France tightens (further) rules on sale of paracetamol and ibuprofen

[helvella]

I thought this of possible interest given the many discussions about availability of thyroid hormones in France and elsewhere. And anyone going to France might find it useful to know.

France tightens (further) rules on sale of paracetamol and ibuprofen

International residents in France often complain about about the fact that ONLY pharmacies sell over-the-counter painkillers like paracetamol and ibuprofen rather than supermarkets or corner shops, but now the rules are getting even stricter.

From Wednesday, January 15th, painkillers like Doliprane, Dafalgam or Advil can no longer be picked up directly off the shelves by customers in pharmacies.

Instead these kind of over-the-counter drugs will all be placed behind the counter, so that while they do not need a prescription, customers will still have to ask the pharmacist if they want to purchase them.

This is already the case in some pharmacies in France but French health regulator ANSM wants it to become the norm in order to stem the over-use of the drugs and the associated health risks. Over-use of paracetamol for example can use damage to the liver.

The measure will affect around 36 different brands of paracetamol including Doliprane, Efferalgan, Dafalgan and 46 kinds of ibuprofen including Advil and Nurofen.

"The ANSM would like the drugs to no longer be placed in free access and instead are all placed behind the counter of the pharmacy, which would strengthen its role of advising patients," said the agency earlier this year.

When asked pharmacists in France often make customers aware of the risks of taking paracetamol and the maximum recommended dose.

thelocal.fr/20200113/france...

[LindaC]

Wow - I won't take any of the opioid etc stuff - only x1 paracetamol when desperate - what's to be done?

[helvella in reply to LindaC]

Suffer.

I bought a product the other day which was on the open shelves in both a Tesco supermarket pharmacy and a Boots shop - despite being classified as [P] - Pharmacy. Which they should ask about. No, I wasn't asked or told anything. (Tesco even rang it up as the wrong product - same price - but that just shows how aware and careful they were.)

[LindaC in reply to helvella]

Yes, still seems to be available here. I loathe taking any but sometimes needs must

On top of the other [long neglected stuff] I've ended up with spinal problems from way back and was last year prescribed opioids - couldn't take them for more than days without intolerable side effects (chest wheezing + swollen ankles). I bought got some Gel Freeze which helped a lot.

Recently offered Gabapentin - not knowing anything about this product - I accepted the prescription but checked online beforehand... eek! Dreadful and likely not even effective. I said, "Looks like I'll just have to 'hit the streets'!" I do hope the receptionist got the context

Medicine seems to push that which is likely worthless or refuse what is much needed.

[TSH110 in reply to LindaC]

I go for good old aspirin. I wonder if the French are the same about aspirin as the others.

[LindaC in reply to TSH110]

Yes, I take the odd one and used to take more - still do before long haul flights - but 'they've' also tried to put us off that too. Guess we all do what we have to off our own bat... docs would quite happily prescribe all manner of 'rubbish' yet - re chronic illnesses - not what we'd prefer. Ah well

[helvella in reply to TSH110]

Well, I think all aspirin products in the UK say:

There is a possible association between aspirin and Reye's syndrome when given to children. Reye's syndrome is a very rare disease, which affects the brain and liver and can be fatal. For this reason aspirin should not be given to children under 16 years unless specifically indicated (e.g. for Kawasaki's disease).

ET EN FRANCE:

Le syndrome de Reye est une maladie rare non inflammatoire pouvant causer des conséquences graves sur le foie et le cerveau. Si la maladie n'est pas prise en charge rapidement, celle-ci peut engendrer des dommages irréversibles au niveau cérébral voire être létale pour l'individu.

Les sujets les plus souvent impactés par le syndrome de Reye sont les enfants et les jeunes adultes âgés de moins de 20 ans. Cependant des cas d'adultes d'âge plus avancé ont déjà été recensés.

