OTC Analgesics Research Articles

Impact of pharmacists’ training on the knowledge of pain and associated risks: results of the OPTYMED 2 study

The use of OTC analgesics is common worldwide, and the importance of the pharmacy teams is growing. Pharmacist-led medication implies that the pharmacy staff should have the necessary knowledge to deliver appropriate drugs, prevent an inappropriate drug consumption, and identify the patients in need of a medical advice. A randomized controlled study to assess the impact of training on pain knowledge and associated situations at risk among the French pharmacists and dispensers was performed. Participants were randomized into two groups receiving (n = 97) or not (n = 93) a training in the e-learning format. The training consisted of the 4 modules including the general knowledge of pain, headaches, acute musculoskeletal and chronic pain. The training modules were accompanied by the summary leaflets. The success rates were significantly higher in the trained group, with 35 % of participants reaching at least 70 % (primary endpoint) versus 2.3 % in the non-trained group. The results were not influenced by the size of the pharmacy. The knowledge improvement was more pronounced for the modules on the general knowledge of pain and headache management. For the questions associated to the risk situations, the success rates of at least 70 % were also significantly higher in the trained group The highest difference in success rates after the training was observed for the use of nonsteroidal antiinflammatory drugs during pregnancy and breastfeeding. Very low rates were obtained in both groups for the secondary headaches and the analgesic treatment adjustment in particular cases, such as chronic alcoholism or low weight. Results of this pilot study show that a training focused on pain could improve the overall knowledge of pain and suggest that it may contribute to a better pain identification, management and referral to physicians of patients at risk by the pharmacy staff in routine practice. The benefits of such a training should be assessed in a long-term prospective study, and the impact of a similar training in real-life practice remains to be evaluated.

What a pain in the … back: a review of current treatment options with a focus on naproxen sodium.

Non-specific low back pain (LBP) represents a challenging and prevalent condition that is one of the most common symptoms leading to primary care physician visits. While established guidelines recommend prioritizing non-pharmacological approaches as the primary course of action, pharmacological treatments are advised when non-pharmacological approaches are ineffective or based on patient preference. These guidelines recommend non-steroidal anti-inflammatory drugs (NSAIDs) or skeletal muscle relaxers (SMRs) as the first-line pharmacological options for acute or subacute LBP, while NSAIDs are the exclusive first-line pharmacological option for chronic LBP. Although SMRs are generally effective for acute LBP, the available evidence does not support the view that they improve functional recovery, and their comparative efficacy to NSAIDs and other analgesics remains unknown, while studies have shown them to introduce adverse events without significantly reducing LBP. Moreover, opioids continue to be widely prescribed for LBP, despite limited evidence for effectiveness and known risks of addiction and overdose. Broader use of non-opioid pharmacotherapy, including the appropriate use of OTC options, is critical to addressing the opioid crisis. The balance of evidence indicates that NSAIDs have a favorable benefit-risk profile when compared to other available pharmacological treatment options for non-specific LBP, a condition that is primarily acute in nature and well-suited for self-treatment with OTC analgesics. While clinical guidelines do not differentiate between NSAIDs, evidence indicates that OTC naproxen sodium effectively relieves pain across multiple types of pain models, and furthermore, the 14-h half-life of naproxen sodium allows sustained, all day pain relief with reduced patient pill burden as compared to shorter acting options. Choosing the most appropriate approach for managing LBP, including non-pharmacological options, should be based on the patient's condition, severity of pain, potential risks, and individual patient preference and needs.

Hemp Dispensaries in NC Promote CBD to Treat Pain and Offer low-CBD/high Price Products

