Co-codamol Over the Counter – All facts you must know

Without a doubt, Co-codamol over the counter is one of the most popular products purchased from the pharmacy. Co-codamol tablets can be purchased from a pharmacy without a prescription. Certain supply restrictions apply when co-codamol is bought over the counter. 

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Migraleve Pink alternative

Migraleve Pink is out of stock! What is the alternative product?

Migraleve Pink tables disappeared from UK pharmacies few months ago and currently there is no signs of any come back. A very vague message on migraleve.co.uk suggests it’s a temporary situation and that the producers are ‘working hard to resolve the situation’. We now know that the issues is not temporary as Migraleve Pink has been out of stock since mid 2018.

Update June 2019:

As of end of June Migraleve Pink, and Migraleve packs containing Pink Tablets and Yellow Tablets are now available.

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How to get modafinil in the UK? ANSWERED

Modafinil (brand name: Provigil) is a medication used in the management of excessive sleepiness associated with a rare condition called narcolepsy. There is a great interest in modafinil for its unlicensed use as a ‘smart drug’ due to its main actions on the body: promoting wakefulness and possibly increasing cognitive performance. Movies like Limitless contributed to greater interest in smart drugs, particularly modafinil which received a label of NZT-48 drug, the limitless pill, a drug which does not exist in real life. Intrest in modafinil created a demand for this drug, and now many online pharmacies sell modafinil on the basis of a private service. In this post, I will explain how to get modafinil in the UK or where to purchase it online.

I will also discuss the following:

  • the legal classification of modafinil
  • mechanism of action of modafinil
  • Is modafinil a ‘smart drug’?
  • possible side-effects associated with modafinil use
  • how to get modafinil / how to get modafinil prescription
  • list of online pharmacies / online doctors which offer supply of modafinil privately

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How long does prescription last?

Prescriptions (NHS, private & vet) need to be dispensed within an appropriate time frame. All prescriptions: NHS, computer-generated, electronic (EPS), or handwritten must be dated. Prescriptions without a date are not legally valid and most likely will not be dispensed. Generally, the most important factor which affects prescription expiry date is the presence of a controlled drug. So, how long does prescription last? Read on. 

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Calpol vapour plug review

Calpol vapour plug is a non-medicine device designed to help your child to breath easily by releasing aromatic oils of lavender, camomile and menthol when they congested or/and have symptoms of cold. Calpol vapour plug can be used for babies from 3 months of age.

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Can I transfer my prescription to any pharmacy?

Tody’s post summarises prescription transfer between pharmacies. After reading this post you will know how to transfer a prescription from one to another pharmacy. This article brings similar concepts to another post – How to change a nominated pharmacy, which I encourage you to read. Transfer of prescriptions between pharmacies can be done easily thanks to Electronic Prescription Service (EPS) which became a default method of prescription transfer between a GP surgery and nominated pharmacy (pharmacy of your choice). EPS allows to send a prescription electronically (with the use of the Internet) between GP surgery and pharmacy. This process is almost instantaneous. There are a couple of situations where a prescription transfer is not possible, so please read this post to find out more. The following will be discussed:

  • transfer of ‘paper’ prescriptions (less common process)
  • transfer of an electronic prescription (EPS)
  • transfer of partly dispensed prescripions

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Over the counter: sleeping pills

In this post I will summarise the main sleeping products available in UK for relief of temporary sleeping problems which are available over the counter without a prescription.

Insomnia can be caused by number of factors. Some common include stress and anxiety. Changing you sleeping habits can improve your sleeping. However there are number of things that can be done to relief insomnia.

NHS UK and Mind offer some excellent tips on improving your sleep.

All products available over the counter ‘for sleeping’ contain sedative antihistamines as main active ingredient. Two antihistamines used in sleeping pills in UK are diphenhydramine and promethazine. Both drugs are sold under different branded names including pharmacy own brands.

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What caused recent drug shortages in UK? (Poll)

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Drug shortages became a ‘hot’ pharmacy topic in the media. Number of articles were published around recent drug shortages in pharmacies as well as in hospitals. This increases workload on pharmacy teams and GP surgeries (GPs report sharp rise in drug shortages driving up workload). Who is to blame?

Read more to see the poll & leave your opinion.

Can you get amoxicillin over the counter without prescription?

Amoxicillin is used to treat a wide range of infections including respiratory infections, middle ear infections, dental abscesses and number of other infections. Amoxicillin is the most commonly prescribed antibiotic in UK with seasonal prescribing patterns. In months of December and January on average about 1 million amoxicillin prescriptions is issued each month (OpenPrescribing.net)

Is amoxicillin available over the counter without prescription?

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Saxenda review – effectiveness of NEW weight loss drug.

