Customer scenario
CUSTOMER SCENARIO
38-year-old Celine has returned to the pharmacy after purchasing a pack of Nytol One-A-Night tablets from you last week. She tells you that she wants to purchase another pack.
You use similar questions to those explained in module 2 and establish the following details from her:
1GET THE FACTS
WHAT SYMPTOMS HAVE YOU BEEN EXPERIENCING?
Celine is suffering from poor, disturbed sleep and stress during the day
HOW LONG HAVE YOU BEEN FEELING LIKE THIS?
Celine has suffered for the last 2.5 weeks
HOW DO YOUR SYMPTOMS AFFECT YOU DAY-TO-DAY?
Celine finds that when she doesn’t get good sleep, she can’t focus as well in the day which makes her more stressed. She is now finding it harder to cope with day-to-day tasks
IS THERE ANYTHING GOING ON IN YOUR LIFE CURRENTLY THAT MAY BE CAUSING THESE SYMPTOMS?
Celine tells you that her young baby has been unwell, which has been quite distressing for her, however the baby seems to be improving
HAVE YOU TRIED THE NYTOL ONE-A-NIGHT TABLETS SUPPLIED OR ANYTHING ELSE TO HELP?
She has been taking the tablets that she bought from you every night this past week. They have been helping, which is why she wants to buy another pack. She tells you that she is no longer breastfeeding and is not pregnant
2ADVISE, MANAGE, REASSURE OR REFER?
From the information you have received from Celine, which steps would you choose to follow?
Select all options that apply.
ALMOST CORRECT!
Celine appears to be struggling temporarily due to her child’s illness so it’s important to show empathy and offer reassurance in this situation. She should be referred to the pharmacist because her symptom severity and duration require further investigation and escalation may be required. Select an additional appropriate answer.
INCORRECT!
Celine’s symptoms appear severe and long lasting (>2weeks) which would be classed as red flags. Offering Celine another product or another pack of Nytol One-A-Night tablets would not be indicated at this stage.
CORRECT!
You can always advise customers about the link between sleep and stress and the impact they can have on health when not managed. Offering lifestyle advice could be useful alongside other methods. Because of her symptom severity and duration, you should refer Celine to the pharmacist as further investigation and escalation may be required.
3CLOSE THE CARE
SLEEP & STRESS MODULES
Make sure you have completed all the modules in this 3-part programme, which explore different ways to manage sleep and stress with product recommendations, and help you identify when to reassure and refer.
MANAGING POOR SLEEP & STRESS STEP BY STEP
Slide or swipe to see the full recommendation ladder.
1. Promethazine NHS. 2021. Available at: https://www.nhs.uk/medicines/promethazine/
2. Diphenhydramine. NHS. 2021. Available at: https://www.nhs.uk/medicines/diphenhydramine/
3. Nytol original 25mg tablets. SmPC. 2024. Available at: https://mhraproducts4853.blob.core.windows.net/docs/f9b92f2820e379bb4e6b96eee90bca23fd3b68ce
4. Nytol One-A-Night 50mg tablets. SmPC. 2024.
Available at: https://mhraproducts4853.blob.core.windows.net/docs/ee06f0bbf202e9f8d79beac1a39163119aeeceb6
5. Nytol liquid caramel flavour 10mg/5ml oral solution. SmPC. 2022.
Available at: https://mhraproducts4853.blob.core.windows.net/docs/cd69bea27da870ac4326ca5bce2f7bd6ba4000ff
6. Wiginton K. What to know about over-the-counter sleep medications. WebMD. 2023.
Available at: https://www.webmd.com/sleep-disorders/otc-sleep-medications-what-to-know
7. Legg T, et al. How to tell if stress is affecting your sleep. 2018. Available at: https://www.medicalnewstoday.com/articles/322994
8. Promethazine hydrochloride 25mg tablets. SmPC. 2023.
Available at: https://mhraproducts4853.blob.core.windows.net docs/477459f173772684436399caef6185ccede43327
9. Durning MV. Tolerance, physical dependence, and addiction explained. WebMD. 2022.
Available at: https://www.webmd.com/mental-health/addiction/tolerance-dependence-addiction-explained
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 £7.89
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 £5.69
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.