Demand for products containing cannabidiol (CBD), a non-intoxicating hemp/cannabis derived compound for the treatment of pain is growing as states legalize medicinal cannabis programs. Currently, only one prescription medication containing CBD is approved by the FDA; Epidiolex, which is used to treat resistant seizures syndromes in children. The FDA has deemed it illegal for companies to make any other medical/therapeutic or health claims about CBD products. Some states, such as North Carolina, have legalized CBD using compassionate programs to promote the access to CBD for patients with these epileptic syndromes. The goal of our study was to determine whether the CBD program in NC complies with FDA advertisement requirements, or these compounds are illegally advertised to treat pain. We also investigated whether the CBD program in NC provides an economic advantage over other pain medication or Epidiolex. We selected the 10 most populated cities of NC and randomly chose 3 hemp/CBD shops (dispensaries) from each city. We collected online information of products from the dispensary websites. Our results show that four types of products are equally present: edible, oral, inhalable, and topical. A word analysis of product description revealed that "pain relief" was the most common medical claim, and epilepsy or seizures were absent. Health claims were mostly related to skin and general wellbeing. The total CBD content of the majority of products was less than 500 mg. The average price for 300 mg of CBD in any type of product is $25, and there was a positive correlation between CBD content and price. We conclude that the NC CBD dispensaries do not comply with FDA requirements or the NC Epilepsy Alternative Treatment Act and heavily promote CBD for the treatment of pain. NC CBD products contain non-clinically meaningful CBD concentrations and higher prices than OTC analgesics or Epidiolex. Grant support from Pilot Award WFU Center for Research on Substance Use and Addiction.

Attitudes towards limited drug prescription rights: A survey of South African chiropractors.

BackgroundSeveral surveys that have been published show opinions regarding a change in the scope of chiropractic practice to include prescription rights. Currently, research into the attitudes of South African chiropractors towards having this right is non-existent.AimTo ascertain the attitudes of South African chiropractors towards the inclusion of drug prescription rights in their scope of practice.SettingThe study was conducted on chiropractors registered with the Allied Health Professions Council of South Africa and members of the Chiropractic Association of South Africa.MethodA self-administrative online questionnaire was developed, and sent via email to all registered chiropractors in South Africa in February 2020. Descriptive statistics were used to analyse the data.ResultsThe response rate for this study was 15.9% (n = 138). 84% (n =105) were in favour of limited prescription rights for over-the-counter medication. However, 79.6% (n = 98) did not agree to full prescriptions rights for non-musculoskeletal drugs. A total of 33.6% (n = 42) rarely recommended OTC and prescription-based analgesics, muscle relaxants and non-steroidal anti-inflammatory drugs (NSAIDs) to their acute patients and 37.9% (n = 52) rarely recommended these drugs to chronic patients. 68.8% (n = 86) were confident in their knowledge of musculoskeletal drugs and 91.2% (n = 112) agreed on further education and training in pharmacology for those practitioners seeking limited medication prescription rights.Conclusion The majority of South African chiropractor respondents indicated an interest in expanding their scope of practice to include limited prescription rights.ContributionThese findings could indicate a shift in the attitudes of chiropractors towards drug prescription rights within the profession.

Ібупрофен як жарознижувальний та знеболювальний препарат у педіатричній практиці (літературний огляд)

Ibuprofen, along with paracetamol, is the drug of choice for lowering fever and pain relief in children; it is a drug sold without a prescription in most countries of the world, in particular in Ukraine, and can be taken by patients at home without prior doctor's examination. It is clear that such an application implies significant advantages over potential risks. In particular, an important condition for «home» use of drugs is the speed of action, the absence of severe side effects, low toxicity, good compatibility with other drugs and a wide therapeutic applicability. Ibuprofen meets these basic requirements, and therefore belongs to the most commonly used molecules in pediatric practice. The question of home use of drugs based on this molecule by parents to lower the temperature in children with acute respiratory diseases remains controversial, because there is an opinion regarding the negative effect of lowering the temperature on the patient's immune response. At the beginning of the COVID-19 pandemic, the question was generally raised about the negative effect of lowering the temperature with ibuprofen on the prognosis of the disease, caused by the Sars-Cov-2 virus. It is the issues of assessing the benefit-risk ratio for the ibuprofen molecule that this literature review is devoted to. Long-term widespread use experience, numerous studies, systematic reviews and meta-analyzes prove the safety, efficacy and good tolerability of Ibuprofen compared to other medications, including OTC analgesics. Current research suggests that its use may go beyond the usual management of pain and fever in common clinical situations in children. Ibuprofen is not only safe for children at standard dosages, but it is also much safer during accidental or deliberate overdose compared to other analgesics that can lead to fatal consequences if misused. Thus, the overall benefit-risk ratio for the use of Ibuprofen to control pain and fever in children remains positive. The author declares no conflicts of interest. Key words: children, antipyretic drugs, analgesics, efficacy, safety, Ibuprofen.

