Sherri Barden MPS
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[post_content] => On 1 October 2025, the Therapeutic Goods Administration (TGA) scheduled methenamine hippurate as a Pharmacist Only medicine to ensure pharmacist oversight of its use.
Up until last week, methenamine hippurate, sold as Hiprex and Uramet was unscheduled, available as a general sales medicine.
Australian Pharmacist outlines the reasons for the rescheduling of this medicine, and what actions a request for Hiprex should now prompt pharmacists to take.
Why is methenamine now an S3 medicine?
In May 2024, a final decision was made to reschedule methenamine to Pharmacist Only for therapeutic preparations, allowing for pharmacist intervention to ensure safe and appropriate use.
While Pharmacy Only scheduling was considered, it was deemed insufficient to prevent inappropriate use by those who have not been medically assessed.
Methenamine hippurate is generally low risk and provides an alternative to antibiotics for recurrent urinary tract infections (UTIs), addressing the community's need to reduce antibiotic resistance. The TGA delegate also noted that patients diagnosed with recurrent UTI and advised by a healthcare practitioner to use methenamine hippurate are unlikely to self-medicate inappropriately.
But for new and infrequent users, unrestricted access outside of pharmacies poses risks of inappropriate self-diagnosis, use for active UTIs without professional input, and masking of underlying medical conditions.
Pharmacist involvement should help to mitigate these risks by enhancing therapeutic advice and reducing errors or misuse while aligning with international classifications in the United Kingdom, United States and New Zealand.
What are the issues with unsupervised use?
Methenamine hippurate’s therapeutic efficacy significantly relies on an acidic urinary pH. So co-administration of urinary alkalisers, such as potassium citrate or acetazolamide, can raise urine pH – limiting formaldehyde formation and diminishing efficacy.
Long-term risks of formaldehyde exposure include gastrointestinal effects and skin irritation.
Methenamine hippurate should also be used judiciously in patients with comorbid conditions that can lead to elevated risks, such as:
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[post_content] => Yesterday (Tuesday 7 October), PSA, in a joint event with Consumer Healthcare Products Australia (CHP Australia), showcased the breadth of pharmacists’ skills and roles at Australian Parliament House.
So who were the pharmacists walking in the corridors of power? And what were their messages for Australia’s politicians?
Australian Pharmacist spoke to some of the trailblazers who made the trip to Canberra for the event.
Hannah Knowles MPS – hospital pharmacy
Flying the flag for hospital pharmacy, Hannah Knowles, Advanced Pharmacist in Patient Flow at the Royal Brisbane and Women’s Hospital, spoke to politicians and delegates about the rapidly evolving role of hospital pharmacists – including leading the Pharmacist Collaborative Medication Prescribing Pilot in her hospital.
[caption id="attachment_30671" align="aligncenter" width="432"]
Hannah Knowles MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Anna Theophilos MPS – community pharmacy, vaccination
Anna Theophilos, community pharmacist, PSA’s Vaccination Ambassador and owner of TerryWhite Chemmart Surrey Hills South (Melbourne), had one main message for politicians: it’s time to end the jurisdictional vaccine lottery.
[caption id="attachment_30670" align="aligncenter" width="446"]
Anna Theophilos MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Drawing on 17 years’ experience, Theophilos highlighted the breadth of community pharmacy services she provides, anchored by immunisation.
Using her ‘spin-to-win’ wheel, Anna highlighted the inequity experienced by patients across Australia, with regulations preventing pharmacist immunisers being able to fully support the immunisation needs of the communities they serve.
“I hope they can see it’s common sense that all pharmacists, regardless of where you practice, can vaccinate according to the Australian Immunisation Handbook. All Australians deserve the same access to vaccinations regardless of where they live.
Deborah Hawthorne FPS – consultant pharmacist
Deborah Hawthorne is well known as a rural pharmacist specialising in consultant practice, diabetes education and aged care. She shared with politicians her experiences of visiting people’s homes to provide Home Medicines Reviews and the benefits patients experience from this service.
Reflecting on the event, Ms Hawthorne hoped her passion for Home Medicines Reviews (HMRs) would make an impact.
‘I’m excited about sharing the role of pharmacists providing HMRs across the country. There is so much more we need to do and we need to be supported [by governments] to do it.’
Jaimee Anderson MPS – First Nations health/ diabetes education
Credentialled Diabetes Educator and pharmacist at Wurli Wurlinjang Health, Jaimee Anderson shared the vital work she does supporting the health of First Nations people in Katherine.
The current PSA Pharmacist of the Year hoped the event would show more pharmacists are needed in more practice settings.
‘What I want politicians to take away is that pharmacists affect change at all levels of clinical care and need to be embedded in all levels of service,’ she said.
‘First Nations peoples have a greater burden of chronic disease. Embedding pharmacists in Aboriginal Health Services has been proven to help close that gap.’
Neil Petrie MPS – aged care
Neil Petrie travelled up to Canberra from Melbourne to provide insight into his work at Donwood Community Aged Care as an on-site pharmacist in aged care, solving medicine safety problems to improve quality of life for residents.
Speaking to AP, Neil reflected on how important it is to make sure political leaders learn more about the breadth of work pharmacists do.
‘Pharmacists have a lot of different roles, not just dispensing of medicines. Today was a great opportunity to showcase all the diversity of pharmacists' roles for medicine safety in our community.’
Nod from a pharmacist MP
Speaking at the event, the Hon. Emma McBride MP FPS reflected on the rapid evolution of the pharmacist profession in the past decade, seeing a range of new team-based pharmacist roles in primary care being created to drive medicine safety.
View this post on Instagram
A post shared by Pharmaceutical Society of Australia (@pharmaceuticalsocietyau)
She also paid tribute to the pharmacists in the room for their work and acknowledged all pharmacists and pharmacy assistants providing care to Australians across the nation.
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[post_content] => Last year, the Therapeutic Goods Administration (TGA) made an interim decision to reschedule this formulation of dihydrocodeine (Rikodeine) to a prescription medicine. Why hasn’t it happened yet?
On 26 July 2024, the interim decision on dihydrocodeine was published, which was made in response to concerns about the potential for misuse, abuse, and dependence associated with the opioid derivative.
The TGA Delegate's interim decision was to amend the Pharmacist Only entry for dihydrocodeine to restrict undivided oral liquid preparations to a maximum primary pack size of 100 mL from 1 October 2025.
So, what happened?
What were the reasons for the interim decision?
The interim decision to amend the Schedule 3 entry for dihydrocodeine was made to balance the potential risks of dihydrocodeine, including respiratory depression, addiction potential and severe adverse effects, against the need for timely patient access to dry cough medicines.
The amendment would also align Australia’s regulations more closely with other jurisdictions such as the United States, Canada, and Europe.
Where is the final decision?
Australian Pharmacist understands that the final decision on the scheduling of dihydrocodeine is yet to be published, despite the implementation date flagged in the interim decision having come and gone last week.
It is highly unusual for an interim decision not to have been followed by a final decision within the usual decision-making timeframe – and to see the proposed implementation date pass without any formal notice.
What’s the reason behind the hold up?
In August 2024, the TGA sought public submissions on the interim decision on dihydrocodeine.
It was reported in September 2024 that, of the 7 submissions received, two were in partial support while five were in opposition of the interim decision.
The TGA noted that final decisions on dihydrocodeine had been deferred while the submissions received from the consultation were further considered.
What should pharmacists do in the meantime?
For now, the scheduling of dihydrocodeine remains unchanged. PSA has reached out to the TGA for confirmation on the final scheduling decision.
Pharmacists report they continue to experience frequent queries for dihydrocodeine from patients, many of whom don’t appear to have symptoms of dry cough.
If diversion, misuse or abuse is suspected, pharmacists should ask the patient further questions to establish the patient’s:
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[post_content] => Advice around flagging SABA-only asthma patients, guiding them to new therapies for optimal management, and correcting inhaler technique.
Ever had those red flags when a patient is having multiple short-acting beta2-agonist (SABA) inhalers dispensed within a short timeframe? Or they’re taking salbutamol alone on multiple days of the week? And what about older patients who were told it was okay to use salbutamol frequently – and now it’s not?
How can pharmacists help these patients gain control over their disease? Or prevent them reaching the 1 g lifetime limit of oral corticosteroid use?
Pharmacist and asthma educator Sherri Barden MPS – who runs her own asthma, hay fever, eczema and chronic obstructive pulmonary disease, APLUS Pharmacy Education business – has heard it all. Routine inquiries about symptom frequency, reliever use and adherence during each pharmacy encounter is a good method, she says, of recognising if suboptimal control is worthy of timely intervention or referral.
Long-term solo SABA users
Patients who ‘just want the blue puffer’ may be the subject of a difficult conversation, according to Ms Barden. ‘Community pharmacists can reframe the conversation by encouraging their staff to firstly explain to the patient that salbutamol or terbutaline are a Pharmacist Only medicine and that the pharmacist will be with them shortly to discuss.’
She encourages pharmacists to use ‘a patient-centred, non-judgemental approach that links the discussion to the person’s goals and wellbeing’. Opening lines for long-term SABA users such as ‘Is this for asthma?’ and ‘I see you’re here for your reliever. Can I check how your asthma has been going lately?’ are recommended.
Another approach could start as: ‘There are some important updates to asthma care in adults and adolescents that could help you breathe easier and prevent flare-ups.’
Using brief symptom assessment tools such as the Asthma Control Test (ACT) and offering a collaborative plan can help make the conversation supportive rather than confrontational, Ms Barden suggests.
