Switches at a Glance
Deregulated medicines
Switches at a glance
Medicines reclassified from prescription-only for supply in pharmacy or general sale. Tap a medicine to see how it works, what the OTC licence allows and when not to supply.
POMPrescription only
→
PPharmacy: sale under a pharmacist's supervision
→
GSLGeneral sale: can also be sold outside pharmacies
The OTC licence sets its own indication, age, dose, duration and pack size. These are often narrower than the prescription licence of the same medicine.
Timeline of first switches
1994
Beclometasone nasal
1995
Fluconazole
2001
LevonorgestrelFlurbiprofen
2004
Omeprazole
2005
Chloramphenicol
2006
AmorolfineSumatriptan
2008
Naproxen (period pain)
2009
Orlistat
2010
Tranexamic acid
2013
Esomeprazole
2015
Ulipristal acetate
2017
SildenafilAtovaquone/proguanilXylometazoline + ipratropium
2020
Fexofenadine 120 mg
2021
DesogestrelFexofenadine 180 mg
2022
Estradiol
2023
Tadalafil
2024
Estriol
2025
Naproxen (musculoskeletal)
The medicines
inhibits / blocks activatesdo not supplyrefer or doctor first
Infections & travelAmorolfinePGSLSwitched 20065% nail lacquerMild distal or lateral fungal nail infection, up to 2 nails
Mechanism → why it matters
Fungal sterol synthesis→ergosterol depleted → fungal membrane damaged
Slow-growing nail: months of treatment
Licence
- For
- Mild distal or lateral fungal nail infection, up to 2 nails
- Who
- 18+
- Dose
- Once a week · fingernails about 6 months, toenails 9–12 months
- Switch
- POM→P 2006 · GSL packs: 3 mL, max 2 nails
Do not supply
- Pregnancy or breastfeeding
Refer / doctor first
- Diabetes, peripheral circulatory disorders, immunosuppression
- Nail dystrophy or destroyed nail plate
- More than 2 nails affected
Counsel
- File the nail before first use and as needed; clean before each application
- Files are not for healthy nails
- Review every 3 months
Infections & travelAtovaquone/proguanilPSwitched 2017250/100 mg tablets (Maloff Protect)Prevention of P. falciparum malaria
Mechanism → why it matters
Parasite mitochondrial electron transport→atovaquone and proguanil act synergistically
Daily dosing from before travel to 7 days after
Licence
- For
- Prevention of P. falciparum malaria
- Who
- Adults 18+ weighing at least 40 kg
- Dose
- 1 daily with food or a milky drink · start 1–2 days before entering the malaria area, continue during the stay and for 7 days after leaving · max 12 weeks' travel
- Switch
- POM→P 2017
Do not supply
- Renal or hepatic impairment of any severity
Refer / doctor first
- Oral anticoagulants, rifampicin, rifabutin, metoclopramide, etoposide, tetracycline and some HIV medicines (see label)
- Pregnancy, planning pregnancy or breastfeeding
- History of depression or seizures; tuberculosis
Counsel
- Bite avoidance is still essential
- Vomiting within 1 h → repeat the dose
Infections & travelChloramphenicolPSwitched 20050.5% eye drops · 1% eye ointmentAcute bacterial conjunctivitis
Mechanism → why it matters
Bacterial 50S ribosome→protein synthesis stops (bacteriostatic)
Treats bacterial, not viral or allergic, conjunctivitis
Licence
- For
- Acute bacterial conjunctivitis
- Who
- 2+
- Dose
- Drops: 1 drop every 2 h for 48 h, then every 4 h (waking hours) · Ointment: about 1 cm 3–4 times a day, or at night if drops used by day · 5 days in total
- Switch
- Eye drops POM→P 2005 · eye ointment POM→P 2007
Do not supply
- Blood disorders (e.g. aplastic anaemia) in the patient or family, or marrow suppression with previous chloramphenicol (wording varies by product)
Refer / doctor first
- Disturbed vision, severe eye pain, photophobia, cloudy eye or abnormal pupil
- Eye injury or foreign body; glaucoma; eye surgery or laser in last 6 months
- Pregnancy or breastfeeding
Counsel
- Drops: keep in the fridge
- No contact lenses during treatment
- See a doctor if no better in 48 h
