Confusion over which drugs to prescribe for sports people

DOCTORS approached for advice on drugs in sport are often unsure which over-the-counter (OTC) medicines contain a banned substance, a survey has found. Of the GPs who took part in the research, 74% believed Sinutab contained a banned substance.

Almost 70% believed Benylin 4 flu contained a banned substance and 79% believed the same of Sudafed Elixir. Just over 50% believed Beechams Hot Lemon did not contain a banned substance.

Dr Philip Crowley, medical editor of Forum, the Irish College of General Practitioners’ publication which carried out the survey results, said prescribing OTC medications to athletes was “a minefield.” “There is a lot of ambiguity about some of the medications and the International Olympic Council’s position on things tends to evolve a lot.

“A classic example, as the Forum article points on, is Lemsip, which in the past was permitted in the Republic, whereas the same product name in Northern Ireland contains phenylephrine, which is a banned substance.”

Pharmacist Brendan Rochford, co-ordinator of the medicine search database eirpharm.com, said the confusion was understandable given the frequent changes in the status of OTC medications.

“For example, prior to last January, Sinutab was prohibited because it contained a decongestant that was prohibited, but since January, its use is permitted. Benylin 4 flu and Sudafed Extra were also prohibited prior to January for the same reason, but have since been allowed. “The most important thing for GPs to do if they are uncertain about a drug is to make sure to use the most accurate source of information including MIMS (Monthly Index of Medical Specialities), to contact the Irish Sports Council or to check our website.”

Dr Crowley said GPs should refer the patient elsewhere if in doubt. “This is obviously critical in terms of not destroying a career.”

The GP study, by Scottish registrar John A Horan was carried out in Co Cork. GPs were given a list of common OTC medicines and asked to identify whether they contained banned substances. Of those who responded, up to 41% said they were being asked to advise on medicines in sport but only 7% had a qualification in sports medicine. Two-thirds were unaware of the Irish Sports Council guidelines.

MIMS was the most commonly used referral source for information about drugs, but only 10% were aware of an internet site source. Few said they referred to the ICGP guidelines. More than a third are frequently asked about Creatine (performance enhancer not licensed in Ireland, but the product by itself is not prohibited) but nearly half believe it contains a banned substance and 22% are unsure.

In most cases when GPs attempted to answer whether they thought an OTC substance was banned, 28% were totally unsure and a further 17% were unsure of more than half the 11 medications included in the survey.