNS depression or within 14 days of taking MAOIs. Potential for
central, peripheral apnoea, reduced arousal in children, not suitable for under 2 years.
Precautions: Pregnancy & lactation. Care in asthma, bronchitis or bronchiectasis, severe coronary artery disease, narrow angle glaucoma,
epilepsy hepatic or renal insufficiency. Avoid driving or using machinery.
Adverse Effects: Drowsiness, headaches, nightmares, disorientation, photosensitivity, blurred vision, dry mouth.
Directions: Dosage: Allergy: Child 2-5 years: 5-15mg/day; 6-12 years: 10-25mg/day; Adults: 25-75mg up to 2-3 times per day.
Dosage: Sedative (under advice of doctor or pharmacist only; limit use to 7 days): child 2-12 years: prescription only, consult a doctor. Adults: 25-75mg. One night-time dose. Nausea and
vomiting, prevention of motion sickness (take night before journey, repeat 6-8 hours if required): 6-12 years: 10mg; Over 12 years: 25mg. For full dosage instructions, please refer
to the datasheet
Price Band: $20.00 - $25.00 Medicine Classification: Pharmacist Only
Page 265

TRAVACALM TRAVEL BAND
WILSON CONSUMER PRODUCTS LTD
Presentation: One pair of wrist bands
Active Ingredients: None
Approved Indications: Relieves nausea due to motion, pregnancy, anaesthesia and chemotherapy, drug-free, no
drowsiness
Contraindications: The travel band must be worn on the Nei-Kuan point. Use at any other location will not relieve nausea.
Precautions: If skin irritation occurs, remove band and seek advice from a medical professional. Individuals with a known
circulation problem should consult a physician before use. The button on the band can be a choking hazard if
removed.
Adverse Effects: None known
Directions: The Nei-Kuan point is located underneath your first finger in between the 2 wrist tendons. Position the button
facing inward over the Nei-Kuan point on both wrists.
Price Band: $20
Medicine Classification: General Sale
»»
Urticaria (Hives)
TELFAST 180
SANOFI CONSUMER HEALTHCARE
Presentation: Tablet: 180mg (10,30 & 50 tabs).
Active Ingredients: Fexofenadine hydrochloride
Approved Indications: For the symptomatic relief of seasonal allergic rhinitis (hay fever), itchy skin rash and urticaria (hives).
Contraindications: Hypersensitivity to any ingredient.
Precautions: Pregnancy & lactation
Adverse Effects: Occasional headache, drowsiness, nausea, fatigue and dizziness.
Directions: Adults and children over 12: one tablet daily.
Price Band: $20.00-$70.00
Medicine Classification: Pharmacy Only Medicine
TELFAST ORAL LIQUID
SANOFI CONSUMER HEALTHCARE
Presentation: Oral liquid 150ml bottle. 30mg/5ml.
Active Ingredients: Fexofenadine hydrochloride.
Approved Indications: Relief of the symptoms of seasonal allergic rhinitis (hay fever), perennial allergic rhinitis and urticaria (hives).
Contraindications: Hypersensitivity to any ingredient.
Precautions: Pregnancy & lactation.
Adverse Effects: Occasional headache, drowsiness, nausea, fatigue and dizziness.
Directions: 6-23 months for itchy skin/hives: 2.5ml twice daily as required.
2-11 year for itchy skin/hives & hay fever allergies: 5ml twice daily as required.
Price Band: $25
Medicine Classification: Pharmacy Only Medicine
»»
Vaginal Health
LACTIGEL
TE ARAI BIOFARMA
Presentation: 7 x 5g single use intravaginal gel applicators.
Active Ingredients: Lactic acid (5%), also contains thymol, glycogen.
Indications: Lactigel immediately restores vaginal pH to normal levels. The vaginal environment pH can be disrupted due to bacterial or
fungal infections, antibiotic use, post menstruation and during menopause.
Contraindications: Previous hypersensitivity to Lactigel ingredients.
Precautions: If vaginal symptoms continue see your healthcare professional.
Adverse Effects: Some people may experience minor discomfort on application that quickly subsides.
Directions: Use Clinically Proven, Non-antibiotic Lactigel for Maintenance: Insert the contents of one Lactigel single use applicator (5g)
after likely disruption to vaginal environment pH (see above), and Acute use: Insert the contents of one Lactigel single use
applicator (5g) at bedtime for 7 nights.