[TSH110 in reply to helvella]

That’s interesting I know it’s deadly to cats and some people have an allergy to salicylic acid so it’s not for everyone

[greygoose]

I don't think I've ever been in a pharmacy, here, where the painkillers were on display. You always have to ask. Most pharmacists in France are control freaks and don't approve of anything OTC! They even tend to question painkillers have been prescribed by the doctor! My daughter gets migraines, and once her partner went to buy her some painkiller, and got the third degree from the pharmacist: how old is she? How much does she weight? How tall is she? What colour is her hair? I kid you not: what colour is her hair! And when asked why they wanted to know that, he was just told that 'we are obliged to ask these questions'. In other words, mind your own business - which is more or less what he said! lol

[JGBH in reply to greygoose]

There is a danger in the UK of overdosing and addiction to such drugs. GPs always recommend to buy and take paracetamol!!!

Surely it’s better being cautious than “trigger happy “ in recommendation to use such drugs?

[greygoose in reply to JGBH]

Hmmm… Not sure that's why they're doing it. It's a power-struggle between different factions. They just like to feel in control, not sure they actually care about the safety of the patient.

[JGBH in reply to greygoose]

That may be the case. They don’t care that much in the UK about patients’ safety. Look at the way they dish out antidepressants... like smarties. So many people are now addicted and that a prescription drug, not over the counter.

[greygoose in reply to JGBH]

Exactly.

[TSH110 in reply to greygoose]

Power freaks or what? That is astonishing.

[greygoose in reply to TSH110]

Indeed.

[helvella]

It isn't just Wolverhampton!

This is about pharmacists independently prescribing:

pharmacyregulation.org/educ...

This is a review of prescribing by nurses and pharmacists from 2017:

discover.dc.nihr.ac.uk/cont...

And there are now paramedic prescribers:

england.nhs.uk/ahp/med-proj...

(That is in England but it is happening in at least some of the rest of the UK as well.)

[TSH110 in reply to helvella]

Do you think it is a good development?

[helvella in reply to TSH110]

Overall, it probably is. After all, many doctors are not that good at prescribing. In that context, many other health workers might be at least as good.

But there are issues like access to medical history which can be a problem.

[Treepie]

Many shops restrict you to two packs of paracetamol .I had to visit two pharmacies and two supermarkets to get my wife a stock to go on holiday after she fell and had a painful back.

[helvella in reply to Treepie]

Legal requirement in the UK.

At some point, they reduced maximum packet size as well. Think it was 1998.

However, despite the possibility, the option of adding an antidote to paracetamol tablets, though explored, has not been widely adopted.

Paradote was a tablet sold in the UK which combined 500 mg paracetamol with 100 mg methionine, an amino acid formerly used in the treatment of paracetamol overdose.

[Fruitandnutcase in reply to Treepie]

Ha, ha, I did that when my husband had a hip replacement and was in need of regular doses of painkillers - he ditched the morphine as soon as he could. I have to say I found it quite fun going up the high street thwarting that little rule. My son who lives in NZ and who had a big neck operation said his doctor gave him huge quantities of paracetamol- think he also got gabapentin or tramadol or something like that which he didn’t take because it was one of the addictive ones. He was amazed that we were limited as to how many paracetamol we could buy.

If someone is hell bent on deliberately harming themselves with paracetamol then limiting them really isn’t going to stop them.

I suppose although it’s irritating it’s probably reasonable to remind people to be careful - there must be a lot of people out there who are not as ‘drug savvy’ as a lot of us on here are. Look at all the people we hear of who have their thyroxine with breakfast and wash it down with a cup of milky coffee.

Saying that I’m really not sure what hair colour has to do with anything. That sounds like over and beyond the call of duty.also explains why I’m never seen or am ever likely to see paracetamol etc in a French supermarket.

[helvella in reply to Fruitandnutcase]

If someone is hell bent on deliberately harming themselves with paracetamol then limiting them really isn’t going to stop them.

That seems obvious. So I was surprised that reducing pack size appeared to affect the number of paracetamol poisoning cases very significantly.

Edited to add a link to this story regarding Australia:

theguardian.com/australia-n...

[SilverAvocado in reply to Treepie]

Being v restricted in going out I find this a big problem. Some supermarkets even apply it to more benign products like cough syrup or rehydration packets. Since I've started getting an organic delivery I now only get access to a supermarket once per month, which means only two restricted items a month.

[TSH110 in reply to SilverAvocado]

Good point, and as my partner says if you wanted to gobble down excessive amounts of paracetamol for non painkilling reasons you’d just do a tour of the shops selling it. It is obstructive to those that do require a good supply of tablets. No context is taken into consideration.

