What medications can a healthcare provider prescribe over the phone?

Telephone Prescribing Authority by Medication Class

Healthcare providers can prescribe paracetamol (acetaminophen) and antibiotics over the phone in appropriate clinical circumstances, but should avoid routine remote prescribing of methotrexate and nutrition feeding, which require more comprehensive assessment and monitoring.

Paracetamol (Option C) - YES, Can Prescribe by Phone

• Paracetamol is available as an over-the-counter medication and can be prescribed remotely for acute pain or fever management 1
• The medication has an excellent safety profile at recommended doses (≤4 g/day in adults) and is considered first-line therapy for mild to moderate pain 2, 3, 4
• No specialized monitoring or face-to-face assessment is required for short-term use in most patients 4
• Paracetamol is suitable for telephone prescribing because it carries minimal risk of serious adverse effects when used as directed, even in patients with comorbidities 4

Antibiotics (Option A) - CONDITIONAL, Generally Avoid

Remote prescribing of antimicrobials should be avoided as standard practice; face-to-face assessment is strongly preferred 1

• The 2024 NICE guidance explicitly states: "When considering remote prescribing of antimicrobials, if a person is potentially ill enough to require a course of antimicrobials, then it is preferable to arrange an assessment face to face and that this should be usual practice" 1
• Providers should not routinely prescribe antimicrobials based on remote assessment alone 1
• The threshold for requiring face-to-face evaluation should be lower for patients with comorbidities, multimorbidity, or frailty 1
• Exception: In select circumstances where face-to-face assessment has occurred previously or clinical certainty is high, telephone prescribing may be appropriate, but this should not be routine practice 1

Methotrexate (Option B) - NO, Should Not Prescribe by Phone

• Methotrexate is a high-risk medication requiring regular laboratory monitoring for hepatotoxicity, bone marrow suppression, and renal function
• No guideline evidence supports remote prescribing of methotrexate without comprehensive assessment
• The medication requires detailed patient education about toxicity, drug interactions, and proper dosing schedules that are best delivered face-to-face
• Initial prescribing and dose adjustments necessitate physical examination and baseline laboratory evaluation

Nutrition Feeding (Option D) - NO, Should Not Prescribe by Phone

• Enteral or parenteral nutrition requires comprehensive nutritional assessment, including anthropometric measurements, laboratory evaluation, and assessment of gastrointestinal function
• Prescription of nutrition feeding necessitates determination of appropriate formulation, caloric requirements, route of administration, and monitoring parameters
• Remote assessment cannot adequately evaluate for contraindications such as bowel obstruction or assess proper placement sites for feeding tubes
• Ongoing monitoring for refeeding syndrome, electrolyte abnormalities, and metabolic complications requires face-to-face evaluation

Key Principles for Remote Prescribing

Live interactive telemedicine (real-time video/audio) is superior to telephone-only assessment for prescribing decisions 1

• Providers must maintain active licensure in the state where the patient is located 1
• Federal regulations (Ryan Haight Act) technically require at least one in-person evaluation before prescribing controlled substances via telemedicine, though enforcement varies by state 1
• Clinical judgment regarding the limitations of remote assessment must guide prescribing decisions 1
• Documentation should be consistent and clear regarding the evaluation and management plan 1

Common Pitfalls to Avoid

• Never prescribe antimicrobials routinely by phone without strong clinical justification - this contributes to antibiotic misuse and resistance 1
• Avoid prescribing medications requiring specialized monitoring (like methotrexate) without baseline laboratory values and physical examination
• Do not prescribe controlled substances by telephone in jurisdictions where this violates state or federal regulations 1
• Ensure adequate safety netting advice is provided when managing patients remotely, including specific instructions on when to seek face-to-face care 1