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. PharmacyToday.co.nz A part of your everyday. New Zealand’s premier pharmacy website keeping you up to date between issues. www.pharmacytoday.co.nz Page 98 HEALTHCARE HANDBOOK 2017-2018 Common Disorders
CONTINUING OTC EDUCATION An ENHANCED ELearning Experience As well as your desktop, you can now access Pharmacy Today ELearning for professional development on your mobile or tablet. Easier and more flexible, this new and improved interactive platform allows you to earn your Enhance points whenever and wherever you want to. Independent, clinical education at your fingertips All pharmacist courses ENHANCE accredited New education modules available monthly FREE to our subscribers Visit www.pharmacytoday.co.nz and click on the ELearning tab. Page 99
According to Stéphane Rossini, incoming Chairman of the Agency Council, the culture of collaboration will remain a factor in ensuring that Switzerland is successful in retaining a high-quality medicines control system: “A globalised economy and the international consumption of therapeutic products entail synergies and collaboration.”
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