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Theme of the Week: Uncommon Behind-the-Counter Drugs

There are a handful of Schedule II medications which are behind the counter, including iron supplements, lice shampoos and pseudoephedrine. But do you know these uncommon ones?

1) Muro 128: A hypertonic formulation (5%) used for corneal edema. In a condition where fluid is building up, a hypertonic formulation of sodium chloride can help draw the fluid out.

2) Combantrin (pyrantel pamoate) is used for pinworms. It is dosed based on weight and patients need to take 1 tablet (=125 mg) for every 11 kg (up to a maximum single dose of 8 tablets (=1 gram)). Make sure to remind patients to repeat in 2 weeks to treat the pinworm eggs.

3) Eurax (crotamiton) is a topical agent used for scabies and itching. While 1st line therapy for scabies will most likely be permethrin 5% (Nix dermal cream or Kwellada lotion), crotamiton is a second line option because it is less effective. Patients will apply the cream all over their body and repeat in 24 hours. The cream is washed off 48 hours after the last application of the cream.

4) Cyproheptadine (Periactin): a member of the antihistamine family for allergies, but as an off-label indication, it also helps to stimulate appetite (because of its action of histamine receptors). This medication is a first-generation antihistamine, so it is drowsy.

5) Buscopan (hyoscine butylbromide) helps with abdominal cramping and spasms via its anticholinergic activity. Interesting fact: the butylbromide moiety introduces a quaternary charged structure, which prevents it from crossing the blood-brain barrier and causing drowsiness.

Next time a patient requests an unusual behind-the-counter medication, you will know!

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