Leyla Hannbeck, head of pharmacy at the National Pharmacy Association, answers three of the 700 questions fielded every day by the NPA’s Pharmacy Services team

QUESTION
How should I deal with expired stock of Schedule 3 controlled drugs?

ANSWER
Expired pharmacy stock of Schedule 3 controlled drugs should be denatured, ideally using a CD destruction kit (available from NPA Sales, on 0844 736 4199) prior to disposal into waste containers. Stocks of Schedule 3 CDs do not need to be recorded or destroyed in the presence of an authorised witness. NPA members can access a number of controlled drug standard operating procedures, guidance and e-learning modules at www.npa.co.uk/knowledge-centre.

QUESTION
What treatment options are available for an acute relapse of multiple sclerosis?

ANSWER
Where a patient is suspected of having an acute relapse of multiple sclerosis they should be assessed by a specialist. Not all relapses require treatment with steroids. The National Institute for Health and Care Excellence recommends:
• Oral methylprednisolone 500mg daily for five days, or
• Intravenous methylprednisolone 1,000mg daily for three to five days, to be considered as an alternative in patients who cannot tolerate oral steroids, where oral steroids have failed, in patient requiring hospital admission for a severe relapse, or if other medical conditions such as depression or diabetes need monitoring.

QUESTION
What is the correct dose of colchicine for gout prophylaxis?

ANSWER
The licensed dose of colchicine for the prophylaxis of gout is 500 micrograms, two to three times a day. But the British Society for Rheumatology recommends 500 micrograms twice a day. Colchicine should be
prescribed concurrently to patients who have already been initiated on long-term treatment with allopurinol or febuxostat. The dose should be reduced to 500 micrograms once daily in elderly patients and those with moderate renal impairment.
Previously, doses of colchicine used for the prophylaxis of gout have varied from 500micrograms once a day to up to three times daily.