Five top myths in pharmacy


confused looking nurse or pharmacist

Debbie Rigby, consultant clinical pharmacist, debunks some of the common held myths in pharmacy

As trusted healthcare professionals within the community, pharmacists should ensure they are up-to-date on the latest guidelines, evidence and research relating to health and disease states that concern their customers.

Pharmacists are in a unique and privileged position to support consumers about how to best manage their medicines – and we can’t do this effectively if we aren’t separating myths from truths.

Here are five of the most common myths floating around still in pharmacy:

 

MYTH #1: You should take ibuprofen with food.

TRUTH: New advice from the Australian Medicines Handbook (AMH) states that ibuprofen can be taken with water alone.1* While the update confirms what a growing number of healthcare professionals have suspected, it means pharmacists need to rethink the advice they provide to customers about taking NSAID analgesics, as well as the advice and training they pass on to their pharmacy staff.

There have been quite a lot of studies done on analgesics looking at the fasted and the fed state. Results of the Tanner et al. study of 2011 show that taking analgesia with food lowers the blood plasma concentration. The study shows that high early plasma concentrations are strongly associated with analgesic efficacy.2

For more information and guidance, access the Australian Medicines Handbook.

*Take oral doses with a glass of water. It may be taken without food but if this upsets your stomach, try taking with a meal.

 

MYTH #2: ‘Use sparingly’ is appropriate advice when it comes to advising patients on the proper use of topical corticosteroids in the treatment of atopic eczema.

TRUTH: ‘Use sparingly’ is advice for topical corticosteroids use that has been around for years and many pharmacists still advise patients, or parents of patients, to follow this advice when treating atopic eczema. This advice is usually given as a result of misplaced concern about patient safety – including adverse effects such as skin thinning.

The Australasian consensus statement, published in the Australasian Journal of Dermatology (May 2015) states: the recommendation ‘use sparingly’ has no value… Use the fingertip unit as a guide. The consensus statement also concluded that when used appropriately, topical corticosteroids have excellent safety profiles.3

In addition, Therapeutic Guidelines (updated end of 2015) recommend TCS as the main treatment for atopic dermatitis in all age groups.4 TCS should be ‘liberally, not sparingly’ applied.2

The Guidelines note that TCS therapy failure is usually due to misplaced fear about safety – despite adverse effects, including skin thinning, being rare.4

To access an accredited atopic eczema online education module designed for GPs and Pharmacists, and to earn CPD points, visit www.skincontrol.com.au. Additional resources such as the fingertip unit guidelines and a summary of the consensus statement can also be accessed from this site.

 

MYTH #3: Paracetamol is an appropriate treatment for those living with osteoarthritis.

TRUTH: For those living with osteoarthritis, paracetamol is one of the more commonly prescribed drugs used to help ease pain. A recent study published in the BMJ (31 March, 2015) highlighted that paracetamol does nothing to relieve the pain of osteoarthritis.5 The National Institute for Health and Care Excellence (NICE) in England, has also warned GPs against prescribing paracetamol for osteoarthritis after experts said that they were ‘extremely concerned’ about the links of higher doses to cardiovascular, gastrointestinal, and renal adverse events.6

To review the BMJ research study, visit http://www.bmj.com/content/350/bmj.h1225.long

 

MYTH #4: You can’t mix antibiotics with alcohol.

TRUTH: Steering clear from alcohol when taking antibiotics has been standard advice from pharmacists for decades. It’s still common to see “Avoid Alcohol” warning labels on the packaging of most antibiotics.

Drinking alcohol in moderation is unlikely to cause problems nor reduce the effectiveness of most antibiotics. However, alcohol consumption while taking antibiotics may reduce energy levels and delay how quickly the patient recovers from illness.7

For more information about alcohol and antibiotics, visit www.nps.org.au

 

MYTH #5: Antibiotics are an effective treatment to relieve for cold & flu symptoms.

TRUTH: Evidence shows that the majority of upper respiratory tract infections (URTIs) are of a viral nature and, as such, symptoms will not improve with antibiotic use.8 Despite an ongoing campaign by the NPS, Australia still has one of the highest levels of antibiotic prescribing in the world (on a per capita basis) with up to 22 million prescriptions written every year in primary care alone.9 It is estimated that, in Australia, for every patient with an URTI who sees a GP, one in 3 will receive a prescription for an antibiotic.10

Healthcare professionals, including pharmacists need to be actively educating patients on the source of their cold and flu symptoms and the effective symptomatic non-prescription treatments available.

For more information about the appropriate use of antibiotics, visit www.nps.org.au

 

References

  1. Australian Medicines Handbook, available at: https://amhonline.amh.net.au/auth. Accessed 18 April 2016
  2. Tanner et al. BMC Clin Pharmacol 2010 10:10
  3. Mooney E. et al. Adverse effects of topical corticosteroids in paediatric eczema: Australasian consensus statement. Australasian Journal of Dermatology 2015; 56: 241–51. Accessed 14 April, 2016
  4. Dermatology Expert group. Therapeutic Guidelines: Dermatology Version 4. Melbourne: Therapeutic Guidelines Limited. www.tg.org.au
  5. Machado GE et al. BMJ 2015;350:h1225. http://www.bmj.com/content/350/bmj.h1225.long. Accessed 18 April 2016
  6. Pulse Today, NICE warns against prescribing paracetamol for osteoarthritis, http://www.pulsetoday.co.uk/clinical/more-clinical-areas/musculoskeletal/nice-warns-against-prescribing-paracetamol-for-osteoarthritis/20003979.fullarticle (date accessed 18 April 2016
  7. NPS MEDICINEWISE – http://www.nps.org.au/medicines/infections-and-infestations/antibiotics/for-individuals/how-do-i-take-my-antibiotics/alcohol-and-antibiotics. Accessed 18 April, 2016
  8. Eccles, Ronald & Weber, Olaf Birkhauser Verlag, Basel (ebook), 2009; 107-15413.
  9. McKenzie D. et al. Aust Prescr 2013; vol36:116-20
  10. Byte from BEACH No: 2012;2 Sydney. FMRC, University of Sydney, 2012 http://sydney.edu.au/medicine/fmrc/beach/bytes/2012-002/

 

 

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6 Comments

  1. Nicholas Logan
    01/06/2016

    Superb top five and well referenced Debbie.

  2. Leah Rosevear
    01/06/2016

    If the antibiotic is griseofulvin or metronidazole then alcohol should be avoided.

  3. Leah Rosevear
    01/06/2016

    Otherwise I agree totally with Nicholas Logan

  4. Karalyn Huxhagen
    01/06/2016

    What about the oral contraceptive and antibiotics and timing of dose?

  5. TheRedShirt
    01/06/2016

    What about tinidazole and alcohol?

    If there is concern about paracetamol’s cardiovascular, gastrointestinal, and renal adverse events when used for OA, then what else is there? Presumably NSAIDs are even worse when it comes to these adverse effects. That leaves opioids?

  6. Jarrod McMaugh
    25/06/2016

    Interestingly, Myth 2 is going to be very difficult to dispel while the CMIs for prescription cortisones still say “Apply a thin film of “

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