4 Warning: Do not drink alcohol

Rhybudd: Peidiwch ag yfed alcohol

To be used on preparations where a reaction such as flushing

may occur if alcohol is taken (e.g. metronidazole). Alcohol

may also enhance the hypoglycaemia produced by some oral

antidiabetic drugs but routine application of a warning label

is not considered necessary.

Patients should be advised not to drink alcohol for as long

as they are receiving/using a course of medication, and in

some cases for a period of time after the course is finished.

5 Do not take indigestion remedies 2 hours before or after you

take this medicine

Peidiwch â chymryd meddyginiaethau camdreuliad 2 awr cyn

neu ar ôl y feddyginiaeth hon

To be used with label 25 on preparations coated to resist

gastric acid (e.g. enteric-coated tablets). This is to avoid the

possibility of premature dissolution of the coating in the

presence of an alkaline pH.

Label 5 also applies to drugs such as gabapentin where the

absorption is significantly affected by antacids. Pharmacists

will be aware (from a knowledge of physiology) that the

usual time during which indigestion remedies should be

avoided is at least 2 hours before and after the majority of

medicines have been taken; when a manufacturer advises a

different time period, this can be followed, and should be

explained to the patient.

6 Do not take indigestion remedies, or medicines containing iron

or zinc, 2 hours before or after you take this medicine

Peidiwch â chymryd meddyginiaethau camdreuliad neu

feddyginiaethau sy’n cynnwys haearn neu sinc, 2 awr cyn neu

ar ôl y feddyginiaeth hon

To be used on preparations containing ofloxacin and some

other quinolones, doxycycline, lymecycline, minocycline, and

penicillamine. These drugs chelate calcium, iron, and zinc

and are less well absorbed when taken with calciumcontaining antacids or preparations containing iron or zinc.

Pharmacists will be aware (from a knowledge of physiology)

that these incompatible preparations should be taken at

least 2 hours apart for the majority of medicines; when a

manufacturer advises a different time period, this can be

followed, and should be explained to the patient.

7 Do not take milk, indigestion remedies, or medicines containing

iron or zinc, 2 hours before or after you take this medicine

Peidiwch â chymryd llaeth, meddyginiaethau camdreuliad, neu

feddyginiaeth sy’n cynnwys haearn neu sinc, 2 awr cyn neu ar ôl

cymryd y feddyginiaeth hon

To be used on preparations containing ciprofloxacin,

norfloxacin, or tetracyclines that chelate calcium, iron,

magnesium, and zinc, and are thus less available for

absorption. Pharmacists will be aware (from a knowledge of

physiology) that these incompatible preparations should be

taken at least 2 hours apart for the majority of medicines;

when a manufacturer advises a different time period, this

can be followed, and should be explained to the patient.

Doxycycline, lymecycline, and minocycline are less liable to

form chelates and therefore only require label 6 (see above).

8 Warning: Do not stop taking this medicine unless your doctor

tells you to stop

Rhybudd: Peidiwch â stopio cymryd y feddyginiaeth hon, oni

bai fod eich meddyg yn dweud wrthych am stopio

To be used on preparations that contain a drug which is

required to be taken over long periods without the patient

necessarily perceiving any benefit (e.g. antituberculous drugs).

Also to be used on preparations that contain a drug whose

withdrawal is likely to be a particular hazard (e.g. clonidine

for hypertension). Label 10 (see below) is more appropriate

for corticosteroids.

9 Space the doses evenly throughout the day. Keep taking this

medicine until the course is finished, unless you are told to stop

Gadewch yr un faint o amser rhwng pob dôs yn ystod y dydd.

Parhewch i gymryd y feddyginiaeth nes bod y cyfan wedi’i

orffen, oni bai eich bod yn cael cyngor i stopio

To be used on preparations where a course of treatment

should be completed to reduce the incidence of relapse or

failure of treatment.

The preparations are antimicrobial drugs given by mouth.

Very occasionally, some may have severe side-effects (e.g.

diarrhoea in patients receiving clindamycin) and in such

cases the patient may need to be advised of reasons for

stopping treatment quickly and returning to the doctor.

10 Warning: Read the additional information given with this

medicine

Rhybudd: Darllenwch y wybodaeth ychwanegol gyda’r

feddyginiaeth hon

To be used particularly on preparations containing

anticoagulants, lithium, and oral corticosteroids. The

appropriate treatment card should be given to the patient

and any necessary explanations given.

This label may also be used on other preparations to

remind the patient of the instructions that have been given.

11 Protect your skin from sunlight—even on a bright but cloudy

day. Do not use sunbeds

Diogelwch eich croen rhag golau’r haul, hyd yn oed ar ddiwrnod

braf ond cymylog. Peidiwch â defnyddio gwely haul

To be used on preparations that may cause phototoxic or

photoallergic reactions if the patient is exposed to ultraviolet

radiation. Exposure to high intensity ultraviolet radiation

from sunray lamps and sunbeds is particularly likely to

cause reactions.