Sexual healthDesogestrelPSwitched 202175 microgram tabletsOral contraception
Mechanism → why it matters
LH surge (hypothalamic–pituitary axis)→ovulation inhibited; cervical mucus thickened
12-hour window for a late pill
Licence
- For
- Oral contraception
- Who
- Women of childbearing age, including adolescents · under 16: weigh benefits and risks carefully
- Dose
- 1 daily at the same time, no break between packs · missed if more than 12 h late
- Switch
- POM→P 2021
Do not supply
- Active venous thromboembolism
- Severe liver disease until liver function is normal
- Known or suspected sex-steroid-sensitive cancer
- Undiagnosed vaginal bleeding
Interactions
- Enzyme inducers (rifampicin, carbamazepine, phenytoin, St John's wort), including in the last 4 weeks
- Ulipristal emergency contraception
Counsel
- Vomiting within 3–4 h counts as a missed pill
- Irregular bleeding is common
- No protection against STIs
Gut & weightEsomeprazoleGSLPSwitched 201320 mg tablets/capsulesShort-term treatment of reflux symptoms (heartburn, acid regurgitation)
Mechanism → why it matters
H⁺/K⁺-ATPase (proton pump)→irreversible block → less acid
Not intended for immediate relief
Licence
- For
- Short-term treatment of reflux symptoms (heartburn, acid regurgitation)
- Who
- 18+
- Dose
- 20 mg once daily · may take 2–3 days to help · see a doctor if needed for more than 14 days
- Switch
- POM→P 2013 · P→GSL 2015
Refer / doctor first
- Significant unintentional weight loss, recurrent vomiting, dysphagia, vomiting blood or black stools
- Over 55 with new or recently changed symptoms
- Previous gastric ulcer or GI surgery
- Jaundice or severe liver disease
Interactions
- Not with another PPI or H2 antagonist
- Clopidogrel: avoid
- Nelfinavir: contraindicated; atazanavir: not recommended
Women's healthEstradiolPSwitched 202210 microgram vaginal tablets (Gina)Vaginal symptoms (dryness, soreness, itching, burning, painful sex) due to oestrogen deficiency
Mechanism → why it matters
Oestrogen receptors in vaginal tissue→epithelium thickens and matures
Improvement may take a few months
Licence
- For
- Vaginal symptoms (dryness, soreness, itching, burning, painful sex) due to oestrogen deficiency
- Who
- Postmenopausal women 50+ with no period for at least 1 year
- Dose
- 1 daily for 2 weeks, then 1 twice a week
- Switch
- POM→P 2022
Do not supply
- Undiagnosed genital bleeding
- Known, past or suspected breast cancer or oestrogen-dependent cancer
- Previous or current VTE; active or recent arterial disease (angina, MI, stroke)
- Current vaginal infection
Refer / doctor first
- Already using systemic HRT
Counsel
- No improvement after 3 months → doctor or pharmacist
- Review at every resupply (each pack lasts up to 3 months)
- Tell the GP at the next routine appointment
Women's healthEstriolPSwitched 20241 mg/g vaginal cream (Ovesse)Vaginal symptoms of the menopause due to oestrogen deficiency
Mechanism → why it matters
Oestrogen receptors in vaginal tissue→epithelium thickens and matures
Improvement takes time
Licence
- For
- Vaginal symptoms of the menopause due to oestrogen deficiency
- Who
- Postmenopausal women 50+ with no period for at least 1 year
- Dose
- 1 applicatorful (0.5 g) daily for 2 weeks, then twice a week
- Switch
- POM→P 2024
Do not supply
- Undiagnosed genital bleeding; oestrogen-dependent cancer
- Previous or current VTE; active or recent arterial disease
- Untreated vaginal infection
- Severe vaginal itching, vulval rash or vulval dermatoses
Counsel
- No improvement after 3 months → refer
Allergy & noseFexofenadineGSLPSwitched 2020120 mg · 180 mg tablets120 mg (GSL): hay fever (seasonal allergic rhinitis) · 180 mg (P): chronic idiopathic urticaria
Mechanism → why it matters
H1 receptor→histamine effects blocked; little entry to the brain
Non-sedating
Licence
- For