Importantly, patients should be advised that SABAs will continue to be available over the counter from pharmacists, but that the newer recommendations require a prescription. MedsChecks or Home Medicines Reviews can also provide opportunities to assess or reassess control, look at triggers or comorbidities contributing to poor control, review adherence and technique, and perform the ACT to track progress over time.
Up to 80% of people with asthma also have allergic rhinitis, Ms Barden points out. So it’s essential to assess or ask people about the upper airway.
If rhinitis ‘is not adequately controlled with the right information and quality use of medicines, it may contribute to poor asthma control’.
Ms Barden recommends the teach-back method for correct inhaler technique using either a placebo device or, better still, suggest the patient have a dose of their medicine with the pharmacist watching, who could then build follow-up and monitoring into routine practice.
National Asthma Council instructional videos for home use and ancillary labels –“Quick and Deep” for dry powder inhalers and “Slow and Steady” for metered dose or soft mist inhalers – reinforce the correct breathing method, Ms Barden says. They also act as ongoing prompts and conversation starters regarding technique.
Clear criteria for escalation, she stresses, should trigger a timely referral to a GP, nurse practitioner or respiratory specialist. In this way, patient progress can be measured, trends identified early, and care escalated if needed.
AP spoke to two pharmacists about interventions with patients with sub-optimal asthma control.
Case 1
David Peachey MPS
Partner/Pharmacist
Hatton & Laws Pharmacy and Priceline Pharmacy Launceston Plaza, Launceston, TAS
Mr B, a regular patient, repeatedly presented earlier than expected for salbutamol purchased as a Pharmacist Only medicine. There was no evidence of preventer use. He described increasing breathlessness and wheeziness, finding it harder to manage everyday activities like walking up the street. He was relying heavily on his SABA inhaler and had not had a recent GP review. This was a clear red flag that his asthma was not under control. His inhaler technique may also have been a factor, especially if copied from someone using it incorrectly.
Approaching Mr B in a supportive, non-judgemental way, I said: ‘I can see you might be experiencing some worsening of your breathing. I’d like to help you improve this. Let’s have a quick catch up in the consult room.’
I find open-ended questions most effective, particularly when patients are struggling. For example: ‘Would you be able to show me how you use your inhaler?’ or ‘Have you used a spacer before? I can show you what it does and how it works.’ Framing it as a way to improve breathing capacity, rather than criticising technique, makes patients more receptive.
When patients are hesitant, I focus on curiosity and reassurance rather than criticism. I explained to Mr B: ‘There are better and easier treatments available now such as anti-inflammatory relievers and a maintenance preventer and reliever in one device.
‘Using a Ventolin inhaler every week may cause side effects to your heart and lungs without you noticing. That might mean talking to your GP about an asthma plan and working together on inhaler technique today.’
By showing patients I am available anytime, I keep the door open, even if they aren’t ready to change immediately. Through this process, I was able to review and improve Mr B’s inhaler technique. Once he gained confidence using a spacer and making small adjustments, his reliance on salbutamol reduced.
Over time, he engaged more with his GP, which led to spirometry and a step-up in therapy with a preventer. Each small success built trust and transformed his asthma management from sub-optimal to stable, effective therapy.
The key lesson is that inhaler technique checks and supportive communication can significantly improve asthma outcomes. Many patients don’t realise how much salbutamol they are using or the risks of long-term reliance.
By engaging with open questions, demonstrating devices, and linking patients back to their GP, pharmacists can guide safer, more effective asthma care while building enduring patient trust.
Case 2
Joanna Luong MPS
Community Pharmacist
PSA Trainer and Assessor
Brisbane, QLD
Poorly managed asthma in the pharmacy is a common presentation. One standout case involved a man requesting over-the-counter salbutamol for his 20-year-old son. When I checked the dispense history, I saw salbutamol had been supplied monthly, always as a Pharmacist Only medicine, with no preventer prescribed and no record of any past clinical interventions.
Frequent reliever use can indicate uncontrolled asthma and may implicate poor inhaler technique. Patient education and collaborative care with a doctor was evidently warranted, to support the quality use of medicines and optimise management.
The man waited impatiently. I was careful my tone didn’t suggest misuse or poor self-management ability by his son. In a friendly, conversational manner, I said: ‘I’ve had many people coming in lately with asthma flare-ups due to the recent weather change. Has your son found that certain triggers worsen his symptoms? I can see he’s had Ventolin dispensed several times over the last couple of months.’
The question was closed, but the context prompted an elaboration of the response, which was that his son ‘usually just uses his inhaler a couple of times a week and that keeps everything under control’.
While acknowledging their satisfaction with their current level of control, I emphasised that, commonly, asthma management can be optimised even in people who consider their asthma well-controlled, and that along with proper inhaler technique, quality of life could be much improved including fewer episodes of wheeziness disrupting their daily activities.
‘Would your son have time at some point to come in for a quick chat so we can check his technique and discuss the updated Australian guidelines for asthma management?’ I asked.
As expected, there was some resistance. I gently reminded the father that guidelines evolve with research, and advice received several years ago may no longer be current, which is why regular medical reviews are recommended, and that my role was to help guide patients in making informed decisions about their health care.
Even though the conversation did not lead to change that day, keeping the conversation supportive and respectful meant he left the pharmacy open to future discussions.
I documented the intervention in the son’s dispense record so my colleagues and I could continue the conversation on subsequent visits. This ongoing engagement helped build rapport, and the father eventually persuaded his son to see his doctor, who prescribed a preventer inhaler now used regularly.
How we communicate can be just as important as what we say.
[post_title] => How pharmacists can combat poor asthma control
[post_excerpt] => How pharmacists can flag SABA-only asthma patients, guide them to new therapies for optimal management, and correct inhaler technique.
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[post_content] => Last year, it was reported that Australian poisons hotlines received almost 1,500 calls about child ingestion of melatonin.
In Western Australia, calls to the poisons hotline about melatonin have nearly doubled from 175 in 2018 to 322 as of August this year, across all age groups – mostly related to gummy products.
In the same month, online health retailer iHerb suspended the sale of melatonin supplements in Australia.
But there are retailers selling these products online, said Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity Australia.
[caption id="attachment_30644" align="alignright" width="300"]
Professor Sarah Blunden[/caption]
‘There are a lot of other companies from the United States that sell it,’ she said.
AP investigates what melatonin toxicity looks like, why so many kids are taking it and how pharmacists can help to ensure safe and effective use of medicines for sleep.
Why have calls to poison hotlines about melatonin gummies doubled?
From Prof Blunden’s perspective, the drivers are straightforward.
‘They are not regulated, they've got sugar in them and they taste good,’ she said. ‘Children love them and parents think they're natural. And without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.’
Independent analyses of melatonin gummies have shown large discrepancies between labelled and actual melatonin content.
‘Two research groups – one in Canada and one in the UK – found some had no melatonin at all, and some had up to 400% of what was on the label,’ Prof Blunden said.
‘without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.'
Professor Sarah Blunden
The Therapeutic Goods Administration (TGA) recently conducted its own review, reporting significant variability between products. For example, The Smurfs Kids Gummies Melatonin 1 mg contained 155–170% variation from the labelled amount.
Endogenous melatonin biology is also highly individual, with retinal light-sensing pathways modulating secretion with wide inter-child variability, and there’s no practical clinical assay to map a child’s secretion pattern outside of a research study.
‘A child who’s particularly light-sensitive might have higher endogenous levels at a certain time, and if they then take several gummies, toxicity could be faster and worse,’ she said. ‘That’s why, when they present to ED, it gets labelled as an “overdose,” but we don’t exactly know what that means.’
What are the symptoms of melatonin toxicity?
Common reported effects of melatonin toxicity include headache, dizziness, nausea, and drowsiness.
Children can also experience central nervous system (CNS) effects, including extreme sedation, nightmares and vivid dreams.
‘Parents might see a very drowsy or unwell child and seek care, or they may witness ingestion of multiple gummies and go to the emergency department (ED),’ Prof Blunden said.
Sometimes, toxicity appears fatal.
‘In a review we conducted, two or three deaths of children who had ingested melatonin were reported, but they are not included in many systematic reviews – including ours – because we couldn’t confirm that melatonin was the cause,’ she said.
‘I also found a paper reporting seven infants who died with high levels of exogenous melatonin in the blood, but causation wasn’t established. It’s unknown – and that is really scary.’
Why are so many kids taking melatonin?
Sleep is increasingly recognised as a crucial factor in community health, said Prof Blunden.
‘Traditionally the pillars were healthy eating and exercise,’ she said. ‘But in the last 20 years, sleep has edged in as equally important.’
This shift is especially relevant for Australian parents, who have long encouraged children to sleep alone.
‘Because we've always had that expectation, there have always been issues around children who don't want to sleep by themselves,’ Prof Blunden said.
Controlled crying was previously the standard response for children resisting independent sleep, but now, behavioural sleep medicine recognises melatonin as another option.
‘The increase in dual-working families, the need for children to sleep independently, the broader community conversation about sleep, and greater availability of melatonin for children who are not typically developing has led to the use of melatonin sharply rising,’ she said.
‘I’m on the board of the International Pediatric Sleep Association. And at the last two conferences, physiologists and clinicians said melatonin prescriptions and use have skyrocketed over the last 5 years,’ Prof Blunden said.
Who is melatonin indicated for and at what dose?
