Pharmacy U

The new OTC nasal corticosteroids – A game changer for pharmacists and their allergy patients


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The introduction of nasal corticosteroids as OTCs is a game changer for both allergy sufferers and the pharmacists who counsel them on managing their symptoms.


For years, physicians have prescribed them as an effective tool in combating seasonal allergic rhinitis (SAR) including hay fever and perennial rhinitis (PAR), as well as the management of sinus pain and pressure symptoms associated with allergic rhinitis. For their part, pharmacists have felt confident in counselling their patients on using this product.


Now, having INS’s (intranasal corticosteroids), such as Flonase® Allergy Relief, available as OTCs gives pharmacists even more opportunities to build relationships with their patients.


“I dispense Flonase all the time since it’s useful for anyone who has allergies that bother them,” says Jack Halpern, pharmacist at Peoples Drug Mart in Toronto, who sees all types of allergies in his practice, from food and drug to pet, seasonal and environmental. “Going OTC won’t change the way I perceive the product or what I tell patients, but it will change how I approach them because they won’t need to present with a prescription.”


Halpern’s patients have more OTC options since in the past they often relied on saline sprays, but more importantly, now he foresees having more opportunities to counsel his patients to help ensure these products are being used properly.


“It’s a great tool to have in our arsenal,” he says. “Pharmacists have the where-with-all to diagnose allergic rhinitis and help provide appropriate treatment options. But in the past, we have been stymied by the fact that if it was determined that a patient needed a nasal steroid, the interaction had to end so that the patient could be sent to their doctor. Now the pharmacist can finish the interaction and go full circle with the patient. It’s all about the open dialogue of speaking with patients and following up with them.”


For Halpern, part of that dialogue is helping patients determine if their symptoms are related to allergies or the colds and flus so prevalent during winter months. “Allergies and colds do have overlap, but there are differentiating factors that have to be deciphered,” says Halpern. “Allergies shouldn’t usually be accompanied by a feeling of unwellness, but they will be more annoying due to their ongoing nature. Asking open-ended questions will help to determine each patient’s needs.”


Strong brand recognition for patients


Switches from Rx to OTC allow for strong brand recognition by both pharmacists and patients (through having it prescribed to them by their doctors).


“The physicians I work with are telling patients to get products like Flonase,” says Tracey Phillips, pharmacist-owner of Westport Village Pharmacy in Westport, Ont. “A lot of physicians are familiar with the Flonase brand; it has strong brand recognition.”


Another benefit, adds Phillips, is that the nasal corticosteroid category gives pharmacists more options to help their patients handle allergy season. “It can be much safer than an oral decongestant. A lot of patients because of other medical conditions – those with hypertension or prostate problems, for instance – cannot take an oral decongestant. A lot of the 12-24-hour allergy preparations advertising sinus congestion relief contain decongestants in amounts that can really throw off their blood pressure. On the flip side, nasal decongestants can lead to side effects if taken for more than three to five days in a row. With the corticosteroid category available OTC, there are a lot more options for patients with other medical conditions.”


Phillips counsels her patients on regular use of corticosteroids. Many patients think these products can be used just when they have symptoms, but she points out that they should be used regularly before and during the allergy season, and not just on an as-needed basis. This differentiates INS’s from nasal decongestants, which can be used just as needed. Whether symptoms are mild, moderate or severe, to get the most benefit from INS’s, she recommends using them for the entire season when there are allergens present and not just on days when symptoms are more noticeable.


“Having nasal corticosteroids available to pharmacists OTC is definitely a game changer and their use is well within the pharmacist’s knowledge, skills and judgment,” says Phillips. “Having Flonase® Allergy Relief available without prescription gives more access to a product that will help our patients better manage their allergy symptoms this season.”