Cerelle vs Cerazette: Are they really the same?

Cerelle and Cerazette are two brands of daily progestogen-only pill (POP), also known as mini-pill. In recent years prescribing of Cerazette in NHS decreased, in place of other brands, including Cerelle. Today I will discuss the reasons for this change and review different aspects of Cerelle vs Cerazette use. 

Summary of the post:

  • Cerelle vs Cerazette: are they the same?
  • Cerelle vs Cerazette: How to take them?
  • Cerelle vs Cerazette: common side effects 
  • Which contraceptive is more popular – Cerelle vs Cerazette? 
  • I used to be prescribed Cerazette, but not anymore. Why? 
  • Can I still request a doctor to prescribe Cerazette?
  • Can I ask the pharmacy to dispense Cerazette instead of Cerelle?
  • How can I get Cerazette pill? Can I buy Cerazette? 
  • Do generic, and branded drugs produce exactly the same effect? 
  • Alternative progesterone-only methods of contraception 

Continue reading “Cerelle vs Cerazette: Are they really the same?”

Domperidone in breastfeeding | Increase milk supply

Several factors can impact breast milk supply with common factors including low frequency of breastfeeding, wrong latching by a baby, late start of breastfeeding, use of formula alongside breastfeeding and some drugs. Drug therapy to increase milk production is usually considered when insufficient milk is produced despite appropriate lactation support (Grzeskowiak et al, 2018). Today I will review the use of domperidone in breastfeeding. One of the uncommon side effects of domperidone is galactorrhoea (excessive milk production), which lead to unlicensed use of domperidone in breastfeeding to increase the production of the milk. I will review several areas considering domperidone in breastfeeding. Summary of the post:

  • What is domperidone
  • Can you get domperidone over the counter? 
  • How domperidone increase milk production? 
  • Domperidone in breastfeeding: Can domperidone increase milk supply?
  • Domperidone dosage in breastfeeding
  • Domperidone: possible side effects
  • Is domperidone excreted in breastmilk? 
  • Can you get domperidone prescribed on the NHS? 
  • How much does domperidone cost (private prescription cost)?
  • Conclusion

Continue reading “Domperidone in breastfeeding | Increase milk supply”

Best creams for thrush | Vaginal thrush treatment

Thrush (also known as candidiasis) is a common condition affecting mainly women; however, men can also get it. Thrush infection may affect the vagina (or penis in men) or mouth (oral thrush). The focus of this post is the treatment of vaginal thrush with creams and combination products, which are available from the pharmacies (including online chemists), supermarkets and other online retailers. Fortunately, creams for thrush are available in pharmacies, and most patients can buy them without seeing a GP. The following will be discussed:

  • Thrush definition and symptoms
  • When to see GP
  • Treatment recommendations
  • Creams for thrush
  • Combination products for the treatment of vaginal thrush
  • Alternative treatments for vaginal thrush
  • Self-care measures to prevent thrush
  • Note on paying for NHS prescriptions when a combination product for the treatment of thrush is prescribed

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Evorel patches incl. Evorel Conti Alternative drugs

Evorel patches have been subject to shortages since 2019. Today the stock of Evorel patches, including Evorel Conti and Evorel Sequi is being replenished with improved availability in many pharmacies due to imposed supply restrictions by the wholesaler which redistributes Evorel products. Today I am looking at different options for treatment of Hormone Replacement Therapy (HRT), focusing on Evorel, Evorel Conti and Evorel Sequi alternative drugs. Additionally, stock availability in the UK for Evorel, Evorel range will be discussed.

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Treatment of cystitis over the counter

Cystitis is a common condition mainly affecting women; however, it can also affect men and children. Mild cystitis is usually a self-limiting condition, meaning it will go on its own. Some patients may need to see their GP, depending on symptoms and their duration. Treatment of cystitis over the counter involves pain management with commonly available analgesics and the symptomatic management with products available from a pharmacy and other stores. Patients may also use different private services to obtain prescription-only treatment (antibiotics) without seeing a GP (NHS). In this post, I will summarise options available for the treatment of cystitis:

  • Over the counter product for the management of symptoms
  • Review of private services offered by UK pharmacies to supply antibiotic for cystitis without seeing a GP

What is cystitis?

Cystitis is defined as the inflammation of the bladder, which is usually caused by a bacterial infection. Other causes of cystitis may also include the use of scented soaps or irritation from sex. Cystitis is the most common type of urinary tract infection (UTI).

Symptoms of cystitis

The main symptoms associated with cystitis:

  • Burning sensation when weeing (passing the urine)
  • Pain on urination
  • Pain in the lower tummy
  • Passing the urine more frequently or wanting to pee after urination
  • Needing to pee more urgently
  • Urine which is dark or cloudy colour, which can also be smelling

Cystitis: Who need to see GP?