In Australia, melatonin is indicated for children aged 2–18 years with neurodevelopmental disorders including:
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[post_content] => On 1 October 2025, the Therapeutic Goods Administration (TGA) scheduled methenamine hippurate as a Pharmacist Only medicine to ensure pharmacist oversight of its use.
Up until last week, methenamine hippurate, sold as Hiprex and Uramet was unscheduled, available as a general sales medicine.
Australian Pharmacist outlines the reasons for the rescheduling of this medicine, and what actions a request for Hiprex should now prompt pharmacists to take.
Why is methenamine now an S3 medicine?
In May 2024, a final decision was made to reschedule methenamine to Pharmacist Only for therapeutic preparations, allowing for pharmacist intervention to ensure safe and appropriate use.
While Pharmacy Only scheduling was considered, it was deemed insufficient to prevent inappropriate use by those who have not been medically assessed.
Methenamine hippurate is generally low risk and provides an alternative to antibiotics for recurrent urinary tract infections (UTIs), addressing the community's need to reduce antibiotic resistance. The TGA delegate also noted that patients diagnosed with recurrent UTI and advised by a healthcare practitioner to use methenamine hippurate are unlikely to self-medicate inappropriately.
But for new and infrequent users, unrestricted access outside of pharmacies poses risks of inappropriate self-diagnosis, use for active UTIs without professional input, and masking of underlying medical conditions.
Pharmacist involvement should help to mitigate these risks by enhancing therapeutic advice and reducing errors or misuse while aligning with international classifications in the United Kingdom, United States and New Zealand.
What are the issues with unsupervised use?
Methenamine hippurate’s therapeutic efficacy significantly relies on an acidic urinary pH. So co-administration of urinary alkalisers, such as potassium citrate or acetazolamide, can raise urine pH – limiting formaldehyde formation and diminishing efficacy.
Long-term risks of formaldehyde exposure include gastrointestinal effects and skin irritation.
Methenamine hippurate should also be used judiciously in patients with comorbid conditions that can lead to elevated risks, such as:
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[post_content] => Yesterday (Tuesday 7 October), PSA, in a joint event with Consumer Healthcare Products Australia (CHP Australia), showcased the breadth of pharmacists’ skills and roles at Australian Parliament House.
So who were the pharmacists walking in the corridors of power? And what were their messages for Australia’s politicians?
Australian Pharmacist spoke to some of the trailblazers who made the trip to Canberra for the event.
Hannah Knowles MPS – hospital pharmacy
Flying the flag for hospital pharmacy, Hannah Knowles, Advanced Pharmacist in Patient Flow at the Royal Brisbane and Women’s Hospital, spoke to politicians and delegates about the rapidly evolving role of hospital pharmacists – including leading the Pharmacist Collaborative Medication Prescribing Pilot in her hospital.
[caption id="attachment_30671" align="aligncenter" width="432"] Hannah Knowles MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Anna Theophilos MPS – community pharmacy, vaccination
Anna Theophilos, community pharmacist, PSA’s Vaccination Ambassador and owner of TerryWhite Chemmart Surrey Hills South (Melbourne), had one main message for politicians: it’s time to end the jurisdictional vaccine lottery.
[caption id="attachment_30670" align="aligncenter" width="446"] Anna Theophilos MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Drawing on 17 years’ experience, Theophilos highlighted the breadth of community pharmacy services she provides, anchored by immunisation.
Using her ‘spin-to-win’ wheel, Anna highlighted the inequity experienced by patients across Australia, with regulations preventing pharmacist immunisers being able to fully support the immunisation needs of the communities they serve.
“I hope they can see it’s common sense that all pharmacists, regardless of where you practice, can vaccinate according to the Australian Immunisation Handbook. All Australians deserve the same access to vaccinations regardless of where they live.
Deborah Hawthorne FPS – consultant pharmacist
Deborah Hawthorne is well known as a rural pharmacist specialising in consultant practice, diabetes education and aged care. She shared with politicians her experiences of visiting people’s homes to provide Home Medicines Reviews and the benefits patients experience from this service.
Reflecting on the event, Ms Hawthorne hoped her passion for Home Medicines Reviews (HMRs) would make an impact.
‘I’m excited about sharing the role of pharmacists providing HMRs across the country. There is so much more we need to do and we need to be supported [by governments] to do it.’
Jaimee Anderson MPS – First Nations health/ diabetes education
Credentialled Diabetes Educator and pharmacist at Wurli Wurlinjang Health, Jaimee Anderson shared the vital work she does supporting the health of First Nations people in Katherine.
The current PSA Pharmacist of the Year hoped the event would show more pharmacists are needed in more practice settings.
‘What I want politicians to take away is that pharmacists affect change at all levels of clinical care and need to be embedded in all levels of service,’ she said.
‘First Nations peoples have a greater burden of chronic disease. Embedding pharmacists in Aboriginal Health Services has been proven to help close that gap.’
Neil Petrie MPS – aged care
Neil Petrie travelled up to Canberra from Melbourne to provide insight into his work at Donwood Community Aged Care as an on-site pharmacist in aged care, solving medicine safety problems to improve quality of life for residents.
Speaking to AP, Neil reflected on how important it is to make sure political leaders learn more about the breadth of work pharmacists do.
‘Pharmacists have a lot of different roles, not just dispensing of medicines. Today was a great opportunity to showcase all the diversity of pharmacists' roles for medicine safety in our community.’
Nod from a pharmacist MP
Speaking at the event, the Hon. Emma McBride MP FPS reflected on the rapid evolution of the pharmacist profession in the past decade, seeing a range of new team-based pharmacist roles in primary care being created to drive medicine safety.
View this post on Instagram
A post shared by Pharmaceutical Society of Australia (@pharmaceuticalsocietyau)
She also paid tribute to the pharmacists in the room for their work and acknowledged all pharmacists and pharmacy assistants providing care to Australians across the nation.
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[post_content] => Last year, the Therapeutic Goods Administration (TGA) made an interim decision to reschedule this formulation of dihydrocodeine (Rikodeine) to a prescription medicine. Why hasn’t it happened yet?
On 26 July 2024, the interim decision on dihydrocodeine was published, which was made in response to concerns about the potential for misuse, abuse, and dependence associated with the opioid derivative.
The TGA Delegate's interim decision was to amend the Pharmacist Only entry for dihydrocodeine to restrict undivided oral liquid preparations to a maximum primary pack size of 100 mL from 1 October 2025.
So, what happened?
What were the reasons for the interim decision?
The interim decision to amend the Schedule 3 entry for dihydrocodeine was made to balance the potential risks of dihydrocodeine, including respiratory depression, addiction potential and severe adverse effects, against the need for timely patient access to dry cough medicines.
The amendment would also align Australia’s regulations more closely with other jurisdictions such as the United States, Canada, and Europe.
Where is the final decision?
Australian Pharmacist understands that the final decision on the scheduling of dihydrocodeine is yet to be published, despite the implementation date flagged in the interim decision having come and gone last week.
It is highly unusual for an interim decision not to have been followed by a final decision within the usual decision-making timeframe – and to see the proposed implementation date pass without any formal notice.
What’s the reason behind the hold up?
In August 2024, the TGA sought public submissions on the interim decision on dihydrocodeine.
It was reported in September 2024 that, of the 7 submissions received, two were in partial support while five were in opposition of the interim decision.
The TGA noted that final decisions on dihydrocodeine had been deferred while the submissions received from the consultation were further considered.
What should pharmacists do in the meantime?
For now, the scheduling of dihydrocodeine remains unchanged. PSA has reached out to the TGA for confirmation on the final scheduling decision.
Pharmacists report they continue to experience frequent queries for dihydrocodeine from patients, many of whom don’t appear to have symptoms of dry cough.
If diversion, misuse or abuse is suspected, pharmacists should ask the patient further questions to establish the patient’s:
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[post_content] => Advice around flagging SABA-only asthma patients, guiding them to new therapies for optimal management, and correcting inhaler technique.
Ever had those red flags when a patient is having multiple short-acting beta2-agonist (SABA) inhalers dispensed within a short timeframe? Or they’re taking salbutamol alone on multiple days of the week? And what about older patients who were told it was okay to use salbutamol frequently – and now it’s not?
How can pharmacists help these patients gain control over their disease? Or prevent them reaching the 1 g lifetime limit of oral corticosteroid use?
Pharmacist and asthma educator Sherri Barden MPS – who runs her own asthma, hay fever, eczema and chronic obstructive pulmonary disease, APLUS Pharmacy Education business – has heard it all. Routine inquiries about symptom frequency, reliever use and adherence during each pharmacy encounter is a good method, she says, of recognising if suboptimal control is worthy of timely intervention or referral.
Long-term solo SABA users
Patients who ‘just want the blue puffer’ may be the subject of a difficult conversation, according to Ms Barden. ‘Community pharmacists can reframe the conversation by encouraging their staff to firstly explain to the patient that salbutamol or terbutaline are a Pharmacist Only medicine and that the pharmacist will be with them shortly to discuss.’
She encourages pharmacists to use ‘a patient-centred, non-judgemental approach that links the discussion to the person’s goals and wellbeing’. Opening lines for long-term SABA users such as ‘Is this for asthma?’ and ‘I see you’re here for your reliever. Can I check how your asthma has been going lately?’ are recommended.
Another approach could start as: ‘There are some important updates to asthma care in adults and adolescents that could help you breathe easier and prevent flare-ups.’
Using brief symptom assessment tools such as the Asthma Control Test (ACT) and offering a collaborative plan can help make the conversation supportive rather than confrontational, Ms Barden suggests.
