Over-the-counter Research Articles

Redundancy of Pharmacologic Ingredients in Over-the-Counter Nasal Sprays.

To evaluate and determine the prevalence of ingredients in over-the-counter (OTC) nasal sprays. Cross-sectional. Retail pharmacies. An inventory of brand-name and generic OTC nasal sprays was recorded at five national pharmacy outlets in August 2023. Data regarding the active ingredients were collected on commercial websites, MedlinePlus and drugs.com, and frequency statistics were calculated. Five pharmacies were visited, at which 12 different brand names of nasal sprays were identified at multiple pharmacies. Nine brand names were associated with multiple formulations, accounting for 49 different products. The active ingredients included in our analysis were oxymetazoline, phenylephrine, fluticasone, triamcinolone, budesonide, azelastine, cromolyn sodium, and mometasone. Nasal decongestants had the greatest number of brand name formulations compared to intranasal steroids and antihistamine sprays which had limited choices. Products that included oxymetazoline were the most widely marketed drug (51 unique products) followed sodium chloride (40 unique products). These findings suggest that there are widespread redundancies in the OTC nasal spray market. Clinician should be aware of the redundancy in OTC formulations and encourage patients to read the labels in order to make informed decisions regarding their use of OTC medications.

Elucidating disparities in sunscreen coverage among state Medicaid preferred drug lists.

Regular application of over-the-counter (OTC) sunscreen is considered the foundation of skin cancer prevention, yet OTC sunscreen is not eligible for reimbursement in almost all state Medicaid benefit plans. On review of 111 Medicaid preferred drug lists (PDLs) across 50 states and the District of Columbia (DC), only five plans were identified that incorporate coverage of sunscreen. Thus, many recipients of Medicaid, the majority of whom are individuals and families of lower socioeconomic status, may encounter financial difficulty and thus forego utilizing sun protective measures due to financial constraints. Here, we compare current Medicaid coverage of OTC sunscreen and discuss calculated and theoretical annual costs of this skin cancer prevention method.

Individual use of self-medication and other remedies in COVID-19 outpatients in Western-Pomerania

We analyzed data from positively tested COVID-19 outpatients to describe self-medication with OTC drugs and use of other remedies against symptoms of SARS-CoV-2 infection. We specifically considered their type and frequency, as well as associations with patient characteristics, and reasons for use. Data were collected between May 1, 2020 and February 22, 2021 with two questionnaires in an observational cohort study with PCR-confirmed SARS-CoV-2-positive adult outpatients in the district of Western Pomerania in Germany. 523 out of 710 outpatients (74%; 340 women and 183 men) reported using drugs and other remedies to relieve COVID-19-symptoms. Overall, participants reported utilization of 1282 finished dosage products or remedies, including 213 different ingredients. In the population of 710 outpatients, utilization of ibuprofen (26%), acetaminophen (21%), metamizole (14%), and acetylsalicylic acid (10%) was most commonly reported. Phytopharmaceuticals, herbal and animal products as well as vitamins and minerals were also frequently reported. Among the 523 participants who used drugs and other remedies, most commonly mentioned reasons for use were headache (40%), other kinds of pain (e.g. myalgia; 37%), fever (24%) and cough (16%). Our analysis showed that a majority of the participants tried to alleviate COVID-19-symptoms using drugs and other remedies. Especially analgesic and antipyretic agents, followed by herbal medicines, were used very frequently.Trial registration: German Register for Clinical Studies DRKS00021672, first registration on December 1st, 2020.

The High Prevalence and Complexity of Over-the-Counter Medication Misuse in Older Adults.

Older adults (≥65 years) are the largest consumers of over-the-counter (OTC) medications and exceptionally vulnerable to the risks of these medications, including adverse drug events (ADEs). However, little is known about how older adults select and use OTCs. This is the first multisite study designed to prospectively quantify the type and intended use of OTCs selected by older adults in community pharmacies where products are purchased. Older adults (n = 144) were recruited from 10 community pharmacies from a Midwestern health system. Participants were given hypothetical symptoms and asked to select one or more OTCs for self-treatment. They were asked to report how they would use the products at symptom onset and when symptoms persisted or worsened. They also reported their current medication list and health conditions. Participants' OTC selections were evaluated for 4 types of misuse: drug-age, drug-drug, drug-disease, and drug-label. Of the 144 participants, 114 (79%) demonstrated at least one type of misuse when describing how they would use their OTC selections at symptom onset. Drug-drug and drug-label misuse had the highest prevalence. Overall, 26 (18%) and 28 (19%) participants showed only drug-drug or drug-label misuse, respectively. Notably, 55 (38%) of participants demonstrated misuse in 2 or more misuse categories. Misuse potential was exacerbated when participants described treating persistent or worsening symptoms. The results highlight the high prevalence and complexity of OTC misuse in older adults and the need for additional work to improve OTC safety.