Price Band: $26.00-$32.00
Medicine Classification: Medical Device
Page 266 HEALTHCARE HANDBOOK 2017-2018 OTC Products

»»
Vitamins & Dietary Supplements
MACU-VISION
BLACKMORES
Presentation: Tablets 90s. Film coated.
Active Ingredients: Ascorbic acid (vitamin C) 250 mg, zinc oxide 49.8 mg (equivalent to zinc 40 mg), alpha tocopheryl acid succinate
(vitamin E) 165 mg (equivalent to 200 IU), cupric oxide 1.25 mg (equivalent to copper 1 mg).
Approved Indications: An antioxidant formula for eye health based on the AREDS research. May help to provide important nutrients to
the macular region of the eye, defend against free radical damage to the retina, including the macular region and lens of the eye
and maintain overall eye health.
Contraindications: Not recommended during pregnancy or breastfeeding. Not recommended for children under 18.
Precautions: Zinc may decrease the absorption and efficacy of some medications. If taking tetracycline or quinolone antibiotics, separate
doses by at least two hours. Contains zinc, which may be dangerous when taken in large amounts or for a long period.
Adverse Effects: May occasionally cause gastric irritation if taken without food.
Directions: Take one tablet a day with your main meal.
Price Band: 49.99
Subsidy Conditions: N/A
Medicine Classification: General Sale
»»
Warts
WARTIE WART REMOVER
WILSON CONSUMER PRODUCTS LTD
Presentation: Chemical cylinder.
Active Ingredients: Contains Dimethylether.
Approved Indications: A freezing treatment for warts and verrucas.
Contraindications: None known.
Precautions: Keep out of reach of children. Pressurised container; may burst if heated. Do not pierce or burn. Keep away from heat/sparks/
open flames/hot surfaces. No smoking. Always read the enclosed leaflet before using the product. Consult a doctor if you suffer
from poor circulation or are diabetic.
Adverse Effects: None known.
Directions: Remove the cap and place on a flat surface holding it by the collar. Firmly hold the collar between thumb and index finger,
twist the cone in a clockwise direction and firmly push down on the cone for 3 seconds until you hear a hissing sound. Wait for
2 seconds whilst the metal tip freezes. Apply frozen tip to the wart for 20 seconds or 40 seconds for a verruca.
Price Band: $20 - $30
Subsidy Conditions: Not subsidised
Medicine Classification: Pharmacy Only Medicine
»»
Weight Loss
SYNETRIM ® SLIM
GOOD HEALTH NZ PRODUCTS (DISTRIBUTED BY BRANDFOLIO)
Presentation: Capsules 60
Active Ingredients: (per capsule) standardised herbal extracts equivalent to dry: Cissus quadrangularis (Synetrim ® ) stem and leaf (phytogenic
ketosterones - 3.75mg), Camellia sinensis (Green Tea) leaf (catechins - 17.5mg), Coffea canephorea (Green Coffee Bean) seed
(chlorogenic acids - 22.5mg). Other ingredients: chromium (from yeast - high chromium) iodine (from potassium iodide).
Approved Indications: A multi-action, all-in-one formula for effective weight management. Supports six key actions: 1. Triple absorption
blocker (dietary fats, carbs and sugar) 2. Healthy fat metabolism 3. Mood balance 4. Healthy cholesterol 5. Appetite & craving
management 6. Blood sugar balance.
Contraindications: Not suitable for children and pregnant or breastfeeding women.
Precautions: Diabetics should monitor themselves as blood sugar levels may be altered (lowered). Weight management products should
be used in conjunction with a balanced diet, exercise programme and lifestyle changes. Advise taking 2 hours away from fat
soluble vitamins or healthy oils like omega-3 fish oil and evening primrose oil.
Adverse Effects: None known
Directions: Take 1 capsule, twice daily before your two largest meals.
Price Band: $25.00-$37.00 Medicine Classification: General Sale
»»
Wound Care
BETADINE ANTISEPTIC
SANOFI CONSUMER HEALTHCARE
Presentation: Ointment: 25g & 65g Tube; Liquid: 15mL & 100mL; Liquid Spray 75mL.