Importantly, patients should be advised that SABAs will continue to be available over the counter from pharmacists, but that the newer recommendations require a prescription. MedsChecks or Home Medicines Reviews can also provide opportunities to assess or reassess control, look at triggers or comorbidities contributing to poor control, review adherence and technique, and perform the ACT to track progress over time.
Up to 80% of people with asthma also have allergic rhinitis, Ms Barden points out. So it’s essential to assess or ask people about the upper airway.
If rhinitis ‘is not adequately controlled with the right information and quality use of medicines, it may contribute to poor asthma control’.
Ms Barden recommends the teach-back method for correct inhaler technique using either a placebo device or, better still, suggest the patient have a dose of their medicine with the pharmacist watching, who could then build follow-up and monitoring into routine practice.
National Asthma Council instructional videos for home use and ancillary labels –“Quick and Deep” for dry powder inhalers and “Slow and Steady” for metered dose or soft mist inhalers – reinforce the correct breathing method, Ms Barden says. They also act as ongoing prompts and conversation starters regarding technique.
Clear criteria for escalation, she stresses, should trigger a timely referral to a GP, nurse practitioner or respiratory specialist. In this way, patient progress can be measured, trends identified early, and care escalated if needed.
AP spoke to two pharmacists about interventions with patients with sub-optimal asthma control.
Case 1
David Peachey MPS
Partner/Pharmacist
Hatton & Laws Pharmacy and Priceline Pharmacy Launceston Plaza, Launceston, TAS
Mr B, a regular patient, repeatedly presented earlier than expected for salbutamol purchased as a Pharmacist Only medicine. There was no evidence of preventer use. He described increasing breathlessness and wheeziness, finding it harder to manage everyday activities like walking up the street. He was relying heavily on his SABA inhaler and had not had a recent GP review. This was a clear red flag that his asthma was not under control. His inhaler technique may also have been a factor, especially if copied from someone using it incorrectly.
Approaching Mr B in a supportive, non-judgemental way, I said: ‘I can see you might be experiencing some worsening of your breathing. I’d like to help you improve this. Let’s have a quick catch up in the consult room.’
I find open-ended questions most effective, particularly when patients are struggling. For example: ‘Would you be able to show me how you use your inhaler?’ or ‘Have you used a spacer before? I can show you what it does and how it works.’ Framing it as a way to improve breathing capacity, rather than criticising technique, makes patients more receptive.
When patients are hesitant, I focus on curiosity and reassurance rather than criticism. I explained to Mr B: ‘There are better and easier treatments available now such as anti-inflammatory relievers and a maintenance preventer and reliever in one device.
‘Using a Ventolin inhaler every week may cause side effects to your heart and lungs without you noticing. That might mean talking to your GP about an asthma plan and working together on inhaler technique today.’
By showing patients I am available anytime, I keep the door open, even if they aren’t ready to change immediately. Through this process, I was able to review and improve Mr B’s inhaler technique. Once he gained confidence using a spacer and making small adjustments, his reliance on salbutamol reduced.
Over time, he engaged more with his GP, which led to spirometry and a step-up in therapy with a preventer. Each small success built trust and transformed his asthma management from sub-optimal to stable, effective therapy.
The key lesson is that inhaler technique checks and supportive communication can significantly improve asthma outcomes. Many patients don’t realise how much salbutamol they are using or the risks of long-term reliance.
By engaging with open questions, demonstrating devices, and linking patients back to their GP, pharmacists can guide safer, more effective asthma care while building enduring patient trust.
Case 2
Joanna Luong MPS
Community Pharmacist
PSA Trainer and Assessor
Brisbane, QLD
Poorly managed asthma in the pharmacy is a common presentation. One standout case involved a man requesting over-the-counter salbutamol for his 20-year-old son. When I checked the dispense history, I saw salbutamol had been supplied monthly, always as a Pharmacist Only medicine, with no preventer prescribed and no record of any past clinical interventions.
Frequent reliever use can indicate uncontrolled asthma and may implicate poor inhaler technique. Patient education and collaborative care with a doctor was evidently warranted, to support the quality use of medicines and optimise management.
The man waited impatiently. I was careful my tone didn’t suggest misuse or poor self-management ability by his son. In a friendly, conversational manner, I said: ‘I’ve had many people coming in lately with asthma flare-ups due to the recent weather change. Has your son found that certain triggers worsen his symptoms? I can see he’s had Ventolin dispensed several times over the last couple of months.’
The question was closed, but the context prompted an elaboration of the response, which was that his son ‘usually just uses his inhaler a couple of times a week and that keeps everything under control’.
While acknowledging their satisfaction with their current level of control, I emphasised that, commonly, asthma management can be optimised even in people who consider their asthma well-controlled, and that along with proper inhaler technique, quality of life could be much improved including fewer episodes of wheeziness disrupting their daily activities.
‘Would your son have time at some point to come in for a quick chat so we can check his technique and discuss the updated Australian guidelines for asthma management?’ I asked.
As expected, there was some resistance. I gently reminded the father that guidelines evolve with research, and advice received several years ago may no longer be current, which is why regular medical reviews are recommended, and that my role was to help guide patients in making informed decisions about their health care.
Even though the conversation did not lead to change that day, keeping the conversation supportive and respectful meant he left the pharmacy open to future discussions.
I documented the intervention in the son’s dispense record so my colleagues and I could continue the conversation on subsequent visits. This ongoing engagement helped build rapport, and the father eventually persuaded his son to see his doctor, who prescribed a preventer inhaler now used regularly.
How we communicate can be just as important as what we say.
[post_title] => How pharmacists can combat poor asthma control
[post_excerpt] => How pharmacists can flag SABA-only asthma patients, guide them to new therapies for optimal management, and correct inhaler technique.
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[post_content] => Last year, it was reported that Australian poisons hotlines received almost 1,500 calls about child ingestion of melatonin.
In Western Australia, calls to the poisons hotline about melatonin have nearly doubled from 175 in 2018 to 322 as of August this year, across all age groups – mostly related to gummy products.
In the same month, online health retailer iHerb suspended the sale of melatonin supplements in Australia.
But there are retailers selling these products online, said Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity Australia.
[caption id="attachment_30644" align="alignright" width="300"] Professor Sarah Blunden[/caption]
‘There are a lot of other companies from the United States that sell it,’ she said.
AP investigates what melatonin toxicity looks like, why so many kids are taking it and how pharmacists can help to ensure safe and effective use of medicines for sleep.
Why have calls to poison hotlines about melatonin gummies doubled?
From Prof Blunden’s perspective, the drivers are straightforward.
‘They are not regulated, they've got sugar in them and they taste good,’ she said. ‘Children love them and parents think they're natural. And without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.’
Independent analyses of melatonin gummies have shown large discrepancies between labelled and actual melatonin content.
‘Two research groups – one in Canada and one in the UK – found some had no melatonin at all, and some had up to 400% of what was on the label,’ Prof Blunden said.
‘without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.'
Professor Sarah Blunden
The Therapeutic Goods Administration (TGA) recently conducted its own review, reporting significant variability between products. For example, The Smurfs Kids Gummies Melatonin 1 mg contained 155–170% variation from the labelled amount.
Endogenous melatonin biology is also highly individual, with retinal light-sensing pathways modulating secretion with wide inter-child variability, and there’s no practical clinical assay to map a child’s secretion pattern outside of a research study.
‘A child who’s particularly light-sensitive might have higher endogenous levels at a certain time, and if they then take several gummies, toxicity could be faster and worse,’ she said. ‘That’s why, when they present to ED, it gets labelled as an “overdose,” but we don’t exactly know what that means.’
What are the symptoms of melatonin toxicity?
Common reported effects of melatonin toxicity include headache, dizziness, nausea, and drowsiness.
Children can also experience central nervous system (CNS) effects, including extreme sedation, nightmares and vivid dreams.
‘Parents might see a very drowsy or unwell child and seek care, or they may witness ingestion of multiple gummies and go to the emergency department (ED),’ Prof Blunden said.
Sometimes, toxicity appears fatal.
‘In a review we conducted, two or three deaths of children who had ingested melatonin were reported, but they are not included in many systematic reviews – including ours – because we couldn’t confirm that melatonin was the cause,’ she said.
‘I also found a paper reporting seven infants who died with high levels of exogenous melatonin in the blood, but causation wasn’t established. It’s unknown – and that is really scary.’
Why are so many kids taking melatonin?
Sleep is increasingly recognised as a crucial factor in community health, said Prof Blunden.
‘Traditionally the pillars were healthy eating and exercise,’ she said. ‘But in the last 20 years, sleep has edged in as equally important.’
This shift is especially relevant for Australian parents, who have long encouraged children to sleep alone.
‘Because we've always had that expectation, there have always been issues around children who don't want to sleep by themselves,’ Prof Blunden said.
Controlled crying was previously the standard response for children resisting independent sleep, but now, behavioural sleep medicine recognises melatonin as another option.
‘The increase in dual-working families, the need for children to sleep independently, the broader community conversation about sleep, and greater availability of melatonin for children who are not typically developing has led to the use of melatonin sharply rising,’ she said.
‘I’m on the board of the International Pediatric Sleep Association. And at the last two conferences, physiologists and clinicians said melatonin prescriptions and use have skyrocketed over the last 5 years,’ Prof Blunden said.
Who is melatonin indicated for and at what dose?