Leveraging publicly available data to evaluate health reform: establishing a methodology to assess the future impact of over-the-counter hearing aids

Health systems are complex and health reform is uncertain. With an aging global population, chronic health conditions are increasing and have become a priority for policymakers. Hearing loss is the third most common chronic condition among older adults and if left untreated, is associated with poor health and social outcomes. In the US, accessibility and affordability have been significant barriers to hearing aid utilization. Through new reform, over-the-counter (OTC) hearing aids are now available. This study demonstrates how publicly available health data was used to establish a methodology to define, characterize, and analyze the target population of this reform. In this retrospective cross-sectional cohort analysis, data from the National Health Interview Survey (NHIS) was utilized, with a sample that included respondents from the 2021 NHIS Sample Adult Interview. Three hearing aid groups (Active, Potential, General) were defined using questions from the NHIS annual core questionnaire and a baseline population health framework was developed. Binary logistic regression confirmed that the framework sufficiently described two group comparisons (Active-Potential, Active General) and also identified the key determinants of hearing aid utilization. Classification and regression tree (CART) classification amply predicted active hearing aid users and verified the key determinants as important predictors. These findings aligned nicely with literature published before OTC hearing aids were made available, confirming the NHIS to be consistent and representative. Our methodology can be repeated to examine the impact of OTC hearing aids in the post-implementation period and similar approaches should be taken to examine other emerging health reforms.

O PAPEL DO FARMACÊUTICO NA ORIENTAÇÃO E CONSEQUÊNCIA DO USO INDISCRIMINADO DE MEDICAMENTOS EM VENDAS LIVRES (MIPS) EM DROGARIAS

This study investigates the essential role of pharmacists in guiding the safe use of over-the- counter (OTC) medicines, addressing the risks of self-medication such as toxicity, adverse reactions, and dangerous drug interactions. The literature review was conducted based on scientific articles, books, and manuals from the Ministry of Health, focusing on the importance of pharmaceutical guidance to prevent the improper use of these medicines. The research highlights the need for awareness and health education to promote the rational use of OTC medicines, emphasizing the pharmacist's relevance in preventing complications and promoting public health.

When do shoppers prefer using QR codes? Empirical evidence from Vietnam

This research aimed to explore the factors influencing the behavioural intention to use over-the-counter (OTC) QR codes for purchasing products in Vietnamese supermarkets. The study included 996 consumers and employed a questionnaire-based survey method to test the hypotheses using partial least squares structural equation modelling (PLS-SEM). Drawing on the theory of reasoned action (TRA) and signalling theory, the findings identified five key factors that positively affected the intention to use OTC QR codes: perceived usefulness of OTC QR codes (e.g., for payment and traceability), attitude, customer satisfaction, and supply chain transparency. Additionally, the perceived usefulness of OTC QR codes positively impacted attitude and customer satisfaction, while its usefulness for traceability enhanced supply chain transparency. The study also identified the moderating influence of personal innovativeness on the relationship between perceived usefulness of OTC QR codes for payment and attitude and customer satisfaction. Furthermore, the moderating role of electronic Word-of-Mouth (e-Word-of-Mouth) in the relationship between customer satisfaction, attitude, and behavioural intention was discovered. This research contributes to the existing literature by expanding our understanding of the perceived usefulness of OTC QR codes and elucidating the various mechanisms through which their both functionalities could encourage consumer adoption in the context of Vietnamese supermarkets.

Health status of senior netball players, their medication use and attitudes towards doping.