Active Ingredients: Povidone-iodine.
Approved Indications: Minor cuts and abrasions and the treatment and prevention of minor skin infections.
Contraindications: Hypersensitivity to povidone-iodine
Precautions: External use only. Pregnancy & lactation. May affect thyroid tests.
Adverse Effects: Skin irritation, redness.
Directions: Apply directly to the affected area, 2-3 times daily as required
Price Band: $8-$20
Medicine Classification: General Sale
Page 267

CRYSTADERM CREAM
AFT PHARMACEUTICALS LTD
Presentation: Cream: 10g, 15g, 25g tube.
Active Ingredients: Hydrogen peroxide 1% w/w.
Approved Indications: Treatment and prevention of minor skin infections such as acne, cuts, scrapes, burns or school sores.
Contraindications: Known hypersensitivity to any ingredient.
Precautions: Use under medical guidance in pregnancy and breastfeeding. Avoid contact with the eyes. Do not use in the
presence of iodine, permanganate and any other strong oxidising agents.
Adverse Effects: Mild sensation of burning may be experienced for a short time after application.
Directions: After cleansing the area, apply cream 2-3 times daily on affected area. A dry film will appear on the skin after
application, which can be washed off with water.
Price Band: $10 - $20 and over (Price varies with pack size). Available on Pharmaceutical Schedule
Subsidy Conditions: Fully subsidised (15g only)
Medicine Classification: General Sale
MICRODACYN WOUND CARE AND HYDROGEL
TE ARAI BIOFARMA
Presentation: Wound care solution: 120ml pump spray bottle. Hydrogel: 60g pump spray bottle.
Active Ingredients: Super oxidized solution. Ancillary substances: hypochlorous acid, sodium hypochlorite.
Indications: For use in irrigating, debriding and moistening acute and chronic wounds. Removes and kills microbes including bacteria,
drug resistant bacteria, fungi, viruses, spores. Enables the bodies wound healing process.
Contraindications: Previous hypersensitivity to Microdacyn
Precautions: Do not inject. For serious wounds see your healthcare professional.
Adverse Effects: Some people may experience minor discomfort on application which quickly subsides.
Directions: For acute wounds, abrasions, cuts and burns: thoroughly irrigate the area with Microdacyn wound care. Microdacyn is noncytotoxic
so will not damage healthy tissue or cells. For chronic wounds: apply a Microdacyn soaked gauze before and after
debridement to aid biofilm destruction. Microdacyn can be used at all ages and all areas of the body including the face. Repeat
Microdacyn use at every dressing change. See product information for more details.
Price Band: $18.00-$22.00
Subsidy Conditions: Microdacyn may be funded by your District Health Board, community nursing service or ACC.
Medicine Classification: Medical Device
SAVLON
RECKITT BENCKISER (NZ) LTD
Presentation: Cream, 30g, 75g.
Active Ingredients: Chlorhexidine hydrochloride 1mg/g, cetrimide 5mg/g. Also contains hydroxybenzoates and phenoxyethanol as
preservatives.
Approved Indications: Cuts, scratches, blisters, insect bites, grazes, windburn, sunburn, nappy rash, cracked and itchy skin.
Contraindications: Hypersensitivity to any ingredient.
Precautions: External use only. If swallowed, seek medical advice. Keep out of eyes and ears.
Adverse Effects: Rarely, sensitive skin reactions.
Directions: Apply as required.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
SOOV CREAM
DOUGLAS PHARMACEUTICALS LTD
Presentation: Cream, 50g tube.
Active Ingredients: Lignocaine hydrochloride 1%, cetrimide 1%, chlorhexidine gluconate 0.2%, phenoxyisopropanol 1%. Lanolin and
paraben free.
Approved Indications: Relieves pain, soothes and helps prevent infection of cuts, grazes, minor burns, scalds, sunburn. Helps relieve
itching and discomfort due to haemorrhoids.
Contraindications: Hypersensitivity to any ingredient.
Precautions: External use only. Avoid eyes.
Adverse Effects: Skin irritation.
Directions: Apply 2-4 times daily.
Price Band: Under $10
Subsidy Conditions: Not subsidised
Medicine Classification: General Sale
Page 268 HEALTHCARE HANDBOOK 2017-2018 OTC Products

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Brokerage
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We have the experience to help in your pharmacy or we can point you in the right direction.