- 120 mg (GSL): hay fever (seasonal allergic rhinitis) · 180 mg (P): chronic idiopathic urticaria
- Who
- 12+
- Dose
- 1 tablet once daily before a meal
- Switch
- 120 mg POM→GSL 2020 · 180 mg POM→P 2021
Refer / doctor first
- Cardiovascular disease: only on a doctor's advice
Interactions
- Aluminium/magnesium antacids: 2-hour gap
- Erythromycin, ketoconazole: higher levels
- Fruit juice reduces absorption (NHS)
Women's healthFluconazolePSwitched 1995150 mg capsuleVaginal thrush; candidal balanitis
Mechanism → why it matters
Fungal CYP51 (14α-demethylase)→ergosterol falls → fungal membrane disrupted
Also inhibits human CYP enzymes → interactions
Licence
- For
- Vaginal thrush; candidal balanitis
- Who
- 16–60
- Dose
- Single 150 mg capsule, swallowed whole
- Switch
- POM→P 1995
Do not supply
- QT-prolonging drugs metabolised by CYP3A4 (e.g. erythromycin)
Refer / doctor first
- Pregnancy or breastfeeding
- More than 2 episodes in 6 months
- Unsure of the cause (Canesten labels: also first episode)
- Abnormal bleeding, ulcers or sores; lower abdominal pain or dysuria
Interactions
- Warfarin
- Sulfonylureas; phenytoin; ciclosporin, tacrolimus
Counsel
- No better within 7 days → doctor
- Planning pregnancy: wait 1 week after the dose
Pain & migraineFlurbiprofenPGSLSwitched 20018.75 mg lozenges · oromucosal spray (Strefen)Short-term relief of sore throat
Mechanism → why it matters
COX enzymes→less prostaglandin in the inflamed throat
NSAID contraindications apply
Licence
- For
- Short-term relief of sore throat
- Who
- Lozenges: over 12 · spray: 18+
- Dose
- 1 lozenge, or 3 sprays, every 3–6 h · max 5 doses in 24 h · max 3 days
- Switch
- Lozenges POM→P 2001 · spray POM→P 2024 · Honey & Lemon lozenges P→GSL 2026
Do not supply
- NSAID hypersensitivity (including aspirin-induced asthma)
- Active or recurrent peptic ulcer/bleeding; GI bleed or perforation with a previous NSAID
- Severe heart, renal or liver failure
- Third trimester
Counsel
- Move the lozenge around the mouth
- See a doctor if no better after 3 days
Allergy & noseIntranasal corticosteroidsGSLPFirst switch 1994current products: beclometasone · budesonide · fluticasone propionate · mometasoneGSL: seasonal allergic rhinitis · some P: also perennial
Mechanism → why it matters
Glucocorticoid receptor→inflammatory gene transcription switched down
Full effect takes several days: use regularly
Licence
- For
- GSL: seasonal allergic rhinitis · some P: also perennial
- Who
- 18+ (some fluticasone P products: 12+)
- Dose
- Lowest dose that controls symptoms · continuous use without a doctor: GSL 1 month; P usually 3 months (check label)
- Switch
- First switch: beclometasone POM→P 1994
Do not supply
- HIV medicines (ritonavir, cobicistat) with Pirinase, Benacort Hayfever Relief or Clarinaze Hayfever Relief
Refer / doctor first
- HIV medicines with other products
- Nasal infection, ulcers, recent nasal surgery or injury
- Using other corticosteroids
- Pregnancy or breastfeeding
Counsel
- No better after 7 days → doctor (14 days for some P products)
Sexual healthLevonorgestrelPSwitched 20011.5 mg tabletEmergency contraception within 72 h of unprotected sex or contraceptive failure
Mechanism → why it matters
LH surge→ovulation delayed or prevented
No effect once ovulation has happened: take it quickly
Licence
- For
- Emergency contraception within 72 h of unprotected sex or contraceptive failure
- Who
- Under 16: labels differ – check the product
- Dose
- 1 tablet as soon as possible · vomiting within 3 h → take another
- Switch
- POM→P 2001
Interactions
- Enzyme inducers in the last 4 weeks (e.g. rifampicin, carbamazepine, St John's wort) → Cu-IUD; if unsuitable, 2 tablets (3 mg) together
Counsel
- BMI over 26 kg/m² or weight over 70 kg may reduce effect → ulipristal, or 3 mg levonorgestrel (CoSRH)
- Period more than 5 days late → pregnancy test