606 Incidence & Influence of Drug Screening in Children with Hypersomnolence During MSLT: Analysis of the Children’s Wisconsin Cohort

Abstract Introduction The Multiple Sleep Latency Test (MSLT) is a validated test for evaluation of hypersomnolence in children and adults. AASM practice parameters recommend performing urine drug screens (UDS) in patients undergoing MSLT to identify substances that alter MSLT results. The study aims are to determine the incidence of positive UDS and their influence on MSLT variables in a cohort of children evaluated for hypersomnolence. Methods All children undergoing an MSLT in Children’s Wisconsin sleep laboratory over an 8-year period (11/1/2012 to 9/30/2020) were included in this retrospective chart review study. Clinical and demographic data, including UDS results were manually abstracted. Record validation conducted by random allocation. Data were summarized as median and IQR or n (%). Chi-square test or Fisher’s exact test were used to examine associations between categorical variables. Results 236 children completed an MSLT. The sample had a median age of 14.1 (IQR 10.5–16.2) years (50.9% female; 63.1% Caucasian). Narcolepsy I (“N1”; n=14; 5.9%), Narcolepsy II (“N2”; n=56; 23.7%), Idiopathic Hypersomnia (“IH”; n=39; 16.5%) were frequently diagnosed. Most children (97.9%) completed a UDS; 60.2% tested positive. Common substances found on UDS were caffeine (62.6%), OTC medications (40.3%), and prescription medications (33.8%), however nicotine (14.3%) and cannabis (5.8%) were also seen. Caffeine was commonly found in those diagnosed with N1 (70%), N2 (69.4%), and IH (54.2%). Fewer children diagnosed with narcolepsy were positive for prescription medications compared to those diagnosed with IH (21.7% versus 41.7%) although results did not reach significance (p=0.08). No child with N1 tested positive for prescription medications. ≥2 substances were found in 43.2% of positive drug screens. OTC medications and caffeine were most commonly co-occurring (23%); OTC analgesics being the most common OTC medication. No association between positivity for >2 substances and sleep diagnosis was found (p=0.5). Conclusion More than half of children undergoing an MSLT had a positive UDS for >1 substance. The impact of these substances on PSG/MSLT parameters (total sleep time, mean sleep onset latency, sleep onset REM periods) is under investigation through additional analysis. Based on the above data our findings support the AASM guidelines of children obtaining a UDS on the day of MSLT. Support (if any):

Sex differences in the consumption of over-the-counter analgesics among amateur volleyball players

BackgroundCompared with the normal adult population, athletes of several sport disciplines, such as endurance sports, ball sports, cycling and swimming, have higher use of over-the-counter analgesics (OTC analgesics). The aim of this study was to describe the epidemiology of OTC analgesic use in volleyball players as a typical competitive sport discipline. One particular focus was placed on the analysis whether the athletes’ use of OTC analgesics was influenced by their performance motivation.MethodsA cross-sectional survey among amateur volleyball players was carried out using a web-based sports questionnaire. The study included athletes of both sexes, 18 years and older, currently playing in a German volleyball league. The athletes’ sport-related complaints were evaluated regarding the use of OTC analgesics. The use of OTC analgesics by athletes was compared with their performance motivation, based on the „Achievement Motives Scale - Sport” (AMS-Sport) questionnaire.ResultsThe analysis of 114 completed questionnaires of amateur athletes revealed that the use of OTC analgesics was sex dependent, with a higher prevalence of use in female players (60%) versus male players (38%). The main reasons for consumption of OTC analgesics were pain in the head, knee and shoulder. The most frequently taken drug was ibuprofen, most often taken at competitions and over a period of 4 years (median). The analysis of the AMS-Sport questionnaire revealed that a logistic regression model for estimating the probability of drug use can be explained by the factors hope of success and years of playing practise in female players but not male players. In females, an increase in the factor hope of success resulted in a lower probability of OTC analgesic use, while an increase in years of playing practise resulted in a higher probability of use.ConclusionThe average duration that volleyball players in this study took OTC analgesics was higher than that of the German population, and OTC analgesic use was more prevalent in female than male volleyball players. Thus, to reduce the prevalence of OTC analgesic use, educational programs should be implemented in sports teams; and, to reduce direct and indirect social pressure, sports teams should also receive sex-specific psychological support.