We can help you understand how your dispensary is performing.
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Free of charge market valuation for your Pharmacy or one you are looking to purchase.
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Pay your monthly account with Amex, ask for terms and conditions.
The option to backorder so you receive the item as soon as it arrives at our warehouse.
We can source products that are not held in stock or those unusual items.
An informative blog full of useful Pharmac content and product information.
www.pharmacistsoutfront.co.nz – This is a website that encourages all to understand the issues that
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www.propharma.co.nz your first point of call for everything ProPharma. Find the latest product
updates, Pharmac updates, Career Lines, Clasifieds and Notices.
Customer Support Team
Representatives
Phone Numbers
Second Source
Our friendly, helpful national customer support team is available from 8.00am to
5.30pm on weekdays and from 8.00am till 12.00pm each Saturday.
Ph 09 915 9587 Fax 09 915 9527
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We regularly host evenings to show interns and staff our warehouse processes and discuss ways to
maximise efficiencies for your pharmacy.
We are proud to support the Auckland School of Pharmacy body, the APSA and we also welcome third
year students to visit our Auckland warehouse as part of their industry training.
We provide our independent pharmacy customers with a variety of retail training activities, held in
Auckland each quarter.
We are key sponsors of the New Zealand Self Medicating Industry events and attend all relevant
conferences.
We are proud to be key sponsors of this annual industry event.
Vantage
Vantage Gold Club
Our business division that runs the most successful retail buying and marketing programme available
to independent pharmacy customers. www.vantageclub.co.nz
Branches Located Nationwide
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2017-2018 Healthcare Handbook
Index
Page 269

Product Index
ANIME LUBRICANT 50ML------------------------------------------------- 257
ANTHISAN CREAM--------------------------------------------------------- 221
ASPEC 75MG---------------------------------------------------------------- 245
AVOMINE--------------------------------------------------------------------- 265
BECONASE ALLERGY & HAYFEVER------------------------------------- 240
BENADRYL CHESTY FORTE----------------------------------------------- 231
BENADRYL MUCUS RELIEF DOUBLE ACTION FORTE COUGH
LIQUID---------------------------------------------------------------------- 232
BENADRYL MUCUS RELIEF PLUS DECONGESTANT------------------ 232
BENADRYL PE CHESTY COUGH & NASAL CONGESTION---------- 232
BENADRYL PE DRY COUGH & NASAL CONGESTION--------------- 230
BETADINE ANTISEPTIC----------------------------------------------------- 267
BETADINE SORE THROAT GARGLE-------------------------------------- 262
BISOLVON CHESTY FORTE------------------------------------------------ 232
BLISTEX MEDICATED RELIEF---------------------------------------------- 228
BONJELA MOUTH ULCER GEL------------------------------------------- 253
BONJELA TEETHING GEL-------------------------------------------------- 222
BONNINGTON’S IRISH MOSS--------------------------------------------- 224
BONNINGTON’S IRISH MOSS--------------------------------------------- 230
BROLENE EYE DROPS------------------------------------------------------ 237
CARTIA------------------------------------------------------------------------ 245
CERUMOL-------------------------------------------------------------------- 235
COCO-SCALP---------------------------------------------------------------- 234
COCO-SCALP---------------------------------------------------------------- 234
COCO-SCALP---------------------------------------------------------------- 256
CODRAL ALL IN ONE------------------------------------------------------- 224
CODRAL ALL IN ONE------------------------------------------------------- 247
CODRAL COLD & FLU------------------------------------------------------ 224
CODRAL COLD & FLU------------------------------------------------------ 247
CODRAL COLD & FLU + COUGH---------------------------------------- 224
CODRAL COLD & FLU + COUGH---------------------------------------- 231
CODRAL COLD & FLU + COUGH---------------------------------------- 248