In Australia, melatonin is indicated for children aged 2–18 years with neurodevelopmental disorders including:
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[post_content] => On 1 October 2025, the Therapeutic Goods Administration (TGA) scheduled methenamine hippurate as a Pharmacist Only medicine to ensure pharmacist oversight of its use.
Up until last week, methenamine hippurate, sold as Hiprex and Uramet was unscheduled, available as a general sales medicine.
Australian Pharmacist outlines the reasons for the rescheduling of this medicine, and what actions a request for Hiprex should now prompt pharmacists to take.
Why is methenamine now an S3 medicine?
In May 2024, a final decision was made to reschedule methenamine to Pharmacist Only for therapeutic preparations, allowing for pharmacist intervention to ensure safe and appropriate use.
While Pharmacy Only scheduling was considered, it was deemed insufficient to prevent inappropriate use by those who have not been medically assessed.
Methenamine hippurate is generally low risk and provides an alternative to antibiotics for recurrent urinary tract infections (UTIs), addressing the community's need to reduce antibiotic resistance. The TGA delegate also noted that patients diagnosed with recurrent UTI and advised by a healthcare practitioner to use methenamine hippurate are unlikely to self-medicate inappropriately.
But for new and infrequent users, unrestricted access outside of pharmacies poses risks of inappropriate self-diagnosis, use for active UTIs without professional input, and masking of underlying medical conditions.
Pharmacist involvement should help to mitigate these risks by enhancing therapeutic advice and reducing errors or misuse while aligning with international classifications in the United Kingdom, United States and New Zealand.
What are the issues with unsupervised use?
Methenamine hippurate’s therapeutic efficacy significantly relies on an acidic urinary pH. So co-administration of urinary alkalisers, such as potassium citrate or acetazolamide, can raise urine pH – limiting formaldehyde formation and diminishing efficacy.
Long-term risks of formaldehyde exposure include gastrointestinal effects and skin irritation.
Methenamine hippurate should also be used judiciously in patients with comorbid conditions that can lead to elevated risks, such as:
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[post_content] => Yesterday (Tuesday 7 October), PSA, in a joint event with Consumer Healthcare Products Australia (CHP Australia), showcased the breadth of pharmacists’ skills and roles at Australian Parliament House.
So who were the pharmacists walking in the corridors of power? And what were their messages for Australia’s politicians?
Australian Pharmacist spoke to some of the trailblazers who made the trip to Canberra for the event.
Hannah Knowles MPS – hospital pharmacy
Flying the flag for hospital pharmacy, Hannah Knowles, Advanced Pharmacist in Patient Flow at the Royal Brisbane and Women’s Hospital, spoke to politicians and delegates about the rapidly evolving role of hospital pharmacists – including leading the Pharmacist Collaborative Medication Prescribing Pilot in her hospital.
[caption id="attachment_30671" align="aligncenter" width="432"] Hannah Knowles MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Anna Theophilos MPS – community pharmacy, vaccination
Anna Theophilos, community pharmacist, PSA’s Vaccination Ambassador and owner of TerryWhite Chemmart Surrey Hills South (Melbourne), had one main message for politicians: it’s time to end the jurisdictional vaccine lottery.
[caption id="attachment_30670" align="aligncenter" width="446"] Anna Theophilos MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Drawing on 17 years’ experience, Theophilos highlighted the breadth of community pharmacy services she provides, anchored by immunisation.
Using her ‘spin-to-win’ wheel, Anna highlighted the inequity experienced by patients across Australia, with regulations preventing pharmacist immunisers being able to fully support the immunisation needs of the communities they serve.
“I hope they can see it’s common sense that all pharmacists, regardless of where you practice, can vaccinate according to the Australian Immunisation Handbook. All Australians deserve the same access to vaccinations regardless of where they live.
Deborah Hawthorne FPS – consultant pharmacist
Deborah Hawthorne is well known as a rural pharmacist specialising in consultant practice, diabetes education and aged care. She shared with politicians her experiences of visiting people’s homes to provide Home Medicines Reviews and the benefits patients experience from this service.
Reflecting on the event, Ms Hawthorne hoped her passion for Home Medicines Reviews (HMRs) would make an impact.
‘I’m excited about sharing the role of pharmacists providing HMRs across the country. There is so much more we need to do and we need to be supported [by governments] to do it.’
Jaimee Anderson MPS – First Nations health/ diabetes education
Credentialled Diabetes Educator and pharmacist at Wurli Wurlinjang Health, Jaimee Anderson shared the vital work she does supporting the health of First Nations people in Katherine.
The current PSA Pharmacist of the Year hoped the event would show more pharmacists are needed in more practice settings.
‘What I want politicians to take away is that pharmacists affect change at all levels of clinical care and need to be embedded in all levels of service,’ she said.
‘First Nations peoples have a greater burden of chronic disease. Embedding pharmacists in Aboriginal Health Services has been proven to help close that gap.’
Neil Petrie MPS – aged care
Neil Petrie travelled up to Canberra from Melbourne to provide insight into his work at Donwood Community Aged Care as an on-site pharmacist in aged care, solving medicine safety problems to improve quality of life for residents.
Speaking to AP, Neil reflected on how important it is to make sure political leaders learn more about the breadth of work pharmacists do.
‘Pharmacists have a lot of different roles, not just dispensing of medicines. Today was a great opportunity to showcase all the diversity of pharmacists' roles for medicine safety in our community.’
Nod from a pharmacist MP
Speaking at the event, the Hon. Emma McBride MP FPS reflected on the rapid evolution of the pharmacist profession in the past decade, seeing a range of new team-based pharmacist roles in primary care being created to drive medicine safety.
View this post on Instagram
A post shared by Pharmaceutical Society of Australia (@pharmaceuticalsocietyau)
She also paid tribute to the pharmacists in the room for their work and acknowledged all pharmacists and pharmacy assistants providing care to Australians across the nation.
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[post_content] => Last year, the Therapeutic Goods Administration (TGA) made an interim decision to reschedule this formulation of dihydrocodeine (Rikodeine) to a prescription medicine. Why hasn’t it happened yet?
On 26 July 2024, the interim decision on dihydrocodeine was published, which was made in response to concerns about the potential for misuse, abuse, and dependence associated with the opioid derivative.
The TGA Delegate's interim decision was to amend the Pharmacist Only entry for dihydrocodeine to restrict undivided oral liquid preparations to a maximum primary pack size of 100 mL from 1 October 2025.
So, what happened?
What were the reasons for the interim decision?
The interim decision to amend the Schedule 3 entry for dihydrocodeine was made to balance the potential risks of dihydrocodeine, including respiratory depression, addiction potential and severe adverse effects, against the need for timely patient access to dry cough medicines.
The amendment would also align Australia’s regulations more closely with other jurisdictions such as the United States, Canada, and Europe.
Where is the final decision?
Australian Pharmacist understands that the final decision on the scheduling of dihydrocodeine is yet to be published, despite the implementation date flagged in the interim decision having come and gone last week.
It is highly unusual for an interim decision not to have been followed by a final decision within the usual decision-making timeframe – and to see the proposed implementation date pass without any formal notice.
What’s the reason behind the hold up?
In August 2024, the TGA sought public submissions on the interim decision on dihydrocodeine.
It was reported in September 2024 that, of the 7 submissions received, two were in partial support while five were in opposition of the interim decision.
The TGA noted that final decisions on dihydrocodeine had been deferred while the submissions received from the consultation were further considered.
What should pharmacists do in the meantime?
For now, the scheduling of dihydrocodeine remains unchanged. PSA has reached out to the TGA for confirmation on the final scheduling decision.
Pharmacists report they continue to experience frequent queries for dihydrocodeine from patients, many of whom don’t appear to have symptoms of dry cough.
If diversion, misuse or abuse is suspected, pharmacists should ask the patient further questions to establish the patient’s:
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[post_content] => Advice around flagging SABA-only asthma patients, guiding them to new therapies for optimal management, and correcting inhaler technique.
Ever had those red flags when a patient is having multiple short-acting beta2-agonist (SABA) inhalers dispensed within a short timeframe? Or they’re taking salbutamol alone on multiple days of the week? And what about older patients who were told it was okay to use salbutamol frequently – and now it’s not?
How can pharmacists help these patients gain control over their disease? Or prevent them reaching the 1 g lifetime limit of oral corticosteroid use?
Pharmacist and asthma educator Sherri Barden MPS – who runs her own asthma, hay fever, eczema and chronic obstructive pulmonary disease, APLUS Pharmacy Education business – has heard it all. Routine inquiries about symptom frequency, reliever use and adherence during each pharmacy encounter is a good method, she says, of recognising if suboptimal control is worthy of timely intervention or referral.
Long-term solo SABA users
Patients who ‘just want the blue puffer’ may be the subject of a difficult conversation, according to Ms Barden. ‘Community pharmacists can reframe the conversation by encouraging their staff to firstly explain to the patient that salbutamol or terbutaline are a Pharmacist Only medicine and that the pharmacist will be with them shortly to discuss.’
She encourages pharmacists to use ‘a patient-centred, non-judgemental approach that links the discussion to the person’s goals and wellbeing’. Opening lines for long-term SABA users such as ‘Is this for asthma?’ and ‘I see you’re here for your reliever. Can I check how your asthma has been going lately?’ are recommended.
Another approach could start as: ‘There are some important updates to asthma care in adults and adolescents that could help you breathe easier and prevent flare-ups.’
Using brief symptom assessment tools such as the Asthma Control Test (ACT) and offering a collaborative plan can help make the conversation supportive rather than confrontational, Ms Barden suggests.
