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Issue link: http://pharmacytimes.epubxp.com/i/614520
cal professional, but whose duration of treatment was determined by a medical professional. Now, however, the decision to initiate treatment and continue treatment has been transferred from the doctor to the patient, which could lead to overuse and misuse. With this, comes the change for potential risks associated with certain drug–drug interactions and long-term use. If PPIs are used for a prolonged period, patients are at an increased risk for fractures, car- diac events, iron deficiency, Clostridium difficile infection, and pneumonia. 10 In addition, study results show an increased risk of reinfarction in patients taking a PPI, especially those found over the counter, and Plavix (clopidogrel). This potential drug-drug interaction may go unrecognized if patients self-treat. 10 Implications of Nasacort, Flonase, Rhinocort Nasal Sprays on Health Care Having these nasal sprays available on OTC shelves provides a treatment option for patients who have high blood pres- sure and require treatment for nasal con- gestion. In the past, this population did not have any OTC treatment options because decongestants are not recom- mended in this population. Increasing accessibility to steroid nasal sprays can become problematic, especially if patients continue to self- medicate without professional guidance and if they are not aware of the possible AEs. The use of steroid nasal sprays can lead to several serious AEs, such as an increased risk for infection, adre- nal insufficiency, and eye problems that include glaucoma and cataracts. They can also lead to a lower growth rate among children using these sprays for prolonged periods of time without pro- fessional guidance. Parents should advise their children to use these nasal sprays for the shortest amount of time necessary to achieve symptom relief and to regu- larly check (or get checked) their child's growth while using these types of sprays. For a prescription medication to be eligible to make the switch to an OTC medication, several requirements need to be met 11,12 : • The OTC indication must be similar to the prescription indication • Patients can easily self-diagnose • Patients can identify their symptoms and self-medicate appropriately based on their symptoms without professional guidance • The medication does not require labora- tory monitoring for safety and efficacy • The FDA looks at the potential for harm if taken as directed by the drug label and also considers the potential for harm if the medication is misused. 11 Knowing what is considered for the switch, what are your thoughts on the classes of medications that may be mak- ing the switch in the near future? These include treatments for 13 : • Benign prostatic hypertrophy • Cholesterol • Hormone replacement • Sexual dysfunction/erectile dysfunction For a list of medications available over the counter in other countries, refer to Table 2. n For references, go to Pharmacy- Times.com/publications/issue. MORE @ PHARMACY TIMES.COM Anyssa Garza received her doctor of pharmacy degree from the University of Texas at Austin. She was later recognized for her contributions to research in the area of alcohol dependence. She went on to act as director of pharmacy for a Central Texas Department of Aging and Disability facility where she provided care for underserved patients for several years. TABLE 2: MEDICATIONS AVAILABLE OVER THE COUNTER OUTSIDE THE UNITED STATES Medication Countries Additional Information Simvastatin United Kingdom Maximum strength: 10 mg Maximum daily dose: 10 mg Lovastatin Canada Maximum daily dose: 1 mg Tamsulosin United Kingdom Maximum strength: 400 mcg Maximum daily dose: 400 mcg Zolmitriptan New Zealand, Sweden New Zealand: pharmacist-only status in a prefilled nasal spray device delivering no more than 5 mg of zolmitriptan Fluconazole (oral) Canada, Finland, Mexico, New Zealand, Norway, United Kingdom 150 mg of oral fluconazole in the treatment of vaginal can- didiasis; may be pharmacist-only status depending on the country Itraconazole South Korea Trimethoprim New Zealand For oral use containing <300 mg /dose; indicated to treat an uncomplicated UTI in women aged 16-65 years; pharmacist must have successfully completed the New Zealand College of Pharmacists' training in the treatment of UTIs. Diclofenac Argentina, Australia, China, Czech Republic, Estonia, Germany, Greece, Hungary, Italy, Mexico, New Zealand, Norway, Poland, Portugal, Slovak Republic, South Korea, Spain, Sweden, Switzerland, The Netherlands, Venezuela Estriol (vaginal) Denmark, Finland, Hungary, Norway, Sweden UTI = urinary tract infection. Adapted from reference 14. 40 PharmacyTimes.com December 2015 | page 33