[SilverAvocado in reply to TSH110]

Yes, v true. I actually have a huge pile of paracetamol and ibuprofen packets at the back of the cupboard, I buy the maximum every chance I get.

I feel I've got no choice. I'm very prone to dislocating my joints, or of course being hypo anything can happen, and I know I won't be able to get enough to last me through at the time. It's one of those many laughable situations with being sick

[TSH110 in reply to SilverAvocado]

You know my mother dislocated her elbow I never thought it might have been related to her hypothyroidism. She did it on a fall rather than it just popping out at will. It can’t be very nice having that happen sorry to hear to hear you get it frequently. Good reason to stockpile 😉

[endomad]

I am in France and was having this conversation yesterday with a friend. I take Co codamol for back and joint pain. Sometimes daily when bad and none when I'm ok, I don't believe in daily pain meds I wait till I get pain. I can only get them in 16 packs restricted to 2 packs a month so 8 days worth a month (in uk box's of 100)

However my friend who injured her back has unlimited high dose tramadol, dyahyracodine, oramorph, 5mg diazepam I am stunned at the monthly amounts of drugs they do on repeat. It would seem it's paracetamol they are unhappy with, they have always been behind the counter at pharmacists in my area.

I have no problem with my T3 or hydrocortisone prescription, estriol cream and my Dr suggested 2mg diazepam instead of Co codamol or tramadol a much stronger drug, which does not suit me. My experience of friends here is a massive culture of over prescribing, so I am surprised paracetamol is seen as the devil, maybe years of over prescribing it has seen a huge surge of damaged livers? Personally I suspect the daily consumption of calvados in this area more damaging.

[endomad in reply to endomad]

Also only selling in chemist not supermarket stops large supermarkets closing down local chemists. You can not buy cigarettes in supermarkets you must go to a 'tabac or bar tabac' most local family bakers in the villages have closed as people get bread at supermarket. As in uk back in the 70's village local shops are now closing, butchers bakers dairies. So good for the chemist shops for keeping all drug sales in responsible hands.

[TSH110 in reply to endomad]

Good point..

[Treepie in reply to endomad]

A former nurse now in her 80’s told me she used to see many with liver damage from too much paracetamol.

[humanbean]

I am not keen on pharmacies and pharmacists having greater responsibility for people getting drugs.

I hate the intrusive questions I have to answer about my health , almost always in public, because there is often a queue of people behind me eavesdropping on what I'm saying. And often those questions are asked by people who are obviously not pharmacists - they sometimes look like school children doing a weekend job.

Going off at a tangent... I hate having to justify myself to the receptionists in my surgery too, just because I have the temerity to want an appointment.

[helvella in reply to humanbean]

It is pretty bad in GP surgeries as well - in various ways but (obviously) particularly when talking to the receptionist.

Pharmacies are supposed to have a room (cubicle?) for privacy but I am not at all convinced they are that much better.

I was quite impressed a few weeks ago - the receptionist made an appointment for a blood test (usual - TSH) without fuss once I explained it would make more sense to have it before a GP appointment.

[Ellie-Louise in reply to helvella]

Maybe the doctor had already entered it on your records.

In my surgery it has to be recorded by the doctor on the computer before I can make an appointment.

[helvella in reply to Ellie-Louise]

I think she checked when my last test was and simply made an appointment but, as I couldn't see the screen, it could have said anything! I certainly hadn't been summoned in any way.

[Ellie-Louise in reply to helvella]

When you said ‘summoned’, my minds eye saw you kneeling down with a sword on your shoulder. 😁

[TSH110 in reply to humanbean]

The public aspect of it concerns me I must admit.

[TSH110 in reply to humanbean]

One young boy at a pharmacy asked me if I might be pregnant on getting a prescription - I was well into my fifties 😂🤣😂 - so green around the gills, unless he really believed I looked much younger than my years despite being a semi snow bird!

[TSH110 in reply to humanbean]

Some of them are dreadful - it must attract people with an inflated sense of self importance who like having power over the vulnerable. They should be banned from doing anything other than booking you in!

[greygoose in reply to humanbean]

Totally agree, HB!

[TSH110]

Yes I have always had excellent advice from pharmacists