Limited research exists on the health and injuries of South African senior netball players. Senior netball players may be at greater risk of injuries and chronic disease due to their age. To treat these conditions, they may use prescription and over-the-counter (OTC) medications and, therefore, may be more vulnerable to unintentional doping. The primary aim of this study was to determine the health status, medication use and attitudes towards doping of South African senior netball players. A cross-sectional descriptive design was employed to collect data by means of an online survey. The validated 8-item Performance Enhancement Attitudes Scale (PEAS) was used to gather information on the netball player's attitudes towards doping. Descriptive statistics were used to describe the data using proportions (categorical), means (normally distributed, continuous) and medians (non-normal distributed, continuous). Doping prevalence and accompanying 95% confidence interval were calculated. Sixty senior netball players consented and completed the self-report questionnaire. The prevalence of chronic disease was 11.67%. Asthma and other conditions such as depression and attention-deficit/hyperactivity (ADHD) had the highest prevalence of 3.33%. The prevalence of chronic prescription medication use was 8.33% and 66.67% of the netball players reported receiving prescription injections, medications or utilizing OTC medications for treating injury or illness suffered 1-6 weeks before or during competition. The netball players do not have a lenient attitude towards doping. The prescription and OTC medication use could put this cohort of netball players at risk of unintentional doping. Anti-doping education aimed at senior athletes may be beneficial to reduce the risk of unintentional doping due to prescription and OTC medication use for injury or illness.

Abstract MP23: Arm Size Coverage of Popular Over-the-Counter Blood Pressure Devices and Implications in US Adults

Background: Recent findings show the impact of an inappropriate cuff size on blood pressure (BP) reading. Despite the emphasis on the value of home BP monitoring, little is known about the coverage of arm circumference in popular over-the-counter (OTC) devices. Aims: To evaluate the coverage of arm circumference in popular BP devices and quantify the proportion of U.S. adults not eligible for using those devices due to arm size. Methods: We searched a large online retailer, Amazon, for ranks, ratings, and number of sold devices and purchased ten of the most popular OTC devices. We recorded data on the cuff sizes and corresponding aim circumference ranges offered in those devices. Subsequently, using data from the National Health and Nutrition Examination Survey 2015-2020 (13,826 adults), we quantified the number of US adults not eligible to use those popular devices due to arm circumference. Results: Nine devices offered cuff size covering arm circumference from 22-42 cm, and one from 22-40 cm ( Table ). We found that ~22 million US adults (6.7% of US adults) could not use these OTC devices since their arm circumferences were <22 cm (1.0 million [0.3%]) or >42 cm (21.4 million [6.4%]). The proportion of adults not covered by these devices was higher in Blacks (11.7%) than in other racial/ethnic groups (≤6.5%). Conclusions: Despite the emphasis on the importance of home BP monitoring, over 20 million US adults may not be eligible to use popular BP devices due to their arm circumference, and Blacks are more susceptible to this issue than other racial/ethnic groups. Manufacturers of OTC blood pressure devices should address this unrecognized disparity for quality and equitable hypertension diagnosis and management integrating home BP monitoring.

Pharmacies Counselling of Patients in the Era of Antifungal Resistance.

Tinea pedis is one of the most prevalent superficial fungal infections. Initial antifungal treatment is often acquired over-the-counter (OTC) without previous consultation with a physician. Lately, increasing antifungal terbinafine resistance has been documented in Denmark and globally and it is therefore of interest to assess how Danish pharmacies advise customers with tinea pedis. One hundred Danish pharmacies were randomly selected and an employee interviewed from each. A structured question guide was followed, with the possibility to add further comments. Interviews of 94 pharmacies were conducted. Six pharmacies never replied. Terbinafine as standard dose or cutaneous solution terbinafine one time application (Lamisil Once (R)) were recommended by 99% of the pharmacy employees as first-line treatment. The customer was advised to seek medical attention when tinea pedis was recurring (93%), or when treatment duration was > 2 weeks (77%). The majority (88%) of the pharmacy employees had no knowledge about antifungal resistance. Only few pharmacy employees were aware of the current problem of antifungal resistance and the majority advised costumers to initiate treatment using OTC topical terbinafine. The problem of emerging antifungal resistance requires attention in order to provide customers with tinea pedis effective treatment and prevent further societal spread of resistance to antifungals.

