What is sold without a prescription. Rules for dispensing prescription drugs

On June 21, 2016, the State Duma adopted in the first reading government bill No. 1093620-6 “On Amendments to the Code of Administrative Offenses of the Russian Federation in terms of improving administrative responsibility in the healthcare sector”. And in September, at a meeting with Roszdravnadzor of the Russian Federation, it was announced that from January 1, 2017, prescription drugs will be under special control of the department.

“In fact, the order of the Ministry of Health and Social Development of the Russian Federation No. 785 “On the procedure for dispensing medicines” is valid from December 14, 2005. It is he who regulates the procedure for dispensing medicines from pharmacies, regardless of the form of ownership. Therefore, we still fine pharmacies for selling medicines without a prescription, ”explained Lyudmila Ilyukhina, deputy head of the department for licensing, supervision and control in the field of medical and social activities of the regional department of Roszdravnadzor.

Recall that 70% of drugs registered in the Russian Federation are dispensed strictly according to prescriptions, and only 30% - without it. But what will change in the new year? Nothing but tougher legislation in terms of control and supervision of pharmacies. Now Roszdravnadzor is constrained by the current legislation and cannot effectively influence pharmacies for violating the quality and safety of medical and pharmaceutical activities. It's just that pharmacists did not always pay attention to these requirements, and the population did not see the problem and did not understand it.

How will they punish?

The current version of the Code of Administrative Offenses does not establish administrative liability for a number of violations in the field of laboratory and clinical practice rules when conducting clinical and preclinical studies of medicinal products for medical use, procedures for the provision of medical care in terms of non-compliance with the mandatory requirements established by them, procedures for conducting medical examinations, examinations and examinations , as well as the procedure for prescribing and prescribing drugs. Therefore, amendments were made to the Code of Administrative Offenses of the Russian Federation (CAO).

The new law proposes very different fines and penalties for violating the drug trade rules, including over-the-counter dispensing of prescription drugs.

So from January 1, 2017, if the fact of selling a medicine without a prescription is revealed, Roszdravnadzor can fine a pharmacist who violated the law in the amount of 5 to 10 thousand rubles (now - from 1,500 to 3 thousand rubles); the official will have to pay from 20 to 30 thousand rubles (now - from 5 to 10 thousand rubles); legal - from 100 to 150 thousand rubles (now - from 20 to 30 thousand rubles). Closing of a drugstore for 3 months (90 days) can become apogee.

Therefore, you understand, most pharmacies, if not all, will not want to take risks and will work strictly according to the letter of the law.

Blame self-medication

The impetus for the changes was the level of self-treatment of the population, which has recently gone off scale, and sometimes turns into very tragic consequences. Here it is already worth dealing with another problem - the lack of doctors and queues in hospitals that force people to go to the pharmacy and consult a pharmacist, which medicines should be taken for a particular disease.

“But the pharmacy must follow the doctor's recommendation, draw the buyer's attention to the storage conditions and the frequency of administration, no more. And the prescription itself is the doctor's appeal to the pharmacist, what exactly he should give to the patient, - Ilyukhina notes. - And now it also happens that a person really visited a doctor, but came to the pharmacy not with a prescription written on the official letterhead, but with a piece of paper on which the doctor indicated the name of the drug. And on these scraps pharmacists dispense drugs. This whole situation needs to change.”

The level of self-medication may be off scale, but this trend has a logical explanation - how long will a person have to sit in a hospital queue for a prescription? Especially considering that the majority prefer not to go on sick leave with every cold, but to carry it on their feet, since hospital authorities do not favor hospitals, and many of us do not consider sluggish SARS to be a real disease, supporting our immunity with drugs (not even antibiotics) from the nearest pharmacy. But now, before going to the pharmacy, you will have to go on a “crusade” to the hospital and sit in line there, most likely not an hour or two.

Shortage and queues

It is impossible to say right now which drugs will be dispensed only by prescription: there is no clear list in fact, it was abolished in 2011, as it was too long and cumbersome. So you will have to focus on the packaging of the drug, which should indicate the name, doses, form of release, manufacturers, expiration date, storage conditions and the release rule - with or without a prescription.

By the way, a similar “innovation” was introduced on the territory of Crimea in June. But this was more likely due to the widespread sale of near-narcotic drugs, which was widespread even when Crimea was part of Ukraine. Using the peninsula as an example, it can be assumed that from January 1, 2017, it will not be possible to buy blood pressure relievers, stimulants such as caffeine, drugs with a narcotic effect (any codeine-containing pain reliever), hormonal drugs, antihistamines that cause drowsiness in a pharmacy without a prescription. By the way, prescriptions for most drugs have a long term - three months.

