CNS and MSK OTC Revision Pack
CNS
Pain: OTC Analgesics
- Used to treat:
1. Mild to moderate pain.
2. Somatic pain.
3. Headache.
4. Dysmenorrhoea.
Common OTC analgesics:
- Paracetamol.
- Aspirin.
- Ibuprofen.
- Codeine/ dihydrocodeine combination products.
- Naproxen.
- Topical formulations (rubefacients, NSAIDS, freezing agents and local anaesthetics).
Paracetamol
- Indication: pain relief and fever.
- Dose for adults: 500mg- 1 g every 4-6 hours (maximum 4g/ day).
- Paracetamol doses for children have been added to help remember them but it may
not be suitable to recommend analgesics for children with certain CNS
presentations.
- Dose for children post-Immunisation: After the Men B vaccine (given at 2 and 4
months of age), it is recommended to give 3 doses of infant paracetamol as a
prophylactic measure against fever. 1 dose (2.5ml of the 120mg/ 5ml suspension) at
the time of the vaccination or shortly afterwards, and then 2 further doses in 4–6-
hour intervals. This exceeds and overrides the current licensing.
- Dose for children 3 months – 6 years (120mg/ 5ml suspension): 3-6 months: 2.5ml
QDS, 6-24 months: 5ml QDS, 2-4 years: 7.5ml QDS, 4-6 years: 10ml QDS.
- Dose for children 6 years+ (250mg/ 5ml suspension): 6-8 years: 5ml QDS, 8-10
years: 7.5ml QDS, 10-12 years: 10ml QDS, 12-16 years: 10-15ml QDS, 16 years+: 10-
20ml QDS.
- Notes: Safe in pregnancy. Caution in liver disease.
Ibuprofen
- Indication: pain relief, fever.
- Dose for adults: 200-400mg every 6-8 hours (max 1200mg/ day).
- Ibuprofen doses for children have been added to help remember them but it may
not be suitable to recommend analgesics for children with certain CNS
presentations.
, - Dose for children 3 months+: 3-6 months (>5kg): 2.5ml TDS, 6-12 months: 2.5ml
TDS-QDS, 1-4 years: 5ml TDS, 4-7 years: 7.5ml TDS, 7-10 years: 10ml TDS.
Codeine (in combination with paracetamol or ibuprofen)
- Indication: Moderate pain (short-term use).
- Dose: Max 3 days OTC use due to risk of dependence.
- Notes: Constipation, drowsiness; not for <12 years.
Diphenhydramine/ Promethazine
- Indication: Short-term insomnia, motion sickness.
- Notes: Sedating antihistamines – cause drowsiness, dry mouth, and confusion in the
elderly.
Buclizine/ Cinnarizine/ Cyclizine
- Indication: Motion sickness.
- Notes: Antihistamines with antiemetic effect; may cause sedation.
Melatonin (Not available OTC in the UK)
- Indication: Jet lag, sleep aid.
- Notes: Should be short-term only; not recommended in pregnancy/ lactation.
St John's Wort (Herbal)
- Indication: Mild depression (self-diagnosed).
- Notes: Interacts with many drugs (CYP450 inducer); not recommended with
contraceptives, antidepressants.
Caffeine (in some combo analgesics)
- Indication: Enhances pain relief, fatigue.
- Notes: Caution with excessive intake – anxiety, insomnia, palpitations.
- Examples of medication containing caffeine: Anadin (aspirin and caffeine), Lemsip
Max Cold and Flu capsules (paracetamol, caffeine, phenylephrine hydrochloride),
Panadol Extra Soluble tablets (paracetamol, caffeine), etc.
Valerian root (Herbal)
- Indication: Mild anxiety, sleep aid.
- Notes: Sedative effects; interacts with CNS depressants.
Headache Types
- Migraine.
- Tension headache.
- Cluster headaches.
- Temporal arteritis.