Saxenda (Liraglutide) is one of two drugs licensed in the UK for weight loss. Saxenda is the brand name of the drug Liraglutide, also known under the branded name of Victoza, which has been used in the treatment of type 2 diabetes in the UK since 2009. The focus of Saxenda review is the use of Liraglutide in weight loss, however other areas are discussed, including: 

  • Licensed indication 
  • Mechanism of action of Saxenda 
  • Dose used in weight loss management 
  • Comparison of Saxenda use in weight loss to Victoza in the management of type 2 diabetes. Are they the same?
  • Effectiveness of Saxenda in weight loss: a review of clinical trials
  • Side effects associated with the treatment 
  • Cost of Saxenda treatment and it’s availability on NHS

Saxenda review: what is the license in the UK?

Saxenda (Liraglutide) was introduced to the UK in 2017. It is licensed as part of a reduced-calorie diet and increased physical activity in obese patients with:

  • BMI of more than 30 (obese) or 
  • BMI of less than 30 but more than 27 (overweight) who have weight-related conditions such as prediabetes, diabetes, hypertension, dyslipidemia (for example, high cholesterol level).

Additionally, if a satisfactory loss of body weight is not achieved (reduction by 5% of initial body weight) in 12 weeks, treatment will be discontinued.

Saxenda review of mechanism of action?

Without going deep into the science, Saxenda’s mechanism of action is described as hormonal. Saxenda mimics actions of GLP-1 hormone (found in our body) to decrease appetite and increased satiety (Sexandapro.com, ND), which contributes to a decrease in calorie intake and consequent weight loss.

Saxenda review of the licensed dose in weight management

Patients who use Saxenda star on a dose of 0.6mg once daily. It is recommended to increase the dose in intervals of at least one week to a maximum dose of 3mg daily. The dose should be increased by 0.6mg with at least seven-day intervals. 

Saxenda comes in the form of a prefilled, multi-dose pen. Saxenda is injected daily into one of the following areas:

  • stomach area 
  • upper leg (thigh), or 
  • upper arm 

The video below demonstrated how the Saxenda pen is used. 

Saxenda for weight loss vs. Victoza for type 2 diabetes, what is the difference?

Both prefilled, same size pens contain the active drug – Liraglutide, at the concentration of 6mg in 1ml. Excipients present  in Saxenda and Victoza are almost the same, with the exception of a couple ‘inactive’ ingredients used in the formulation of Saxenda. The following are the main differences/similarities between both products:

Saxenda

Victoza

Licensed indication Weight management (weight loss) in conjunction with hypocyloric diet and exercise in obese patients (BMI over 30) or patients with BMI over 27 with other health conditions. Management of type 2 diabetes in conjunction with diet and exercise. Victoza can be used on its own where metformin contra-indicated or intolerant or as combination therapy with other antidiabetic drugs.
Age For adults only Adults and children over ten years of age
Dose Starting dose of 0.6mg increased to maximum of 3mg daily. Starting dose of 0.6mg increased to maximum of 1.8mg. Higher doses are not recommended.
Side effects Similar for both products. Refer to product information leaflet for more details.
Cost for private patients Around £75 per pen. Around £50 per pen.
Can you get it on NHS? Yes, however unlikely. Yes.

Saxenda review of effectiveness?

Main studies: summary (NICE, 2017)

The main evidence behind the effectiveness of Saxenda comes from 4 clinical trials. Patients who used Saxenda were obese or overweight and had co-morbidity such as hypertension. During the trials, there was a significant difference in weight loss between patients who used Saxenda and patients who used a placebo product (a product which did not contain the active drug). All patients who participated in clinical trials received lifestyle interventions for weight loss, such as reduced-calorie diet and increased exercise. 

Across all studies (duration between 32-160 weeks), the estimated weight loss was between 5.4% and 4% of body weight (NICE, 2017). However, many patients regained the weight after stopping the treatment.

Overall, more patients who received Saxenda treatment left clinical trials due to side effects experienced (9.2-13%) versus 3.3%-6% who received placebo treatment (ibid).

Weight-loss outcomes: summary study 1 (Pi-Sunyer et al., 2015)

  • 56-week study in obese patients (BMI over 30) or patients with BMI 0ver 27 with other conditions such as high cholesterol or blood pressure levels
  • 3731 patients
  • Placebo-controlled: some patients used product with no active drug
  • Dose of Saxenda used: 3mg once daily in combination with advice (counseling) on lifestyle changes.  
  • Outcomes:
    • 63.2% of patients who used Saxenda lost 5% or more of body weight as compared to 27.1% of placebo patient group
    • 33.1% of patients on Saxenda lost 10% or more of their body weight as compared to 10.6% on placebo treatment 
    • Most common reported side effects were nausea and diarrhoea
    • Serious side effects were experienced by 6.2% of patients who used Saxenda versus 5% patients on placebo           

Study 2 (Le Roux et al., 2017):

  • three-year study in obese patients with prediabetes
  • 2254 participants who received treatment with Saxenda (3mg once daily) or placebo in conjunction with a reduced-calorie diet and increased exercise
  • 2% of patients treated with Saxenda developed diabetes as compared to 6% who used placebo treatment
  • Overall, Saxenda may reduce the risk of diabetes development in obese or prediabetic patients 

