OTC Table

Conditions Symptoms Drugs that may

cause it
Treatment with
age group
When to refer
Aphthous
ulcers (MAU) or
Mouth ulcers
They occur in
small crops,
are roundish,
grey white in
colour and
painful. Pain
can subside in
3-4 days.
Cytotoxic drugs,

NSAIDS,

Nicorandil,

B-blockers and
alendronate
1. Adcortyl in
orabase: (any age)
2. Corlan
(hydrocortisone) in
over 12.
3. Choline
salicylate (bonjela)
over 10.
4. Anbesol, Calgel
(anaesthetics)
5. Corsodyl (during
pregnancy and
breastfeed as well)

Children under
10
Duration longer
than 14 days.
Painless ulcer
Systemic fever
Crops of 5-10
Ulcergreater
than 1cm

Oral thrush Creamy-white
soft elevated
patches that
can be wiped
off revealing
underlying
erythematous
mucosa.
Pain,
soreness,
altered taste
and burning
tongue can
be present.
Inhaled

corticosteroids,

antibiotics
(broad
spectrum)
Daktarin Gel
(miconazole) it has
superior cure rate
than the POM
nystan.

Used in infants
upwards.
Hold the gel in
mouth for as long
as possible.
Use for 2 days.
Duration longer than 3
weeks.

Immunocompromised

Painless lesions

Diabetic.
Gingivitis Inflammation
of gums

Swelling and
reddening of
the gums
which bleed
easily with
slight trauma.
E.g. brushing
teeth.

Plaque might
be present
Warfarin

Heparin

NSAIDS
Corsodyl

Betadine
(povodine-iodine)
over 6

Hexetidine
(oraldene) over 6

Peroxyl (hydrogen
proxide) over 6
Foul taste associated
with gum bleeding

Loose teeth

Signs of systemic illness

Spontaneous gum
bleeding.
Dyspepsia Bloating

Flatulence
Feeling of
fullness
ACE I, Alcohol,
Antibiotics,
Bisphosphonates
CCBs
Iron
First line: Antacids
or
Antacids/alginates:
over 12y olds.

ALARM: Anaemia, Loss
of weight, Anorexia,
Recent onset of
progressive symptoms,
Melaena

Heartburn
Nausea
and/or
vomiting.
Metformin
Metronidazole
Nitrates
Oestrogens
Potassium supp
Sibutramine
Steroids
Theophylline.
Zantac (ranitidine)
and Pepcid
(famotidine): over
16s

Zanprol
(Omeprazole) in
over 18s with
moderate to
severe symptoms.



Dysphasia

Treatment failure

Persistent vomiting
Referred pain that is
severe
Irritable bowel
syndrome (IBS)
Abdominal
pain or
discomfort
located in the
left lower
quadrant of
the abdomen,
which is
sometimes
relieved by
defecation or
passage of
wind. Altered
defecation
(constipation
n diarrhoea)
present.
Hyoscine
(buscopan) over
12

Mebeverine
(colofac IBS) over
10

Pepppermint oil
(colpermin) over
15

Alverine over 12
Blood in the stool

Children under 16

Fever

Nausea and/or vomiting

Patient over 45 with
recent change of bowel
habit.

Severe abdominal pain

Steatorrhoea
Haemorrhoids
(piles)
Bleeding

Perianal
itching

Mucus
discharge,
Pain
Diet increasd
fibre

Anusol

Anusol plus HC

Germoloids

All suitable in over
12s however if
present first time
under 20s should
be referred.
Blood mixed in the stool

Fever

Unexplained rectal
bleeding

Persistent change in
bowel habit in middle-
aged patients.
Cystitis Pain when
passing urine
associated
with pain and
frequency.
Cranberry juice

Potassium citrate
(Effercitrate and
Cystopurin) over
1 year

Sodium citrate
Children under 16 and
grannies over 70

Diabetes

Duration longer than
7days

Cymalon
Treat for 2 days.
Men (Unlucky bro)

Immunocompromised

Pregnancy

Vaginal discharge
Patients with fever,
nausea, vomiting



Primary
dysmenorrhoea
(period pain)
Lower
abdominal
cramping
pains shortly
before
(6hours) and
for 2-3 days
after onset of
bleeding.