CODRAL DAY & NIGHT---------------------------------------------------- 225
CODRAL DAY & NIGHT---------------------------------------------------- 248
CODRAL MULTI ACTION COLD & FLU---------------------------------- 225
CODRAL MULTI ACTION COLD & FLU---------------------------------- 248
CODRAL NIGHTIME COLD & FLU---------------------------------------- 225
CODRAL NIGHTIME COLD & FLU---------------------------------------- 248
CODRAL RELIEF MAX STRENGTH 6 SIGNS COLD & FLU------------ 225
CODRAL RELIEF MAX STRENGTH 6 SIGNS COLD & FLU------------ 249
CODRAL RELIEF MAX STRENGTH COLD & FLU +
DECONGESTANT--------------------------------------------------------- 226
CODRAL RELIEF MAX STRENGTH COLD & FLU +
DECONGESTANT--------------------------------------------------------- 249
CODRAL® SORE THROAT LOZENGES ANTIBACTERIAL +
ANAESTHETIC LIME & LEMON FLAVOUR--------------------------- 263
CODRAL® SORE THROAT LOZENGES ANTIBACTERIAL HONEY
& LEMON FLAVOUR----------------------------------------------------- 262
CODRAL® SORE THROAT LOZENGES ANTIBACTERIAL
MENTHOL FLAVOUR---------------------------------------------------- 263
COLOXYL--------------------------------------------------------------------- 229
COLOXYL DROPS----------------------------------------------------------- 229
COLOXYL WITH SENNA--------------------------------------------------- 229
CRYSTADERM CREAM----------------------------------------------------- 220
CRYSTADERM CREAM----------------------------------------------------- 268
DOZILE------------------------------------------------------------------------ 260
DULCOLAX------------------------------------------------------------------- 230
DUREX EXTRA SAFE-------------------------------------------------------- 258
DUREX PERFECT GLIDE---------------------------------------------------- 257
DUREX REAL FEEL----------------------------------------------------------- 258
EAR CLEAR------------------------------------------------------------------- 236
EAR CLEAR EAR CLEANSER----------------------------------------------- 236
EASYCHECK MIDSTREAM PREGNANCY TESTS---------------------- 255
EASYCHECK OVULATION KIT-------------------------------------------- 255
FLIXONASE------------------------------------------------------------------- 239
FRADOR----------------------------------------------------------------------- 253
GASTROLYTE----------------------------------------------------------------- 235
GASTRO-SOOTHE----------------------------------------------------------- 250
GAVISCON DOUBLE STRENGTH----------------------------------------- 245
GAVISCON DOUBLE STRENGTH TABLETS----------------------------- 245
GAVISCON DUAL ACTION LIQUID-------------------------------------- 246
GAVISCON DUAL ACTION TABLETS------------------------------------ 246
GAVISCON INFANT--------------------------------------------------------- 246
GAVISCON LIQUID---------------------------------------------------------- 246
GAVISCON TABLETS-------------------------------------------------------- 247
HABITROL GUM------------------------------------------------------------- 260
HABITROL LOZENGE------------------------------------------------------- 260
HABITROL PATCH----------------------------------------------------------- 261
HAMILTON SUNSCREEN--------------------------------------------------- 265
HARMONY MENOPAUSE-------------------------------------------------- 250
HYLO-FRESH----------------------------------------------------------------- 236
KI HAY FEVER---------------------------------------------------------------- 239
LACTIGEL--------------------------------------------------------------------- 266
LAMISIL CREAM------------------------------------------------------------- 238
LAMISIL DERM GEL--------------------------------------------------------- 238
LANSINOH-------------------------------------------------------------------- 220
LANSINOH RANGE---------------------------------------------------------- 220
LEMSIP COUGH MAX MUCUS HOT DRINK--------------------------- 226
LEMSIP MAX ALL IN ONE CAPSULES----------------------------------- 226
LEMSIP MAX COLD & FLU DAY & NIGHT CAPSULES---------------- 226
LEMSIP MAX COLD & FLU DAY & NIGHT CAPSULES---------------- 249
LICE CLEAR------------------------------------------------------------------- 243
LIVOSTIN EYE DROPS------------------------------------------------------ 240
LIVOSTIN NASAL SPRAY--------------------------------------------------- 240
MACU-VISION--------------------------------------------------------------- 237