50972 Allergens and Marketing Claims of Popular Over-the Counter Acne Washes

50972 Allergens and Marketing Claims of Popular Over-the Counter Acne Washes

Over-the-Counter Hearing Aids: A Nationwide Survey Study to Understand Perspectives in Primary Care.

The expansion of over-the-counter (OTC) hearing aids has raised inquiries regarding primary care physicians' (PCP) knowledge, perspective, and perceived roles. We aimed to understand PCP perspectives on OTC hearing aids via nationwide online surveys. RedCap survey was distributed to PCPs via online forums and public mailing lists. Outcomes included PCPs' attitudes toward, perceived role surrounding, confidence managing, and knowledge of OTC hearing aids. Regression analyses were performed to identify associated factors including demographics and practice characteristics. Cohort included 111 PCPs primarily working in non-rural (83.8%) outpatient academic medical centers (47.5%), with a mean (SD) of 16.9 (11.6) years practicing. Most reported unfamiliarity (61.3%) with OTC hearing aids but viewed them positively (91.9%). They often perceived themselves as poor sources of OTC hearing aid information (63.1%) but desired involvement (90.1%) and believed associated knowledge is important (98.2%). Rural practice environment was associated with less familiarity toward OTC hearing aids (β = -0.72, [95% CI -1.40 to -0.04]). Respondents answered 5.0 (2.4) of 10 OTC hearing aid knowledge questions correctly. Using 5-point Likert scale, participants reported most confidence recognizing signs/symptoms of hearing loss 3.71 (0.84), but less confidence educating 1.68 (0.96) about and determining candidacy 1.72 (1.05) for OTC hearing aids. Participants reported continuing medical education courses and published guidelines would effectively improve their OTC hearing aid knowledge. PCPs displayed positive attitudes toward OTC hearing aids and valued involvement. Addressing unfamiliarity/knowledge gaps surrounding OTC hearing aids through courses and published guidelines may help clarify misconceptions and promote hearing health care. NA Laryngoscope, 2024.

Knowledge, Attitudes and Practice About Vitamin Supplements Counseling in Libyan Community Pharmacies

Pharmacists play an important role in the healthcare system and have a greater impact on the outcome of public health programs. Patients who seek vitamin advice presume the role of community pharmacists including the recommendation of effective vitamin supplements. This study aimed to evaluate knowledge, attitudes and professional practices of Libyan community pharmacists in counselling patients about the safe consumption of vitamins. A cross-sectional study was conducted in pharmacies located in Tripoli, Libya between October 2023 and February 2024. Data collection was carried out using semi-structured self-administrated questionnaire. A total of 235 pharmacists participated in this study. The majority (75.3%) of pharmacists believed that a balanced diet is more achievable by eating healthily than by vitamins supplements. 76.6% of participants believed that chronic consumption of certain vitamins would not shorten life spans, while 65.5% agreed that vitamin supplements could be toxic or might contain unlabeled harmful ingredients. Less than half of pharmacists (35.3) were aware that some antioxidant vitamins have been verified to be of unproven value, or may even cause cancer. 80% of pharmacists would recommend vitamins on a regular basis without prescription, the majority agreed that counselling on vitamin supplements is part of their role in pharmaceutical care (94.5%), in addition to providing relevant information to other healthcare professionals (76.6%). Moreover, responses to specific knowledge questions, such as the interactions of vitamins with drugs or the recommended dietary allowance of vitamins for infants, children, and pregnant women, were negative. Furthermore, only a minority of pharmacists (48.5%) would recheck the accuracy of dose regimens in prescriptions and 50.6% of participants would follow up patients to record any consequences of vitamins consumption. The questionnaire revealed satisfactory awareness of community pharmacists about their role in counselling; however, further programmes to update their knowledge are mandatory to emphasise the importance of vitamin supplements as part of complementary medicine, and their exclusion from being considered as merely over the counter (OTC) products.