USA suicide-related exposure to OTC analgesics

USA suicide-related exposure to OTC analgesics

Suicide attempts by self-poisoning in the United States among 10–25 year olds from 2000 to 2018: substances used, temporal changes and demographics

Objective: To evaluate the substances used, outcomes, temporal and demographics associated with suicide attempts by self-poisoning in children and young adults aged 10–25 years old from 2000 to 2018.Methods: This is a retrospective review of suspected-suicide self-poisoning cases reported to the National Poison Data System (NPDS) from US Poison Centers from 2000 to 2018 for patients 10–25 years old. For comparison of annual rates, we obtained population data by year of age from the US Census Bureau. We evaluated changes in: monthly and annual incidence/rate per 100,000 population, substances used and outcome by patient age and demographics.Results: There were 1,677,435 cases of suicide attempt by self-poisoning among individuals 10–25 years old reported to US PCCs from 2000 to 2018. There were 410,940 self-poisoning cases (24.5%) with a serious medical outcome, and the proportion of exposures that resulted in a serious medical outcome increased with increasing age group. For the age groups of 10–12, 13–15 and 16–18 years of age, there was a significant increase after 2011, which was influenced primarily by females. The substance groups with the greatest number of serious medical outcomes were OTC analgesics, antidepressants, antihistamines and antipsychotics. ADHD medications were common in the younger age groups of 10–15 years, while the sedative/hypnotics occurred more commonly in the older age groups. The groups with the greatest increase in serious medical outcomes after 2011 were antidepressants, OTC analgesics, antihistamines and ADHD medications. Opiates were less commonly involved (7.4%) in cases with serious medical outcomes and decreased significantly in the 19–25 year-old age groups after 2012. States with a lower population per square mile had a greater number of reported cases with serious medical outcomes. There was a significant decrease in the number of cases in the age groups of 10–18 years during the traditional non-school months of June–August compared with September–May. This seasonal trend occurred among cases with all outcomes and among cases with serious medical outcomes. This decrease did not occur in the age group of 19–21 years, and there was an increase during summer months in the age group 22–25 years.Conclusions: The substances used during self-poisoning varies by age group but appears to include substances available to that age group, with a significant increase after 2011, increased rates in more rural states, and a seasonal variation of increased rates during school months among adolescents but not among young adults. Two of the top substances, OTC analgesics and antihistamines, in all age groups, comprising more than a third of all substances used, are widely available over-the-counter with no restrictions regarding access. Of additional concern, ADHD medications had the highest risk of a serious medical outcome.

Pharmacists should do more to help patients with OTC analgesics, experts say

Pharmacists should do more to help patients with OTC analgesics, experts say

Uncomfortable Uncertainty: Do OTC Analgesics Disrupt Fetal Germ Cell Development?

Uncomfortable Uncertainty: Do OTC Analgesics Disrupt Fetal Germ Cell Development?

Prevalence and Determinants of Over-the-Counter Analgesics Usage among Patients attending Primary Health Care Centers in Jeddah, Saudi Arabia

Objective: To estimate the prevalence and describe the pattern of OTC use among patients attending primary healthcare (PHC) centers, and to assess their knowledge and attitude regarding the related side effects. Method: A cross-sectional study was carried out among 400 adult patients attending the General Medicine clinic in 10 selected PHC centers in Jeddah, Saudi Arabia. The data collected included socioeconomic parameters, practice and pattern of OTC analgesics use in past 6 months, knowledge and attitude about OTC analgesics, and safety assessment. Results: Results showed that 84.4% of the participants were using OTC analgesics, at least twice per week in 59.3% of the cases, and for Key words: Analgesics, Auto medication, Non-steroid anti-inflammatory, Over-the-counter, Painkiller, Paracetamol.

Could Codeine Containing OTC Analgesics Sold in Romania be Used as Recreational Drugs?