MACU-VISION--------------------------------------------------------------- 267
MAXICLEAR COLD & NASAL RELIEF------------------------------------ 227
MAXICLEAR HAYFEVER & SINUS RELIEF------------------------------- 241
MAXIGESIC------------------------------------------------------------------ 241
MAXIGESIC------------------------------------------------------------------ 251
MEDIJEL----------------------------------------------------------------------- 253
MERSYNDOL----------------------------------------------------------------- 250
MERSYNDOL----------------------------------------------------------------- 254
MICRODACYN WOUND CARE AND HYDROGEL-------------------- 268
MINTEC----------------------------------------------------------------------- 250
MOOV HEAD LICE SOLUTION-------------------------------------------- 244
MUCINEX MAXIMUM STRENGTH--------------------------------------- 233
NASPIRA---------------------------------------------------------------------- 222
NASPIRA---------------------------------------------------------------------- 227
NEUTRALICE ADVANCE LOTION----------------------------------------- 244
NEUTRALICE CONDITIONER SHAMPOO LICE EGG REMOVER---- 244
NEUTRALICE NATURAL SPRAY------------------------------------------- 244
Page 270 HEALTHCARE HANDBOOK 2017-2018 Index

NICORETTE 16HR INVISIPATCH PATCH--------------------------------- 261
NICORETTE COOLDROPS LOZENGE------------------------------------- 261
NICORETTE GUM----------------------------------------------------------- 261
NICORETTE INHALATOR--------------------------------------------------- 262
NICORETTE QUICKMIST--------------------------------------------------- 262
NUK---------------------------------------------------------------------------- 221
NUROFEN--------------------------------------------------------------------- 241
NUROFEN COLD & FLU PE------------------------------------------------ 227
NUROFEN FOR CHILDREN------------------------------------------------- 222
NUROFEN FOR CHILDREN SOFT CHEWABLE CAPSULES 7+------- 222
NUROFEN PLUS-------------------------------------------------------------- 241
NUROFEN ZAVANCE------------------------------------------------------- 242
NUROMOL------------------------------------------------------------------- 242
OPTREX EYE WASH WITH EYE BATH----------------------------------- 236
OPTREX RED EYES EYE DROPS------------------------------------------- 237
OPTREX SORE EYES-------------------------------------------------------- 237
OTRIVIN ADULT-------------------------------------------------------------- 227
OTRIVIN JUNIOR------------------------------------------------------------- 228
OTRIVIN PLUS---------------------------------------------------------------- 228
OVUPLAN 10 DAY PREGNANCY PLANNING KIT--------------------- 255
OVUPLAN SCOPE----------------------------------------------------------- 255
PALMER’S SKIN THERAPY OIL-------------------------------------------- 221
PALMER’S SKIN THERAPY OIL-------------------------------------------- 235
PAMOL ALL AGES----------------------------------------------------------- 223
PAMOL INFANT DROPS---------------------------------------------------- 223
PANADOL OPTIZORB------------------------------------------------------- 242
PANADOL OSTEO----------------------------------------------------------- 253
PANADOL RAPID------------------------------------------------------------ 242
PARACARE------------------------------------------------------------------- 243
PARACARE FOR BABIES & YOUNG CHILDREN
3 MONTHS TO 6 YEARS------------------------------------------------ 223
PARACARE FOR CHILDREN 6+ YEARS & ADULTS-------------------- 223
PHARMACY HEALTH CONGESTED COLD & COUGH--------------- 231
PHARMACY HEALTH GEES LINCTUS------------------------------------ 233
PHARMACY HEALTH STUBBORN DRY TICKLY COUGH------------- 231
PHENERGAN----------------------------------------------------------------- 220
PHENERGAN----------------------------------------------------------------- 265
PINETARSOL------------------------------------------------------------------ 234
PINETARSOL------------------------------------------------------------------ 252
PINETARSOL------------------------------------------------------------------ 257
PREGNOSIS EARLY PREGNANCY TEST DIP & READ------------------ 256
PREGNOSIS IN STREAM EARLY PREGNANCY TEST------------------ 256
PROCTOSEDYL-------------------------------------------------------------- 239