Effects of online marketplace-sourced over-the-counter tooth whitening products on the colour, microhardness, and surface topography of enamel: an in vitro study

ObjectivesThis study compared the whitening effect, microhardness, and enamel surface alterations of over-the-counter (OTC) tooth bleaching products with those of a dentist-prescribed at-home bleaching agent.Materials and methodsThe products available on a popular online marketplace were comprehensively searched and then rated using a specific formula. The effects of the lowest-rated OTC agent (LRA) and the highest-rated OTC agent (HRA) were compared with those of a dentist-prescribed bleaching agent (DPA) on the enamel of extracted human teeth. The bleaching efficacy, post-bleaching microhardness changes, and morphological alterations were assessed by spectrophotometric analysis, Vickers hardness testing, and scanning electron microscopy (SEM) respectively. Statistical analyses included one-way ANOVA and post hoc tests, maintaining a significance level of P < 0.05.ResultsThe search of the online marketplace revealed 15 products. The LRA (Teeth Whitening Serum Gel, GEN, China) and the HRA (Bright White-Lovely Smile Premium Teeth Whitening strips, Ray of Smile, USA) were identified on the basis of their ranking. DPA resulted in significantly better tooth whitening than did LRA. The enamel microhardness was lower in the LRA treatment group (14.2%) than in the control and HRA treatment groups (8.84% and 7.26%, respectively). LRA also caused severe topographical alterations to the enamel.ConclusionCompared with the poorly rated product, the dentist-prescribed tooth bleaching product resulted in greater colour improvement, less microhardness reduction, and surface changes. The highest-rated product was comparable with the dentist-prescribed agent in this study.

Comprehensive evaluation of xylometazoline hydrochloride formulations: Ex-vivo and in-vitro studies

Xylometazoline is a well-established nasal decongestant that has been used alone and in combination with dexpanthenol as an over the counter (OTC) medicine. Considering the possibility of further improvement of xylometazoline nasal formulations, hyaluronic acid (HA) was evaluated as an additional ingredient. The aim of this study was to investigate the permeation, mucosal retention, and mucoadhesion properties of a new xylometazoline-HA [Xylo-HA] formulation ex vivo and to explore the potential benefits of incorporating HA in the formulation in vitro. Sheep nasal mucosa was used in the ex vivo study, where Xylo-HA was compared with xylometazoline alone [Xylo-Mono], and in combination with dexpanthenol [Xylo-Dex] to understand the impact of formulation changes. The permeation of xylometazoline was generally low (Xylo-Mono 11.14 ± 4.75 %, Xylo-HA 14.57 ± 5.72 % and Xylo-Dex 11.00 ± 3.05 % of the applied dose). The steady state fluxes of xylometazoline were determined as 12.64 ± 3.52 μg/cm2h, 14.94 ± 3.38 μg/cm2h and 12.19 ± 2.05 μg/cm2h for Xylo-Mono, Xylo-HA and Xylo-Dex, respectively. No significant differences were observed between the formulations in the permeation nor mucosal retention studies (p > 0.05 for all), while Xylo-HA exhibited superior mucoadhesive proprieties (p < 0.05 for all). The effects on wound healing and barrier integrity of the three xylometazoline formulations were tested in vitro on HaCaT cells. To better elucidate the role of HA, an additional HA formulation without xylometazoline was prepared (HA-Mono). A scratch test was performed to evaluate wound healing, revealing that the test formulations did not achieve complete wound closure within 72 h and demonstrated a similar effect at the end of the testing period. To assess the effect on barrier integrity, cells were treated for 5 days with daily measurements of transepithelial electrical resistance (TEER). At the end of the experiment, Xylo-Dex showed a moderate 14 % increase in TEER, while Xylo-Mono did not significantly affect this parameter. TEER rose by 951 % in the Xylo-HA, and by 10497 % in the HA group, suggesting that incorporating HA led to enhanced barrier function. Further clinical studies are recommended to better understand the clinical implications and efficacy of the Xylo-HA formulation, with particular focus on the role of HA.

Real-world evaluation of treatment utilization by women experiencing vasomotor symptoms associated with menopause in the United States and Europe: Findings from the REALISE study