12 Do not take anything containing aspirin while taking this

medicine

Peidiwch â chymryd unrhyw beth sy’n cynnwys aspirin gyda’r

feddyginiaeth hon

To be used on preparations containing sulfinpyrazone whose

activity is reduced by aspirin.

Label 12 should not be used for anticoagulants since label

10 is more appropriate.

13 Dissolve or mix with water before taking

Gadewch i doddi mewn dwˆr cyn ei gymryd

To be used on preparations that are intended to be dissolved in

water (e.g. soluble tablets) or mixed with water (e.g. powders,

granules) before use. In a few cases other liquids such as

fruit juice or milk may be used.

14 This medicine may colour your urine. This is harmless

Gall y feddyginiaeth hon liwio eich dwˆr. Nid yw hyn yn arwydd o

ddrwg

To be used on preparations that may cause the patient’s urine

to turn an unusual colour. These include triamterene (blue

under some lights), levodopa (dark reddish), and rifampicin

(red).

BNF 78 Cautionary and advisory labels for dispensed medicines 1589

Cautionary and advisory labels | Appendix 3

A3

15 Caution: flammable. Keep your body away from fire or flames

after you have put on the medicine

Rhybudd: Fflamadwy. Ar ôl rhoi’r feddyginiaeth ymlaen,

cadwch yn glir o dân neu fflamau

To be used on preparations containing sufficient flammable

solvent to render them flammable if exposed to a naked flame.

16 Dissolve the tablet under your tongue—do not swallow. Store

the tablets in this bottle with the cap tightly closed. Get a new

supply 8 weeks after opening

Rhowch y dabled i doddi dan eich tafod - peidiwch â’i lyncu.

Cadwch y tabledi yn y botel yma gyda’r caead wedi’i gau yn

dynn. Gofynnwch am dabledi newydd 8 wythnos ar ôl ei hagor

To be used on glyceryl trinitrate tablets to remind the patient

not to transfer the tablets to plastic or less suitable

containers.

17 Do not take more than... in 24 hours

Peidiwch â chymryd mwy na... mewn 24 awr

To be used on preparations for the treatment of acute migraine

except those containing ergotamine, for which label 18 is

used. The dose form should be specified, e.g. tablets or

capsules.

It may also be used on preparations for which no dose has

been specified by the prescriber.

18 Do not take more than... in 24 hours. Also, do not take more

than... in any one week

Peidiwch â chymryd mwy na... mewn 24 awr. Hefyd, peidiwch â

chymryd mwy na... mewn wythnos

To be used on preparations containing ergotamine. The

dose form should be specified, e.g. tablets or suppositories.

19 Warning: This medicine makes you sleepy. If you still feel sleepy

the next day, do not drive or use tools or machines. Do not drink

alcohol

Rhybudd: Bydd y feddyginiaeth hon yn eich gwneud yn gysglyd.

Os ydych yn dal i deimlo’n gysglyd drannoeth, peidiwch â gyrru,

defnyddio offer llaw neu beiriannau. Peidiwch ag yfed alcohol

To be used on preparations containing hypnotics (or some

other drugs with sedative effects) prescribed to be taken at

night. On the rare occasions when hypnotics are prescribed

for daytime administration (e.g. nitrazepam in epilepsy),

this label would clearly not be appropriate. Also to be used

as an alternative to the label 2 wording (the choice being at

the discretion of the pharmacist) for anxiolytics prescribed to

be taken at night.

It is hoped that this wording will convey adequately the

problem of residual morning sedation after taking ‘sleeping

tablets’.

21 Take with or just after food, or a meal

Cymerwch gyda neu ar ôl bwyd

To be used on preparations that are liable to cause gastric

irritation, or those that are better absorbed with food.

Patients should be advised that a small amount of food is

sufficient.

22 Take 30 to 60 minutes before food

Cymerwch 30 i 60 munud cyn bwyd

To be used on some preparations whose absorption is thereby

improved.

Most oral antibacterials require label 23 instead (see

below).

23 Take this medicine when your stomach is empty. This means an

hour before food or 2 hours after food

Cymerwch y feddyginiaeth hon ar stumog wag. Mae hyn yn

golygu awr cyn, neu 2 awr ar ôl bwyd

To be used on oral antibacterials whose absorption may be

reduced by the presence of food and acid in the stomach.

24 Suck or chew this medicine

Bydd angen cnoi neu sugno’r feddyginiaeth hon

To be used on preparations that should be sucked or chewed.

The pharmacist should use discretion as to which of these

words is appropriate.