QV GENTLE WASH---------------------------------------------------------- 234
QV SKIN LOTION------------------------------------------------------------ 235
QV SKIN LOTION------------------------------------------------------------ 257
RESTORANAIL--------------------------------------------------------------- 238
SAVLON----------------------------------------------------------------------- 268
SENOKOT--------------------------------------------------------------------- 230
SOLVEASY TINEA CREAM------------------------------------------------- 238
SOOV CREAM--------------------------------------------------------------- 268
SPATONE 100% NATURAL LIQUID IRON SUPPLEMENT------------- 249
STINGOSE-------------------------------------------------------------------- 221
STREPFEN INTENSIVE HONEY & LEMON LOZENGES----------------- 263
STREPSILS PLUS ANAESTHETIC THROAT SPRAY---------------------- 263
STREPSILS PLUS LOZENGES----------------------------------------------- 264
STREPSILS SOOTHING HONEY AND LEMON LOZENGES------------ 264
STREPSILS SORE THROAT & BLOCKED NOSE------------------------- 264
SUDAFED NASAL SPRAY-------------------------------------------------- 258
SUDAFED PE NASAL DECONGESTANT--------------------------------- 259
SUDAFED PE NIGHT-------------------------------------------------------- 259
SUDAFED PE SINUS + ALLERGY & PAIN RELIEF----------------------- 259
SUDAFED PE SINUS DAY + NIGHT RELIEF------------------------------ 260
SUDAFED PE SINUS + PAIN RELIEF--------------------------------------- 259
SUNSENSE SENSITIVE INVISIBLE------------------------------------------ 265
SYNETRIM® SLIM----------------------------------------------------------- 267
Telfast 180-------------------------------------------------------------------- 266
TELFAST ORAL LIQUID----------------------------------------------------- 240
TELFAST ORAL LIQUID----------------------------------------------------- 266
TELFAST Range-------------------------------------------------------------- 239
TIGER BALM OIL------------------------------------------------------------ 251
TIGER BALM RED STRENGTH OINTMENT------------------------------ 251
TIGER BALM WHITE REGULAR STRENGTH OINTMENT------------- 251
TRAVACALM TRAVEL BAND---------------------------------------------- 266
TURMERIC 15800 COMPLEX--------------------------------------------- 256
TURMERIC EXTRA STRENGTH-------------------------------------------- 254
URAL-------------------------------------------------------------------------- 233
UROFEM (1000MG D-MANNOSE TABLETS)--------------------------- 233
VIRABAN---------------------------------------------------------------------- 229
VIRALEX®-------------------------------------------------------------------- 228
VOLTAREN EMULGEL------------------------------------------------------- 252
VOLTAREN EMULGEL------------------------------------------------------- 264
VOLTAREN OSTEO GEL 12 HOURLY------------------------------------- 254
VOLTAREN RAPID 12.5----------------------------------------------------- 243
VOLTAREN RAPID 12.5----------------------------------------------------- 252
VOLTAREN RAPID 25------------------------------------------------------- 243
VOLTAREN RAPID 25------------------------------------------------------- 252
WARTIE WART REMOVER------------------------------------------------- 267
ZANTAC----------------------------------------------------------------------- 247
ZOSTRIX----------------------------------------------------------------------- 254
ZOSTRIX HP------------------------------------------------------------------ 258
Page 271

Manufacturer’s Index
AFT Pharmaceuticals Ltd
Ph: 09 488 0232 Fx: 09 488 0234
Rumina Natural Care Ltd
Ph: 300 6280 Fx: 300 6281
Aspen Pharmacare
Ph: 09 570 1080 Fx: 09 915 9581
Sanofi Consumer Healthcare
Ph: 09 580 1810 Fx: 09 580 1811
BDM Grange Limited
Ph: 09 443 9300 Fx: 09 443 9301
Blackmores
Ph: 09 526 7430 Fx: 09 526 7459
Douglas Pharmaceuticals Ltd
Ph: 09 835 0660 Fx: 09 835 0695
Te Arai BioFarma
Ph: 0800 TE ARAI (832 724)
Email: enquiries@tearaibiofarma.com
Wilson Consumer Products Ltd
Ph: 09 379 5350 Fx: 09 379 5356
Good Health NZ Products
(Distributed by Brandfolio)
Ph: 0800 897 969 Fx: 0800 479 648
GlaxoSmithKline Consumer Healthcare
Ph: 09 367 2900 Fx: 09 367 2910
Johnson & Johnson (New Zealand) Ltd
Ph: +61 2 8260 8000 Fx: +61 2 8260 8100
Martin & Pleasance (Distributed by Brandfolio)
Ph: 0800 897 969 Fx: 0800 479 648
NeilMed Pharmaceuticals, Inc.
