What you need to know
WHAT YOU NEED TO KNOW
Before recommending any products or medicines, it is important to keep in mind some red flags that would require you to involve the pharmacist.
SYMPTOMS HAVE NOT IMPROVED/WORSENED > 2 WEEKS
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TAKING OTHER MEDICATION OR HAVING MEDICAL CONDITIONS
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PREGNANT OR BREASTFEEDING WOMEN
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CUSTOMERS < 18 YEARS
Using this customer scenario, you can understand which type of questions are useful to obtain important information to decide whether to offer advice, recommend a treatment or involve the pharmacist
Alex is in his early 20s and visits the pharmacy looking for something non-medicated that will help him stay alert in the day, but still help him keep calm.
1GET THE FACTS
WHAT SYMPTOMS HAVE YOU BEEN EXPERIENCING?
Knowing if he suffers from sleep and/or stress issues can help you decide the best OTC treatment required.
Alex explains that he feels quite stressed and overstimulated and has struggled to fall asleep the last few nights.
HOW LONG HAVE YOU BEEN FEELING LIKE THIS?
Understanding how long he has had these symptoms will help you establish whether this issue could potentially be causing long-term health effects, and help you decide which step on the ladder is most appropriate.
Alex explains he has felt more stressed than usual for the last week.
HOW DO YOUR SYMPTOMS AFFECT YOU DAY-TO-DAY?
Recognising the severity of your customer’s symptoms and how much they impact his day-to-day life will help you decide which step on the ladder is most appropriate.
Alex explains that he wakes up feeling unrested and tired, which makes him less productive in the day and therefore more stressed. He is confused as to why he can’t sleep even though he feels sleepy.
COULD YOUR SYMPTOMS BE CAUSED BY A RECENT EVENT IN YOUR LIFE?
Learning what may be causing the sleep and/or stress issue is a useful way to determine if it is temporary and if it can be helped with an OTC treatment.
Alex reveals that he has exams coming up in a few days that he is quite worried about. He expresses that he can’t wait for them to be over!
HAVE YOU TRIED OR TAKEN ANYTHING TO HELP?
Knowing what methods customers have tried already will help guide you on which step in the recommendation ladder to follow.
Alex tells you that he has tried to follow some sleep hygiene tips like reducing his screen time before bed, however they have not helped much. He does not take any regular medicines or have any medical conditions.
2ADVISE & MANAGE OR
REASSURE & INVOLVE PHARMACIST
Now think about if you would choose to advise and manage or reassure and involve the pharmacist.
ADVISE
Alex tells you that he is confused as to why he is struggling to sleep even though he feels tired. Which option(s) would provide him with the best advice? Select all options that apply.
one is not managed well, the other is affected
it more difficult to relax before bed or fall asleep
This can negatively impact upon stress, causing a sleep-stress cycle
Nearly there!
CORRECT!
These are all useful ways of explaining the sleep-stress link to Alex.
MANAGE
Which of the following products do you think will be best for keeping Alex feel alert during the day but still help him stay relaxed? Select ONE option.
INCORRECT!
Alex requires a product that will help him stay alert but relaxed during the day.
This product is more suitable to promote sleep, so would be inappropriate for daytime use.
CORRECT!
NytEase Mind and Mood Support tablets contain naturally sourced ingredients to support mental performance whilst maintaining a normal, balanced mood and relaxation. This product is also suitable for use in the day or at night.
REASSURE & INVOLVE PHARMACIST
There are no red flags that require you to involve the pharmacist. His symptom duration and severity also do not indicate the need for further escalation so you can reassure him that with lifestyle advice and the use of these products, his symptoms should improve.
3COMPLETE CARE
UPCOMING MODULES
Keep an eye out for the next training modules which will explore different ways to manage sleep and stress with product recommendations, and help you identify when to reassure and refer.
YOUR OTC CHOICE OF SLEEP & STRESS SOLUTIONS
TO MEET DIFFERENT NEEDS
Scroll or swipe to see more.
1. Wakui N, et al. Relieving psychological stress and improving sleep quality by bergamot essential oil use before bedtime and upon awakening:
A randomized crossover trial. Complement Ther Med. 2023;77:102976.
2. Lv XN, et al. Aromatherapy and the central nerve system (CNS): therapeutic mechanism and its associated genes. Curr Drug Targets. 2013 Jul;14(8):872-9
3. Lillehei AS, et al. Effect of Inhaled Lavender and Sleep Hygiene on Self-Reported Sleep Issues: A Randomized Controlled Trial. J Altern Complement Med.