The following groups of patients are advised to see their GP when experiencing symptoms of cystitis:

  • Children
  • Men (cystitis is much less common in men)
  • Pregnant women
  • Symptoms lasting longer than three days
  • Symptoms getting worse (cystitis can lead to kidney infection)
  • Patients with severe symptoms such as concomitant high temperature or blood in the urine
  • Patients who get cystitis often

Self-care measures recommended in the management of cystitis:

  • Drinking plenty of fluids, preferably water or drinks which do not contain caffeine or sugar 
  • No evidence exists to support the use of cranberry juice or cranberry products to improve the symptoms of cystitis

How to reduce the risk of getting cystitis?

Reducing the risk of cystitis, for example:

    • After using the toilet wipe from the front (vagina) to the back (bottom)
    • Empty bladder after having sex
    • Drinking plenty of fluids throughout the day
    • Avoiding perfumed soaps and bubble bath

Treatment of cystitis over the counter: pain management

Patients are advised to use simple analgesia for pain relief related to cystitis. Over the counter painkillers which can be used include:

  • Paracetamol
  • Ibuprofen (if suitable)

Treatment of cystitis over the counter

Over the counter products used in the treatment of cystitis are used to manage symptoms of mild cystitis. Patients with symptoms which persist after a two-day course with over the counter product for cystitis or symptoms which worsen should speak to a doctor.

Where can you buy products for cystitis?

Most pharmacies and larger grocery stores sell products for cystitis. The number of products can also be purchased online on Amazon and other websites. Although I review the use of the two most popular cystitis products, there are plenty of other brands available online and from pharmacies containing the same active ingredients.

Options for over the counter treatment of cystitis

Products used in the management of cystitis make the urine less acidic, helping with cystitis symptoms such as painful urination, burning, and stinging. Two main ingredients used in cystitis relief products include:

  • Potassium citrate
  • Sodium citrate

Neither of the products has antibiotics properties. Additionally, there is little evidence to support their effectiveness.

Products used to relieve cystitis symptoms come in the form of powders, which are mixed with water.

CanesOasis for management of cystitis

Sale
2,804 Reviews
Canesoasis Cystitis Relief, Cranberry Flavour Oral Solution, 6 Sachets
  • 48hr complete course of treatment
  • CanesOasis is specially designed to provide effective relief from the stinging and burning of cystitis
  • CanesOasis is specially designed to provide effective relief from the symptoms of cystitis

CanesOasis comes in the form of granules (cranberry flavour), which contain sodium citrate.

CanesOasis age restrictions

Patients must be 16 years of age to purchase the product. CanesOasis should not be used by children or by men.

How to take CanesOasis?

One sachet three times a day for two days. Mix content of sachet with water.

Can anyone use CanesOasis?

Customers who are allergic to sodium citrate should not use CanesOasis.

Sodium citrate should not be used by patients with:

  • high blood pressure
  • heart disease
  • diabetes
  • history of kidney disease
  • pregnant women
  • patient on a low sodium (salt) diet

Cystopurin Granules for cystitis

Cystopurin is another popular brand of cystitis relief products. Cystopurin comes in the form of granules. When mixed with water, a cranberry flavoured drink is formed.

Sale
1,195 Reviews
Cystopurin Cystitis Relief, Cranberry Flavour and Low in Sodium, 6 Sachets
  • Granular powder, flavoured with cranberry extract
  • Suitable for adults, elderly and children over 6 years
  • Effective relief from the symptoms of cystitis

Cystopurin contains potassium citrate, which is an alternative option to previously discussed sodium citrate. Cystopurin is a low sodium preparation, which may be a better option for patients who seek low-sodium products.

Cystopiurin: age restrictions

Adults and children over six years of age can use Cystopurin. Children over six years of age should only use Cystopurin after the advice from a doctor.   

Can anyone use Cystopurin?

Patients with a history of kidney disease and patients allergic to potassium citrate should not use Cystopurin. Patients who take ACE inhibitors (e.g., ramipril) and potassium-sparing diuretics (e.g., amiloride) should consult their doctor before using Cystopurin. Generally, patients who take those drugs should not use potassium preparations due to the risk of hyperkalaemia (high potassium levels).

Cystopiurin is not recommended during pregnancy or breast-feeding unless advised by a doctor.

How to take Cystopiurin?

Cystopiurin granules should be mixed with water. One sachet should be taken three times a day for two days

Private services for the treatment of cystitis

Can you get antibiotics over the counter for the treatment of cystitis?

Generally, you can’t get over the counter antibiotics for treatment of cystitis. However, there are few options offered by pharmacies in the form of private services, which may allow patients to buy antibiotics without seeing a GP.

Boots Cystitis Test & Treat Service

Boots offer a private service for testing and treatment of UTIs, including the supply of prescription-only medication without seeing a GP.