ObjectivesDespite the profound impact of menopausal symptoms on women, treatment utilization is low, and many seek alternative therapies. The REALISE study aimed to evaluate the treatment landscape – that is, pharmacological treatment, lifestyle changes (LC), and use of over-the-counter (OTC) products – for women from six high-income countries experiencing vasomotor symptoms (VMS) and receiving healthcare. Study designAnalysis of a secondary dataset, the Adelphi Real World Disease Specific Programme™, a large, cross-sectional, point-in-time survey conducted in the United States and five European countries (February–October 2020). Physicians provided demographic, clinical, and treatment data; women were stratified by VMS severity (mild; moderate-severe) and presence of concomitant sleep/mood symptoms. Women completed forms on VMS severity, concomitant symptoms, LC, and OTC product use. Two subgroups were identified: VMS-only and VMS + sleep/mood. Main outcome measuresPrescription treatment, LC, and OTC product utilization. ResultsPhysicians (n = 233) provided data on 1767 women; 825 (46.7 %) completed a self-completion form. Physicians rated 60 % of women with moderate-severe VMS, of whom 709 (66.8 %) were currently prescribed pharmacological treatment; 27.1 % had never been prescribed. Hormone therapy was most frequently prescribed in the moderate-severe group (overall, 49.8 %; VMS-only, 57.4 %; VMS + sleep/mood, 47.3 %), followed by serotonergic antidepressants (15.7 %; 9.7 %; 17.6 %, respectively). Most women (78.3 %) with moderate-severe VMS adopted LC, and 57.6 % used at least one OTC product for VMS relief. ConclusionsNearly a third of women with moderate-severe VMS had never received treatment despite access to healthcare. This, combined with the prevalent use of LC/OTC products, suggests an unmet need for new treatment options to manage VMS and concomitant sleep/mood symptoms.

Effects of a cannabidiol/terpene formulation on sleep in individuals with insomnia: a double-blind, placebo-controlled, randomized, crossover study.

Cannabidiol (CBD) is increasingly used as a health supplement, though few clinical studies have demonstrated benefits. The primary objective of this study was to evaluate the effects of an oral CBD-terpene formulation on sleep physiology in individuals with insomnia. In this double-blind, placebo-controlled, randomized clinical trial, 125 individuals with insomnia received an oral administration of CBD (300 mg) and terpenes (1 mg each of linalool, myrcene, phytol, limonene, α-terpinene, α-terpineol, α-pinene, and β-caryophyllene) for ≥ 4 days/week over 4 weeks using a crossover design. The study medication was devoid of Δ9-tetrahydrocannabinol (Δ9-THC). The primary outcome measure was the percentage of time participants spent in the combination of slow wave sleep (SWS) and rapid eye movement (REM) sleep stages, as measured by a wrist-worn sleep-tracking device. This CBD-terpene regimen marginally increased the mean nightly percentage of time participants spent in SWS + REM sleep compared to the placebo [mean (SEM), 1.3% (0.60%), 95% C.I. 0.1 to 2.5%, P = 0.03]. More robust increases were observed in participants with low baseline SWS + REM sleep, as well as in day sleepers. For select participants, the increase in SWS + REM sleep averaged as much as 48 minutes/night over a four-week treatment period. This treatment had no effect on total sleep time (TST), resting heart rate or heart rate variability, and no adverse events were reported. Select CBD-terpene ratios may increase SWS + REM sleep in some individuals with insomnia, and may have the potential to provide a safe and efficacious alternative to over-the-counter (OTC) sleep aids and commonly prescribed sleep medications. ClinicalTrials.gov NCT05233761.

Real-world evidence evaluation on consumer experience and prescription journey of diclofenac gel in Sweden.

The aim of this study was to understand profiles of topical Voltaren gel diclofenac (VGD) 2.32 and 1.16% consumers through analyzing prescription patterns and to characterize treatment satisfaction, functional impairment, and pain relief after over-the-counter (OTC) VGD use in Sweden under real-world conditions. This observational, real-world study conducted in Sweden had retrospective and prospective segments. The retrospective secondary data segment utilized 12-month diclofenac gel prescription data from the Swedish eHealth Agency (E-hälsomyndigheten). The prospective segment included electronic surveys completed at baseline and weeks 4 and 12 by adult consumers who purchased OTC VGD to treat their pain. Secondary data analyses (n = 12,145) showed that 56.7% of patients receiving diclofenac gel were females ≥70 years old. Most patients did not switch pain treatments; the mean time between diclofenac gel refills was about 2.5 months. From the surveys (n = 264), VGD provided pain relief, indicated by improvement in 11-point pain numeric rating scale scores. Average pain severity at baseline was 5.8 - improving by a mean of 1.3 and 1.9 points at weeks 4 and 12, respectively. The majority of consumers reported improvement in daily functioning (i.e., health-related quality of life [HRQoL]), and most were at least somewhat satisfied with VGD treatment results. This real-world study provides important insights into the prescription patterns of diclofenac gel and the consumer experience with OTC VGD in Sweden. Patients rarely switched to other topical nonsteroidal anti-inflammatory drugs, and VGD consumers reported pain relief and improved HRQoL compared to baseline - resulting in treatment satisfaction.