Importantly, patients should be advised that SABAs will continue to be available over the counter from pharmacists, but that the newer recommendations require a prescription. MedsChecks or Home Medicines Reviews can also provide opportunities to assess or reassess control, look at triggers or comorbidities contributing to poor control, review adherence and technique, and perform the ACT to track progress over time.
Up to 80% of people with asthma also have allergic rhinitis, Ms Barden points out. So it’s essential to assess or ask people about the upper airway.
If rhinitis ‘is not adequately controlled with the right information and quality use of medicines, it may contribute to poor asthma control’.
Ms Barden recommends the teach-back method for correct inhaler technique using either a placebo device or, better still, suggest the patient have a dose of their medicine with the pharmacist watching, who could then build follow-up and monitoring into routine practice.
National Asthma Council instructional videos for home use and ancillary labels –“Quick and Deep” for dry powder inhalers and “Slow and Steady” for metered dose or soft mist inhalers – reinforce the correct breathing method, Ms Barden says. They also act as ongoing prompts and conversation starters regarding technique.
Clear criteria for escalation, she stresses, should trigger a timely referral to a GP, nurse practitioner or respiratory specialist. In this way, patient progress can be measured, trends identified early, and care escalated if needed.
AP spoke to two pharmacists about interventions with patients with sub-optimal asthma control.
Case 1
David Peachey MPS
Partner/Pharmacist
Hatton & Laws Pharmacy and Priceline Pharmacy Launceston Plaza, Launceston, TAS
Mr B, a regular patient, repeatedly presented earlier than expected for salbutamol purchased as a Pharmacist Only medicine. There was no evidence of preventer use. He described increasing breathlessness and wheeziness, finding it harder to manage everyday activities like walking up the street. He was relying heavily on his SABA inhaler and had not had a recent GP review. This was a clear red flag that his asthma was not under control. His inhaler technique may also have been a factor, especially if copied from someone using it incorrectly.
Approaching Mr B in a supportive, non-judgemental way, I said: ‘I can see you might be experiencing some worsening of your breathing. I’d like to help you improve this. Let’s have a quick catch up in the consult room.’
I find open-ended questions most effective, particularly when patients are struggling. For example: ‘Would you be able to show me how you use your inhaler?’ or ‘Have you used a spacer before? I can show you what it does and how it works.’ Framing it as a way to improve breathing capacity, rather than criticising technique, makes patients more receptive.
When patients are hesitant, I focus on curiosity and reassurance rather than criticism. I explained to Mr B: ‘There are better and easier treatments available now such as anti-inflammatory relievers and a maintenance preventer and reliever in one device.
‘Using a Ventolin inhaler every week may cause side effects to your heart and lungs without you noticing. That might mean talking to your GP about an asthma plan and working together on inhaler technique today.’
By showing patients I am available anytime, I keep the door open, even if they aren’t ready to change immediately. Through this process, I was able to review and improve Mr B’s inhaler technique. Once he gained confidence using a spacer and making small adjustments, his reliance on salbutamol reduced.
Over time, he engaged more with his GP, which led to spirometry and a step-up in therapy with a preventer. Each small success built trust and transformed his asthma management from sub-optimal to stable, effective therapy.
The key lesson is that inhaler technique checks and supportive communication can significantly improve asthma outcomes. Many patients don’t realise how much salbutamol they are using or the risks of long-term reliance.
By engaging with open questions, demonstrating devices, and linking patients back to their GP, pharmacists can guide safer, more effective asthma care while building enduring patient trust.
Case 2
Joanna Luong MPS
Community Pharmacist
PSA Trainer and Assessor
Brisbane, QLD
Poorly managed asthma in the pharmacy is a common presentation. One standout case involved a man requesting over-the-counter salbutamol for his 20-year-old son. When I checked the dispense history, I saw salbutamol had been supplied monthly, always as a Pharmacist Only medicine, with no preventer prescribed and no record of any past clinical interventions.
Frequent reliever use can indicate uncontrolled asthma and may implicate poor inhaler technique. Patient education and collaborative care with a doctor was evidently warranted, to support the quality use of medicines and optimise management.
The man waited impatiently. I was careful my tone didn’t suggest misuse or poor self-management ability by his son. In a friendly, conversational manner, I said: ‘I’ve had many people coming in lately with asthma flare-ups due to the recent weather change. Has your son found that certain triggers worsen his symptoms? I can see he’s had Ventolin dispensed several times over the last couple of months.’
The question was closed, but the context prompted an elaboration of the response, which was that his son ‘usually just uses his inhaler a couple of times a week and that keeps everything under control’.
While acknowledging their satisfaction with their current level of control, I emphasised that, commonly, asthma management can be optimised even in people who consider their asthma well-controlled, and that along with proper inhaler technique, quality of life could be much improved including fewer episodes of wheeziness disrupting their daily activities.
‘Would your son have time at some point to come in for a quick chat so we can check his technique and discuss the updated Australian guidelines for asthma management?’ I asked.
As expected, there was some resistance. I gently reminded the father that guidelines evolve with research, and advice received several years ago may no longer be current, which is why regular medical reviews are recommended, and that my role was to help guide patients in making informed decisions about their health care.
Even though the conversation did not lead to change that day, keeping the conversation supportive and respectful meant he left the pharmacy open to future discussions.
I documented the intervention in the son’s dispense record so my colleagues and I could continue the conversation on subsequent visits. This ongoing engagement helped build rapport, and the father eventually persuaded his son to see his doctor, who prescribed a preventer inhaler now used regularly.
How we communicate can be just as important as what we say.
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[post_excerpt] => How pharmacists can flag SABA-only asthma patients, guide them to new therapies for optimal management, and correct inhaler technique.
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[post_content] => Last year, it was reported that Australian poisons hotlines received almost 1,500 calls about child ingestion of melatonin.
In Western Australia, calls to the poisons hotline about melatonin have nearly doubled from 175 in 2018 to 322 as of August this year, across all age groups – mostly related to gummy products.
In the same month, online health retailer iHerb suspended the sale of melatonin supplements in Australia.
But there are retailers selling these products online, said Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity Australia.
[caption id="attachment_30644" align="alignright" width="300"] Professor Sarah Blunden[/caption]
‘There are a lot of other companies from the United States that sell it,’ she said.
AP investigates what melatonin toxicity looks like, why so many kids are taking it and how pharmacists can help to ensure safe and effective use of medicines for sleep.
Why have calls to poison hotlines about melatonin gummies doubled?
From Prof Blunden’s perspective, the drivers are straightforward.
‘They are not regulated, they've got sugar in them and they taste good,’ she said. ‘Children love them and parents think they're natural. And without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.’
Independent analyses of melatonin gummies have shown large discrepancies between labelled and actual melatonin content.
‘Two research groups – one in Canada and one in the UK – found some had no melatonin at all, and some had up to 400% of what was on the label,’ Prof Blunden said.
‘without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.'
Professor Sarah Blunden
The Therapeutic Goods Administration (TGA) recently conducted its own review, reporting significant variability between products. For example, The Smurfs Kids Gummies Melatonin 1 mg contained 155–170% variation from the labelled amount.
Endogenous melatonin biology is also highly individual, with retinal light-sensing pathways modulating secretion with wide inter-child variability, and there’s no practical clinical assay to map a child’s secretion pattern outside of a research study.
‘A child who’s particularly light-sensitive might have higher endogenous levels at a certain time, and if they then take several gummies, toxicity could be faster and worse,’ she said. ‘That’s why, when they present to ED, it gets labelled as an “overdose,” but we don’t exactly know what that means.’
What are the symptoms of melatonin toxicity?
Common reported effects of melatonin toxicity include headache, dizziness, nausea, and drowsiness.
Children can also experience central nervous system (CNS) effects, including extreme sedation, nightmares and vivid dreams.
‘Parents might see a very drowsy or unwell child and seek care, or they may witness ingestion of multiple gummies and go to the emergency department (ED),’ Prof Blunden said.
Sometimes, toxicity appears fatal.
‘In a review we conducted, two or three deaths of children who had ingested melatonin were reported, but they are not included in many systematic reviews – including ours – because we couldn’t confirm that melatonin was the cause,’ she said.
‘I also found a paper reporting seven infants who died with high levels of exogenous melatonin in the blood, but causation wasn’t established. It’s unknown – and that is really scary.’
Why are so many kids taking melatonin?
Sleep is increasingly recognised as a crucial factor in community health, said Prof Blunden.
‘Traditionally the pillars were healthy eating and exercise,’ she said. ‘But in the last 20 years, sleep has edged in as equally important.’
This shift is especially relevant for Australian parents, who have long encouraged children to sleep alone.
‘Because we've always had that expectation, there have always been issues around children who don't want to sleep by themselves,’ Prof Blunden said.
Controlled crying was previously the standard response for children resisting independent sleep, but now, behavioural sleep medicine recognises melatonin as another option.
‘The increase in dual-working families, the need for children to sleep independently, the broader community conversation about sleep, and greater availability of melatonin for children who are not typically developing has led to the use of melatonin sharply rising,’ she said.
‘I’m on the board of the International Pediatric Sleep Association. And at the last two conferences, physiologists and clinicians said melatonin prescriptions and use have skyrocketed over the last 5 years,’ Prof Blunden said.
Who is melatonin indicated for and at what dose?
In Australia, melatonin is indicated for children aged 2–18 years with neurodevelopmental disorders including:
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[post_content] => On 1 October 2025, the Therapeutic Goods Administration (TGA) scheduled methenamine hippurate as a Pharmacist Only medicine to ensure pharmacist oversight of its use.
