Counselling needs to be related to the age, experience, background, and understanding of the individual patient. The pharmacist should ensure that the patient understands how to take or use the medicine and how to follow the correct dosage schedule. Any effects of the medicine on driving or work, any foods or medicines to be avoided, and what to do if a dose is missed should also be explained. Other matters, such as the possibility of staining of the clothes or skin by a medicine should also be mentioned.
For some preparations there is a special need for counselling, such as an unusual method or time of administration or a potential interaction with a common food or domestic remedy, and this is indicated where necessary.
Many preparations are now dispensed in unbroken original packs that bear complete instructions for the patient or provide a leaflet addressed to the patient. These labels or leaflets should not normally be obscured or removed. Where it is known that such instructions are provided with an original pack intended for the patient no label has been listed under the preparation. Label 10 may be used where appropriate. Leaflets are available from various sources advising on the administration of preparations such as eye-drops, eye ointments, inhalers, and suppositories.
SCOPE OF LABELS
In general no label recommendations have been made for injections on the assumption that they will be administered by a health professional or a well-instructed patient. The labelling is not exhaustive and pharmacists are recommended to use their professional discretion in labelling new preparations and those for which no labels are shown.
Individual labelling advice is not given on the administration of the large variety of antacids. In the absence of instructions from the prescriber, and if on enquiry the patient has had no verbal instructions, the directions given under 'Dose' should be used on the label.
It is recognised that there may be occasions when pharmacists will use their knowledge and professional discretion and decide to omit one or more of the recommended labels for a particular patient. In this case counselling is of the utmost importance. There may also be an occasion when a prescriber does not wish additional cautionary labels to be used, in which case the prescription should be endorsed 'NCL' (no cautionary labels). The exact wording that is required instead should then be specified on the prescription.
Pharmacists have traditionally labelled medicines with various wordings in addition to those directions specified on the prescription. Such labels include 'Shake the bottle', 'For external use only', and 'Store in a cool place', as well as 'Discard . . . . days after opening' and 'Do not use after . . . .', which apply particularly to antibiotic mixtures, diluted liquid and topical preparations, and to eye-drops. Although not listed in the BNF these labels should continue to be used when appropriate; indeed, 'For external use only' is a legal requirement on external liquid preparations, while 'Keep out of the reach of children' is a legal requirement on all dispensed medicines.
It is the usual practice for patients to take standard tablets with water or other liquid and for this reason no separate label has been recommended.
The label or labels for each preparation are recommended after careful consideration of the information available. However, it is recognised that in some cases this information may be either incomplete or open to a different interpretation.