Non-prescription analgesics and asthma

With the increase in the number of NSAIDs available in Australia without a prescription, more people will use such medications, increasing the potential for adverse reactions to occur in people sensitive to aspirin. Currently a number of these products are available in supermarkets etc. as well as in pharmacies

Pharmacists’ responsibilities

Pharmacists train their staff to screen consumers who are purchasing over-the-counter analgesics, and refer these consumers to the pharmacist when appropriate. Pharmacists must personally take all reasonable steps to ascertain the therapeutic need and give directions for use to consumers who request products scheduled as Pharmacist Only Medicines. Consumers sensitive to aspirin need to be warned of the possibility of adverse reactions from commonly available pain relievers, low dose aspirin and cough and cold products as listed in Tables 1 and 2.

• It should be noted that adverse reactions may occur with topical products as well as oral forms.^{22<LE V>}
• A warning should be issued with the sale of many herbal products containing either salicylates or allergenic ingredients or contaminates. Teething gels containing choline salicylate are contraindicated in people with a known allergy to salicylates and should be used with caution in susceptible individuals.²³
• Low dose aspirin for the prevention of ischaemic stroke, transient cerebral ischaemic events or ischaemic heart disease should be used with the same caution in people with asthma.^{24<LE IV>} If antiplatelet therapy is necessary and aspirin cannot be taken, alternative therapies are available.

It is difficult to produce recommendations for the group of individuals with asthma who are without high-risk features and who have never been exposed to NSAIDs.²⁴

Table 1  Examples of Over-The-Counter Analgesics23 Oral  Topical products Aspirin, including low dose aspirin Diclofenac Diclofenac 25mg  Ketoprofen Flurbiprofen 8.75mg Ibuprofen Ibuprofen 200mg Methylsalicylate rubs Ketoprofen 25mg Piroxicam Mefenamic acid 250mg Salicylic acid-containing products Naproxen sodium 220, 275mg       Paracetamol

 

Table 2 Examples of Combination Products containing Over-The-Counter NSAIDs Aspirin/codeine combinations Aspirin/dihydrocodeine Ibuprofen combination products

Health professionals can consult MIMS, APP Guide, AUS DI, Australian Medicines Handbook or Medical Director for further information about brand names of products.

Labelling and consumer medicines information (CMI) should highlight the possibility of AIA with NSAIDS.

Adverse reactions should be recorded and reported to ADRAC.