Ph: 08006345633 Fx: 09 5707279
Phoenix MedCare Limited
Ph: 093607592 Fx: 021338019
PSM Healthcare Ltd. t/a API Consumer Brands
Ph: 09 279 7979 Fx: 09 279 7999
Reckitt Benckiser (NZ) Ltd
Ph: 09 839 0200 Fx: 09 839 0202
Page 272 HEALTHCARE HANDBOOK 2017-2018 Index

THINK PARACETAMOL TABLETS
ARE ALL THE SAME?
PANADOL WITH
OPTIZORB®
STANDARD
PARACETAMOL
CHOOSE PANADOL WITH OPTIZORB
FOR ADVANCED ABSORPTION *
*FASTER ABSORPTION COMPARED WITH STANDARD PARACETAMOL TABLETS.
Panadol® with Optizorb® Formulation contains 500mg paracetamol per tablet/caplet. Indications and dosage: For the temporary relief of pain and fever.
Adults and children 12 years: 1 – 2 tablets/caplets every 4-6 hours (maximum 8 tablets/caplets in 24 hrs). Children 7 –12 years: ½ – 1 tablet/caplet every 4-6 hours (maximum
8 tablets/caplets in 24 hrs). Contraindications: Patients with a previous history of hypersensitivity to paracetamol or to any of the excipients; in children under 7 years.
Adverse reactions (very rare): Thrombocytopenia; anaphylaxis, cutaneous hypersensitivity reactions including skin rashes, angioedema and Stevens Johnson syndrome;
bronchospasm, especially in patients sensitive to aspirin and other NSAIDs; hepatic dysfunction.
Panadol, Optizorb and the beacon device are registered trade marks of the GSK group of companies or its licensor. Auckland, NZ. TAPS NA8960. CHANZ/CHPAN/0020/17a.

Topiramate Actavis
Topiramate 25mg, 50mg, 100mg, 200mg
Stop
Migraines
Before
They Start
FULLY FUNDED.
WITH NO SPECIAL AUTHORITY
Consider migraine prevention for patients suffering from frequent headache ≥ 2/
week; migraines that significantly interfere with daily routine, and uncommon
migraine conditions, including hemiplegic migraine, basilar migraine, migraine
with prolonged aura, and migrainous infarction.
Good clinical evidence supports the clinical efficacy of topiramate in the
treatment of migraine prevention. Within one month patients can expect:
Migraine Pain intensity decreased
Frequency of migraines decreased
Quality of life increased (1)
1. Nelles G et al. J Headache Pain 2010; 11:33-44
Topiramate Actavis (topiramate) 25, 50,100 & 200mg Tablets. Prescription Medicine. Indications: Epilepsy-adults and children 2 years plus as monotherapy in patients with newly
diagnosed epilepsy, for conversion to monotherapy in patients with epilepsy, as add-on therapy in partial onset seizures, generalised tonic-clonic seizures or seizures associated with
Lennox-Gastaut syndrome. Migraine: prophylaxis of migraine headache in adults.
Precautions: Adequate hydration required. Suicidal behaviour/ideation/attempt, nephrolithiasis, oligohydrosis, anhidrosis, hyperthermia, acute myopia, glaucoma, metabolic acidosis,
mood disturbances, depression, renal or hepatic impairments, psychiatric-behavioural disturbances, pregnancy, lactation, fetal harm, congenital malformations, oral clefts in infants.
Interactions: Digoxin, CNS depressants, oc, lithium, risperidone, hydrochlorothiazide, metformin, pioglitazone, glibenclamide, phenytoin, carbamazepine, valproic acid, agents
predisposing to nephrolithiasis, propranolol, amitryptyline, haloperidol, diltiazem, flunarizine. Dosage: Migraine: Start with 25mg/day and increase weekly to total daily dose of 100mg/
day re clinical outcome. Epilepsy: Monotherapy: Target dose of 100mg/day to maximum of 500mg/day. Add-on therapy: Target dose of 200-400mg/day with maximum of 1000mg/
day. Adverse Effects: Decreased appetite and weight loss. Consult the full data sheet at www.medsafe.govt.nz before prescribing. Actavis New Zealand Ltd, Auckland. TAPS NA 8622