Of course, there is no point in panicking and stocking up on drugs on an industrial scale, but it is worth reviewing your home medicine cabinet and replenishing it with some drugs of paramount importance. After all, the New Year holidays are coming, during which it will be possible to see a doctor only by calling an ambulance. And judging by the fact that the Office of Rospotrebnadzor in the Kursk region predicted the peak incidence of SARS precisely for the New Year holidays, the number of people who want to see a doctor and receive a cherished prescription from him will increase dramatically.

After the order of the Ministry of Health on new rules for dispensing medicines came into force, pharmacies became stricter. For example, they do not sell antibiotics without a prescription. What else is possible and what is not possible under the new order, Elena Nevolina, executive director of the Pharmacy Guild, told RG.

1. Why is it now impossible to buy an antibiotic freely?

Antibiotics have always been classified as prescription drugs, which should only be used when prescribed by a doctor. In our country, they often treat any cold, just "just in case." The results of such uncontrolled reception are deplorable. In the world, strains of causative agents of serious diseases, such as tuberculosis, have appeared that do not respond to known antibiotics. Such diseases simply cannot be cured! In early October, the Strategy for Preventing the Spread of Antimicrobial Resistance in Russia was approved. One of the principles: to put the use of antibiotics under strict control. At the pharmacy, you need to present a prescription written on the form. Yes, it is inconvenient, unusual, takes time. But we must understand: the uncontrolled use of antibiotics does more harm than good.

2. Are there any restrictions on dispensing alcohol-containing drugs?

There are no conditions "two bottles of hawthorn in one hand" exist. Alcohol-containing drops, which belong to over-the-counter drugs (this is indicated by the manufacturer in the instructions), for example, the same hawthorn tinctures, drops like Corvalol are sold without any restrictions. True, soon such tinctures will not be sold in bottles of more than 25 ml. But now many manufacturers fulfill this condition.

3. Is it true that light sedatives are now also strictly prescription?

Here the situation is the same as with antibiotics. If the manufacturer indicated in the instructions for the drug that it is dispensed by prescription, the pharmacy is obliged to ask the buyer for a prescription. Therefore, drugs such as amitriptyline, phenibut, grandoxin should still be prescribed by a doctor. A simple form will suffice. And the pharmacist, releasing the medicine, must "repay" the prescription with a seal.

4. Prescription drugs, such as statins, often need to be taken for a long time. Will I have to visit the doctor regularly now?

If the doctor is sure that the patient needs long-term permanent treatment, the doctor has the right to write out a prescription, indicating its validity period - up to 1 year. Only the prescription should indicate how often and in what dose the patient can receive medicine on it. Each time, a note is made on the prescription that the medicine has been dispensed. A year later, the prescription with all the marks from the patient is withdrawn and remains in the pharmacy for storage. The shelf life of used prescriptions depends on which medicine was prescribed - it can be stored for three months, and five years, if we are talking about drugs and other strictly controlled drugs.

Since 2017, control over the dispensing of prescription drugs from pharmacies has been strengthened. At the same time, there is currently no official list of all drugs that must be dispensed strictly by prescription. Everything is controlled by Roszdravnadzor.

Mikhail Khaustov

Pharmacists themselves should focus primarily on instructions for medicines, where there are indications for sale with or without a prescription. As a result, antibiotics, antiviral drugs, modern tranquilizers and antidepressants, as well as “harmless”, according to many consumers, drugs fell into disgrace. Everything is controlled by Roszdravnadzor.

1 What really happened?

The order "On the procedure for dispensing medicines" has been in force in the Altai Territory for more than 10 years.

But since January 1, 2017, Roszdravnadzor, in connection with changes to the law "On the Protection of Consumer Rights", conducts test purchases in pharmacies and severely fines those who sell any of these drugs without a prescription. this is due to changes in the federal. Now any citizen or legal entity can complain that a prescription drug was freely sold to him in a pharmacy.

2 Why are consumers dissatisfied?

People are especially dissatisfied with the fact that now it will be difficult to buy popular painkillers, such as Nise, Nimesil and Ketanov (prescription drug).

3 Why were the restrictions introduced?

The official explanation for the tightening of requirements for dispensing drugs is as follows: the level of self-treatment of citizens is extremely high, and the uncontrolled use of a number of drugs leads to sad consequences for health.

This is especially true of the ability to freely purchase potent drugs, including antibiotics. Taking them without the supervision of specialists undermines the immune system and leads to a decrease in the effect of drug treatment in general.