Up until last week, methenamine hippurate, sold as Hiprex and Uramet was unscheduled, available as a general sales medicine.
Australian Pharmacist outlines the reasons for the rescheduling of this medicine, and what actions a request for Hiprex should now prompt pharmacists to take.
Why is methenamine now an S3 medicine?
In May 2024, a final decision was made to reschedule methenamine to Pharmacist Only for therapeutic preparations, allowing for pharmacist intervention to ensure safe and appropriate use.
While Pharmacy Only scheduling was considered, it was deemed insufficient to prevent inappropriate use by those who have not been medically assessed.
Methenamine hippurate is generally low risk and provides an alternative to antibiotics for recurrent urinary tract infections (UTIs), addressing the community's need to reduce antibiotic resistance. The TGA delegate also noted that patients diagnosed with recurrent UTI and advised by a healthcare practitioner to use methenamine hippurate are unlikely to self-medicate inappropriately.
But for new and infrequent users, unrestricted access outside of pharmacies poses risks of inappropriate self-diagnosis, use for active UTIs without professional input, and masking of underlying medical conditions.
Pharmacist involvement should help to mitigate these risks by enhancing therapeutic advice and reducing errors or misuse while aligning with international classifications in the United Kingdom, United States and New Zealand.
What are the issues with unsupervised use?
Methenamine hippurate’s therapeutic efficacy significantly relies on an acidic urinary pH. So co-administration of urinary alkalisers, such as potassium citrate or acetazolamide, can raise urine pH – limiting formaldehyde formation and diminishing efficacy.
Long-term risks of formaldehyde exposure include gastrointestinal effects and skin irritation.
Methenamine hippurate should also be used judiciously in patients with comorbid conditions that can lead to elevated risks, such as:
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[post_content] => Yesterday (Tuesday 7 October), PSA, in a joint event with Consumer Healthcare Products Australia (CHP Australia), showcased the breadth of pharmacists’ skills and roles at Australian Parliament House.
So who were the pharmacists walking in the corridors of power? And what were their messages for Australia’s politicians?
Australian Pharmacist spoke to some of the trailblazers who made the trip to Canberra for the event.
Hannah Knowles MPS – hospital pharmacy
Flying the flag for hospital pharmacy, Hannah Knowles, Advanced Pharmacist in Patient Flow at the Royal Brisbane and Women’s Hospital, spoke to politicians and delegates about the rapidly evolving role of hospital pharmacists – including leading the Pharmacist Collaborative Medication Prescribing Pilot in her hospital.
[caption id="attachment_30671" align="aligncenter" width="432"] Hannah Knowles MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Anna Theophilos MPS – community pharmacy, vaccination
Anna Theophilos, community pharmacist, PSA’s Vaccination Ambassador and owner of TerryWhite Chemmart Surrey Hills South (Melbourne), had one main message for politicians: it’s time to end the jurisdictional vaccine lottery.
[caption id="attachment_30670" align="aligncenter" width="446"] Anna Theophilos MPS with David Batt MP, Member for Hinkler (Qld)[/caption]
Drawing on 17 years’ experience, Theophilos highlighted the breadth of community pharmacy services she provides, anchored by immunisation.
Using her ‘spin-to-win’ wheel, Anna highlighted the inequity experienced by patients across Australia, with regulations preventing pharmacist immunisers being able to fully support the immunisation needs of the communities they serve.
“I hope they can see it’s common sense that all pharmacists, regardless of where you practice, can vaccinate according to the Australian Immunisation Handbook. All Australians deserve the same access to vaccinations regardless of where they live.
Deborah Hawthorne FPS – consultant pharmacist
Deborah Hawthorne is well known as a rural pharmacist specialising in consultant practice, diabetes education and aged care. She shared with politicians her experiences of visiting people’s homes to provide Home Medicines Reviews and the benefits patients experience from this service.
Reflecting on the event, Ms Hawthorne hoped her passion for Home Medicines Reviews (HMRs) would make an impact.
‘I’m excited about sharing the role of pharmacists providing HMRs across the country. There is so much more we need to do and we need to be supported [by governments] to do it.’
Jaimee Anderson MPS – First Nations health/ diabetes education
Credentialled Diabetes Educator and pharmacist at Wurli Wurlinjang Health, Jaimee Anderson shared the vital work she does supporting the health of First Nations people in Katherine.
The current PSA Pharmacist of the Year hoped the event would show more pharmacists are needed in more practice settings.
‘What I want politicians to take away is that pharmacists affect change at all levels of clinical care and need to be embedded in all levels of service,’ she said.
‘First Nations peoples have a greater burden of chronic disease. Embedding pharmacists in Aboriginal Health Services has been proven to help close that gap.’
Neil Petrie MPS – aged care
Neil Petrie travelled up to Canberra from Melbourne to provide insight into his work at Donwood Community Aged Care as an on-site pharmacist in aged care, solving medicine safety problems to improve quality of life for residents.
Speaking to AP, Neil reflected on how important it is to make sure political leaders learn more about the breadth of work pharmacists do.
‘Pharmacists have a lot of different roles, not just dispensing of medicines. Today was a great opportunity to showcase all the diversity of pharmacists' roles for medicine safety in our community.’
Nod from a pharmacist MP
Speaking at the event, the Hon. Emma McBride MP FPS reflected on the rapid evolution of the pharmacist profession in the past decade, seeing a range of new team-based pharmacist roles in primary care being created to drive medicine safety.
View this post on Instagram
A post shared by Pharmaceutical Society of Australia (@pharmaceuticalsocietyau)
She also paid tribute to the pharmacists in the room for their work and acknowledged all pharmacists and pharmacy assistants providing care to Australians across the nation.
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[post_content] => Last year, the Therapeutic Goods Administration (TGA) made an interim decision to reschedule this formulation of dihydrocodeine (Rikodeine) to a prescription medicine. Why hasn’t it happened yet?
On 26 July 2024, the interim decision on dihydrocodeine was published, which was made in response to concerns about the potential for misuse, abuse, and dependence associated with the opioid derivative.
The TGA Delegate's interim decision was to amend the Pharmacist Only entry for dihydrocodeine to restrict undivided oral liquid preparations to a maximum primary pack size of 100 mL from 1 October 2025.
So, what happened?
What were the reasons for the interim decision?
The interim decision to amend the Schedule 3 entry for dihydrocodeine was made to balance the potential risks of dihydrocodeine, including respiratory depression, addiction potential and severe adverse effects, against the need for timely patient access to dry cough medicines.
The amendment would also align Australia’s regulations more closely with other jurisdictions such as the United States, Canada, and Europe.
Where is the final decision?
Australian Pharmacist understands that the final decision on the scheduling of dihydrocodeine is yet to be published, despite the implementation date flagged in the interim decision having come and gone last week.
It is highly unusual for an interim decision not to have been followed by a final decision within the usual decision-making timeframe – and to see the proposed implementation date pass without any formal notice.
What’s the reason behind the hold up?
In August 2024, the TGA sought public submissions on the interim decision on dihydrocodeine.
It was reported in September 2024 that, of the 7 submissions received, two were in partial support while five were in opposition of the interim decision.
The TGA noted that final decisions on dihydrocodeine had been deferred while the submissions received from the consultation were further considered.
What should pharmacists do in the meantime?
For now, the scheduling of dihydrocodeine remains unchanged. PSA has reached out to the TGA for confirmation on the final scheduling decision.
Pharmacists report they continue to experience frequent queries for dihydrocodeine from patients, many of whom don’t appear to have symptoms of dry cough.
If diversion, misuse or abuse is suspected, pharmacists should ask the patient further questions to establish the patient’s:
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[post_content] => Advice around flagging SABA-only asthma patients, guiding them to new therapies for optimal management, and correcting inhaler technique.
Ever had those red flags when a patient is having multiple short-acting beta2-agonist (SABA) inhalers dispensed within a short timeframe? Or they’re taking salbutamol alone on multiple days of the week? And what about older patients who were told it was okay to use salbutamol frequently – and now it’s not?
How can pharmacists help these patients gain control over their disease? Or prevent them reaching the 1 g lifetime limit of oral corticosteroid use?
Pharmacist and asthma educator Sherri Barden MPS – who runs her own asthma, hay fever, eczema and chronic obstructive pulmonary disease, APLUS Pharmacy Education business – has heard it all. Routine inquiries about symptom frequency, reliever use and adherence during each pharmacy encounter is a good method, she says, of recognising if suboptimal control is worthy of timely intervention or referral.
Long-term solo SABA users
Patients who ‘just want the blue puffer’ may be the subject of a difficult conversation, according to Ms Barden. ‘Community pharmacists can reframe the conversation by encouraging their staff to firstly explain to the patient that salbutamol or terbutaline are a Pharmacist Only medicine and that the pharmacist will be with them shortly to discuss.’
She encourages pharmacists to use ‘a patient-centred, non-judgemental approach that links the discussion to the person’s goals and wellbeing’. Opening lines for long-term SABA users such as ‘Is this for asthma?’ and ‘I see you’re here for your reliever. Can I check how your asthma has been going lately?’ are recommended.
Another approach could start as: ‘There are some important updates to asthma care in adults and adolescents that could help you breathe easier and prevent flare-ups.’
Using brief symptom assessment tools such as the Asthma Control Test (ACT) and offering a collaborative plan can help make the conversation supportive rather than confrontational, Ms Barden suggests.