Abstract Objective: Analgesic medicines containing combinations of nonsteroidal anti-inflammatory drugs and codeine are available without prescription. Codeine, in these combinations can not be used recreationally due to the high toxicity profile of the nonsteroidal anti-inflammatory drugs. However, methods for extracting codeine from these types of medication are available on the internet. The purpose of this work is to evaluate if codeine can be extracted from codeine containing analgesics sold without prescription. Methods: High Performance Liquid Chromatography (HPLC) with UV detection was used to measure the amounts of codeine and nonsteroidal anti-inflammatory drugs recovered after applying an extraction method described on the internet. Results: The results show that codeine can be very easily separated from NSAID as aspirin, acetaminophen, ibuprofen using the cold water extraction method. However, very large differences (20 to 90%) were recorded for the recovery of codeine depending on the OTC product that was used. That large difference increases the risk of potentially lethal overdoses when the user switches between “similar” products. Conclusions: Our work shows that analgesic medication with codeine content can be recreationally used after the extraction of codeine. In order to prevent this, the sell of this type of products should be regulated or products that do not allow the extraction of codeine should be developed.

Life after bariatric surgery: Use of OTC analgesics

O is estimated to affect more than 36% of adults and 17% of youth in the United States.1 For individuals with severe or morbid obesity, bariatric surgical interventions offer substantial and sustainable reductions in weight and incidence of obesity-related comorbidities and may improve quality of life.2 Of the four main bariatric surgical procedures, the combination restrictive–malabsorptive Roux-en-Y gastric bypass (RYGB) is most common, accounting for an estimated 34.2% of procedures in 2013.3,4

DTB Select: 1 | January 2016

New contraindication for ▼mirabegron ● Naloxone: new regulations for emergency use ● OTC analgesics for acute pain ● Interventions have lasting effect on preventing or delaying diabetes ● EMA: no...

Non-prescription (OTC) oral analgesics for acute pain - an overview of Cochrane reviews.

Non-prescription (over-the-counter, or OTC) analgesics (painkillers) are used frequently. They are available in various brands, package sizes, formulations, and dose. They can be used for a range of different types of pain, but this overview reports on how well they work for acute pain (pain of short duration, usually with rapid onset). Thirty-nine Cochrane reviews of randomised trials have examined the analgesic efficacy of individual drug interventions in acute postoperative pain. To examine published Cochrane reviews for information about the efficacy of pain medicines available without prescription using data from acute postoperative pain. We identified OTC analgesics available in the UK, Australia, Canada, and the USA by examining online pharmacy websites. We also included some analgesics (diclofenac potassium, dexketoprofen, dipyrone) of importance in parts of the world, but not currently available in these jurisdictions.We identified systematic reviews by searching the Cochrane Database of Systematic Reviews (CDSR) on The Cochrane Library through a simple search strategy. All reviews were overseen by a single review group, had a standard title, and had as their primary outcome numbers of participants with at least 50% pain relief over four to six hours compared with placebo. From individual reviews we extracted the number needed to treat for an additional beneficial outcome (NNT) for this outcome for each drug/dose combination, and also calculated the success rate to achieve at least 50% of maximum pain relief. We also examined the number of participants experiencing any adverse event, and whether the incidence was different from placebo. We found information on 21 different OTC analgesic drugs, doses, and formulations, using information from 10 Cochrane reviews, supplemented by information from one non-Cochrane review with additional information on ibuprofen formulations (high quality evidence). The lowest (best) NNT values were for combinations of ibuprofen plus paracetamol, with NNT values below 2. Analgesics with values close to 2 included fast acting formulations of ibuprofen 200 mg and 400 mg, ibuprofen 200 mg plus caffeine 100 mg, and diclofenac potassium 50 mg. Combinations of ibuprofen plus paracetamol had success rates of almost 70%, with dipyrone 500 mg, fast acting ibuprofen formulations 200 mg and 400 mg, ibuprofen 200 mg plus caffeine 100 mg, and diclofenac potassium 50 mg having success rates above 50%. Paracetamol and aspirin at various doses had NNT values of 3 or above, and success rates of 11% to 43%. We found no information on many of the commonly available low dose codeine combinations.The proportion of participants experiencing an adverse event were generally not different from placebo, except for aspirin 1000 mg and (barely) ibuprofen 200 mg plus caffeine 100 mg. For ibuprofen plus paracetamol, adverse event rates were lower than with placebo. There is a body of reliable evidence about the efficacy of some of the most commonly available drugs and doses widely available without prescription. The postoperative pain model is predominantly pain after third molar extraction, which is used as the industry model for everyday pain. The proportion of people with acute pain who get good pain relief with any of them ranges from around 70% at best to less than 20% at worst; low doses of some drugs in fast acting formulations were among the best. Adverse events were generally no different from placebo. Consumers can make an informed choice based on this knowledge, together with availability and price. Headache and migraine were not included in this overview.