- Trigeminal neuralgia.
CNS
Pain: OTC Analgesics
- Used to treat:
1. Mild to moderate pain.
2. Somatic pain.
3. Headache.
4. Dysmenorrhoea.
Common OTC analgesics:
- Paracetamol.
- Aspirin.
- Ibuprofen.
- Codeine/ dihydrocodeine combination products.
- Naproxen.
- Topical formulations (rubefacients, NSAIDS, freezing agents and local anaesthetics).
Paracetamol
- Indication: pain relief and fever.
- Dose for adults: 500mg- 1 g every 4-6 hours (maximum 4g/ day).
- Paracetamol doses for children have been added to help remember them but it may
not be suitable to recommend analgesics for children with certain CNS
presentations.
- Dose for children post-Immunisation: After the Men B vaccine (given at 2 and 4
months of age), it is recommended to give 3 doses of infant paracetamol as a
prophylactic measure against fever. 1 dose (2.5ml of the 120mg/ 5ml suspension) at
the time of the vaccination or shortly afterwards, and then 2 further doses in 4–6-
hour intervals. This exceeds and overrides the current licensing.
- Dose for children 3 months – 6 years (120mg/ 5ml suspension): 3-6 months: 2.5ml
QDS, 6-24 months: 5ml QDS, 2-4 years: 7.5ml QDS, 4-6 years: 10ml QDS.
- Dose for children 6 years+ (250mg/ 5ml suspension): 6-8 years: 5ml QDS, 8-10
years: 7.5ml QDS, 10-12 years: 10ml QDS, 12-16 years: 10-15ml QDS, 16 years+: 10-
20ml QDS.
- Notes: Safe in pregnancy. Caution in liver disease.
Ibuprofen
- Indication: pain relief, fever.
- Dose for adults: 200-400mg every 6-8 hours (max 1200mg/ day).
- Ibuprofen doses for children have been added to help remember them but it may
not be suitable to recommend analgesics for children with certain CNS
presentations.
, - Dose for children 3 months+: 3-6 months (>5kg): 2.5ml TDS, 6-12 months: 2.5ml
TDS-QDS, 1-4 years: 5ml TDS, 4-7 years: 7.5ml TDS, 7-10 years: 10ml TDS.
Codeine (in combination with paracetamol or ibuprofen)
- Indication: Moderate pain (short-term use).
- Dose: Max 3 days OTC use due to risk of dependence.
- Notes: Constipation, drowsiness; not for <12 years.
Diphenhydramine/ Promethazine
- Indication: Short-term insomnia, motion sickness.
- Notes: Sedating antihistamines – cause drowsiness, dry mouth, and confusion in the
elderly.
Buclizine/ Cinnarizine/ Cyclizine
- Indication: Motion sickness.
- Notes: Antihistamines with antiemetic effect; may cause sedation.
Melatonin (Not available OTC in the UK)
- Indication: Jet lag, sleep aid.
- Notes: Should be short-term only; not recommended in pregnancy/ lactation.
St John's Wort (Herbal)
- Indication: Mild depression (self-diagnosed).
- Notes: Interacts with many drugs (CYP450 inducer); not recommended with
contraceptives, antidepressants.
Caffeine (in some combo analgesics)
- Indication: Enhances pain relief, fatigue.
- Notes: Caution with excessive intake – anxiety, insomnia, palpitations.
- Examples of medication containing caffeine: Anadin (aspirin and caffeine), Lemsip
Max Cold and Flu capsules (paracetamol, caffeine, phenylephrine hydrochloride),
Panadol Extra Soluble tablets (paracetamol, caffeine), etc.
Valerian root (Herbal)
- Indication: Mild anxiety, sleep aid.
- Notes: Sedative effects; interacts with CNS depressants.
Headache Types
- Migraine.
- Tension headache.
- Cluster headaches.
- Temporal arteritis.
- Trigeminal neuralgia.