Pain & migraineNaproxenPGSLSwitched 2008250 mg gastro-resistant tabletsPeriod pain (15–50) · acute musculoskeletal pain (18–50)
Mechanism → why it matters
COX-1 and COX-2→less prostaglandin
NSAID contraindications apply
Licence
- For
- Period pain (15–50) · acute musculoskeletal pain (18–50)
- Who
- 15–50 or 18–50 by product
- Dose
- 500 mg, then 250 mg after 6–8 h if needed · max 750 mg a day · max 3 days
- Switch
- Period pain POM→P 2008, P→GSL 2016 (9-tablet pack) · musculoskeletal pain POM→P 2025
Do not supply
- NSAID hypersensitivity
- Active or past peptic ulcer or GI bleed
- Severe heart, liver or renal failure
- Third trimester
Interactions
- Other NSAIDs or aspirin; anticoagulants; SSRIs; corticosteroids
- Lithium: levels rise
Gut & weightOmeprazoleGSLSwitched 200420 mg tablets/capsulesShort-term treatment of reflux symptoms (heartburn, acid regurgitation)
Mechanism → why it matters
H⁺/K⁺-ATPase (proton pump)→irreversible block → less acid
Not intended for immediate relief
Licence
- For
- Short-term treatment of reflux symptoms (heartburn, acid regurgitation)
- Who
- 18+
- Dose
- 20 mg once daily · may take 2–3 days to help · see a doctor if needed for more than 14 days
- Switch
- 10 mg POM→P 2004 · 20 mg P→GSL 2019 · current OTC packs: 20 mg, 7 or 14
Refer / doctor first
- Significant unintentional weight loss, recurrent vomiting, dysphagia, vomiting blood or black stools
- Over 55 with new or recently changed symptoms
- Previous gastric ulcer or GI surgery
- Jaundice or severe liver disease
Interactions
- Clopidogrel: avoid
- Nelfinavir: contraindicated; atazanavir: not recommended
Gut & weightOrlistatPSwitched 200960 mg capsules (alli)Weight loss in overweight adults (BMI 28 or over), with a reduced-calorie, lower-fat diet
Mechanism → why it matters
Gastric and pancreatic lipases→less dietary fat absorbed
Oily stools if meals are high in fat
Licence
- For
- Weight loss in overweight adults (BMI 28 or over), with a reduced-calorie, lower-fat diet
- Who
- 18+
- Dose
- 60 mg with each main meal · max 3 a day · max 6 months
- Switch
- POM→P 2009
Do not supply
- Ciclosporin; warfarin or other oral anticoagulants
- Chronic malabsorption; cholestasis
- Pregnancy; breastfeeding
Refer / doctor first
- Levothyroxine, antiepileptics, amiodarone, antiretrovirals, diabetes medicines
- Kidney disease
Counsel
- Skip the dose if a meal is missed or has no fat
- Multivitamin at bedtime
- Extra contraception if severe diarrhoea
- No weight loss after 12 weeks → pharmacist or GP
Sexual healthSildenafilPSwitched 201750 mg tablets · orodispersible filmErectile dysfunction
Mechanism → why it matters
PDE5→cGMP rises → smooth muscle relaxes
Works only with sexual stimulation; with nitrates, blood pressure can fall dangerously
Licence
- For
- Erectile dysfunction
- Who
- Men 18+
- Dose
- 50 mg about 1 h before sex · max once a day
- Switch
- POM→P 2017
Do not supply
- Nitrates or nitric oxide donors (incl. amyl nitrite); riociguat; ritonavir
- MI or stroke in last 6 months, unstable angina, severe heart failure
- Severe hepatic impairment or BP under 90/50
- Previous NAION
Refer / doctor first
- Taking an alpha blocker
- Severe renal impairment
Counsel
- Erection over 4 h → urgent help
- Sudden vision loss → stop, urgent help
- See a GP within 6 months
Pain & migraineSumatriptanPSwitched 200650 mg tabletsAcute relief of migraine with a clear diagnosis
Mechanism → why it matters
5-HT1B/1D receptors→cranial vessels constrict; less neuropeptide release
Can constrict coronary vessels → cardiovascular contraindications
Licence
- For
- Acute relief of migraine with a clear diagnosis
- Who
- 18–65
- Dose
- 50 mg · second dose at least 2 h later only if migraine returns · max 100 mg in 24 h
- Switch
- POM→P 2006
Do not supply
- Ischaemic heart disease, previous MI, peripheral vascular disease, stroke or TIA
- Moderate/severe or uncontrolled hypertension