4 Are pharmacies ready?

The Ministry of Health of the Altai Territory assured that all state medical institutions currently have the necessary stock of various forms of prescription forms, and doctors are ready to prescribe and prescribe drugs.

Cold, flu.

5 Will there be concessions?

• for chronic patients, it is allowed to set the validity of the prescription up to one year, that is, the doctor does not have to go to the doctor every month for a new prescription. But this is if the course of the disease does not change. However, usually these people are already regularly observed by specialists;
• contraceptives: first you have to go to the gynecologist, but the doctor can write a prescription for a quarter or even a year, indicating the frequency of his leave.

6 What drugs should be sold by prescription only?

• antibiotics;
• neuroleptics;
• psychotropic substances;
• ampoule and hormonal (contraceptives and other) preparations;
• agents for the regulation of blood pressure.

Cold, flu. Medicines.

7 What can be bought without a prescription?

All drugs for the treatment of transient diseases are antiviral and antipyretic.

There is no complete official list of drugs that must be sold strictly by prescription.

8 How to understand: by prescription or not?

If the pharmacy refused to sell you the drug, citing the lack of a prescription, then you can immediately double-check the information. Just ask your pharmacist to give you a prescription for the medicine or look it up on the internet.

In the instructions for each medicine there is a line "Rules for dispensing from pharmacies" and then it is indicated: "by prescription" or "without". That's all.

9 What should be on the prescription?

• data about the patient (surname, initials and address of residence);
• surname of the doctor;
• two seals are put - a doctor and a medical institution;
• the name of the medicinal product according to INN (international non-proprietary name, and not according to the trade name);
• in one recipe there can be up to three items with an indication of the frequency of their sale: month, quarter or year.
• Prescriptions are required to be accepted at any pharmacy in any locality, while personal documents do not need to be presented.

10 How many medicines are sold without a prescription?

Only 30% of drugs registered in the Russian Federation can be sold without a prescription. The use of the rest requires control by the attending physician and the presentation of a prescription form upon purchase.

When I was in medical school, the Latin language seemed magical and mysterious. Melodious words flashed in each recipe: recipe, da, signa. Take it, give it, mark it. They sounded like exquisite music that few understand. Today, doctors have almost forgotten them, and prescriptions in pharmacies have become a rarity ...

During the days of Soviet health care, the recipe was a sacred document; everyone knew, . Without a letterhead, on which letters vaguely reminiscent of Latin were drawn in a practiced medical manner, only vitamins, citramone, and a couple of medicines were sold in the pharmacy. Then it was impossible to imagine that the doctor, instead of a signed and sealed prescription, would suddenly give you a piece of paper with gibberish.

In the 1990s, the decades-old order dissipated like the specter of communism. And although theoretically all orders of the Ministry of Health continued to function, their observance became a pure formality. Instead of neat forms, doctors now have sheets with manufacturers' symbols and drug trade names. Sometimes a whole treatment regimen of a dozen drugs is painted on scraps of paper, in order to save money, set out in small handwriting that fills all the free space.

More than once I had to deal with the fact that doctors give the patient ... a medical card as a prescription. Say, the pharmacy will sort it out. And if not?

Physician Interests

Any leader knows that giving orders is only half the battle. An order broadcast on the air can hang in it forever, forgotten and abandoned by everyone, like old galoshes. To ensure that orders are not ignored, their execution must be controlled.

As soon as Soviet total control loosened its iron grip, prescriptions began to be written out less and less. Today, doctors practically do not see the need for them, with the exception of cases when they prescribe psychotropic, narcotic drugs and tranquilizers.

Doctors' reluctance to tie the knot with additional documentary circulation is understandable. Firstly, any doctor has a lot of paperwork - sometimes it takes more time to fill out various cards and forms than to communicate with patients.

Secondly, it is a document. It can be found at any time and, in case of an incorrect appointment, call the doctor to account.

And thirdly, according to the order of the Ministry of Health of Russia No. 1175n, “the appointment and prescribing of drugs is carried out<…>by international non-proprietary name. This means that the doctor does not have the right to write the trade name of the medicine in the prescription, except in rare cases when there is no international or group name. This approach does not always suit the doctor: he will not be able to officially prescribe the original drug or analogue, which, in his personal opinion, is the most effective. In addition, one should not exclude the possibility that the doctor simply does not remember the international name.

But what about the patient? Doesn't he care what paper he leaves the doctor's office with?

Patient Interests

When a doctor prescribes a drug "orally" or is limited to handwritten notes, most patients do not feel the trick. And he is, and a lot.