25 Swallow this medicine whole. Do not chew or crush

Llyncwch yn gyfan. Peidiwch â chnoi neu falu’n fân

To be used on preparations that are enteric-coated or

designed for modified-release.

Also to be used on preparations that taste very unpleasant

or may damage the mouth if not swallowed whole.

Patients should be advised (where relevant) that some

modified-release preparations can be broken in half, but

that the halved tablet should still be swallowed whole, and

not chewed or crushed.

26 Dissolve this medicine under your tongue

Gadewch i’r feddyginiaeth hon doddi o dan y tafod

To be used on preparations designed for sublingual use.

Patients should be advised to hold under the tongue and

avoid swallowing until dissolved. The buccal mucosa

between the gum and cheek is occasionally specified by the

prescriber.

27 Take with a full glass of water

Cymerwch gyda llond gwydr o ddwˆr

To be used on preparations that should be well diluted (e.g.

chloral hydrate), where a high fluid intake is required (e.g.

sulfonamides), or where water is required to aid the action

(e.g. methylcellulose). The patient should be advised that ‘a

full glass’ means at least 150 mL. In most cases fruit juice,

tea, or coffee may be used.

28 Spread thinly on the affected skin only

Taenwch yn denau ar y croen sydd wedi’i effeithio yn unig

To be used on external preparations that should be applied

sparingly (e.g. corticosteroids, dithranol).

29 Do not take more than 2 at any one time. Do not take more than

8 in 24 hours

Peidiwch â chymryd mwy na 2 ar unrhyw un adeg. Peidiwch â

chymryd mwy nag 8 mewn 24 awr

To be used on containers of dispensed solid dose

preparations containing paracetamol for adults when the

instruction on the label indicates that the dose can be taken on

an ‘as required’ basis. The dose form should be specified, e.g.

tablets or capsules.

This label has been introduced because of the serious

consequences of overdosage with paracetamol.

30 Contains paracetamol. Do not take anything else containing

paracetamol while taking this medicine. Talk to a doctor at once

if you take too much of this medicine, even if you feel well

Yn cynnwys paracetamol. Peidiwch â chymryd unrhyw beth

arall sy’n cynnwys paracetamol tra’n cymryd y feddyginiaeth

hon. Siaradwch gyda’ch meddyg ar unwaith os ydych yn cymryd

gormod, hyd yn oed os ydych yn teimlo’n iawn

To be used on all containers of dispensed preparations

containing paracetamol.

32 Contains aspirin. Do not take anything else containing aspirin

while taking this medicine

Yn cynnwys aspirin. Peidiwch â chymryd unrhyw beth arall sy’n

cynnwys aspirin tra’n cymryd y feddyginiaeth hon

To be used on containers of dispensed preparations

containing aspirin when the name on the label does not include

the word ‘aspirin’.

1590 Cautionary and advisory labels for dispensed medicines BNF 78

Cautionary and advisory labels | Appendix 3

A3

Appendix 4

Wound management products and

elasticated garments

CONTENTS

Basic wound contact dressings page 1591

Low adherence dressing 1591

Absorbent dressings 1593

Advanced wound dressings 1594

Hydrogel dressings 1594

Vapour-permeable films and membranes 1595

Soft polymer dressings 1596

Hydrocolloid dressings 1598

Foam dressings 1599

Alginate dressings 1600

Capillary-acting dressings 1601

Odour absorbent dressings 1601

Antimicrobial dressings 1601

Honey dressings 1602

Iodine dressings 1602

Silver dressings 1603

Other antimicrobials 1604

Specialised dressings 1605

Protease-modulating matrix dressings 1605

Silicone keloid dressings 1605

Adjunct dressings and appliances 1606

Surgical absorbents 1606

Wound drainage pouches page 1606

Physical debridement pads 1607

Complex adjunct therapies 1607

Topical negative pressure therapy 1607

Wound care accessories 1607

Dressing packs 1607

Woven and fabric swabs 1607

Surgical adhesive tapes 1608

Skin closure dressings 1609

Bandages 1609

Non-extensible bandages 1609

Light-weight conforming bandages 1609

Tubular bandages and garments 1610

Support bandages 1611

Adhesive bandages 1612

Cohesive bandages 1612

Compression bandages 1612

Multi-layer compression bandaging 1613

Medicated bandages 1614

Compression hosiery and garments 1614

Graduated compression hosiery 1614

Lymphoedema garments 1614

The correct dressing for wound management depends not

only on the type of wound but also on the stage of the

healing process. The principal stages of healing are:

cleansing, removal of debris; granulation, vascularisation;

epithelialisation. The ideal dressing for moist wound healing

needs to ensure that the wound remains: moist with

exudate, but not macerated; free of clinical infection and

excessive slough; free of toxic chemicals, particles or fibres;

at the optimum temperature for healing; undisturbed by the

need for frequent changes; at the optimum pH value. As

wound healing passes through its different stages, different

types of dressings may be required to satisfy better one or

other of these requirements. Under normal circumstances, a

moist environment is a necessary part of the wound healing

process; exudate provides a moist environment and

promotes healing, but excessive exudate can cause

maceration of the wound and surrounding healthy tissue.

