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The NPA's pharmacy services team receives over 700 enquiries every day. Head of pharmacy Leyla Hannbeck shares some recent common queries from members

When should folic acid be given if a patient is taking methotrexate for rheumatoid arthritis?

The British Society for Rheumatology guidelines for disease modifying antirheumatic drug therapy say that folic acid can be taken on any day as long as it is not on the same day as the methotrexate because it may adversely affect absorption. Folic acid should be taken for the duration of methotrexate therapy because adverse effects can occur at any time.

Do veterinary prescriptions for Schedule 2 or 3 Controlled Drugs have to be written on standardised prescription forms?

No, they don't. There is also no requirement for the dispensing pharmacy to send veterinary prescriptions for Schedule 2 or 3 Controlled Drugs (CDs) to the relevant NHS agency at the end of the month for audit purposes. Veterinary prescriptions should be retained by the dispensing pharmacy for at least five years.

Can yellow fever vaccine be given at the same time as the injectable or oral typhoid vaccine?

Yes, it can. However, if the yellow fever vaccine is given at the same time as the injectable typhoid vaccine, it is preferable to administer them in different limbs. If this is not possible, they should be given at different sites, at least 2.5cm apart. If for any reason the yellow fever vaccine cannot be given at the same time as Vivotif, the oral typhoid vaccine, then there should be an interval of four weeks between administration.

Does the good practice recommendation of only supplying up to 30 days' treatment of a CD apply to Schedule 4 CDs, such as diazepam?

Yes. The national government health departments have issued strong recommendations that the maximum quantity of a Schedule 2, 3 or 4 CD prescribed should not exceed 30 days' treatment. While it is not illegal to dispense a prescription with more than 30 days' supply, home office guidance advises that pharmacists should be satisfied there is an appropriate reason for such a supply.

Is a repeatable veterinary prescription allowed for tramadol capsules 50mg?

A repeatable veterinary prescription is not allowed for a Schedule 2 or 3 CD, and tramadol is a Schedule 3 CD. The prescription can only be dispensed once, and only within the 28-day validity period. However, repeat prescriptions for Schedule 4 and 5 CDs are allowed on a veterinary prescription but the repeats must be dispensed within 28 days for Schedule 4 CDs or six months for Schedule 5 CDs.

Before dispensing a CD prescription, the pharmacist should check it is legally valid. It may be handwritten or computer generated, but it must be signed by the prescriber. It must also contain: the name of the animal; the name and address of the owner/keeper of the animal or address to where the CD is to be delivered; the name, form and strength of the drug; the quantity of the CD in both words and figures; the full dose to be administered; and a declaration that the CD is prescribed for an animal or herd under the vet's care.