The recipe is protection. It's no secret that anyone can make mistakes. But folk wisdom claims that the mistakes of teachers and doctors are given to us more dearly, and this is true. If the doctor incorrectly prescribed the medicine, which led, for example, to the development of side effects or a deterioration in the condition, the patient may apply for satisfaction to higher authorities. However, this possibility exists only when he has evidence: a prescription or an entry in a medical record, and preferably both. When there is no written evidence of the appointment, the search for justice can be forgotten.

The recipe is a guarantee. The medicine is written out on a prescription form in accordance with the requirements of Order No. 1175n. In this case, the doctor fully (not in an abbreviated version) indicates the international name and dosage. In addition, in the signature - the last Russian-language chapter of the prescription intended for the patient - the doctor briefly describes the scheme of application.

It is difficult to confuse a medicine prescribed in a prescription with anything: the document contains comprehensive information. But if a pharmacist is handed a piece of paper instead of an official form, then there is no guarantee that the dose and even the name of the medicine itself are correctly indicated on it. The doctor writes the prescription illegibly and “forgets” in the bustle to indicate the release form, and now instead of cefazolin, cefotaxime looks at the pharmacist, and the antiherpetic ointment zovirax becomes the antibiotic zyvox. In a properly designed recipe, such oversights are excluded.

Seriously, in my practice there was a pediatrician who wrote out appointments in such a “professional” handwriting that the whole team was going to decipher them. And every time the doctor was limited to pages from notebooks instead of prescription forms. Where is the guarantee that in some pharmacy pharmacists will not “refill” the patient with a “consonant” drug?

The recipe is confidence. Do not forget that even uncontrolled orders remain valid. And if in the vast majority of pharmacies antibiotics can be bought only with a vague note or even without it, this does not mean at all that a prescription is not needed. Any pharmacist at any time can refuse to sell an antibiotic without a prescription and will be absolutely right. Therefore, the official form is the confidence that the medicine will be bought.

It turns out that when writing a prescription, the doctor acts primarily in the interests of the patient, sometimes to the detriment of himself. That is why prescriptions are so rarely written out. But we, potential patients, have every right to insist on compliance with the order. It's so simple - to protect your rights and health with the help of a regular prescription form.

Marina Pozdeeva

Photo thinkstockphotos.com

Nowadays, everyone who turns to doctors is conditionally divided into two camps. The first half are those who do not accept antibiotics and rely on traditional medicine and body reserves. The second, on the contrary, considers any treatment without ineffective and requires the doctor to prescribe them without fail. Where is the truth and is it possible to use antibiotics without a doctor's prescription - let's try to figure it out.

When are antibiotics needed?

Of course, the brilliant invention of pharmacological science - the antibiotic - has saved more than one life. Previously, it was practically a panacea that raised the dying from their beds. Today it is commonplace: in any pharmacy you can easily buy antibiotics without prescriptions, for every taste and budget.

But before running for an antibacterial drug for any sneezing and pain in the side, it is worth remembering when their use makes sense.

• Complications after respiratory viral infections. It is the complications, since the antibiotic is powerless against a viral disease. Usually secondary infection is manifested by a sharp deterioration in health after a short period of recovery.
• Laboratory-confirmed bacterial infections and the inflammatory processes they cause.
• Chronic inflammatory diseases and their relapses.
• Acute manifestation of inflammatory processes.
• Prevention of infectious inflammation after surgical interventions.

In serious situations, the regimen for the use of antibiotics is prescribed by the attending physician. But with seasonal ailments and exacerbations of chronic diseases, we tend to prescribe ourselves antibiotics without prescriptions.

Application features

Quite quickly and effectively help to pacify the symptoms of the disease. But besides the fact that they must be correctly selected, it is necessary to adhere to certain rules for antibiotic treatment, otherwise they will not be able to work or side effects of the drugs will appear.

• Antibiotics sold without a doctor's prescription should be taken strictly according to the scheme described in the instructions for the drug. The dosage is calculated depending on the weight or age of the patient. You can be guided by the regimen prescribed by the doctor individually for the patient.
• It is undesirable to skip doses of the drug. If you need to take an antibiotic two or three times a day, it is best to do it at the same time.
• Antibiotic treatment should take a course of at least 5 days. The course of admission must be completed, even if the visible symptoms of the disease no longer bother. If the effect of the treatment does not occur, the doctor may extend the course of treatment with the drug or recommend changing the drug.
• During treatment, the use of alcohol in any form is unacceptable. It not only creates a colossal load on the liver, but can also weaken the effect of the antibiotic. As a result, there will be no benefit from the treatment, but only harm.