2015 Jul;21(7):430-8.
4. Grinspoon P. Cannabidiol (CBD): What we know and what we don't. Harvard Health. 2021 Sept.
Available at: https://www.health.harvard.edu/blog/cannabidiol-cbd-what-we-know-and-what-we-dont-2018082414476
5. Painscale. How CBD Functions in the Body. 2017. Available at: https://www.painscale.com/article/how-cbd-functions-in-the-body
6. NHS. Medical cannabis (and cannabis oil). 2022. Available at: https://www.nhs.uk/conditions/medical-cannabis/
7. CBD Category Report, 2023. Nytol Product deck
8. Food Standards Agency. CBD products linked to novel food applications. 2023. Available at: https://data.food.gov.uk/cbd-products/products-list
9. National Institutes of Health (NIH). Valerian Fact Sheet for Health Professionals. 2013 Available at: https://ods.od.nih.gov/factsheets/Valerian-HealthProfessional/
10. Healthline. Drink a cup of passionflower tea every night for better sleep. 2019. Available at: https://www.healthline.com/health/food-nutrition/passion-flower-tea
11. Janda K, et al. Passiflora incarnata in Neuropsychiatric Disorders-A Systematic Review. Nutrients. 2020;12(12):3894.
12. Butterweck V, et al. Hypothermic effects of hops are antagonized with the competitive melatonin receptor antagonist luzindole in mice. J Pharm Pharmacol.
2007;59(4):549-52
13. MHRA. Summary of Product Characteristics. Nytol Herbal Tablets. 2023.
Available at: https://mhraproducts4853.blob.core.windows.net/docs/b40f9c34c2993f999bba7235d601a41590809067
14. MHRA. Summary of Product Characteristics. Nytol Herbal Simply Sleep One-A-Night Tablets. 2023.
Available at: https://mhraproducts4853.blob.core.windows.net/docs/feb6ca6df6d75fb43329455693d8ef1d9d4e9b0f
15. MHRA. Summary of Product Characteristics. Nytol Herbal Simply Sleep and Calm Elixir. 2023.
Available at: https://mhraproducts4853.blob.core.windows.net/docs/d2ae5949f3e9cadfc13024a067d41b6b5f93228f
Online sources last accessed February 2024
Nytol® Herbal Tablets (GSL) contains extracts of hops, valerian and passion flower. A traditional herbal medicinal product for use in the relief of temporary sleep disturbances exclusively based on long-standing use as a traditional remedy. Adults over 18 years: 2 tablets approximately 1 hour before bed. Children under 18 years: Not recommended. Take continuously for 2–4 weeks. Seek medical advice if symptoms persist after 4 weeks. Contraindications: Known hypersensitivity to ingredients. Precautions: Avoid concomitant use of alcohol, hypnotics or synthetic sedatives. Use with caution during pregnancy/lactation. Side effects: GI disturbances, hypersensitivity, tachycardia, dizziness, headaches, nightmares or vivid dreams. THR 20894/0073. THR Holder: Brunel Healthcare Manufacturing Ltd, William Nadin Way, Swadlincote, Derbyshire, DE11 0BB. Revision date: 12/2023. RRP (Inc. VAT): 30s £6.89
SPC: https://mhraproducts4853.blob.core.windows.net/docs/b40f9c34c2993f999bba7235d601a41590809067
Nytol® Herbal Simply Sleep One-A-Night Tablets (GSL) contains valerian root extract. A traditional herbal medicinal product for use in the temporary relief of sleep disturbances exclusively based on long-standing use as a traditional remedy. Adults over 18 years: 1 tablet approximately 30-60 minutes before bed. If necessary, 1 additional tablet can be taken earlier during the evening. Children under 18 years: Not recommended. Take continuously for 2–4 weeks. Seek medical advice if symptoms persist after 4 weeks. Contraindications: Known hypersensitivity to ingredients. Precautions: Avoid concomitant use of alcohol, hypnotics or other sedatives. Use with caution during pregnancy/lactation. Side effects: GI disturbances, dizziness, headaches, nightmares or vivid dreams. THR 01074/0002. THR Holder: G. R. Lane Health Products Limited, Sisson Road, Gloucester, GL2 0GR, United Kingdom. Revision date: 12/2023. RRP (Inc. VAT): 21s £7.49
SPC: https://mhraproducts4853.blob.core.windows.net/docs/16d4a91fd3b358effd469ab3c08c15d7d2e8412f
Nytol® Herbal Simply Sleep & Calm Elixir (GSL) contains extract of valerian. A traditional herbal medicinal product for use in the temporary relief of symptoms of mild anxiety and to aid sleep, exclusively based on long-standing use as a traditional remedy. Adults over 18 years: For mild anxiety: two 5ml spoonful’s three times a day with water or fruit juice if desired. To aid sleep: two 5ml spoonful’s 30 minutes before bedtime with an earlier dose during the evening if necessary. Maximum dose: 4 single doses per day. Take continuously for 2-4 weeks. Seek medical advice if symptoms persist after 4 weeks. Children under 18 years: Not recommended. Contraindications: known hypersensitivity to ingredients. Precautions: Avoid concomitant use of alcohol, hypnotics or other sedatives. Contains sucrose. Use during pregnancy/lactation not recommended. Contains alcohol (1300mg ethanol in each 5ml) which should be taken into account in high-risk groups such as those with liver-disease or epilepsy. Harmful for those suffering from alcoholism. Side effects: GI disturbances, dizziness, headaches, nightmares or vivid dreams. THR 28255/0017. THR Holder: Rutland Biodynamics Ltd, Town Park Farm, Brooke, Rutland, LE15 8DG, United Kingdom. Revision date: 12/2023. RRP (Inc. VAT): 100ml £7.49 SPC: https://mhraproducts4853.blob.core.windows.net/docs/d2ae5949f3e9cadfc13024a067d41b6b5f93228f
