Ask Your Pharmacist
I heard in the news that my pharmacist can now treat tick bites to prevent Lyme disease. How do I get the treatment?
As of May 15, 2023, a pharmacist is now able to assess your risk of Lyme disease after being bitten by a tick and may prescribe antibiotics if needed. The cost associated with this assessment is covered by the New Brunswick Department of Health. This newly covered service makes it possible for eligible New Brunswickers to get timely access to care after a tick bite and to avoid long emergency room wait times. Although many pharmacies will be able to accommodate a walk-in assessment, to make the best use of your time, it is recommended to book an appointment on your pharmacy’s website or by calling your pharmacy.
Lyme disease is caused by infection with the bacterium Borrelia burgdorferi. Borrelia is transmitted by certain species of Ixodes ticks. In New Brunswick, Lyme disease is primarily spread through the bite of infected blacklegged ticks (Ixodes scapularis).
To be eligible for coverage, you must have a valid Medicare card and you must be assessed in person within 72 hours of tick removal from your body. Those who reside in a nursing home or a correctional facility are not eligible. You must not have symptoms of Lyme disease already. Your pharmacist will consider many factors to determine if a prescription for antibiotics is warranted, based on your exposure.
The pharmacist will identify the tick, when possible, to determine the likelihood of infection. Consideration will also be given to the geographical location where you were bitten since we know that certain areas of the province are at moderate or high risk of ticks carrying the bacteria that causes Lyme disease. Risk of infection is increased when the duration the tick is attached to your body and feeding, or engorged, is at least 36 hours.
Obtaining this information, along with your medication and allergy history, will allow your pharmacist to make an assessment about the need for antibiotics, based on criteria agreed upon by experts. If antibiotics are warranted, adults may be prescribed a single dose doxycycline 200 mg (i.e., two 100 mg tablets or capsules) to be taken at the same time. For children, the dose of doxycycline is calculated in milligrams based on weight, and treatment is a single dose. Doxycycline sometimes irritates the esophagus when swallowed. To minimize this side effect, take the pills with a full glass of water. You may choose to take doxycycline with food because it can be hard on the stomach. Avoid laying down for at least one hour after taking the medication.
Remember, although the pharmacist’s assessment is covered by Medicare, the program does not cover the cost associated with the dispensing of drugs. Many drug plans cover the cost of doxycycline. The average cost of doxycycline 200 mg without a drug plan is about $15.
Prevention is key. Protect. Check. Remove. Act. The best way to avoid Lyme disease is to protect yourself from getting bitten by a tick. When out for a hike, keep to the center of the path so that you are less likely to brush up against a tick that is hanging out on the local greenery. Wear light-coloured, long-sleeved shirts and pants to spot ticks more easily. Tuck your shirt into your pants and pull your socks over your pant legs.
Insect repellent containing the active ingredient Icaridin (i.e., PiACTIVE retails for approximately $15.00 a can). Icaridin is active against ticks and is a safer choice (compared to DEET products) for children six months and older as well as adults. Icaridin-containing bug spray may be applied on your skin and clothing (always follow the directions on the label). Reapply often when you are outdoors for any period.
When you come inside after a hike, put dry outdoor clothes in a dryer on high heat for 10 minutes to kill off any ticks. If your clothes are damp, additional drying time is needed. If you need to wash your clothes first, hot water is recommended. If the clothes cannot be washed in hot water, tumble dry on low heat for 90 minutes or high heat for 60 minutes.
Do daily full-body tick checks on yourself and your children, especially in the hair, under the arms, in and around the ears, inside the belly button, behind the knees, between the legs and around the waist. Shower within two hours of being outdoors to remove ticks that have not yet attached.
After the tick has been removed, act. Watch for erythema migrans, which is a skin rash that looks like a bull’s eye. Contact your primary care provider or pharmacist if you develop a rash or flu-like symptoms over the next 30 days after a tick bite.
Visit the N.B. Department of Health webpage for further information.
Dr. Kevin McLaughlin (PharmD, BScPharm, BSc, ACPR) is the Director of Professional Practice with the New Brunswick Pharmacists' Association. Kevin's home practice is at Kennebecasis Drugs in Rothesay, New Brunswick. His opinions are published in several newspapers for educational and informational purposes only. They are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. If you have a question you’d like to see answered in his column, you can send it to him at AskYourNBPharmacist@gmail.com.
Dr. Kevin McLaughlin (PharmD, BScPharm, BSc, ACPR) is the Director of Professional Practice with the New Brunswick Pharmacists' Association. Kevin's home practice is at Kennebecasis Drugs in Rothesay, New Brunswick. His opinions are published in several newspapers for educational and informational purposes only. They are not intended as a diagnosis, treatment or as a substitute for professional medical advice, diagnosis or treatment. If you have a question you’d like to see answered in his column, you can send it to him at AskYourNBPharmacist@gmail.com.