Any repackaged paracetamol should “consist of whole strips, either packs of 20 or 30”, the General Pharmaceutical Council (GPhC) wrote on a frequently asked questions (FAQs) page on its website.

“We understand that pharmacies may be experiencing difficulties in obtaining over the counter (OTC) pack sizes of paracetamol from wholesalers at this time,” the GPhC said.

Pharmacy teams should use their “professional judgement” to decide if repacking paracetamol is needed, it added.

“Where large packs of loose tablets are to be used, it is recommended that a pack size of up to a maximum of 32 is supplied,” the GPhC said.

Not on the shelves

“Pharmacies may break down larger packs of paracetamol to prepare smaller packs for people, and the public, who need them,” a GPhC spokesperson said last week (March 19).

Pharmacies should not put the repackaged packs on the “open shelves” for patients to pick up themselves, the GPhC said. Instead, they should make patients aware, through a notice, that they can get paracetamol “from the pharmacist or the pharmacy team at the medicines counter”.

The Royal Pharmaceutical Society (RPS) said on its COVID-19 update page that pharmacists might be asked to justify taking this decision but that the organisation would be supportive of them applying their “professional judgement to help people”.

The RPS also offered some advice for pharmacies, including making a record of each intervention and deciding on the quantity to supply depending on each customer’s needs.

“Charge a reasonable price for the medicine. It is not professional to charge excessive prices and we do not support this,” the RPS added.

Last week (March 20), C+D reported that pharmacies have not only been struggling to get a hold of paracetamol but have faced wholesaler price increases.

Labelling and PIL

The GPhC said packs of paracetamol that have been split and repackaged by pharmacy teams must be labelled to include:

• the name, dosage form and strength of the product
• directions for use of the product
• precautions relating to the use of the product 
• the date on which the product is sold or supplied
• the name and address details of the pharmacy, which would usually appear on a dispensing label

Pharmacies should also include the wording “store out of the reach and sight of children”, the expiry date of the medicine and, “if possible” the batch number and details of the manufacturer and the “capital letter ‘P’ within a rectangle, with no other marks in the rectangle”.

“Ideally, people should be provided with a patient information leaflet with each supply,” the GPhC said. The information to include on this can be found on the regulator's website.

Anti-inflammatories and COVID-19

The Medicines and Healthcare products Regulatory Agency (MHRA) advised patients last week (March 20) to take paracetamol instead of ibuprofen to treat the symptoms of COVID-19.

This is because “there is some debate” that suggests that ibuprofen and other non-steroidal anti-inflammatory medications (NSAIDs) “may increase complications from simple acute respiratory infections or slow recovery”.

However, the MHRA stressed that at this point, “evidence is not conclusive”.

“There is currently no scientific evidence suggesting that ibuprofen or other NSAİDs worsen COVİD-19,” Dr Melek Akay, oncology research fellow at University College London Hospital told C+D last week (March 20).

“However, paracetamol should be first line treatment for fever or pain due to any respiratory viral illness. Based on anecdotal reports, it is reasonable to avoid ibuprofen, but more evidence is required to make a formal recommendation.”

For full guidance on how to supply repackaged paracetamol products, please visit the GPhC’s website.

Due to COVID-19, workers across UK pharmacy are under great pressure right now. If you would like to find out how you can help, take a look at current vacancies in and around your location. All levels of pharmacy professionals are needed.