Importantly, patients should be advised that SABAs will continue to be available over the counter from pharmacists, but that the newer recommendations require a prescription. MedsChecks or Home Medicines Reviews can also provide opportunities to assess or reassess control, look at triggers or comorbidities contributing to poor control, review adherence and technique, and perform the ACT to track progress over time.
Up to 80% of people with asthma also have allergic rhinitis, Ms Barden points out. So it’s essential to assess or ask people about the upper airway.
If rhinitis ‘is not adequately controlled with the right information and quality use of medicines, it may contribute to poor asthma control’.
Ms Barden recommends the teach-back method for correct inhaler technique using either a placebo device or, better still, suggest the patient have a dose of their medicine with the pharmacist watching, who could then build follow-up and monitoring into routine practice.
National Asthma Council instructional videos for home use and ancillary labels –“Quick and Deep” for dry powder inhalers and “Slow and Steady” for metered dose or soft mist inhalers – reinforce the correct breathing method, Ms Barden says. They also act as ongoing prompts and conversation starters regarding technique.
Clear criteria for escalation, she stresses, should trigger a timely referral to a GP, nurse practitioner or respiratory specialist. In this way, patient progress can be measured, trends identified early, and care escalated if needed.
AP spoke to two pharmacists about interventions with patients with sub-optimal asthma control.
Case 1
David Peachey MPS
Partner/Pharmacist
Hatton & Laws Pharmacy and Priceline Pharmacy Launceston Plaza, Launceston, TAS
Mr B, a regular patient, repeatedly presented earlier than expected for salbutamol purchased as a Pharmacist Only medicine. There was no evidence of preventer use. He described increasing breathlessness and wheeziness, finding it harder to manage everyday activities like walking up the street. He was relying heavily on his SABA inhaler and had not had a recent GP review. This was a clear red flag that his asthma was not under control. His inhaler technique may also have been a factor, especially if copied from someone using it incorrectly.
Approaching Mr B in a supportive, non-judgemental way, I said: ‘I can see you might be experiencing some worsening of your breathing. I’d like to help you improve this. Let’s have a quick catch up in the consult room.’
I find open-ended questions most effective, particularly when patients are struggling. For example: ‘Would you be able to show me how you use your inhaler?’ or ‘Have you used a spacer before? I can show you what it does and how it works.’ Framing it as a way to improve breathing capacity, rather than criticising technique, makes patients more receptive.
When patients are hesitant, I focus on curiosity and reassurance rather than criticism. I explained to Mr B: ‘There are better and easier treatments available now such as anti-inflammatory relievers and a maintenance preventer and reliever in one device.
‘Using a Ventolin inhaler every week may cause side effects to your heart and lungs without you noticing. That might mean talking to your GP about an asthma plan and working together on inhaler technique today.’
By showing patients I am available anytime, I keep the door open, even if they aren’t ready to change immediately. Through this process, I was able to review and improve Mr B’s inhaler technique. Once he gained confidence using a spacer and making small adjustments, his reliance on salbutamol reduced.
Over time, he engaged more with his GP, which led to spirometry and a step-up in therapy with a preventer. Each small success built trust and transformed his asthma management from sub-optimal to stable, effective therapy.
The key lesson is that inhaler technique checks and supportive communication can significantly improve asthma outcomes. Many patients don’t realise how much salbutamol they are using or the risks of long-term reliance.
By engaging with open questions, demonstrating devices, and linking patients back to their GP, pharmacists can guide safer, more effective asthma care while building enduring patient trust.
Case 2
Joanna Luong MPS
Community Pharmacist
PSA Trainer and Assessor
Brisbane, QLD
Poorly managed asthma in the pharmacy is a common presentation. One standout case involved a man requesting over-the-counter salbutamol for his 20-year-old son. When I checked the dispense history, I saw salbutamol had been supplied monthly, always as a Pharmacist Only medicine, with no preventer prescribed and no record of any past clinical interventions.
Frequent reliever use can indicate uncontrolled asthma and may implicate poor inhaler technique. Patient education and collaborative care with a doctor was evidently warranted, to support the quality use of medicines and optimise management.
The man waited impatiently. I was careful my tone didn’t suggest misuse or poor self-management ability by his son. In a friendly, conversational manner, I said: ‘I’ve had many people coming in lately with asthma flare-ups due to the recent weather change. Has your son found that certain triggers worsen his symptoms? I can see he’s had Ventolin dispensed several times over the last couple of months.’
The question was closed, but the context prompted an elaboration of the response, which was that his son ‘usually just uses his inhaler a couple of times a week and that keeps everything under control’.
While acknowledging their satisfaction with their current level of control, I emphasised that, commonly, asthma management can be optimised even in people who consider their asthma well-controlled, and that along with proper inhaler technique, quality of life could be much improved including fewer episodes of wheeziness disrupting their daily activities.
‘Would your son have time at some point to come in for a quick chat so we can check his technique and discuss the updated Australian guidelines for asthma management?’ I asked.
As expected, there was some resistance. I gently reminded the father that guidelines evolve with research, and advice received several years ago may no longer be current, which is why regular medical reviews are recommended, and that my role was to help guide patients in making informed decisions about their health care.
Even though the conversation did not lead to change that day, keeping the conversation supportive and respectful meant he left the pharmacy open to future discussions.
I documented the intervention in the son’s dispense record so my colleagues and I could continue the conversation on subsequent visits. This ongoing engagement helped build rapport, and the father eventually persuaded his son to see his doctor, who prescribed a preventer inhaler now used regularly.
How we communicate can be just as important as what we say.
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[post_content] => Last year, it was reported that Australian poisons hotlines received almost 1,500 calls about child ingestion of melatonin.
In Western Australia, calls to the poisons hotline about melatonin have nearly doubled from 175 in 2018 to 322 as of August this year, across all age groups – mostly related to gummy products.
In the same month, online health retailer iHerb suspended the sale of melatonin supplements in Australia.
But there are retailers selling these products online, said Sarah Blunden, Professor and Head of Paediatric Sleep Research, CQUniversity Australia.
[caption id="attachment_30644" align="alignright" width="300"] Professor Sarah Blunden[/caption]
‘There are a lot of other companies from the United States that sell it,’ she said.
AP investigates what melatonin toxicity looks like, why so many kids are taking it and how pharmacists can help to ensure safe and effective use of medicines for sleep.
Why have calls to poison hotlines about melatonin gummies doubled?
From Prof Blunden’s perspective, the drivers are straightforward.
‘They are not regulated, they've got sugar in them and they taste good,’ she said. ‘Children love them and parents think they're natural. And without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.’
Independent analyses of melatonin gummies have shown large discrepancies between labelled and actual melatonin content.
‘Two research groups – one in Canada and one in the UK – found some had no melatonin at all, and some had up to 400% of what was on the label,’ Prof Blunden said.
‘without dosage requirements, they might give them one, two or three, and there’s no pharmacist or doctor monitoring the dose.'
Professor Sarah Blunden
The Therapeutic Goods Administration (TGA) recently conducted its own review, reporting significant variability between products. For example, The Smurfs Kids Gummies Melatonin 1 mg contained 155–170% variation from the labelled amount.
Endogenous melatonin biology is also highly individual, with retinal light-sensing pathways modulating secretion with wide inter-child variability, and there’s no practical clinical assay to map a child’s secretion pattern outside of a research study.
‘A child who’s particularly light-sensitive might have higher endogenous levels at a certain time, and if they then take several gummies, toxicity could be faster and worse,’ she said. ‘That’s why, when they present to ED, it gets labelled as an “overdose,” but we don’t exactly know what that means.’
What are the symptoms of melatonin toxicity?
Common reported effects of melatonin toxicity include headache, dizziness, nausea, and drowsiness.
Children can also experience central nervous system (CNS) effects, including extreme sedation, nightmares and vivid dreams.
‘Parents might see a very drowsy or unwell child and seek care, or they may witness ingestion of multiple gummies and go to the emergency department (ED),’ Prof Blunden said.
Sometimes, toxicity appears fatal.
‘In a review we conducted, two or three deaths of children who had ingested melatonin were reported, but they are not included in many systematic reviews – including ours – because we couldn’t confirm that melatonin was the cause,’ she said.
‘I also found a paper reporting seven infants who died with high levels of exogenous melatonin in the blood, but causation wasn’t established. It’s unknown – and that is really scary.’
Why are so many kids taking melatonin?
Sleep is increasingly recognised as a crucial factor in community health, said Prof Blunden.
‘Traditionally the pillars were healthy eating and exercise,’ she said. ‘But in the last 20 years, sleep has edged in as equally important.’
This shift is especially relevant for Australian parents, who have long encouraged children to sleep alone.
‘Because we've always had that expectation, there have always been issues around children who don't want to sleep by themselves,’ Prof Blunden said.
Controlled crying was previously the standard response for children resisting independent sleep, but now, behavioural sleep medicine recognises melatonin as another option.
‘The increase in dual-working families, the need for children to sleep independently, the broader community conversation about sleep, and greater availability of melatonin for children who are not typically developing has led to the use of melatonin sharply rising,’ she said.
‘I’m on the board of the International Pediatric Sleep Association. And at the last two conferences, physiologists and clinicians said melatonin prescriptions and use have skyrocketed over the last 5 years,’ Prof Blunden said.
Who is melatonin indicated for and at what dose?
In Australia, melatonin is indicated for children aged 2–18 years with neurodevelopmental disorders including:
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Australian Pharmacist is the official journal for Pharmaceutical Society of Australia Ltd.
