Self Directed Learning: Handling calls about Analgesia

Case Scenario 1
Question / I’m going on holiday and have some Motilium® to take with me. If I need to can I take paracetamol as well?
What further background information do you need to clarify the question and minimise the risks when advising the caller? /

PERSON

/

MEDICINES

Who is asking?
Lady 26 years
New or worsening symptoms?
No

Any allergies/medical conditions?

No / Medicines (name, dose, frequency)?
Motilium 10mg tablets
Anadin Paracetamol
Why asking?
Patient has seen interaction with Motilium® on the leaflet for her paracetamol tablets.
She takes Motilium® on holiday just in case she has sickness or vomiting and also takes Anadin Paracetamol for any pain, aches or hangovers!
Gather the further background information BEFORE searching for information.
What information sources would you use? / MedicinesChest Online:
Anadin Paracetamol – White capsule shaped tablet containing paracetamol 500mg
BNF and Stockley’s Drug Interactions - via MedicinesComplete
No interactions listed between paracetamol and domperidone (Motilium®)
eMC:
Search ‘Domperidone’
Motilium 10mg tablets [Domperidone]– nil re interaction with paracetamol
Domperamol® (Discontinued) contains Paracetamol 500mg and domperidone 10mg for migraine.
Search ‘Paracetamol’
ANADIN PARACETAMOL® - 4.5 Interaction with other medicinal products and other forms of interactions.
Metoclopramide and Domperidone: The absorption of paracetamol is increased by metoclopramide and domperidone. However, concurrent use need not be avoided.
MIDRID®
Metoclopramide and domperidone accelerate absorption of paracetamol.
PANADOL ULTRA®
The speed of absorption of paracetamol may be increased by metoclopramide or domperidone.
What advice would you give?
Or would you refer? / No interaction is reported in the standard interaction texts. There was even a preparation on the market for migraine, Domperamol®, that contained domeperidone and paracetamol in combination, but this has been discontinued.
However, several manufacturers of paracetamol products suggest that domperidone may speed up the rate at which paracetamol is absorbed. This could be seen as an advantageous interaction.

Self Directed Learning: Handling calls about Analgesia

Case Scenario 2
Question / A lady phones NHSD. She wants to know if she can take Paramol (which she has in the house) for a really bad headache.
What further background information do you need to clarify the question and minimise the risks when advising the caller? /

PERSON

/

MEDICINES

Who is asking?
30 years old lady.
New or worsening symptoms?
No

Any allergies/medical conditions?

No allergies
Hypothyroid

Pregnancy (stage, going well)?

no / 25mg thyroxine/day.
Took 8x Paramol®soluble yesterday.
Gather the further background information BEFORE searching for information.
What information sources would you use? / MedicinesChest:
Paramol® soluble
Contains: Paracetamol 500 mg, Dihydrocodeine tartrate 7.46 mg
REASONS SHE MAY NOT TAKE DRUG - Need to check for:
  1. DRUG - DISEASE problem (contraindication/caution)
  2. DRUG – DRUG problem (interaction)
eBNF
4 Central nervous system4.7 Analgesics4.7.2 Opioid analgesics
DIHYDROCODEINE TARTRATE
Cautions - see under Morphine Salts and notes above; interactions: Appendix 1 (opioid analgesics)
Contra-indications - see under Morphine Salts and notes above
MORPHINE SALTS
Contraindications – none relevant
Cautions - hypotension, hypothyroidism
Interaction search: there are no documents listings interactions between dihydrocodeine and levothyroxine searched.
eMC PIL: Paramol®
4.4 Special warnings and precautions for useDosage should be reduced in the elderly, in hypothyroidism, chronic hepatic disease and renal insufficiency.
If you need to use this medicine for more than three days at a time, see your doctor or pharmacist. Taking dihydrocodeine regularly, for a long time, can lead to addiction. Taking a painkiller for headaches too often, or for too long, can make them worse.
What advice would you give?
Or would you refer? / Paramol contains paracetamol and dihydrocodeine. Paracetamol alone would be preferable.
If caller not happy with that could REFER for further info re ‘caution’ found:
Dihydrocodeine should be taken with ‘caution’ if hypothyroid. Manufacturers advice is to reduce the dihydrocodeine dose if hypothyroid but
  • this product already has a low dose and
  • the patients hypothyroidism should be controlled on thyroxine
So should not be a problem for one-off treatment.
Advise about potential side effects (listed in patient information leaflet inside the pack or BNF/ eMC)

Role Preparation for Nurse Advisors: Handling Medicines Calls November 2007 v1.0