Paris (AFP)

No more aspirin, Doliprane or Advil self-service in pharmacies: even if these widely used drugs are sold without a prescription, you will have to ask the pharmacist from January 15, to limit the risks associated with misuse.

"From January 15, 2020, these drugs can no longer be presented in free access in pharmacies" and "will all have to be placed behind the pharmacist's counter," announced Tuesday the drug agency (ANSM).

This "strengthens the pharmacist's advisory role to patients who wish to have it without a prescription," added the ANSM.

After a first opinion to this effect in early October, this final decision was taken after an adversarial procedure with the laboratories concerned.

This measure concerns drugs containing paracetamol (Doliprane, Efferalgan, etc.), as well as certain non-steroidal anti-inflammatory drugs (NSAIDs): those based on ibuprofen (such as Nurofen or Advil) and aspirin.

These drugs are the most used in self-medication as painkillers or against fever in adults and children, according to the ANSM.

Until now, they can be sold in direct access, the customer serving himself on the shelves of the pharmacy. However, in reality, many pharmacists have already chosen to place them behind their counter, even before the decision of the ANSM.

"These are widely used drugs, it's good that patients can have access to them, but we have to do everything we can to make sure they are used correctly," said Dr Philippe Vella, director of analgesic drugs at AFP. ANSM.

Because misuse involves risks.

Taken in too high doses, paracetamol can cause serious liver damage, which may require a transplant or even be fatal.

At the end of 2017, a young woman, Naomi Musenga, died after being mocked on the phone by an operator from the Samu of Strasbourg, which had caused a big wave of emotion in France. According to the investigation, this death was "the consequence of intoxication with paracetamol absorbed by self-medication over several days".

- "Overdose = Danger" -

For a healthy adult weighing more than 50 kg, the maximum dose of paracetamol is 3 grams per 24 hours, not exceeding 1 gram per dose with a space of at least 6 hours between each dose.

In addition, the maximum recommended duration of treatment is "3 days in case of fever, 5 days in case of pain, in the absence of a prescription", reminds the ANSM.

In July, the gendarme of the drug decided that the warning "overdose = danger" should now appear on the boxes of paracetamol.

For their part, NSAIDs "are in particular liable to cause kidney complications, serious infectious complications and are toxic to the fetus in the event of exposure from the beginning of the 6th month of pregnancy", according to the ANSM.

She had issued a warning on this subject in April, following an investigation that suggested the aggravating role of two types of NSAIDs, those based on ibuprofen and ketoprofen, in the event of infection.

In 18 years, from 2000 to 2018, 337 cases of infectious complications, including 32 deaths, have been listed for ibuprofen.

These are severe infections that cause hospitalizations, sequelae and death.

They can affect the skin and soft tissues: this is the case of "necrotizing fasciitis", infections caused by a bacterium called "flesh-eating", which causes amputations and death.

It can also be septicemia, pneumonia complicated by abscesses, brain abscesses or ENT infections reaching the thorax (mediastinitis).

These infectious complications (mainly due to two bacteria, streptococcus or pneumococcus) were observed after very short duration of treatment with NSAIDs (2 to 3 days).

The survey also showed that NSAIDs continue to be used to treat children with chickenpox, when they should be avoided in favor of paracetamol.

"In case of pain or fever, especially in a context of common infection such as angina or cough", it is necessary "to favor the use of paracetamol while respecting the rules of good use", underlines the ANSM.

© 2019 AFP