- Severe liver impairment
- MAOIs (or within 2 weeks); ergotamine or another triptan
Refer / doctor first
- 4 or more attacks a month, or a change in pattern
Interactions
- SSRIs/SNRIs: serotonin syndrome
Sexual healthTadalafilPSwitched 202310 mg tabletsErectile dysfunction
Mechanism → why it matters
PDE5→cGMP rises → smooth muscle relaxes
Long half-life (about 17.5 h): effect lasts up to 36 h
Licence
- For
- Erectile dysfunction
- Who
- Men 18+
- Dose
- 10 mg at least 30 min before sex · max once a day · not for continuous daily use
- Switch
- POM→P 2023 · some 10 mg packs remain POM
Do not supply
- Nitrates or nitric oxide donors (incl. amyl nitrite, nicorandil); riociguat
- MI in last 90 days; unstable angina or angina during sex; stroke in last 6 months
- Heart failure (NYHA 2+) in last 6 months; uncontrolled arrhythmia; BP under 90/50 or uncontrolled hypertension
- Previous NAION
Refer / doctor first
- Using it at least twice a week
Counsel
- Sudden hearing or vision loss → stop, urgent help
Women's healthTranexamic acidPSwitched 2010500 mg tabletsHeavy menstrual bleeding with regular 21–35-day cycles
Mechanism → why it matters
Plasminogen activation→less fibrinolysis → clots persist
Clot history → do not supply
Licence
- For
- Heavy menstrual bleeding with regular 21–35-day cycles
- Who
- 18–45
- Dose
- 2 tablets 3 times a day once bleeding starts · max 4 days per period
- Switch
- POM→P 2010
Do not supply
- Active thromboembolic disease or history of blood clots
- Anticoagulants; oral contraceptives
- Renal impairment
- Irregular bleeding
Counsel
- No better after 3 cycles → doctor
- Visual disturbance → stop
Sexual healthUlipristal acetatePSwitched 201530 mg tabletEmergency contraception within 120 h (5 days)
Mechanism → why it matters
Progesterone receptor (modulator)→ovulation delayed, even close to the LH surge
Progestogens can reduce its effect (CoSRH)
Licence
- For
- Emergency contraception within 120 h (5 days)
- Who
- Women of childbearing age, including adolescents
- Dose
- 1 tablet as soon as possible · vomiting within 3 h → take another
- Switch
- POM→P 2015
Interactions
- Enzyme inducers
- Not with levonorgestrel emergency contraception
- Hormonal contraception: wait 5 days before starting, condoms meanwhile (CoSRH)
Counsel
- Breastfeeding: SmPC says avoid for 1 week; CoSRH says no need to stop
Allergy & noseXylometazoline + ipratropiumPSwitched 2017nasal spray (Otrivine Extra Dual Relief)Blocked and runny nose with a cold
Mechanism → why it matters
α-adrenoceptors→nasal vessels constrict → decongestion
Muscarinic receptors on nasal glands→less secretion → runny nose dries
Two drugs, two symptoms
Licence
- For
- Blocked and runny nose with a cold
- Who
- 18+
- Dose
- 1 spray each nostril up to 3 times a day, at least 6 h apart · max 5 days (MHRA, Apr 2026; labels may still say 7)
- Switch
- POM→P 2017
Do not supply
- Glaucoma
- Dry or atrophic rhinitis
- Surgery that may have breached the dura (e.g. transnasal)
- Allergy to atropine-like drugs
Refer / doctor first
- Enlarged prostate or bladder neck obstruction
- Pregnancy
Interactions
- MAOIs or tri/tetracyclic antidepressants (incl. last 2 weeks)
- Other anticholinergics
Always check the label of the product in hand: brands of the same medicine can differ in age limits, contraindications and durations. Summary lines cover every current OTC product unless a product is named; P and GSL chips show the legal categories approved by the MHRA, and not every pack may be on sale. Sources (checked 3 October 2026): eMC SmPCs and PILs for UK P and GSL products; MHRA table of approved reclassifications, public assessment reports, reclassification announcements and Drug Safety Update (30 April 2026); CoSRH (formerly FSRH) emergency contraception guidance; NHS.uk. Detailed pages for each medicine follow in this section.