Saxenda review of possible side effects and warnings 

Like with all drugs, the use of Saxenda for weight loss comes with a risk of side effects. Very common side effects, experienced by 10% or more patients include: 

  • Nausea
  • Vomiting 
  • Diarrhoea
  • Constipation 

Additionally, there is a number of common side effects, including:

  • Dry mouth
  • Dizziness
  • Hypoglycaemia (low sugar level)
  • Dyspepsia and Gastro-oesophageal reflux disease (GORD)
  • Fatigue 

Please note this is not an exhaustive list. For a list of all side effects and warnings, read product information leaflet, which can be found online

Saxenda cancer risk

One of the first warnings that pop up when visiting www.saxendapro.com is important safety information about risks of thyroid C-cell tumors (Saxendapo.com, ND):

  • Liraglutide cause dose-dependent and treatment duration-dependent thyroid C-cell tumors in both rats and mice
  • It is not known if Saxenda has the same effect in humans
  • Patients should be informed about the risk and possible symptoms of thyroid tumors 

Other warnings:

  • Acute pancreatitis including fatal and non-fatal hemorrhagic or necrotizing pancreatitis (death of pancreas due to lack of blood supply)
  • Acute gallbladder disease
  • Risk of hypoglycaemia when used with other ant-diabetic drugs
  • Heart rate increase
  • Renal impairment
  • Hypersensitivity reactions
  • Suicidal behaviours:
    • During a clinical trial in humans, 9 of 3384 patients (0.3%) treated with Saxenda reported suicidal thoughts (0.1% for placebo) with one attempted suicide.

For more information, visit the above warning visit SaxendaPro website.

Saxenda cost

Saxenda cost per pen

Saxenda cost varies between pharmacies. Saxenda can be purchased online with prices of around £75 per pen.

Saxenda monthly cost

  • Each Saxenda pen contains 18mg of active drug Liraglutide in 3ml of solution.
  • If the maximum daily dose was used 3mg, for example, one pen would last six days; therefore, the patient would require five pens each month to deliver a maximum daily dose of 3mg.
  • Based on this monthly cost of Saxenda would equal to £375.

Where to buy Saxenda?

Saxenda can be purchased online from registered pharmacies. When Saxenda is purchased online, normally, patients need to answer a number of questions about their health to access the suitability of the product. Patients who have Saxenda prescribed privately can use any conventional pharmacy to process a Saxenda prescription. The prices in high street pharmacies may vary; therefore, it is recommended to call/visit a few pharmacies to get the best deal.

Saxenda weight loss on NHS?

Saxenda can be prescribed in the UK. Saxenda is not commonly prescribed in the UK. Prescribing information available on OpenPrescibing.net shows that it was only prescribed 13 times in January 2019 (an increase from 7 in December 2018).

As of today, Saxenda use in NHS is very limited and not included in NICE recommendations on identifying, assessing, and managing obesity. The only current treatment option recommended by this guide is Orlistat.

European Medicine Agency, which publishes reports for each medication that receives marketing authorisation noted that it is ‘unlikely that any potential weight loss achieved with liraglutide’ will continue after the treatment is stopped.

Saxenda review summary

Trough its novel mechanism of action, Saxenda offers an interesting approach to weight loss; however there is a wide range of possible common very common side effects. NHS and private treatment carry a high price tag to NHS and private patients, making it almost not affordable. Obese patients may consider other options such as treatment with Orlistat, which is taken orally. The effectiveness of Orlistat in weight loss is covered in a separate post, Orlistat review: Can you achieve a weight loss? By far, physical exercise and a well-balanced diet is the most effective way of weight loss.

References:

  • Le Roux Carel W., Arne Astrup,Ken Fujioka, Frank Greenway, David C W Lau, Luc Van Gaal, Rafael Violante Ortiz, John P H Wilding, Trine V Skjøth, Linda Shapiro Manning, Xavier Pi-Sunyer, Andreas Hamann, Alain Barakat, Matthias Blüher, Thomas Linn, Andrea Mölle et al. (2017). 3 years of Liraglutide versus placebo for type 2 diabetes risk reduction and weight management in individuals with prediabetes: a randomised, double-blind trial. Available at: https://doi.org/10.1016/S0140-6736(17)30069-7 Accessed on 14/12/2019
  • NICE (2017). Obese, overweight with risk factors: Liraglutide (Saxenda). Available at: https://www.nice.org.uk/advice/es14/chapter/Key-points Accessed on 16/03/2019
  • Pi-Sunyer, Xavier and Astrup, Arne and Fujioka, Ken and Greenway, Frank and Halpern, Alfredo and Krempf, Michel and Lau, David C.W. and le Roux, Carel W. and Violante Ortiz, Rafael and Jensen, Christine Bjørn and Wilding, John P.H. (2015). A Randomized, Controlled Trial of 3.0 mg of Liraglutide in Weight Management. Available at: https://doi.org/10.1056/NEJMoa1411892 Accessed on 14/12/2019
  • Saxendapro.com (ND). Mechanism of action. Available at: https://www.saxendapro.com/how-saxenda-works.html Accessed on 16/03/2019