Ibuprofen: a model medicine for self-care of common conditions

The expansion and development of the self-care agenda across Europe and beyond has the potential to realise huge efficiencies for national health services. Self-medication of common ailments is one of the themes being developed by community pharmacy in several European countries. In the UK, as part of this development, ibuprofen was one of the first Prescription Only Medicines switched to Pharmacy Only (P) status and, arguably, the most successful. Within 4 years of switching, ibuprofen had 25% of the over-the-counter analgesic market and was a main choice for community pharmacists when recommending treatment for mild-to-moderate pain and fever in both adults and children over 6 months (now permitted from 3 months). However, self-care of minor conditions appears not to be developing in line with the objectives of the self-care agenda. The reliance on national health systems for these conditions is still a major and unnecessary burden on health service resources. Taking ibuprofen use as a marker of this, whereas initially it was widely used for the effective and well-tolerated treatment of minor conditions, pharmacists now appear to offer significant barriers to its wider use. One reason for this could be criticism of community pharmacists' competence when dealing with and treating common conditions. For example, in the UK in the early 1980s, pharmacists have contributed to a risk averse approach. Another is that certain restrictions that may have been justified in 1983 when ibuprofen was granted P status (e.g. caution in asthmatic patients and patients with history of severe gastrointestinal complaints), have acted as a barrier to wider treatment with ibuprofen. However, there is currently little evidence to support the continued maintenance of all these barriers. Regulators may need to revisit the Summary of Product Characteristics and community pharmacists to update their knowledge of ibuprofen, and possibly other switched medicines, where unjustified barriers to use exist if pharmacists are to contribute more successfully to the self-care agenda.