Push-Me Pull-You: Comparative Advertising in the OTC Analgesics Industry

We model comparative advertising as brands pushing up own brand perception and pulling down the brand image of targeted rivals. We watched all TV advertisements for OTC analgesics 2001-2005 to construct matrices of rival targeting and estimate the structural model. These attack matrices identify diversion ratios and hence comparative advertising damage measures. We find that outgoing comparative advertising attacks are half as powerful as self-promotion in raising own perceived quality and cause more damage to the targeted rival than benefit to the advertiser. Comparative advertising causes most damage through the pull-down effect and has substantial benefits to other rivals.

THE IMPACT OF TELEVISION ADVERTISING OF MEDICINAL PRODUCTS ON OTC PAINKILLERS PURCHASE IN POLAND

Introduction: Drug manufacturers take a variety of activities to meet the needs of their potential customers. One of the most important elements of drug promotion is advertising. The aim of the study was to point out the relationship between television advertising and purchasing decisions on OTC analgesics among students of Warsaw Medical University. Material and method: The research tool was an anonymous survey. The research was conducted via the Internet. Results: The results showed that television advertising of medicinal products has a significant impact on purchasing decisions among students of Warsaw Medical University. However, students most often suggest the efficacy of the drug while making the decision about purchasing of medicinal product (46.55%). Respondents indicated that the advertising is the most authentic, when the drug is recommended by a doctor. From among all OTC painkillers, students bought mainly headache tablets (90%) and the least often products for bones and joints ache (59.47%). Conclusions: Television advertising is an important promotional tool and a starting point in terms of the impact on potential buyers of drugs. The study shows that television advertising has a significant impact also on the purchase decisions of students. The survey results also indicate that painkillers are one of the most popular categories of medicinal products available without a prescription, which confirms the information published in many reports from the pharmaceutical market, indicating that the consumption of painkillers constantly remains at a high level.

Gebrauch und potenzielle Risiken durch nicht verschreibungspflichtige Schmerzmittel

We investigated the use of prescription and non-prescription (over-the-counter, OTC) analgesics and the associated risks in elderly patients with multiple morbidities. Pain medication use was evaluated from the baseline data (2008/2009) of the MultiCare cohort enrolling elderly patients with multiple morbidities who were treated by primary care physicians (trial registration: ISRCTN89818205). We considered opioids (N02A), other analgesics, and antipyretics (N02B) as well as nonsteroidal anti-inflammatory drugs (NSAIDs; M01A). OTC use, duplicate prescription, dosages, and interactions were examined for acetylsalicylic acid, diclofenac, (dex)ibuprofen, naproxen, and acetaminophen. Of 3,189 patients with multiple morbidities aged 65-85 years, 1,170 patients reported to have taken at least one prescription or non-prescription analgesic within the last 3 months (36.7 %). Of these, 289 patients (24.7 % of 1,170) took at least one OTC analgesic. Duplicate prescription was observed in 86 cases; 15 of these cases took the analgesics regularly. In two cases, the maximum daily dose of diclofenac was exceeded due to duplicate prescription. In 235 cases, patients concurrently took a drug with a potentially clinically relevant interaction. In 43 cases (18.3 % of 235) an OTC analgesic, usually ibuprofen, was involved. About one third of the elderly patients took analgesics regularly or as needed. Despite the relatively high use of OTC analgesics, the proportions of duplicate prescription, medication overdoses, and adverse interactions due to OTC products was low.

Marketing approaches for OTC analgesics in Bulgaria

The marketing management includes analysis of market opportunities, selection of target markets, planning, developing and implementing of marketing strategies, monitoring and result control. The object of the present study was to analyse the marketing approaches applied for non-steroidal anti-inflammatory drugs (NSAIDs) in Bulgaria. The performed SWOT(planning method used to evaluate the strengths, weaknesses, opportunities, and threats) analysis for one of the leading Bulgarian manufacturers marked the complex corporative strategy for stimulating the sales of NSAIDs. The study results show that the legislation frame in the country gives an opportunity for regulation of the NSAID market in order that incorrect marketing approaches such as disloyal competition are avoided.