Nytol® One-A-Night 50mg Tablets (P) contains diphenhydramine hydrochloride. An aid to the relief of temporary sleep disturbance. Adults and children 16 years and over: 1 tablet taken 20 minutes before bed. Children under 16 years: Not recommended. Do not use for more than 2 weeks without medical advice. Avoid concomitant use of alcohol or other antihistamine-containing preparations. Contraindications: Stenosing peptic ulcer, pyloroduodenal obstruction, known hypersensitivity to ingredients. Precautions: Use with caution with the elderly, during pregnancy/lactation, myasthenia gravis, epilepsy or seizure disorders, narrowangle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis and COPD, moderate to severe renal or hepatic impairment, intolerance to some sugars. Interaction with CNS depressants (including alcohol), monoamine-oxidase inhibitors, anticholinergic drugs (e.g. atropine, tricyclic antidepressants), metoprolol, venlafaxine. Side effects: Fatigue, sedation, drowsiness, dizziness, dry mouth, tachycardia, palpitations, convulsions. PL 02855/0070. MAH: Omega Pharma Limited, Wrafton, Braunton, Devon, EX33 2DL, United Kingdom. Revision date: 01/2024. RRP (Inc. VAT): 20s £8.19
SPC: https://mhraproducts4853.blob.core.windows.net/docs/632e57fa716c861dd120dad8103e7f30255e113b
Nytol® Original 25mg Tablets (P) contains diphenhydramine hydrochloride. An aid to the relief of temporary sleep disturbance. Adults and children 16 years and over: 2 tablets taken 20 minutes before bed. Children under 16 years: Not recommended. Do not use for more than 2 weeks without medical advice. Avoid concomitant use of alcohol or other antihistamine-containing preparations. Contraindications: Stenosing peptic ulcer, pyloroduodenal obstruction, known hypersensitivity to ingredients. Precautions: Use with caution with the elderly, during pregnancy/lactation, myasthenia gravis, epilepsy or seizure disorders, narrowangle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis and COPD, moderate to severe renal or hepatic impairment, intolerance to some sugars. Interaction with CNS depressants (including alcohol), monoamine-oxidase inhibitors, anticholinergic drugs (e.g. atropine, tricyclic antidepressants), metoprolol, venlafaxine. Side effects: Fatigue, sedation, drowsiness, dizziness, dry mouth, tachycardia, palpitations. PL 02855/0071. MAH: Omega Pharma Limited, Wrafton, Braunton, Devon, EX33 2DL, United Kingdom. Revision date: 12/2023. RRP (Inc. VAT): 20s £5.99
SPC: https://mhraproducts4853.blob.core.windows.net/docs/5af8576b8d5c2bc3a2f83e05d1b8d66d8b7ad864
Nytol® Liquid Caramel Flavour 10mg/5ml oral solution (P) contains diphenhydramine hydrochloride. As a sleep aid: as a short-term mild hypnotic. Adults and children 16 years and over: 10 to 25ml at bedtime, or after retiring when sleep is not readily achieved. Children under 16 years: Not recommended. Avoid concomitant use of alcohol or other antihistamine-containing preparations. Contraindications: Stenosing peptic ulcer, pyloroduodenal obstruction, known hypersensitivity to ingredients. Precautions: Use with caution with the elderly, during pregnancy/lactation, myasthenia gravis, epilepsy or seizure disorders, narrowangle glaucoma, prostatic hypertrophy, urinary retention, asthma, bronchitis and COPD, moderate to severe renal or hepatic impairment, intolerance to some sugars. Interaction with CNS depressants (including alcohol), monoamine-oxidase inhibitors, anticholinergic drugs (e.g. atropine, tricyclic antidepressants), metoprolol, venlafaxine. Side effects: Fatigue, sedation, drowsiness, dizziness, disturbance in attention, unsteadiness, dry mouth, tachycardia, palpitations, arrhythmias. PL 02855/0313. MAH: Omega Pharma Limited, Wrafton, Braunton, Devon, EX33 2DL, United Kingdom. Revision date: 12/2023. RRP (Inc. VAT): 300ml. £10.99
SPC: https://mhraproducts4853.blob.core.windows. net/docs/cd69bea27da870ac4326ca5bce2f7bd6ba4000ff
If users experience any side effects, they should discontinue use and seek pr ofessional medical advice.
To report any potential side effects, contact us or use the MHRA’s Yellow Card Scheme available at https://yellowcard.mhra.gov.uk/ or search for MHRA Yellow Card in the Google Play or Apple App Store.