Survey of community pharmacists' opinions on drug scheduling in Ontario and Québec.

Over the past decade, Canada has witnessed a shift of several drugs from prescription-only to behind-the-counter (BTC) and over-the-counter (OTC) status. This work examined community pharmacists' agreement with the current scheduling of agents used in the management of allergic rhinitis, heartburn, and vulvovaginitis. From September to October 2022, an online survey was administered to pharmacists practicing in in Ontario and Québec. The survey aimed to gather insights into their preferred scheduling for 15 medicines commonly used to manage the three selected conditions. Pharmacists were asked whether they agreed with the current scheduling status of each and, if not, how they feel it should be scheduled. 715 pharmacists completed the survey, 462 from Ontario and 253 from Québec. Most were staff pharmacists working 30 or more hours per week, having been a pharmacist for 1-10 years. Ontario pharmacists expressed a preference for scheduling change for five drugs (four prescription [terconazole for intravaginal use, famotidine, rupatadine, mometasone nasal spray] and one unscheduled [ranitidine 75 mg]), while Québec pharmacists expressed preference for scheduling change for three prescription drugs (terconazole for intravaginal use, famotidine, rupatadine). As pharmacy practice continues to evolve, pharmacists' comfort with initiating previously prescription-only therapy independently or assisting patients with self-selection may similarly evolve. Of the five drugs identified as having a discrepancy between current status and pharmacist preference, four are prescription and may be candidates to consider for prescription to OTC switch. Pharmacists in Ontario and Québec have expressed preference for most products used in the treatment of allergic rhinitis, heartburn, and vulvovaginitis to be categorised as Schedule II (BTC) or Schedule III (OTC) available only in pharmacies.

Transungual Penetration and Antifungal Activity of Prescription and Over-the-Counter Topical Antifungals: Ex Vivo Comparison.

Topical antifungals for toenail onychomycosis must penetrate the nail to deliver an inhibitory concentration of free drug to the site of infection. In two ex vivo experiments, we tested the ability of topical antifungals to inhibit growth of Trichophyton rubrum and Trichophyton mentagrophytes, the most common causative fungi in toenail onychomycosis. Seven topical antifungals were tested: three U.S. Food and Drug Administration-approved products indicated for onychomycosis (ciclopirox 8% lacquer; efinaconazole 10% solution; tavaborole 5% solution) and four over-the-counter (OTC) products for fungal infections (tolnaftate 1% and/or undecylenic acid 25% solutions). The ability to inhibit fungal growth was tested in the presence and absence of keratin. Products were applied either to human cadaverous nails or keratin-free cellulose disks prior to placement on an agar plate (radius: 85mm) seeded with a clinical isolate of T. rubrum or T. mentagrophytes. After incubation, the zone of inhibition (ZI), defined as the radius of the area of no fungal growth, was recorded. In the nail penetration assay, average ZIs for efinaconazole (T. rubrum: 82.1mm; T. mentagrophytes: 63.8mm) were significantly greater than those for tavaborole (63.5mm; 39.1mm), ciclopirox (7.4mm; 3.6mm) and all OTC products (range: 10.5-34.2mm against both species; all P < 0.001). In the cellulose disk diffusion assay, efinaconazole and tavaborole demonstrated maximal antifungal activity against both species (ZIs = 85mm); average ZIs against T. rubrum and T. mentagrophytes were smaller for ciclopirox (59.0 and 55.7mm, respectively) and OTC products (range: 31.2-57.8mm and 25.7-47.7mm, respectively). Among all antifungals tested, the ability to penetrate human toenails to inhibit growth of both T. rubrum and T. mentagrophytes was greatest for efinaconazole, followed by tavaborole. These results indicate superior transungual penetration of efinaconazole compared to the other antifungals, suggesting lower keratin binding in the nail.