The volume and viscosity of exudate changes as the wound

heals. There are certain circumstances where moist wound

healing is not appropriate (e.g. gangrenous toes associated

with vascular disease).

Advanced wound dressings are designed to control the

environment for wound healing, for example to donate fluid

(hydrogels), maintain hydration (hydrocolloids), or to absorb

wound exudate (alginates, foams).

Practices such as the use of irritant cleansers and

desloughing agents may be harmful and are largely obsolete;

removal of debris and dressing remnants should need

minimal irrigation with lukewarm sterile sodium chloride

0.9% solution or water.

Hydrogel, hydrocolloid, and medical grade honey dressings

can be used to deslough wounds by promoting autolytic

debridement; there is insufficient evidence to support any

particular method of debridement for difficult-to-heal

surgical wounds. Sterile larvae (maggots) are also available

for biosurgical removal of wound debris.

There have been few clinical trials able to establish a clear

advantage for any particular product. The choice between

different dressings depends not only on the type and stage of

the wound, but also on patient preference or tolerance, site

of the wound, and cost. For further information, see Buyers’

Guide: Advanced wound dressings (October 2008); NHS

Purchasing and Supply Agency, Centre for Evidence-based

Purchasing.

Prices quoted in Appendix 4 are basic NHS net prices; for

further information see Prices in the BNF under How to use

the BNF.

The table below gives suggestions for choices of primary

dressing depending on the type of wound (a secondary

dressing may be needed in some cases).

Basic wound contact dressings

Low adherence dressing

Low adherence dressings are used as interface layers under

secondary absorbent dressings. Placed directly on the wound

bed, non-absorbent, low adherence dressings are suitable for

clean, granulating, lightly exuding wounds without necrosis,

and protect the wound bed from direct contact with

secondary dressings. Care must be taken to avoid

granulation tissue growing into the weave of these dressings.

Tulle dressings are manufactured from cotton or viscose

fibres which are impregnated with white or yellow soft

paraffin to prevent the fibres from sticking, but this is only

partly successful and it may be necessary to change the

BNF 78 Basic wound contact dressings 1591

Wound management | Appendix 4

A4

dressings frequently. The paraffin reduces absorbency of the

dressing. Dressings with a reduced content (light loading) of

soft paraffin are less liable to interfere with absorption;

dressings with ‘normal loading’ (such as Jelonet ®) have been

used for skin graft transfer. Knitted viscose primary dressing

is an alternative to tulle dressings for exuding wounds; it can

be used as the initial layer of multi-layer compression

bandaging in the treatment of venous leg ulcers.

Knitted polyester primary dressing

Atrauman

Non-adherent knitted polyester primary dressing

impregnated with neutral triglycerides

Atrauman dressing (Paul Hartmann Ltd) 10cm 6 20cm= £0.80, 20cm

6 30cm= £2.20, 5cm 6 5cm= £0.34, 7.5cm 6 10cm= £0.35

Knitted viscose primary dressing

N-A Dressing

Warp knitted fabric manufactured from a bright viscose

monofilament.

N-A dressing (Systagenix Wound Management Ltd) 19cm 6 9.5cm=

£0.67, 9.5cm 6 9.5cm= £0.35

N-A Ultra

Warp knitted fabric manufactured from a bright viscose

monofilament.

N-A Ultra dressing (Systagenix Wound Management Ltd) 19cm 6

9.5cm= £0.64, 9.5cm 6 9.5cm= £0.34

Profore

Warp knitted fabric manufactured from a bright viscose

monofilament.

Profore (Smith & Nephew Healthcare Ltd) wound contact layer 14cm

6 20cm= £0.33

Tricotex

Warp knitted fabric manufactured from a bright viscose

monofilament.

Tricotex dressing (Smith & Nephew Healthcare Ltd) 9.5cm 6 9.5cm=

£0.35

Paraffin Gauze Dressing

Cuticell

(Tulle Gras). Fabric of leno weave, weft and warp threads of

cotton and/or viscose yarn, impregnated with white or

yellow soft paraffin; for light or normal loading

Cuticell (BSN medical Ltd) Classic dressing 10cm 6 10cm= £0.30

Jelonet

(Tulle Gras). Fabric of leno weave, weft and warp threads of

cotton and/or viscose yarn, impregnated with white or

yellow soft paraffin; for light or normal loading

Jelonet (Smith & Nephew Healthcare Ltd) dressing 10cm 6 10cm=

£0.42