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Lack of OTC anti-emetics?

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  • Lack of OTC anti-emetics?

    Recently my mum had a vomiting bug which was causing her to throw up every hour, I went to the pharmacy and all they could offer was the neuroleptic Prochlorperazine. This to me seems absurd, there are so many anti-emetics which are safer and equally effective such as Ondansetron and Domperidone, why are these drugs not available without a prescription yet a neuroleptic which causes extrapyramidal side effects and potentially tardive dyskinesia, neuroleptic malignant syndrome and torsades de points is freely available? The situation seems mental, and what is the point of studying pharmacy for 4 years if a pharmacist is prohibited from selling a simple anti-emetic drug for a common illness?

    Yes it's a bit of a rant, but how has the UK come to this? *sigh*

  • #2
    Domperidone : risk of cardiac side effects https://www.gov.uk/drug-safety-updat...c-side-effects
    Ondansetron : not without its own cardiac and serotonin syndrome risks. Only licenced for chemo/radio induced vomiting too.

    Was in a similar situation; pharmacy did not have the generic OTC prochlorperazine and would not sell Buccastem M due to licence restriction of vomiting with migraine.

    What we need is someone that makes the rules to try and get help for the condition that your mum had.
    Expect a rule change very quickly.
    47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
    2018 AD : Modern Man : I shopped, I clicked, I collected.
    How times change.

    If you find you have read something that has upset or offended you an anyway please unread it at once.

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    • #3
      My wife suffers from bouts of sickness and nausea. We have used a Kwells under the tongue which works in about ten minutes for over 60 years. I use it when go to the dentist to reduce saliva. In the very old times, Belladonna Tincture was used in stomach mixtures, eg Mist Mag Trisil and Belladonna. For long acting centrally active antiemetic now use Cinnarizine (Stugeron). On a cruise we take a 75mg (available in Spain) before crossing Bay of Biscay. It was Kwells that was used on D day for the troops. No sedative effects. If you can't get Kwells, then Buscopan. All about the Vagus nerve.
      johnep

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      • #4
        Originally posted by Pharmanaut View Post
        Domperidone : risk of cardiac side effects https://www.gov.uk/drug-safety-updat...c-side-effects
        Ondansetron : not without its own cardiac and serotonin syndrome risks. Only licenced for chemo/radio induced vomiting too.

        Was in a similar situation; pharmacy did not have the generic OTC prochlorperazine and would not sell Buccastem M due to licence restriction of vomiting with migraine.

        What we need is someone that makes the rules to try and get help for the condition that your mum had.
        Expect a rule change very quickly.
        The risk of cardiac side effects for the otc dose of 10mg was very small and compared to typical neuroleptics (which are known for their cardiac side effects) domperidone has a more favourable safety profile so the current rules aren't following the empirical data. At the end of the day you have to put things in perspective and look at the risk of the drug vs the morbidity of the condition, severe vomiting outside a hospital environment is a real risk for dehydration and electrolyte imbalance and needs to be treated aggressively to prevent potentially serious harm to the patient.

        The risk of harm for the drugs we are talking about is like being hit by a bus when crossing the street, something that you need to be cautious of but accept that it's a necessary risk to have a normal life.

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        • #5
          Problem is that the lawyers advise the patients to go after the pharmacist instead of the medics.
          Or at least that's what it was a few years ago.

          Even if you are right you still get put through the wringer, at work and by the regulator.
          Is it worth it?
          47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
          2018 AD : Modern Man : I shopped, I clicked, I collected.
          How times change.

          If you find you have read something that has upset or offended you an anyway please unread it at once.

          Comment


          • #6
            I have always used Kwells without any problems. Used to use Avomine but when could not get any gradually changed to Stugeron. So if you are feeling queasy, then fast acting locally active Atropine, for longer term centrally acting then Cinnarizine. We were going round Chatsworth when suddenly I felt sick and started looking for suitable vases etc. (no toilets in the main building), A Kwells (always carried by my wife) under my tongue stopped the sensation.
            johnep

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            • #7
              Originally posted by Pharmanaut View Post
              Problem is that the lawyers advise the patients to go after the pharmacist instead of the medics.
              Or at least that's what it was a few years ago.

              Even if you are right you still get put through the wringer, at work and by the regulator.
              Is it worth it?
              This is probably why I didn't pursue pharmacy as a career, pharmacology is very interesting, but being relegated to sticking labels on boxes ala community pharmacy, just has no appeal to me.

              Pharmacists should be recognised as medical professionals who can prescribe these other anti emetic drugs in limited circumstances, instead it is very much a "computer says no" scenario in the UK these days.

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              • #8
                Originally posted by Energize View Post

                This is probably why I didn't pursue pharmacy as a career, pharmacology is very interesting, but being relegated to sticking labels on boxes ala community pharmacy, just has no appeal to me.

                Pharmacists should be recognised as medical professionals who can prescribe these other anti emetic drugs in limited circumstances, instead it is very much a "computer says no" scenario in the UK these days.
                Not the sort of thing most of us signed up for but that's the reality of things.
                Everything done by the SOP.
                47 BC : Julius Cesar : Veni Vidi Vici : I came, I saw I conquered.
                2018 AD : Modern Man : I shopped, I clicked, I collected.
                How times change.

                If you find you have read something that has upset or offended you an anyway please unread it at once.

                Comment


                • #9
                  Something that I have realised is that many pharmacists don't appear to be aware that cyclizine is actually a P medicine. We don't tend to advertise it or recommend it much due to it's misuse potential. With regards to your statement, I do agree that there is a limited option list, but I will say that when it comes to N&V, the lists of medicines is limited anyway, whether POM or P. There is actually still a decent list of options available in pharmacy for N&V. But many of these medicines are not licensed for general N&V but rather for specific reasons i.e motion sickness, migraine etc. Clinically you could use many of them for general causes but you will be doing so off license.

                  I personally rarely recommend medicines for vomiting, unless it's associated with specific known causes i.e migraine. If the causes of their vomiting is unknown and mild, I just recommend diarolyte (or similar) sachets. But if their symptoms are moderate or they've been vomiting for more than a day, I'll refer to GP. If they have severe symptoms or signs of dehydration, I'll refer to hospital.

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