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We selected tramadol as a representative drug to address our objective because it is widely prescribed as an unscheduled opioid analgesic and can easily be purchased from NPOPs. As such, the geometric growth in the use of online pharmacies around the world should prompt intense medical and regulatory discussion about their role in the provision of medical care. These medications include HIV drugs, benzodiazepines, and cholesterol medications, as well as lifestyle drugs, such as diet pills and erectile dysfunction medications. In fact, one study demonstrated the efficacy of utilizing an accredited online pharmacy to prescribe Viagra. They also provided a more complete medical history 21. To manage the increased use of online pharmacies, however, more regulations are being proposed, including the Online Pharmacy Safety Act and the development of state-run online pharmacy programs 22, 23.

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In independent prescribing rights and, more recently, legislation has been passed to allow for pharmacists to be independent prescribers. Independent prescribers take responsibility for: the clinical assessment of the patient; establishing a diagnosis; indicating the clinical management required and prescribing where necessary. They prescribe medicines from the British National Formulary (or part thereof) in accordance with their professional competency. Supplementary prescribing is defined as a voluntary prescribing partnership between an independent prescriber and a supplementary prescriber to implement an agreed patientspecific CMP with the patients agreement. There are a number of criteria that must be met for supplementary prescribing to occur (www. gov.

A serious side effect or fibrates is a myositis-like syndrome, which is made worse by concurrent use of statins. Such a combination is not recommended except in cases of severe familial hyperlipidaemia. Nicotinic acid derivatives reduce the release of VLDLs from the liver and the removal of triglycerides from them in adipose tissue. This results in a fall in circulating LDL levels. An example is acipimox.

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