Associated
back pain,
nausea
and/or
vomiting may
occur
Ibuprofen first
line over 16

Naproxen (feminax
ultra) over 15
50years olds

Buscopan
(hyoscine) over
12
Heavy or unexplained
bleeding.

Pain experienced before
menses

Systemic symptoms

Women over 30 with
new symptoms

Pain that increases on
onset of menses

Bleeding in post-
menopausal women
Heavy
menstrual
bleeding
Blood loss
that is greater
than normal

Heavier
bleeding than
normal
menses.
Anticoagulants

Cimetidine

Steroids

Thyroid
hormones

MAOis

Phenothiazines
Tranexamic acid
(cyklo- f): over 18
and under 45
years old

Dont use in
following:
pregnancy n
breast feeding

Diabetics, obese
and nulliparous
women

Thromboembolic
disease (personal
or family history)

Mild to moderate
renal failure.
Pelvic pain

Intermenstrual bleeding

Postcoital bleeding or
postcoital pain

Treatment failure.
Psoriasis Chronic
relapsing
inflammation.
Tar based
products - can
stain clothes n
Lesions that are
expensive, follow recent
infection or cause
Salmon pink
lesions with
silvery white
scales and
well defined
boundries.
skin.
Dithranol: stain
skin purple brown
but clears in time

Emollients
moderate to severe
itching.

Pustular psoriatic
lesions

Patients with psoriatic
lesions but no family
history of psoriasis.
Dandruff Dry scalp,
itchy and
flaky.
Flakes of
dead skin are
usually visible
in the hair
close to the
scalp, might
be visible on
the shoulders
and collars of
clothing.
Coal tar products

Selenium sulphide
(selsun) over 5

Zinc pyrithione
Head n shoulders

Ketoconazole
(Nizoral)
OTC treatment failure
with medicated
shampoo

Suspected fungal
infection
Fungal
infections
Imidazoles/steroid
combination
over 10

Terbinafine (lamisil
AT) Over 16

Lamisil Once
over 18

Fungal nail
infection
Amorolfine
Curanail Over
18s

Warts Occur on the
backs of the
hands,,
fingers and
knees either
singly or in
crops
Salicylic acid-based
products Bazuka,
cuplex, wartex,
duofilm, salactol
salatac

Formaldehyde-
Veracur
Anogenital warts

Warts that itch, bleed

Warts that have grown
and changed colour

Lesions on the face

Multiple and
widespread


Verrucas Found on the
sole of the
foot usually in
weight-
bearing areas
or on the
metatarsal
heads or heel.

Corns n
Calluses
Treat same as
corns and verrucas

Scabies Severe
pruritus
especially at
night, can be
caused by
direct
physical
contact
(naughty)
Permethrin
(Lyclear) over 2
months

Malathion (Derbac
M and Quellada
M) over 6
months

Benzyl Benzoate
(Ascabiol)

Crotamiton (Eurax)
over 3

Eczema Emollients

Hydrocortisone
Dermacort, HC45,
Lanacort over
10s

Clobetasone
(Eumovate) over
12

Headache Over use of
some medicines
including the
ones to treat the
headache itself.

Nitrates


Imigran recovery
(sumatriptan)
over 18

Buccastem M
(prochlorperazine)
over 18 in
patients who
experience nausea
and vomiting

Migraleve in over
10



Insomnia Caffeine (tea,
coffee,
Chocolate)

Theophylline

Carbamazepine,
Phenytoin

Alcohol

SSRIs
Promethazine
(sominex and
Phenergan)

Diphenhydramine
- over 16 (Nytol,
Nightcalm)

Melatonin

Herbal (german
chamomile,
Children under 12

Duration more than 3
weeks

Insomnia with unknown
cause

Anxiety n depression

Undiagnosed medical
conditions

Diuretics

Beta blockers

Griseofulvin
skullcap, wild
lettuce, lavender)
Nausea and
vomiting
Cytotoxics

Opiates

Iron

Antibiotics

NSAIDS

Potassium
supplements

SSRIs

Nicotine Gum

Theophylline
Domperidone
(Motillium) over
16s

Prochlorperazine
(Buccastem M)
over 18s

Motion
sickness
Cyclizine (valoid)-
over 6

Cinnarizine
(stugeron) over 5

Meclozine (Sea-
legs) over 2

Hyoscine (Joy-
rides) over 3

Kwells over 10

Kwells kids over
4

Promethazine
(avomine) - over 5