In a nutshell, patients need to purchase a Dip UTI test kit online or from Boots pharmacy (£10) and complete the urine dipstick test. Patients need to download an app and follow the instructions from the app. The test takes a few minutes only.

Once the test is completed, patients need to see a pharmacist in one of Boots stores to discuss the results. If appropriate, a pharmacist can offer the supply of prescription-only antibiotic for which the patient needs to pay (£15).   

Superdrug cystitis treatment

Superdrug’s cystitis service is aimed at women aged under 65. In contrast to Boots cystitis service, Superdrug requires the patient to answer a short questionnaire to get antibiotic treatment.

As a part of the treatment, Superdrug offers a three-day course with MacroBid® antibiotic. MacroBid® is a brand of nitrofurantoin antibiotic, currently recommended as a first-line treatment of UTI in the UK. MacroBid® comes in the form of modified-release capsules, which are usually taken twice a day.  

Patients are also able to order antibiotic treatment for future use in case they experience symptoms of cystitis.

Patients can choose to ‘click and collect‘ the treatment from Superdrug Pharmacies, or choose delivery instead.

Superdrug’s cystitis treatment costs £25, which includes 6 MacroBid® 100mg capsules (3-day course).

The usual dose for treatment of cystitis with MacroBid®:

  • Take one capsule twice a day for three days

Lloyds Pharmacy Cystitis treatment

Lloyds Pharmacy offers a three-day course/treatment of cystitis also with MacroBid® antibiotic as a part of Online Doctor services. Patients who cannot take MacroBid® (nitrofurantoin) may choose an alternative treatment with trimethoprim, another antibiotic.

Patients need to complete a short online questionnaire with the answers reviewed by one of the clinicians. When approved, patients can collect their medication from selected Lloyds Pharmacy branch.

Cost of the service: £23.99 for a three-day course with MacroBid®.

Treatment of cystitis with ‘Online Doctor’ services

There are many websites which offer private online consultations with doctors. Some patients may have access to online doctor services trough private healthcare with their employers. However, services like Push Doctor (and many others), for example, are accessible to the general public.

Patients may obtain a private prescription to treat cystitis with an antibiotic after a consultation with a doctor.

Overall, this option may add up to a higher cost of the treatment, but it will depend on whether one already has access to private services and at what price.

The treatment’s total cost would be equal to the cost of a consultation with a doctor + prescription fee (may be included in the cost of service) + cost of drug supplied by pharmacy.

When a private prescription is brought to a pharmacy, the patient needs to pay for the cost of medication and any additional markup (which may be 20% or more on top of the drug cost). For a 3 day course with MacroBid capsules, patients may expect to pay around £6 (price will vary between pharmacies). Some pharmacies may have a minimum charge for supplying drugs on private prescriptions, which may be more than £6.

Conclusion: what is the best treatment for cystitis?

Cystitis is a self-limiting condition in many cases. Patients with mild symptoms can use over the counter painkillers to help with pain and products containing potassium or sodium citrate.

Antibiotics are effective in the treatment of cystitis and UTIs. Out of three options discussed, Superdrug Pharmacy and Lloyds Pharmacy offers the antibiotic treatment with no test to confirm a bacterial infection. This may be the most convenient and fastest way of getting an antibiotic without seeing a doctor.

Patients need to be aware that antibiotic treatment for cystitis is not always required. Overuse of antibiotics can lead to antibiotic resistance, which means that in long term antibiotics become less effective in the treatment of infections (PHE, n.d.).

References:

Public Health England, PHE (n.d.). Treating your infection – urinary tract infection (UTI). Available at:  https://www.prescqipp.info/umbraco/surface/authorisedmediasurface/index?url=%2fmedia%2f3162%2ftreating-your-infection-uti.pdf Accessed on 26/06/2020

Antibiotics for UTI when pregnant: recommendations

Urinary-tract infection (UTI) is a common condition experienced in pregnancy. Physiological changes to the urinary tract during the pregnancy, such as dilation of the urethra and decreased bladder capacity, increase the risk of urinary infections (Hebak, 2019). UTI is an umbrella term which defines infection of the bladder (cystitis), kidneys, or urethra. In this post, I am looking at recommended antibiotics in UTI when a pregnant patient is affected by this condition.  Continue reading “Antibiotics for UTI when pregnant: recommendations”

Dianette For Acne – review of treatment with a ‘pill’

Acne is a common skin condition. In the UK, more than 3.5 million visits are made by patients to GP practices, who seek the treatment for this condition. The first-line treatment for acne includes topical preparations, such as topical retinoid products, topical antibiotics, alone or in combination with benzoyl peroxide (NICE, 2018). Hormonal treatment is recommended when patients do not respond to first-line therapy and as an optional treatment to systemic (oral) antibiotics. Today, I review the use of Dianette for acne treatment, a hormonal (contraceptive) pill available as a prescription-only medication.

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