Reviews of patients who have to be treated with antibiotics are almost always positive. But the key to the success of treatment in the first place is the right choice of drug.

Groups of antibacterial drugs

Depending on the nature and severity of the disease, antibiotics of different groups are used: they have different effects and affect different types of bacteria. The stronger the drug, the more dangerous it is to use antibiotics without prescriptions or recommendations from doctors.

The most popular groups of antibiotics are:

1. Penicillins. They affect not only bacteria, but are also able to stop their growth and reproduction. Virtually no toxic effects on the body. Quite quickly excreted and lose effectiveness with prolonged use: bacteria develop resistance to the drug. Allergic reactions are possible.
2. Cephalosporins. They have a wide spectrum of action and are effective in a variety of bacterial infections. The advantage of this group of antibiotics is the ability to destroy penicillin-resistant bacteria. Among the side effects, an allergic reaction and a violation of the microflora are observed.
3. Macrolides. Block the growth and reproduction of bacteria; able to penetrate into cells and fight pathogens of complex diseases. Virtually non-toxic: suitable for long courses of treatment, but can be used in short courses of antibiotics.
4. Tetracyclines. They also affect the reproduction and growth of bacteria, but with prolonged use they can have a devastating effect on the body. Most often used for external use in the form of ointments and creams.

How to choose an antibiotic?

Self-administering antibiotics without a prescription is always a risk. Properly selected drug is always the first step on the road to recovery.

For the treatment of infections of the oral cavity, chronic scarlet fever, as well as infection of wound surfaces and pneumonia, the most popular representatives of such drugs are used - ampicillin and amoxicillin. These preparations are resistant to the action of hydrochloric acid of the stomach, therefore they are effective in the form of capsules or tablets. You need to apply them twice a day, regardless of the meal.

When there is a urinary tract, respiratory tract, inflammatory processes of an acute and chronic nature in ENT diseases, antibiotics of a number of cephalosporins are used. The most popular drugs are ceftriaxone, cefotaxime, cefuroxime. The effectiveness of treatment increases with intramuscular administration of drugs 2 times a day at regular intervals.

An over-the-counter antibiotic that has shown high efficacy in the treatment of chlamydia, genital infections, and SARS is azithromycin. It is the most popular member of the macrolide group. It is also widely used for the treatment of infectious diseases in children and pregnant women due to low toxicity against the background of a pronounced antibacterial effect. You need to take azithromycin according to the scheme described in the instructions for the drug. Most often, this is a single use per day of a tablet or suspension.

In inflammatory diseases of the skin, infection of wounds, as well as bacterial infections of the mucous membranes, ointments containing tetracycline are widely used. They are relatively safe for topical use and quite effective.

Features of the treatment of children

It is even more dangerous for children to take antibiotics without prescriptions: an incorrectly selected drug may not have the expected effect, and the disease will progress.

Many mothers know their children well: in babies, frequent respiratory infections are accompanied by the same complications. The pediatrician prescribes an antibiotic according to the standard scheme. And when history repeats itself, parents rush not to the pediatrician for a prescription, but to the pharmacy for salvation in the form of an antibiotic.

In this case, self-medication is permissible, but subject to constant monitoring of the baby's condition. If the symptoms do not go away after three days of treatment, and health worsens, a pediatrician should be consulted immediately.

Most often, parents themselves take antibiotics of the penicillin group: amoxicillin, flemoxil, ampicillin. They are quite effective in diseases of the throat and upper respiratory tract.

You should not take more complex drugs on your own: the pediatrician will not only write down the antibiotic regimen, but also prescribe additional medications to reduce the harmful effects of drugs on the child's body.

Let's be careful!

If you decide to take antibiotics on your own, without waiting for a doctor's recommendation, then you need to remember a few basic points of treatment.

1. Antibiotics require regularity and severity of administration.
2. Some drugs affect not only the "bad" bacteria that cause the disease, but also the "good" microflora. Be prepared for intestinal disturbances, you may have to combine antibiotics and lactobacilli.
3. Do not take alcohol, as well as fatty and heavy foods. The antibiotic is excreted by the liver, the load on it is increased due to illness and treatment, you should not abuse its industriousness.
4. Closely monitor the state of health: at the slightest sign of an allergic reaction, deterioration of the condition or the appearance of new symptoms, the drug should be stopped and consult a doctor.

Which antibiotics can be taken without prescriptions, and which ones are not worth it - it's up to you. If you know your body well and can say that this or that antibiotic will help you, take it according to the instructions. But if in doubt, it is better to take the time and consult a doctor: the result will be faster and more effective.