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

Question

Why does the PIL for nitrofurantoin capsules (MercuryPharma) advise special care if the patient has diabetes?

Answer

Peripheral neuropathy has been reported as an infrequent side- effect of nitrofurantoin. If this condition occurs, treatment should be stopped immediately. Peripheral neuropathy can be a complication of diabetes; as such any occurrence could be due either to the nitrofurantoin or the diabetes. It would be advisable for patients with diabetes to be counselled and monitored if nitrofurantoin is considered the appropriate drug for them.

Question

What is Mirvaso 3mg/g gel used for, and what are the counselling points?

Answer

Mirvaso 3mg/g gel contains brimonidine and is used in the treatment of facial erythema of rosacea in adults. A “pea-size amount” should be applied to each of the following areas: the forehead, chin, nose and each cheek, and spread out thinly and evenly. It should be applied once daily for as long as the redness remains. Care should be taken to avoid the eye areas, lips and nasal membranes. Hands should be washed straight after application. Other cutaneous medicinal products for the treatment of inflammatory rosacea lesions and cosmetics may be applied after the Mirvaso has dried.

Question

How soon does the oral typhoid vaccine, Vivotif capsules, provide protection, and for how long?

Answer

The oral typhoid vaccine, Vivotif capsules, is a live attenuated vaccine. Three capsules need to be taken in total to provide an optimal immune response. One capsule should be taken on alternate days (day one, day three and day five). Protection is provided approximately seven to 10 days after a patient has taken the last dose on day five; however, not all patients will be fully protected by the vaccine. Therefore, contact with, or eating/drinking, potentially contaminated food or water, should be avoided as a precaution. If a patient is continuously or repeatedly exposed to Salmonella typhi protection may persist for at least three years. However, a patient who travels occasionally to endemic areas will only be protected for 12 months. The patient would, therefore, need a further course if they return to an endemic area after this time.