Anti-inflammatory risk downplayed in open channel

Nearly three-quarters of pharmacists would like to see greater restrictions on the availability of ibuprofen, an AJP poll has revealed

Following concerns expressed by pharmacists that Australians could be at risk from taking ibuprofen without supervision – as well as the Advisory Committees on Chemicals and Medicines Scheduling interim decision not to change pack sizes or schedule – AJP asked whether readers would like to see such changes made.

At the time of writing, 47% (171 votes) of AJP readers said they would support the upscheduling of all OTC ibuprofen to Pharmacy Only.

Another 6% (21 votes) said they would like to see the pack sizes of S2 ibuprofen reduced, while 18% (64 votes) would like to see the pack sizes reduced as well as all ibuprofen scheduled S2.

Only 28% (101) votes supported keeping the status quo.

PSA president Shane Jackson told the AJP that the PSA supports ibuprofen availability through pharmacies.

“I think the risks of anti-inflammatory drugs is being downplayed, and they can be especially downplayed in an open-selling environment,” he said.

“You need the advice of a pharmacist, and there’s been studies internationally that suggested that people aren’t following the labels and are actually taking higher than the recommended doses.

“We want ibuprofen only available in pharmacies. You get the availability of a pharmacist, and you get the environment where people can actually access advice if required.”

PSA members had expressed concern that they had seen multiple boxes of ibuprofen purchased in supermarkets, “where people are buying outside of what the scheduling intent is,” he said.

“That’s an issue, and that needs to be fixed.

“The lack of data about what’s going wrong with ibuprofen in supermarkets has people saying, ‘well there’s no problem,’ and we believe there is a problem.”

Pharmacist and obstetric medication and medication safety consultant Ron Batagol recently penned a piece for the AJP with the University of Tasmania’s Gregory Peterson, asking whether it was time to revisit the idea of upscheduling all OTC ibuprofen to Pharmacy Only.

He told the AJP that he’s not surprised at the strong support for such a measure in our poll, but “It’s pleasing, because I think pharmacists well understand the risk-benefit ratio” of such an upschedule.

“The main point is not whether people should use ibuprofen, or not use it – unless they sit down and have a doctor appointment about it, a well-versed pharmacist is the place to start that discussion,” he said.

“For example, the labelling which the TGA relies upon: apart from the children’s product, there’s nothing in adult labelling warning of the risks of dehydration and fluid depletion, which is a big issue especially for people doing a lot of exercise.”

He again warned of adverse effects such as acute renal failure in patients who took an ACE inhibitor or ARB medicine with a diuretic, and then took an NSAID – the “triple whammy” effect.

Mr Batagol said that he’s sure a range of stakeholders will have their say in the Scheduling Delegate’s final decision – though “you’d have to be pessimistic on their form that they’re going to change their interim decision, but we’ll all have some useful comments to make.”

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  1. Angus Thompson

    Time and time again I see elderly patients for a HMR with a supermarket-obtained pack of ibuprofen and apart from age, they invariably have co-morbidities that make NSAID use hazardous. The furore over CACC has overshadowed the inappropriate S2 status of ibuprofen. But let’s just hope if we are going to play the card that we as pharmacists are the appropriate guardians of ibuprofen, we do better than this…

    • Ex-Pharmacist

      But Angus, how would this hazardous use of Ibuprofen be any safer if sold in Pharmacy? (Please reflect on how items are most commonly sold in community pharmacy, and not the theoretical ‘best practice’ which we serve up to governments.)

      • PrescribingSolutions

        As per the link I shared, I am very aware that the pharmacy profession does not always live up to best practice standards. However that should not mean that we abandon aspirations to do so and to have systems in place which are consistent with that. If we take the view that when sectors of the profession fail to do the right thing we scrap controls designed to protect the public, where does that end? Following that logic we could argue that because some prescribers use antibiotics irrationally, we may as well remove them from Rx only status….

  2. thebarefootpharmacist

    Yep … and my vote was based entirely on the risk to patients taking the ‘barely therapeutic doses’ recommended on the OTC packs and was in no way motivated by the opportunity to stick it to the supermarkets 😉

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